After the Doctors Appointment

Huge sigh of relief!! The doctor's appointment is over and it went far better than we were anticipating!! Thank you so much for all of your prayers and support! We felt an amazing amount of peace throughout this appointment (quite different than last week). My parents went with us so that they could be the extra ears and hear all of the information that we may forget and ask any questions that we may not have thought about.

Today we met with the diabetes educator, Margaret. We had a little bit of an inside scoop about Margaret, because the photographer that I work for (Cristi Owen) is also a registered dietitian and used to work with Margaret at Banner Baywood. Cristi couldn't have been more right about how sweet and knowledgeable Margaret is. we were told that our appointment would only be 30 minutes, and Margaret used a full hour to be very thorough in her description of everything that is going on, and spent a lot of time answer all of our questions.



So let me start giving you the information that I got from the diabetes educator and the doctor today:

Q. How often should Dustin check his blood glucose (BG) levels?
A. Dustin should check his BG levels at least twice a day. Once in the morning and once before dinner. It he wants he could add a third time, being before lunch. We shouldn't be surprised if the amount of times checking his BG levels increases as the years go on. This is normal.

Q. What are the BG levels that Dustin should be striving for?
A. Around 100 is what we are striving for at any point in time (give or take 20)

• 160 two hours after a meal is good
• 180 is a little high
• 200+ on a consistent basis means that we need to come back to the doctor and look at new treatment options
• When Dustin's levels are seriously high (i.e. above 250) we should stay away from vigorous exercise until they drop

Q. What kind of Insulin Injections will Dustin go on?
A. Levemir. His daily dosage is 12 units. Levemir is a synthetic insulin. Years ago they used to use animal insulin, but now it is mostly all synthetic. This means it is exactly like human insulin and has very few side effects

Q. What time will Dustin need to give himself the injection?
A. Dustin will need to give himself the injections in the morning. It needs to be at a consistent time. Always within an hour of the same time

Q. Why does Dustin need to give the injections in the abdomen?
A. This is because it will give the best and most even absorption. There is a small area on the back of the arm that you can also give the injection, but it is hard for a person to do that on their own without help.

Q. Where should Dustin store the insulin?
A. The insulin needs to be stored in a cool place, preferably the refrigerator. When traveling we will need to have a little cooler that we can carry everything with us.

Q. Tell me more about the injections?
A. The insulin is not stored in a typical looking syringe. They call it a little pen. It carries up to 300 units of insulin in it and has disposable needles. So the one pen will last us approximately 3 weeks. Dustin will need to prime the pen using 2 units of insulin and then inject 12 units of insulin daily. This is a VERY small dosage of insulin. To give you an idea, this pen can inject up to 80 units of insulin at one time. It is a very small needle, and very fine. They told him that it goes in gently (not like throwing darts). You would give it the same force that you would use with a pin to pop a balloon. Dustin gave himself one placebo injection and one real injection while we were there. The placebo injection hurt more because it was sugar water, and this burned a little. He said that although it wasn’t comfortable, pricking his finger to get his blood glucose levels hurt more.

Q. Can Dustin drink alcohol while on insulin?
A. You should limit your alcohol content while on insulin. Although many people don’t adhere to this, this is the best thing you can do for your body. He can have 2 drinks a day. And Margaret was quick to tell us that if you didn’t have your two drinks one day, you couldn’t save them for another day. Alcohol can lower your blood sugar levels, but you typically won’t see this happen until hours after you stop drinking. The liver does actually play a role in insulin production. But when you drink, it spend so much energy processing the alcohol that it stops helping the pancreas produce insulin. This is the reason he should limit his alcohol intake.

Q. What should Dustin' diet look like?
A. As most of you know we have been on a very strict diet the last six months as we have tried to manage this. The doctor, diabetes educator, and my friend who is a registered dietitian do not believe that this is a diet we should remain on. Dustin can consume 60-75 grams of carbohydrates per meal. He needs to be prudent with his fat content and have reasonable size servings of protein (i.e. not too much). Here are four things Margaret told us to remember in regards to his diet:

1. Be consistent with your meal routine. The time and volume of meals should be consistent day to day.
   
2. Be smart about your portion sizes.
   
3. Keep added sweets to a minimum. Sugar substitutes are fine. Coke Zero and sports drinks such as Propel and Power 0 are okay as well.
   
4. Keep down the fat in each meal

We will meet with Cristi Owen soon to learn more about diet!! Thank you Cristi!!

Q. What other things did we learn?
A. It is not uncommon to see wheat sensitivity and celiac disease with diabetes, because this is also an auto-immune disorder. We should continue to manage this as much as possible, while keeping up with the 60-75 grams of carbs per meal.

Many of you asked us why Dustin’s case was unique. Mainly this is because of his deficiency with his GAD antibodies (I still don’t understand this). And mostly the doctor said that Dustin is unique because he was able to manage to survive with almost no insulin production without being hospitalized. PRAISE GOD FOR THIS!!!!

Q. Whats the next step?
A. Back to the doctor in four weeks for our follow up and to see how Dustin’s body is reacting to the insulin. It is very likely that we will go up with insulin units at this time. He started Dustin on such a low level of insulin units because of the very strict diet that he has been adhering to. He didn’t want to shock Dustin’s system with the new treatment.


I hope that this is helpful and gives you all a little insight into our day!! Love you all very much and am so thankful for the support and help you have given us!!