Moved in....
Well, I got all moved in to the new office last Friday. A few things in the education room that I still need to bring over, but for the most part I am moved in. That is a GREAT feeling! I am just so excited for the program. I have a few special plans for the program in mind for the next year. The pump therapy being one, and also trying to bring more "Spanish-Friendly" material and classes to OCAHS.
As far as me, the Symlin is going alright. We have a "Love-Hate" relationship going on. To me it seems a little unpredictable. Like I will take it and sometimes I am perfect 3-4 hours later, whereas other times (not as often) I can spike then and remain high despite what I do. It's like my liver is just pumping out the glucose to make up for the time it was suppressed. I made heart-shaped pancakes on Father's Day for my hubby (everyone together...awwwwwww...)which ended up bringing me almost to tears in church. Bolused about 75% of my usual dose of insulin after eating one small pancake with light syrup, an egg and a small piece of bacon, I usually bolus after I eat now since the Symlin delays gastric emptying anyway. My CGMS (Dexcom) showed that I was steady at 100 all morning,yet 3 hours later my CGMS showed climbing sugars (which I verified with my meter) and got up to almost 350! I haven't been that high in a LONG time! I was about to start bawling out of frustration! After a correction injection I did start coming down. Wondering if it may have just been a bad pump site as I haven't had any problems since then. In fact my Symlin experience has been great since then!
Posted by Cari Roorda
Getting Settled...
Well, today I am not "in the office" but tomorrow marks my first patient in the new office, so I need to go in and do some last minute organization (I may even move a book shelf or table from my house if I can muster the muscle). I am so thrilled with the new office space and being able to better serve OCAHS patients.
I hope to be able to really buckle down and get my pump training certification from Minimed as soon as I am finished with this move. It won't take me long, as I have been a pumper for over 7 years now. Hope you all enjoy that warm weather out there!
Posted by Cari Roorda
I am so excited!
I am really excited to have this blog. I will keep my patients updated on the many different issues that interest them. As for what's new with me...I have moved my office from the clinic to the Medical Office Building (by the Physical Therapy office) and now will be able to teach right in my office and have a separate teaching area set up in there. Many of you will recognize what a huge benefit that will be and I will be more available for drop-ins on my scheduled office days, as now we will have a place to meet.
What's new with MY diabetes care? I have been enjoying my Dexcom Continuous Glucose Monitoring System (CGMS). It is such a wonderful tool and the best addition to my diabetes treatment since my pump. Both have allowed me to have tighter, more personalized control and the CGMS helps me to see what foods and different activities do to my sugars. I've been using the Dexcom for about a month now, and absolutely love it. I've also recently started taking Symlin injections. Symlin is a synthetic replacement of the hormone Amylin, which insulin dependent diabetics are lacking, since it is created in the beta cells which are either destroyed through the auto-immune process of type 1 or are "burned-out" (hence the term beta cell exhaustion) in insulin-dependent type 2s. Amylin plays a role in satiety, regulating gastric emptying and in controlling hepatic glucose release. It was developed after being "discovered" as lacking in insulin dependent diabetics back in 1987. It has been in the works and in trials since that time. It is marketed for "diabetics taking meal-time insulin who have failed to achieve control with insulin alone". Well, I hadn't exactly failed at that although my a1c hasn't been as low as I would like it since last Fall with all of the chaos of moving and new jobs. We all know how that goes! I was also intrigued by the weight-loss side effect and though my post-meal sugars aren't too bad, there is always room for improvement. I have been taking about 1/2 of my previous dose of mealtime insulin as suggested by Amylin Pharmaceuticals, the maker of Symlin, and of course the advice of my endocrinologist. So far I really have seen a different. This morning was great as normally that is when I have the hardest time with my sugars but today they were so even! I took my Symlin about 35 minutes before I ate and then had my coffee with cream and 1/2 sugar 1/2 Splenda blend and normally I would have to bolus at least 2 units for that but my basal insulin must've been enough to cover that becuase I didn't need to bolus at all (this is by just watching my CGMS)and then I did take 1 unit for my 2 pieces of whole wheat toast. So far so good on the CGMS.
I plan on keeping my Symlin journey updated here as well, as many of you have expressed interest in how that works. So far I have only had a minimal amount of nausea, which is the most common side effect. (okay, so I WAS dry-heaving on the way to take my oldest to vacation Bible School this morning).
Posted by Cari Roorda
Great Article
I found this article while searching on an "off-label" delivery route for Symlin (doubt if I can talk about that here...top secret, ya know?). It talks a lot about the closed loop artificial pancreas and is just an extremely interesting article and very informative. I just wanted to share:
http://en.wikipedia.org/wiki/Artificial_pancreas
If that doesn't link you directly to the article, copy and paste into the address bar of your browser. I am used to working in Mozilla Firefox vs. Internet Explorer (which I am using here from the office).
Posted by Cari Roorda
Support Group on the 11th
So I had a hard time deciding on a topic for the support group on the 11th. I had several ideas, but had to choose just one. Many of you have asked about inhaled insulin and I thought that would be a good way to go this time. I also wanted to discuss Diabetes Burnout and ways to head it off. I think I will save that for this Fall. Back to the inhaled insulin- I have arranged for the Exubera rep to come and do a short presentation and then be on hand to answer questions about Exubera and getting started on the inhaled insulin.
I will not be in the office until next Friday, the 6th as I have family out from Washington and things are really slow in the office lately. Must be the beautiful weather- nobody wants to come to the clinic when it's this gorgeous out.
I am still doing well-much better- without the Symlin. I am glad I decided to give it a rest for a while. My sugars are stable again and I feel much better. I am a little bummed that it isn't going to work for me but I think if they figure out a "long acting" type of Symlin I would be open to trying it again.
Posted by Cari Roorda
Adios Symlin!
Well, I thought I would at least give myself an "emotional break" after the Symlin stress- so I didn't take any Symlin at all today and my sugars are back to being "perfect and perfectly predictable". Guess as the saying goes "If it ain't broke, don't fix it!". I am bummed that it looks like Symlin will be a no-go for me, but relieved to have my blood sugars back to where they belong. It was a good reminder to me of how those swings can affect your mood! Wow- They aren't kidding when they list "irritability" as a side effect of whacky sugars. I feel so much more like myself today. Even the appetite has returned- Ha-ha- not that I missed it. ;)
Thanks for letting me share my Symlin journey here. Let me say I don't want to rule it out for everyone, I do think Symlin has it's place and if Amylin Pharmaceuticals ever comes out with a long acting Symlin in addition to the meal time dose, sign me up! For now I will be content with my pump full of straight Humalog and my Dexcom which is the best addition to my diabetes self-management since I got my pump over 7 years ago! I love that thing and strongly encourage anyone who can swing it financially to get ones of these. If you want to know more about the price of one you can contact me through email or by phone.
Posted by Cari Roorda
Welcome!
Welcome to my home on the web, where you can find resources and tools to help manage your diabetes. Use this site to send me email, check my schedule, download blood glucose logs and other helpful tools, and learn more about diabetes.
The tabs located at the top right of the page will help you find what you need. Use the "About Me" tab to find out more about me and see my group schedule. The "Resources" tab is a library of helpful tools and information to help you manage and learn more about your diabetes. Finally "Blog" will take you to a collection of my personal tips, practice updates, and other useful information that is updated regularly.
Posted by Cari Roorda
My Symlin Progress
Well, it looks as if I am getting used to the Symlin. My side effect of nausea has improved dramatically today. I am still on the second "titration dose" for type 1's, which is 5 units or 30 mcg before each meal ( traditionally 3 meals a day but I have had to add it another time as I tend to eat smaller amounts more often, and really notice in the post-meal blood sugar spikes when I don't take it). I've found that injecting immediately when I start to eat helps a lot with the nausea and with making sure that I don't get too full too fast. I was taking it before sitting down and then as life goes, I would get busy with something else and by the time I sat down to eat I was sick and had absolutely no appetite. Anyway, if tomorrow morning goes as well as the last 2 days have, then it will be time to titrate to 7.5 units or 45 mcg, before I top out at 10 units (hopefully by the end of the weekend). I think I have an idea of what you Byetta users are experiencing,so now I can empathize even more. I can definitely see the postprandial (post-meal) control and it is so exciting! Especially now that I have my Dexcom CGMS and can see in real-time what my blood sugars are doing with a new reading every few minutes. I tell you, I was hoping to be cured by now, but we've really come a long way, and I feel very fortunate to not only be a diabetic in this day and age, but also to be a Diabetes Educator with access to the latest information and upcoming technology. It is my mission to pass this on to my patients so that you can all benefit from the recent advances in the tools for diabetes management.
Also, tonight I started riding a bike again! My husband thought that it would be a good family activity for us to get bikes this year (which it would be if we made more time for it). So after about a month of my new bike sitting in the garage, I decided to join my husband and older son for a ride. It was a blast! By the end of the ride I was able to ride the bike with my 2 year old on the back in his seat. When I first tried it was really hard to balance but I got used it it quickly. I forgot how much I used to enjoy riding. Now that we live in town I have the perfect place to ride. We even rode through the cemetery and I realized I must be getting to know a lot of people here in Orange City when I knew most of the last names on the head stones. I must say though, I am not in ideal shape! I have a lot of conditioning to do- It did help to learn how to use the gears...I was riding in the hardest of settings for about 5 minutes (Ha-ha!) before my husband showed me how to switch gears. I am getting the hang of that now.
Ciao'!
Posted by Cari Roorda
Frustrated...
Yes, your Diabetes Educator is human too, and gets frustrated with things once in a while. I was doing so great with the CGMS and felt that greatly improved control for me and the decisions I would make were influenced by being able to see instant feedback on my blood sugar. So I REALLY had been wanting to give this Symlin a try- many, many of my friends and fellow diabetics have loved it, and seeing that it is a hormone I SHOULD make but don't, I should have to take it, right?
The problem for me lies in the unpredictability. Sure, I get full faster and have lost a few pounds, great side effect! But what happens is it slows your gastric emptying...so you absorb the carbs slower. Almost like a chemically induced gastroparesis. I can see where it would be helpful...if it were released 24 hours a day like a basal insulin is (along with a bolus meal dose), but the short spikes of it leave me climbing way too high after some meals. But not until 3 hours after meals. Strange and if that were the only problem, then I could handle it but I am not sure I can handle it happening sometimes and not others. Unpredictability is something I am not a big fan of. I don't want to give up yet- or at least I change my mind by the next meal when I say "No more" after a bad experience with delayed highs after Symlin. I don't want to shoot this drug down for anyone else. I have seen it do great things for many people, but why not me? I don't know that answer. Symlin also suppresses hepatic (liver) glucose release, via blocking the release/uptake of glucagon (Byetta and Januvia also do this). So it almost seems like in addition to my gastric emptying being slowed, right as the Symlin is wearing off at 3 hours, I am fighting the carb absorption AND increase in hepatic glucose release. I guess I am the "Guinea pig" as none of our patients are using this yet and what better way for me to know how it works (or doesn't!) than to use it myself. I don't know why I can't let go and throw in the towel (or would that be syringe?)- possibly the weightloss side effect? Crazy isn't it? But it does REALLY help with satiety.
Also my insulin use would definitely go up. (Along with hunger!)
Well, thanks for taking the Symlin journey with me here folks. I will post what I decide to do once I decide on it! The fact that I am blogging at almost 3 a.m. on a day that I work should help me decide, shouldn't it?
Posted by Cari Roorda
Symlin update
So from what I've been reading in different blog archives dating back to 2005, it seems that I may fall in with the people who don't use less insulin with Symlin at all, so do I still "need it"? It does help me not want to snack (until it wears off at 3-4 hours, when I want to eat everything in sight!). As all other options are exhausted, I may just try my old I:C ratio to see how it does. It does seem like when there isn't Symlin in my system, my insulin does NOT work as well. I end up needing MORE insulin. Maybe my liver is just waiting for the amylin to be out of sight so it can dump glucose into my blood...(: I'll tell you one thing...I miss the "normalcy" that just plain old insulin gave me! At least I knew what to expect. Still part of me feels like I "need" this hormone that I am lacking.
Today I mixed (here is the off-label part...shhh...)about 1/3 Symlin and the rest Humalog (though not advised!) into my pump after reading about other people doing this with some success. It did well!! I didn't go over 125 after dinner tonight (or after the iced latte I had after work). I felt a little "odd" though like I was on something... and then tonight it didn't go as well after my walk. Now I think it was a delayed absorption of carbs from dinner as well as glycogen release from my lengthy walk/jog. After that I decided that I wasn't comfortable going to bed with the mix in my pump (I only did a tiny bit as to test it out during the day)as I don't know the suspension and wouldn't want unpredictable amounts of either in my system! (even though there wasn't even enough Symlin in there for what was one of my previous doses). I do think that Symlin will get to the point of being a 24-hour basal and bolus med as people are already wearing 2 pumps (one for Symlin one for Insulin!) in some cases! Can you imagine me with TWO pumps AND my Dexcom!? I would have to bring my rolling bag with me everywhere I went-Ha-ha! We're getting there people! Just wish it didn't take so long...
I keep saying "One more day..." and thinking I will get it. I think I might just have to bid Symlin farewell. Maybe I can at least take a break and then see how I respond next week.
Hope that you are all doing well! Also I have a lot of pens available, samples, vouchers, so if you've been thinking about trying one, let me know! (:
Next week I am going to be in the office on Monday and Friday.
Posted by Cari Roorda
