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Type 1 Diabetes

Hundreds of endo appointments

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I’ve had Type 1 Diabetes for 28 years. I see my endocrinologist about every 3 months, so I’ve had over a hundred appointments so far. And to be honest, today’s appointment was the first one I prepared for.

I know the drill- it used to be to bring in my logbook (which as a teen could have been completely made up at times) and get labs drawn, only to find out what my a1c was, a week later. Now it’s a finger stick in the office for an a1c result within minutes and surrendering my pump to a nurse so she can download pages and pages of data. It’s roughly the same thing, every time.

Today was different. Today I had a short list of items to discuss. When I pulled out my planner, my endocrinologist seemed excited to have a new challenge.

Item 1: A new pump and CGM

In a week, the warranty for my current pump and continuous glucose monitor expires. I’m currently on the MiniMed 530G. I was on a MiniMed pump for the first 8 years of my pumping career. I switched to an Omnipod and dexcom for a few years and then when back to MM when the 530G was released. Although the pod works great for a lot of people, for me, the tube pump provides more consistent insulin delivery. As much as I enjoyed the freedom of the pod, ultimately a tube pump is just better for me.

If you asked me a few months ago which pump I would switch to, I would have immediately said the MiniMed 670. The closed loop is exciting. When I took the time to think of what was important to me, I found that:

  • I want fresh, new technology that also looks current.
  • I want and need flexibility in my CGM site location. I have to use my MM CGM off label- I cannot get reliable results on my abdomen.
  • I want the option to view my CGM data where it’s convenient for me- my phone, a watch, on my pump.
  • I want my pump to be as discreet as possible. Not bulky.

For me this means exploring the T Slim from Tandem with Dexcom. This combo meets my needs better. The device is colorful and simple to update the software for. Dexcom sensors require much less taping than my current sensors, which means that when my Rheumatoid Arthritis is making it difficult for me to reach my back or behind my arm, I can more easily insert a sensor. Dexcom data can be viewed on the pump, on my phone, on a smart watch, and even sent to my husband.

Of course now I wait to see if my insurance is as excited to pay as I am to get started…

Item #2: Weight Loss

I go to the gym as often as my RA allows (usually at least 3 times a week). Like a lot of people with diabetes, I have fallen into the trap of eating roughly the same things as I know the carbs and how much insulin to take. But, unlike a lot of people with diabetes, I also have Rheumatoid Arthritis which can make diabetes Management a pain, literally.

Everything affects my blood sugar- pain, inflammation, lack of activity due to stiffness, nausea, etc. I’ve found that my insulin use has gone up as I often have pesky highs when I’m feeling awful and they aren’t easy to bring down. And with all of the extra insulin, my weight isn’t easy to bring down either.

I asked my endo about meds that would reduce my daily insulin intake which would in turn, help with weight loss.

First med we discussed was Afrezza. I have seen so many fellow diabetics using it with great results. But I quickly learned that those great results weren’t worth the risks for me. Since Afrezza is inhaled insulin, there’s concern for how this affects your lungs. Because Rheumatoid Arthritis caused me to develop asthma and with the risk of RA and lung damage, my endo and I quickly decided that this wasn’t worth the risk at all.

Next up was Invokanna. This drug causes you to basically urinate sugar instead of allowing your kidneys to reabsorb it (this article is a great resource for explaining these meds in better detail). This comes with a higher risk for infection, especially a UTI. Since I’m extremely infection prone (thanks again RA), I quickly eliminated this one as well.

Lastly, my endocrinologist mentioned Victoza. In short, Victoza is a daily injection that helps slow glucagon production, slow ingestion, and decrease appetite. Side effects? Nausea for the first few weeks. I can deal with doubling up my Zofran if I have to- much less scary than an added infection risk or potential lung problem.

So yay! we found a medication to try. But now, I get to wait again to see if my insurance will cover this off label use.

While I wait for my heath insurance to determine my fate, I’d really like to hear from you. What pump are you on and why do you love it? Have you tried adding any medication to your insulin only regimen. What happened if you did?

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