On Friday, I found out I had papillary thyroid cancer. This was found during a routine check of my thyroid due to my type 1 diabetes. Wow, typing that it sounds like a lot of crummy stuff has happened recently. And then my legs fell off, and one of my ears got a fungus...

Anyway, the kind I have is very slow-growing, and it's possible I have had it for a year or more. Treatment involves removal of the thyroid. The next step is to call the surgeon and schedule a meeting, and then figure out the timeline from there.

So there you go. Can't wait to see what happens next. Ugh.

So far this new stuff is working out well. I have been in a good range of glucose levels for the last couple of days. Not going into the low dangerous level.

After meeting with the doctor yesterday, I am now on long-acting and short-acting insulin separately. Hopefully it will be easier to fine-tune the doses to prevent me from going low before lunch.

For the last few days last week I was dropping into the 55-65 range before lunch. The doctor on Saturday reduced my morning dose of insulin from 22 to 16 units. So for those keeping score, my morning does has been adjusted from 25 to 29 to 27 to 26 to 22 to (now) 16. My evening dose has stayed constant at 12 units.

The good news is that Sunday I managed to keep my blood sugar in a good range. However, Sunday night/Monday morning my level dropped to 53 (!!! personal best! woo hoo! -- that's sarcastic, by the way. 53 is very bad). We followed the suggestions and got it back up, but here it is at 1:23 AM on Monday and I am typing a blog entry. Let's keep our fingers crossed that this is a fluke and my new reduced dosages will do the trick.

Today was doctor appointment day. Melissa and I met with the nutritionist, and got the information we needed to make good food choices. We had been doing a lot of the stuff on the list previously, but it was nice to have it all written out.

The bad news is that it is confirmed that I have Type I diabetes, and I will need to be on insulin forever. Or until they find a cure. Hopefully we will get an administration more "science oriented" than the current one, to really get cracking on stem cell research. Or we can always go back to leeches and drilling holes in people's skulls to let out the demons. Of course, my health plan would only cover leeches, and the drilling would need a referral, which I would probably not qualify for.

Type I has the same risk factors as Type II, the only difference is that my body is fighting the insulin I produced, and eventually destroyed my pancreas' ability to create the stuff. Or is destroying, might be the better tense to use. So that means I need the synthetic insulin to draw glucose out of my blood-stream. But food choices are the same, and as long as I keep my levels in the normal range, I have a good chance of avoiding long-term complications. The dubious silver lining is that statistically it turns out that people with Type I have a better track record of managing the disease than people with Type II. This is because you have to monitor Type I more closely, so there is less chance complacency might set in.

Type I diabetes is caused by genetic factors, it seems. So it is not a diet/exercise problem, like what they think contributes to Type II. But not a lot is known on the subject. The next step is to meet with an endocrinologist and get my dosages of insulin nailed down. But in the meantime, I am keeping on with what I am doing, which is diet, exercise, my 70/30 insulin, and lots of monitoring.

Funny note: When we were talking with the nutritionist, she asked how many times per day I tested. I said six, and that I knew it was a lot, but was trying to get a lot of data points for my glucose levels. She then said, "I love dealing with people in IT." (that's Information Technology). The funny thing was, I had not mentioned my job at that point. We all had a good laugh at that.

One week in, and I have learned a few things:

1. Carbs are important to watch. Carbs = Sugar
2. I have been feeling pretty crummy for the last few weeks, but it happened so gradually I did not realize how bad it was. Having my blood glucose levels at more normal levels is quite nice.
3. I can give myself injections and not pass out.
4. See #3 again
5. The diet restrictions are not too bad. Sure no concentrated sugars, but almost everything else is OK, at least in moderation.

I have been testing my levels 6 times a day, once before meals, and then 2 hours later. And being in email contact with my doctor has already resulted in one change to my insulin dosages. So far my numbers are going in the right direction. I am logging my food, blood tests, exercise, and insulin dosages. The next step is to meet with the nutritionist and a follow-up appointment with my doctor next week.

With the first week behind me, I am more comfortable with my condition, and feel like it is something I can deal with. Of course, after the first 24 hours there was nowhere to go but up!

The funny story I mentioned in my last entry happened during my Monday doctor appointment. The doctor had mentioned several initial treatment options, and we were discussing them, Melissa had mentioned (at some length) how much I hated needles, injections, blood work, etc. Then, during the discussion she casually said "Maybe we should have his glucose level tested now." in a very upbeat way. (I am pretty sure there was an implied "Bwah-ha-ha-ha" evil-villain type laugh, though).

With apologies to Stanley Kubrick.

Saturday was calmer after we woke up from our adventure at the ER. We did some more research, got the Diabetes Cookbook for Dummies an pretty much settled in. I did not have any tools for monitoring my blood glucose levels yet, so we just tried to make sensible choices.

Sunday morning we went for my fasting blood test and then did more research (and I posted my original blog entries). We came up with some plans for snacks, meals, etc.

Monday we hit the ground running with a doctor's appointment. The results for Sunday's blood tests were not in, but Dr. Shen was able to look at the Friday results and make some deductions. He also scheduled me for more blood tests, which we did on Monday also. Results are pending on those.

I now have my glucose monitor, and for the next 4-6 weeks I will be using insulin to "give my pancreas a rest". Hopefully after 4-6 weeks it will recover enough so that I can go off insulin and manage this with diet/exercise and maybe oral medications (i.e. pills).

I also had some frustration with the initial usage of my glucose monitor, but 7 finger-pricks later I had a reading. It was high, but the GOOD news was that my next measurement 2 hours after eating my level was in the normal range. So that is cause for celebration. And even better, the second time around the testing went off without a hitch.

Next up tomorrow: How to work the insulin injections.

(Sorry this one was not as funny, I have a funny story which I will include tomorrow. Promise.)

Read Friday, Part I if you need to catch up. Long story short, I was diagnosed with diabetes on Friday.

After dinner, Melissa and I headed to Kaiser's Urgent Care facility for my 8:30 PM appointment. When we got there, the place was packed, but we got in fairly quickly thanks to my reservation. Better than call-ahead seating even! When I was there, the nurse used the finger-prick method to test my blood sugar level. It registered as "High", which meant it was outside of the range the machine could read. Since the machine could read up to 500, it was not a good sign.

After a little while the doctor came in and explained that their blood chemistry machine was down, which would mean they would have to courier tests to the lab, and that would entail a 4 hour wait for results, and since they closed at 1 AM we would not be able to complete the procedure. So they were referring me to (cue ominous music) the Holy Cross Hospital Emergency Center, right down the street. It turns out, Holy Cross Hospital Emergency Center would be better served staffing their facility with trained (or untrained) pigeons rather than most of the people who were currently on staff Friday night.

We arrived Friday and there was a long line, and most of the waiting chairs were full. So of course they only had one person checking in people. We checked in around 11:00 PM after a 15-20 minute wait in line. The person checking us in demanded to know my IMMEDIATE symptoms, and was NOT happy when I tried to explain I was just diagnosed with diabetes and was here for an IV and insulin. So I basically bundled up my warning signs and told her those were my immediate symptoms. This was to be a recurring theme during the visit. She was also of the school of customer service that's main teaching was "Don't waste words talking to the person when curt nods will do."

After this wonderful opening act, we waited for about an hour, and then I was called up again and a nice nurse asked me again what my symptoms were, why I was here, and took standard vitals. Kaiser had given me a letter explaining why I was there, what needed to be done, and that they authorized treatment. Kaiser contracts with Holy Cross for care, so it looked like a standard thing. The person checking me in glanced at it I guess to get more information, but this was the first time it was read, and entered into the computer system. Not that it mattered for future reference, but I don't want to give away any exciting plot twists! We then got to go back to the waiting room for another 30 minutes or so. At around 12:45 AM (Saturday!) we got to go back to the triage area, and I got a finger prick test (now down to mid-300's, yay) and then the doctor came in. I should have paid more attention because this was the last we saw of the doctor until around 5 AM. Darn, there I go spoiling the surprise again!

The doctor asked why I was here, and then had to go out in the hall to find out where the nurse had put my clipboard with all the medical info and letter from Kaiser. The nurse had wandered out of the room and just placed it on the desk beside the phone in the hallway. Once the doctor had it in hand, we said Kaiser had sent us over for insulin and IV fluids to flush my system. The doctor began to argue that there was nothing in the chart about any "flush" and he did not know what we were talking about and of course we would do the insulin and IV but this "flush" thing he did not understand. When we made him understand that it seemed like the flush was simply a way the insulin/IV treatment was described to us, he got very huffy and puffed that this was not the correct terminology. After 4 hours of having quality medical care inflicted on me, with Melissa in tow, we were both very glad to have this information on correct usage, and I made a mental note to send the doctor a thank you note for taking time out of giving us useful information to really show his medical school training. (I wish there was some way to denote extreme sarcasm on my blog.)

When the insulin was administered, I had to wait an hour before the blood test could be taken again. The nurse came in about 30 minutes later to take blood and we told her the doctor said to wait an hour. So she went to confirm that, and then came back after the hour was up, and my blood sugar level had only dropped about 50 points. So after 15 minutes or so they decided to repeat the procedure. The nurse came in, game me more insulin, and added another bag to the IV line. At that point I fell asleep, and woke up about an hour and twenty minutes later and the nurse had not come back. After about a hour and thirty minutes another nurse came back. It seems they had closed that section and nobody was told we were back there waiting. So that was wonderful. We were moved to a room in the main ER, and asked the nurse to see the doctor so we could get at least some idea of what the end result was. Because at this point we had asked a lot of questions like "how long will this take?" and "what is a good level we need to get to?" and had not gotten any good answers. The nurse told us to be "a little patient" and the doctor would be with us "shortly". I also should mention that our original nurse saw me walking into the ER wheeling my IV stand and said she did not abandon us, she was just moved to this other section (which was literally the next room over from where we were). I am not a linguist, but I think leaving us and not bothering to mention to anyone we were there and waiting might be a dictionary definition of "abandon". But that could just be me.

The doctor was with us "shortly", if we define that as 45 minutes later. He said my new levels looked OK for now, and he called Kaiser and set up an appointment for Monday morning, and also got me set up at Kaiser for another round of blood work. And that I should (I swear this is an exact quote) "watch what I eat." That was the limit of his advice. I asked some questions like if I should avoid certain foods and he said "sweets". Well, duh. I also asked about fruits, some have more sugars than others. He said they were all OK. Which was directly contradicted by the nurse who checked us out a few minutes later. Although the nurse said that Splenda and other artificial sweeteners contain some sugar so I should probably avoid them. And to not eat too much bad stuff because it would raise my blood sugar, but not eat too little because that would lower it and that could be dangerous as well. "It's a fine line", she said. And that was about all the useful advice I got from the fine people at Holy Cross.

Thus terrified of putting anything in my mouth, and terrified not to, we left the hospital around 6 AM, and got home around 6:30 AM. So 8:30 PM to 6:30 AM on the first day I found out I had diabetes. The icing on the cake was that Mac has been having "stomach issues", so when we got home, tired and frustrated, there were three "issues" that I had to steam clean out of the carpet. I ended my Friday with Melissa and I finally getting to bed at 7:30 AM on Saturday.

Maybe it's a metaphor for this situation I find myself in, you get a lot of crap thrown at you all at once, and just have to figure out how to deal with it. Anyway, it is what it is, and I guess I am grateful for Holy Cross for providing such a horrible situation that everything else looks better by comparison. My suggestion is that you steer clear of Holy Cross in Silver Spring, MD unless you have a dire emergency and it is the only hospital close by.

I have diabetes.

Found out on Friday afternoon, June 29 (iPhone launch day). I went in to get blood taken Friday morning for testing. Melissa drove, because I typically don't do well with people sticking things in my arm, and draining stuff out of me. When I went in, they stuck the needle in my arm and the next thing I remember were two nice lab technicians holding my arms to make sure I did not fall out of my chair when I had passed out. Sadly, they did not get any blood that time around. After laying down, they tried again with my left arm, but did not manage to get anything out of me. The third time was the charm, thy were able to get what they needed from the top of my left hand. I should state for the record that the medical people did their job very well, I am just a big wuss when it comes to needles. I was told that they would probably have the results no earlier than Monday.

On Friday, around 4 PM, I got a call from a person from Kaiser. They said I had extremely high blood sugar levels (about 300, normal is 60-110) and they wanted me to come in right away because I was going to get insulin and some electrolyte solution via I.V. drip to bring my levels down and flush the sugar out of my system (remember that, it comes up later). So I grabbed my stuff, told my boss I was leaving, and then ran out the door to go home. I was pretty sure I was not going to get much work done after that anyway. That was my first confirmation of the diabetes.

A little back-story on the diagnosis. Two weeks ago, I went to the doctor because I noticed my vision was blurry sometimes. My glasses are 3 or so years old, and my contact lens prescription is a little over a year old. It was blurry wearing either one. I have had prescription changes before, but they have never come on that suddenly, at least as I recalled, so it seemed a little odd to me. The doctor said my eyes looked fine, and I was just resigned to getting new glasses/contacts. But there were some other odd signs. I was drinking a lot more water, which I had initially thought was OK because it was summer, and getting much warmer. Hot temps = more water. The other odd sign was I was losing weight. I was trying to loose weight, so that was not a big deal, but when my weekly loss went from around 2 pounds a week (the safe range) to 4-5 pounds per week, that was cause for concern. Taken all together, and with a dollop of WebMD thrown in, I thought it might be a good idea to get things checked out. A quick email to my doctor, and I was authorized to go to the lab to get blood drawn.

Now we can fast forward to Friday afternoon. I had just arrived home from work, and the doctor called. She confirmed the diabetes diagnosis, but did not know if it was type I or type II at this point and confirmed I needed to go to get my IV and insulin later today, and I had an appointment set up for 8:30 PM at Kaiser's Urgent Care facility (which is the only one open after-hours and weekends). At this point I was still in shock, so I did not have a lot of questions. To be more precise, I had about a million questions, but I was not able to articulate them. We discussed something, I don't really recall what, I think maybe steps to take from here, what the process was going to be, but I am not 100% sure what she said.

I called my parents, Melissa called her parents, I spent some time being upset about it and then took a deep breath and calmed down a little, Melissa, of course, was a tremendous help, just being there as a shoulder to cry on, asking questions, making sure we thought of questions to ask the doctor when we went in that night, and just generally being helpful. That is one of the many reasons why I love her so much.

In part II of our Friday adventure, we explore Kaiser (good) and the workings of the Holy Cross Emergency Center (not good).