Living with diabetes, part... something

When I was still seeing Dartmouth Endocrinology, the doctor put me on Ozempic to help keep my blood sugar down. We never really decided if it was working after about six months, so I stopped taking it. I am one of those weird people who doesn't like paying for a medication if it's not producing any results. A few months later, my insurance decided they were no longer going to cover Ozempic (as they do.) My endo decided to put me on Trulicity as a replacement. It kind of worked, so I stayed with it. Overall, however, I was not at all happy with what endocrinology was doing for me - or, more to the point, was not doing for me. My blood sugar was still way out of control. Anytime I would send a note to them asking for help, it would be about a week before anybody even acknowledged that they had received the message. I'd get a short response saying they would run it by the doctor, which was pretty much the same as saying, "Scram kid, you're bothering me." Forget trying to call them and sitting on hold - no one would answer the phone or return voicemails. The few times I got to speak to a human, I was told they were short-staffed, and had other patients to deal with. I finally got to the point where I had to ask, "when is it my turn? When do they help me?" I am constantly waiting for them to help other people, but eventually, they have to get through that queue and get to me, right? So I started going to Concord Endocrinology to see what they could do. One of the first things they noticed was that I was still on the starter dosage of Trulicity after almost a year and a half. The question came up, "Why?" to which I could only respond, "Because it's Dartmouth Endocrinology. They dropped the ball and forgot all about me." So the doctor put me on Mounjaro. I was back on a starter dosage, but he promised it would work better, so I was willing to try it.

I don't know how much you know about diabetes. Your body takes in glucose (sugar) and converts it to energy. Glucose is one of those things that has received a rather negative connotation (kinda like carbs), but the truth is your body requires glucose (carbs) to operate. Like many things, it's "all things in moderation." Too much glucose is bad for you, as is not enough. If you've ever spent a day with a lot of exercise and very little food and suddenly started feeling very shaky and sweaty or cramping of muscles, that's often a sign of low blood sugar or hypoglycemia. A person without diabetes is able to process and store extra sugar by creating insulin. Too much sugar can lead to weight gain and other complications. A diabetic is unable to process this glucose because their body does not create insulin properly. A type two diabetic does not reliably create enough insulin to handle the incoming sugar. Some people are lucky enough to control this with a proper diet and enough exercise, but occasionally, you get someone like me who requires a little bit of extra help in the form of injected insulin and a glucose monitor. A type one diabetic doesn't create insulin at all and must rely on a glucose monitor and injections. Along come medications called semiglutides like Ozempic and Mounjaro. These medications do not contain insulin but rather stimulate your body to create its own insulin. The dosage may vary, but while you're getting used to a semiglutide, you could potentially get very sick. While I was on the starter dosage of Mounjaro, I got used to it fairly quickly. That's the point of the starter dosage - to make sure your body can tolerate it. I did, but more importantly, it WORKED.

Once you go a couple of months, they increase the dosage, or at least that's what's supposed to happen. Unfortunately, around the time endocrinology was going to increase my dosage, the rest of the world discovered that semiglutides make great weight loss supplements. This meant things like Trulicity and Mounjaro were almost impossible to get unless you were using it to lose weight. So you could sit on your couch, not exercise, and still lose weight because the semiglutide was killing any cravings to eat. On the other hand, people who needed to lower their blood sugar were unable to obtain it. (Large corporations selling supplements that don't normally work suddenly had the idea to buy the stuff in bulk and load their warehouses with it so they could sell it on social media as a weight loss panacea.) My endocrinologist tried putting me back on Ozempic, but it did not work. I reported that it was not doing anything for me, and my average blood sugar numbers were going way high. Normally, blood sugar is supposed to hover around 100. 70 is the low point; Anything lower than that is considered hypoglycemic and if left unchecked can go too low, which can lead to passing out and dying. Fun fun. On the other hand, if your blood sugar goes too high, that can lead to long-term bad effects like failed organs, clogged arteries, and, in my case, stroke. More fun! Before I got on the Mounjaro, it was not unusual for me to have blood sugars in the high 200s, low 300s, and occasionally even 400. This is considered to be very bad, especially since I had already suffered from two strokes. I've already been told that I'm insulin resistant, so there were days when, no matter how much insulin I told my pump to give me, it would do absolutely nothing. Once the Mounjaro started to work, however, my blood sugar normalized. I was having days, even weeks, where I was "in the zone" (meaning I stayed around 100.) Anything I eat has to be compensated for by giving myself an appropriate amount of insulin to counter the carbs. I was at a point where that insulin actually did what it was supposed to do. It canceled out the carbs that I was taking in and left me at a fairly normal number. But, of course, you all know that no good deed goes unpunished. Since I was unable to get Mounjaro in the .25 dose, my endocrinologist said "let's see if we can get it in the .75 dose." For one thing, the manufacturer had finally started to get caught up, but it was still hard to get. Most people using it for weight loss are using the starter dose, so perhaps a higher dose would be easier to obtain. So I started taking the .75 dose. Because I had gone almost two months without taking any at all, this higher dosage immediately started making me sick. Not only did I have no appetite, but I couldn't eat anything at all. I was throwing up, or worse, feeling like I was going to, but I didn't. Kind of hard to sleep when your stomach is constantly waking you up for a false alarm. Fortunately, it's summer, and I'm able to do some work from home, but I was still unable to leave the house because I was too tired and sick to do anything other than sit in a chair in my home office, which is near a bathroom. I suffered through three weeks of this. I would take a shot on Sunday, feel shaky on Monday but well enough to go to work, then spend Tuesday to Thursday being very sick to my stomach and not sleeping from night sweats and running to the bathroom. I would finally start to feel okay over the weekend, only to start the process over again on Sunday. Finally, on the third week of this, I told the doctor (after being sick at 4:00 a.m.) that I just can't do this anymore. He put me on a .5 dosage to give my body time to get used to it. At the time of this writing, it's still on backorder. I'm not taking any this week, and I actually feel good for a change. Still not feeling very hungry but at least I'm functional. I might actually be able to do my job for a change. That would be nice, wouldn't it? We'll see what happens when the new dosage finally becomes available.