Monday, November 21, 2011

2/3 of the way there and things are changing... maybe too much

Today is day 60 out of 90.  I've stayed adherant to my diet and exercise plan, and been under my calorie goal every day except for one (my sweet neighbor brought over delicious, warm, homemade rosemary bread - I am human!).  Depending on the scale and time of day, I have lost between 11 and 14.5 pounds, and my BMI may be as low as 39!  Coming down from 42, that's awesome. 

Here's a weird thing - my insurance wouldn't pay anything towards my RNY if I went below a BMI of 40 if I wasn't diabetic.  So in this strange case, being diabetic is a good thing.  My next change - wait for it - my diabetes is improving.  Yup.  I've been lighter than this weight before (right after I was diagnosed with diabetes 17 months ago) and my blood sugar was out of control.  About two weeks ago I had a morning fasting blood glucose level under 100.  That was only perhaps maybe the 4th time it's been that good.  Then this last week, every reading has been in the 80s.  This morning, at 7:30 am my level was 78.  That was actually a little scary, because I wasn't symptomatic for hypoglycemia, and I don't normally take my levels or eat that early in the morning.  They both usually happen an hour later.  This morning, if I had waited another hour, I could have had my blood sugar levels crashing. 

So my levels have been stable since then, and tonight I'm going to take less long acting insulin (10 units instead of 15).  I see my doctor and get labwork in 7 days, and with Thanksgiving this week, I don't think I could get in any sooner.  She and I had discussed adjusting my insulin if my numbers were low, so I feel comfortable with doing this change now.  Here's what I'm not comfortable with...

What if I am no longer considered diabetic in the next 30 days???  

On one hand - it's a wonderful possibility.  It's the major reason I wanted the surgery - to not be diabetic any more or have to worry about those co-morbidities.  I would live longer, be healthier, etc.  There's no reason I couldn't keep on my current diet. 

On the other hand, if I'm not diabetic, my insurance will no longer approve the surgery.  As it is, I will already have to pay about $5000 for the surgery.  Paying the whole $22,000 is not a possibility right now.  So I could have done all of this work for 90 days just to disqualify myself. 

Why do I need the surgery if I'm losing weight so well now?  Because I've always been successful at losing 20-30 pounds over 6 months or so.  It's when it gets to 9 months and out and I'm still not losing any more weight.  I get frustrated, and feel like being on the diet isn't worth it if I'm still obese with all the co-morbidities that come with it.  I have stopped dieting, and eventually gained it back. 

Having been through that cycle several times on my own, with Nutrisystem, and with Weight Watchers, I just don't know how I could handle it if it happened again.  I really want the tool of my new stomach - with a tiny appetite (at least in my honeymoon period) so I can train myself for my relationship with food for the rest of my life.  I want to dump if I eat too much carbs - to me the RNY is like implanting antabuse in an alcoholic; if you eat (or drink) the wrong thing you get sick, so you reinforce good behavior.   I want my pancreas to start making more insulin the day of the surgery.  I want the reset button to get pushed on my stomach so I know what it feels like to feel full (and not WANT to feel full). 

Well, I won't know what's going to happen until it does.  And just because I'm lowering my insulin dose doesn't mean I'll be off it soon, or off the glucofage.  So I shouldn't worry.  But it's like a little itch saying "what if..." in the back of my head.  On the positive side - being stressed raises blood sugar, so maybe just stressing about my lower levels will be enough to keep me diabetic for sure?  It's a twisted world we live in, and with insurance requirements it's no reason we all go a little crazy.  And right now I'm queen of Looney Land. 

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