Today ends five (5) months on a serious low-carb high-fat lifestyle. My weight continues to fluctuate up and down, but the overall trend is still down. I’m not going to set new goals for next month. It seems that every time I set a new low for carb intake, I have a rash of migraines—10 to 17 consecutive days—until my body adjust to the new carb goal. So I’m keeping my calories and macronutrients the same as last month: 1200 calories, fat 100 g, carbs 30 g, protein 45 g, and fiber 20 g. My average blood glucose did not decrease significantly, staying at about 125. What I need to focus on in June—and probably for the rest of the summer—is exercise. I’m doing better! Taking Barley out for walks more and making an effort to ride my trike. It’s just so discouraging lately with all the cold, overcast weather we’ve been having!
I had a diabetic retinal screening last week, and received this standard-answer report the following day:
We are pleased to inform you that review of the screening images taken in the Diabetic Screening Clinic did not demonstrate any diabetic eye disease. We recommend that you continue to work with your primary care physician to obtain optimal blood sugar, cholesterol and blood pressure control. Please remember that optimizing blood sugar, cholesterol and blood pressure will help you minimize the chance of losing vision from diabetic retinopathy. I recommend repeating the diabetic retinopathy screening photos in two years.
I should be going in for bloodwork in a couple of weeks. Last week I got an email message from my Kaiser practitioner (a Pharm.D. who my primary care physician assigned to me several years ago when my blood glucose was running high). I’d like to include our entire conversation:
Dr. P: It looks like you are due to get some nonfasting blood test. Please get them done at your earliest convenience.
Also, are you still taking your cholesterol medication, simvastatin? It looks like you last refilled 9/2014. Did you have any problem with it? Do we need to switch to another better cholesterol medication for you?
Me: Yes, it has been over a year since I had an A1C. I also need to have a fasting complete lipid panel, thyroid test, and kidney and liver function tests. I have not had a fructosamine test since 2011, and tests for calcium, magnesium, and potassium since 2009 (when I was hospitalized 5 days for kidney failure). I stopped taking simvastatin a few months ago when I realized that I have not had a high cholesterol test since 2001. I’m more concerned about triglycerides, though, and am still taking Slo-Niacin as prescribed for that. I would like to get the blood work done during the second week in June as I have a very heavy workload during the first week. Please let me know if I can get all these tests at that time.
Dr. P: Thank you for your update. Your doctor has already ordered all your blood tests below except calcium and magnesium. Unfortunately, I am not authorized to order these two items. Please follow up with Dr. Chan to add that to your blood test.
I would encourage you to resume simvastatin as recommended. Studies have shown that simvastatin can prevent heart attacks and strokes even if your bad cholesterol (LDL) looks good. We are putting all patients on statins now. Do I need to order that for you?
Please let me know.
Me: Thank you for the update regarding the order for my blood tests. I will contact Dr. Chan for the ones you are not authorized to order.
I do not wish to resume statins at this time. My main concern is that it will make my diabetes worse and is not good for my liver and kidneys.
Dr. P: Your blood sugars were good being on simvastatin. I doubt simvastatin will increase your blood sugars. However, I am more concern of putting yourself at higher risk of heart attack and strokes. Slo-niacin may affect your liver as well but it does not protect your heart. I highly recommend you reconsider resuming simvastatin or switch to atorvastatin that can protect your heart and lower your triglycerides.
I did not respond to Dr. P’s last message, but I did email Dr. Chan with:
Dr. Poon recently contacted me that I am due for bloodwork. I responded to her: “Yes, it has been over a year since I had an A1C. I also need to have a fasting complete lipid panel, thyroid test, and kidney and liver function tests. I have not had a fructosamine test since 2011, and tests for calcium, magnesium, and potassium since 2009 (when I was hospitalized 5 days for kidney failure).”
She responded back to me: “Your doctor has already ordered all your blood tests except calcium and magnesium. Unfortunately, I am not authorized to order these two items. Please follow up with Dr. Chan to add that to your blood test.”
So I am contacting you to verify which blood tests have been ordered for me. If possible, I would like A1C, complete fasting lipid panel, thyroid tests, liver and kidney function, Fructosamine, Calcium, Magnesium, and Potassium. I would like to get the blood work done during the second week in June. Please let me know if I can get all these tests at that time.
I did not mention Dr. P’s insistence on statins. I shall wait to hear from Dr. Chan this coming week.
