Brain foggy

Jan. 3rd, 2011 08:11 pm
urocyon: Grey fox crossing a stream (Default)
Sorry I haven't been around much lately. I've been having a hard time with commenting, but have been reading some.

An excellent post from [personal profile] kaz I didn't have the spoons to comment on earlier: Variability, video and being a Good Disabled Person. (So it's also not just me with the commenting variability, which was kind of reassuring to see. *shakes head*) The variability is probably one of the most difficult things to deal with, IME.

Lately I've been having a lot of brain fog (pretty good description, BTW) and "migraines". Now I'm suspecting that the wonky blood sugar and possible-TLE may be ganging up together in sort of a vicious circle. The two go together a lot apparently, and fluctuating blood glucose will trigger seizures which then raise your blood glucose levels. (Nice! :-|) It would explain a lot, including why the BG levels have been so hard to manage.

(More support for the seizure idea, which I ran across while looking for something entirely different, here. The same thing happened to me multiple times as to the OP there when going off medications acting as anticonvulsants--and onto ones that will lower the seizure threshold.)

From the brain fog link, I ended up trying the Online Cognitive Screening Test from University of Florida, out of curiosity, the other night. The results were both encouraging and, erm, really not. On one hand, yeah, I'm not just imagining that the brain fog is a significant problem; OTOH, scoring 1st-3rd percentile "very low" on an assessment intended for people with Alzheimer's when you're tired is more than a little demoralizing. :( Not that verbal memory and task switching are my strong points at the best of times; I've been hesitant to retry it when just "normally" fatigued. But, again on the brighter side, maybe I'm not coping so badly (and/or Not Trying Hard Enough) after all. *wry smile*
urocyon: Grey fox crossing a stream (Default)
Some further evidence that this is, indeed, a viral problem I'm dealing with: my blood sugar has gone absolutely wild, without other factors changing remarkably. At this point, I think at least half the crappiness is down to hyperglycemia. I'm really not in good shape with that ATM, and suspect that I'd be feeling much better much more quickly (and hold up to the viral component better) if my blood sugar were back under some kind of control. It's had me scared, and even more worried about getting the house ready to move within a couple of months' time.

I've been stressing more about honestly not being able to get an appointment at the GP's (between medical PTSD and non-voice accessibility problems), which has probably not helped my health. (Especially since I'm suspecting I stressed my way into being vulnerable to icky viruses in the first place.) It's a very uncomfortable situation, which I haven't been able to see many ways out of. Being sick and drained of energy leaves me way less able to deal with just about everything else, in a "Help! I Seem to be Getting More Autistic!" kind of way. Stressing over it only makes things that much harder to deal with.

But, I am not feeling so trapped now, since I thought to look more into other options. Sitagliptin (Januvia), a DPP-4 inhibitor, is the only medication which has helped me so far, without any noticeable side effects. Apparently, it's down to poorly-understood insulin resistance subtypes whether a person will respond well to metformin or a DPP-4 inhibitor; a vanishingly small number of people are helped by both. At least, according to the doctor in the US who gave me the Januvia in the first place--and that makes sense.

So, I am tempted to try berberine, which is also a DPP-4 inhibitor (along with some other actions). There has been some promising research, and it seems worth a try after I track down a suitable supplement.

With any luck, that will at least help me get into enough better shape that I am capable of dealing with the GP, without so many worries about getting steamrolled, dismissed, and possibly even sectioned because I am obviously not in good physical shape, I'm behaving more "weirdly", and my verbal communication skills (especially in realtime) have mostly gone down the drain.

This GP has already shown a pattern of dismissing what I have to say, and it's hard to vote with your feet under the NHS. Small consolation: he's never said one word about my BMI, nor said anything to indicate he assumes I'm a couch potato--and even commented that, as fit as I looked already, diet and exercise probably wouldn't cut it. Lack of blamy comments is refreshing, even if some of his other behavior isn't. This is also the guy who didn't want to hear about persistent serious GI effects and symptoms of B12/thiamine deficiency from the metformin.

It irks me to have to do endruns and pay for stuff in the hopes that it will work--especially when I can theoretically get free prescriptions under the NHS--but accessibility is accessibility. And this is not a situation where "I guess you'll just have to do it" (complete with angry/exasperated tone) is of any help whatsoever.
urocyon: Grey fox crossing a stream (Default)
Looking for something else entirely, I ran across some info I wish I'd had well before this.

From Johns Hopkins' Diabetes and Exercise -- Keeping Your Blood Glucose Levels in Check:
If you have diabetes, you should always check your blood glucose levels twice before exercising: once 30 minutes in advance, and again just before starting. This routine will let you know whether your blood glucose is stable, rising, or dropping.

A safe pre-workout blood glucose level is between 100 mg/dL and 250 mg/dL. If the level is less than 100 mg/dL, have a carbohydrate snack (such as a piece of fruit or three graham crackers) before starting to exercise to prevent hypoglycemia.

People with type 2 diabetes should limit snacking, however, especially if they are exercising to lose weight. If this is the case, your doctor may recommend lowering the dose of your medication on the days that you exercise. If your blood sugar is above 250 mg/dL and you have type 1 diabetes, test your urine for ketones; delay exercise if ketone levels are moderate or high. Regardless of your type of diabetes, do not exercise if your blood glucose levels are 300 mg/dL or higher.


I had figured out to watch for hypos on my own (medicated or no, mine seems really reactive), but had no idea that I should be careful at higher readings. Why is that?

From Mayo Clinic's Diabetes and exercise: When to monitor your blood sugar:
300 mg/dL (16.7 mmol/L) or higher. Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.


It can also send your blood sugar higher, for a variety of reasons.

This would explain some things. :-| I also doubt that it's very good for your system to have such rapid swings from high to low, which is more likely to happen when mine is pretty high starting out. (The way that makes me feel for a couple of days afterward would also suggest it's not great!)

Now I'm wondering how I managed to miss that, up to this point. If you've got Type 2, medical professionals usually just push exercise (you lazy slob, you!) without much further information--or even finding out how active you are already--but I've done rather a lot of research out of self-preservation. Maybe I managed to skim over that very important information? *scratches head*

This is yet another reminder that I need to get up the nerve to go and try to get more Januvia from the GP. Diet and exercise changes have not made much of a difference in my readings, and I'm suspecting that directly iatrogenic diabetes may well behave differently from "normal" Type 2. :(
urocyon: Grey fox crossing a stream (Default)
I just roasted some hulled sunflower seeds with a little soy sauce and garlic powder, and they smelled so wonderful when I took them out that I had to resist grabbing some while they were hot. :) Really easy, just drizzle the seasonings on them in a bowl, stir to coat, and stick them on a baking sheet in a moderate oven for about 5 minutes. Glad I set the timer for 5 instead of 10, because they were really toasty as it was!

Even though I've been trying to eat more sunflower and pumpkin seeds for both the yumminess and the magnesium content, I almost forgot we had a 500g bag of the sunflower seeds! They're still good, though.

ATM I'm eating some leftover enchiladas I put in the oven with them (microwave is kaput). Not forgetting to eat lunch is a good plan anyway, but I need to head out in a while to pick up a package at the postal depot, and would prefer that my blood sugar not dip too low. *shakes head* Max can go along, since it's a nice walk for him. We've been trying a front-clip harness to deal with his pulling--actually, [personal profile] vatine made one!--and it should be a lot easier on me to take him out. Bit of a vicious circle, that: he gets excited and super-pully, so Mommy can't take him out without pain, so he develops a lot more pent-up energy and turns into Pully Bully no matter what we do. That opposition reflex? He's got it in spades. If he weren't almost 12 now, he'd sooo love to do some weight pulling. (Well, I'm sure he'd still like it, but I'd feel kinda cruel to the old man dog, healthy as he is.) His walk is totally different with the harness, with none of that head-down, hunched-shoulders pulling posture. :) Hopefully this will improve the situation! This will be my first solo run with the new harness.

I'm looking forward to getting the benfotiamine in particular (not "just" preventative; I had a deficiency). I'd put off ordering more, out of false economy, since it's £20+ for a month's bottle here that goes for about US$12. But the muscle spasms have been getting worse again, and I really should know better by now, with the continuing polydipsia/polyuria. :-|

ETA: I was just about to flip because I couldn't find the "sorry you were out" slip for that parcel. That would be because I handily pinned it to the kitchen bulletin board. *facepalm*
urocyon: Grey fox crossing a stream (Default)
Some good news: the still-kinda-difficult dietary changes do seem to be helping my blood sugar levels. I'm out of test strips and have been putting off buying more; since I've been avoiding the GP, I can't get free ones. I'll just have to go ahead and cave, and buy another batch. (That is definitely one thing I'll miss about the NHS: free prescriptions if you have certain chronic conditions!) But, I've been feeling relatively hypo a lot--especially after exercise--since a couple of days after the change. By this point anywhere near normal would feel low, though.

I was reminded of this because I'm having to eat something and rest a while now, after getting in from the grocery store (ended up walking down there after all). Annoying, but also encouraging. :)

Oh yes, not only did I go ahead and get some cooked chicken breast, I also "splurged" on already cut-up fruit salad. Pretty good indication of lingering poverty mentality when you're nowhere near the "buy food or pay the light bill" point, and those purchases feel like splurging. :-| But I successfully fought the cheapness urge, in the interest of not being grouchy and hobbling by the time supper's ready!

Edit: I have been doing better, though, at not kicking myself over rarely making it down to Romford Market on the appropriate days. Sure, you can get some really good deals on produce, especially if you hit not long before they're closing down (hard to beat £1 for a huge bowl of stuff!), but that takes an assortment of spoons I don't always have. First I have to remember that it is a market day, then I have to walk or bus it down there, then I have to stalk around through noisy crowds and see what looks good, then I have to drag it home and figure out what to do with it. That hasn't been happening much. Though, come to think of it, I may drag Ingvar down there tomorrow afternoon. *g*
urocyon: Grey fox crossing a stream (Default)
Getting ready to put something in there, I discovered that I forgot to wash out the slow cooker crock after the last use, so it got a hot Oxi stuff soak a little while ago. Ick.

Yesterday I picked up a nice-looking pork shoulder roast from the reduced section, since Ingvar isn't here. (He really dislikes cuts with lots of muscle bundle divisions like the shoulder.) It's now in the crock, so I don't have to turn the oven on with the muggy, hot-for-this-climate weather. Later, I'll chuck some celery, carrots, onion, garlic, and fresh rosemary in there, and maybe a potato or two.

That was 1.5 kg of meat for £3. Rather a lot for one person, but I'm planning to mix up some Carolina barbecue sauce (a lot like peri-peri with slightly different ingredient availability that side of the Atlantic) and turn the leftovers into pulled pork. Actually, I've been craving the barbecue flavor, but we do have an open bottle of really yummy peri-peri sauce in the fridge. Max might get some of the leftovers, as well. :)

The potato is in question, since I'm strongly considering going lower carb--especially starch, since I'm particularly sensitive to it--again. Even before meds set off the insulin resistance, I don't think my body was set up to handle much starch happily. That dietary change helped with managing my blood sugar before, but I got kinda turned off it through its being absolutely necessary for the almost-year I was taking metformin, which causes malabsorption. (Scarily, this has been suggested as a very bulimia-like weight loss treatment.) I still stayed sick and semi-dehydrated, but less so. My glucose control was worse on it, probably from staying sick and dehydrated. *headdesk* When I finally stopped taking that, it was such a relief to be able to eat a lot of foods without being really sorry afterward. Our old friend demand resistance probably had something to do with it, as well.

Still, I felt much better when I was eating a lot less starch than I have been lately, even with a lot of care devoted to balancing. I shouldn't have to think about what I'm eating and when as much, going back to a lower carb diet. Not to mention making avoiding gluten much simpler. ;)

After we move and get settled into a house, I am sooo going to plant some Jerusalem artichokes. (I can't even find the Tsalagi name for them, which is particularly annoying in context.) We just haven't had room for a good stand of them here, and they're not wild for the digging.

The past few months, I've had to go back on meat, with my ridiculously high energy and protein needs right now. I was eating enough beans, nuts, cheese (already a compromise), etc.--and eventually sustainable wild fish, as a compromise I was vaguely ethically happy with--that I didn't have room left for a variety of fruit and veg, and it still wasn't enough. Now I'm not ravenously hungry all the time, and don't think I've lost further muscle mass. Which was getting to be a bit of a problem.

The thing is, medically necessary as this shift back to eating rather a lot of meat seems to be for now, I'm not ethically happy with the idea. At all. Even the RSPCA monitored "Freedom Food"-labelled stuff available here does not meet my standards; the animals are still too tightly confined and commodified. Most lamb and properly grazed beef are just about OK, if still raised specifically for sale as food.

If I were back home, I'd probably be doing an awful lot of shopping at Brush Creek Buffalo Store, and finding meat and eggs from other farmers I know to raise their animals decently. (That was admittedly easier with my non-autistic, extroverted mother around. Not only did she tend to work with/otherwise know people who would sell surplus animal products, she had the gift of gab and could easily find other sources.) Living in an urban area now, I can't investigate this in person. Much less have access to wild animals, which would be closest to ideal.

Then there's the cost. We are thankfully not poor, even with my being unable to work now. The cost of more meat is more of an annoyance. But, I have held onto enough poverty mentality in some ways that I'm already uncomfortable with spending about £2 more a day on food, now that I'm back on some meat. I learned well, and have to fight urges to be just plain cheap with food (and just about everything else). Going lower carb, that £2 will at least double, even if I compromise even more on the ethical considerations. Meat is really, really expensive in the UK. (Yes, I am used to--if not fond of the idea of--US meat subsidies. The difference is amazing.) The stuff from the Buffalo Store--direct from the owners' herd--is barely more expensive than lowest common denominator beef here. OK, maybe that's an exaggeration, but not by as much as I'd like.

And yeah, I also continue with the disability shame, feeling bad about needing to spend that much extra just for me even if it's directly health-related. Especially since I'm not doing paid work.

But, that's looking like my best option at the moment. While I could eat what I wanted to, within reason, during my brief Januvia jaunt, the medical PTSD is continuing to get in the way. And I need to do something to get my blood sugar under control. The situation is untenable. Needs must, and all that. :-|
urocyon: Grey fox crossing a stream (Default)
It looks as if I should be able to manage my blood sugar without meds, after all!

It's been running under 10/180 most of the time the past few days, since I've been checking it regularly again. That includes after eating. The highest reading was 12.7/228.6, first thing in the morning. It's not swinging wildly, like it was.

This is lower--and far more consistent--than it was running, regularly, on metformin. (Not only did it make me sick, it just didn't work.) What's different? My nutritional status is the main variable that's changed. This would tend to support my speculations that being low on vitamins which are directly involved in glucose metabolism might screw up your blood sugar levels--further depleting thiamine in particular, for extra fun.

All the Maxercise (thanks, [livejournal.com profile] vatine!) lately probably hasn't hurt, but I was getting more exercise before when the blood sugar was really high and unstable. The main reason I became less active was dizziness, etc. And I haven't been needing to eat as carefully, since I've been off the metformin. One lower reading this afternoon came after I'd eaten a lunch with some brown rice, a banana, and diluted juice to wash it down! Lack of vitamin deficiency is the main factor that's left.

This is very encouraging. I'd wondered before why nothing I did seemed to make much difference in blood sugar levels, beyond the obvious like consuming huge quantities of concentrated sugar. It was frustrating and discouraging. Now, at least I've got a tentative explanation.

The Januvia didn't give me any noticeable side effects, while seeming to work, but I'd rather not take it if I don't have to.

Oh yes, and the depression is much better now, too. Some of that is probably also from correcting the deficiencies.
urocyon: Grey fox crossing a stream (Default)
Looking through Vol. 1 of Travell & Simons' Myofascial Pain and Dysfunction--which I haven't bought, expensive as the set is--after it turned up on Google Books when I was trying to find a reference on short arms and ill-fitting furniture, I ran across some other interesting info.

Yep, it's probably a good thing I went back on the B complex, plus the B vitamins in Magnesium-OK. I was not remembering that, besides the swinging thyroid weirdness (which I've been getting again, from prolonged stress), the repeatedly uncontrolled diabetes will interfere with absorption and conversion of a number of things. Including B vitamins for which I'm showing signs of insufficiency, or outright deficiency in a couple of cases. The disturbing oculomotor weirdness (not to mention increased brain fog and fatigue) I've been running into lately may well be coming from being low on thiamine, for example. The ear infection has proven much harder to deal with because I was already getting dizzy from my eyes not wanting to focus properly, and probaby more directly from vitamin depletion.

I was also not bearing in mind that the ethnic liver chemistry may well be changing requirements for a lot of things--besides the lingering celiac absorption issues--as a large part of the "wild natural individual variation" thing. "Enough" determined statistically--mostly from samples of rather different ethnic background--may well not be enough of some things for me at the best of times. Judging by the traditionally high intake of a number of foods full of nutrients I seem to be running low on--like leafy green veggies, beans, fish, and nuts--back home, this would not surprise me at all.

Yeah, I'd recognized the feeling of being low on B12 again, but was blaming a lot of the rest on spending months* really running myself into the ground, with neglect and overt under/malnutrition. That likely had a lot to do with it, though in a more complicated way than I had thought. No wonder I've been craving liver, which is chock full of several nutrients I seem to be low on right now. (I think I will go ahead and buy some later, and [livejournal.com profile] vatine doesn't have to eat any.) Trying to get more of a number of things from food sources has not been enough, and no wonder! I may just need to set up a pill box to help me remember the supplements--which I may well just have to keep taking regularly, judging by this experience.

The good news is, assuming I get sufficient vitamin intake to work around the absorption/conversion oddness, apparently most of the symptoms should be much better within 4-6 weeks. I was starting to get scared by some of this stuff**, and it's reassuring to find a probable explanation which is easier to do something about than the nebulous "stress".

Another helpful thing is just finding out that I've got a "good" reason to be feeling pretty damned disabled right now. ATM, I'm too dizzy and clumsy to risk a jaunt through the shower--what with all the actual falling down lately--but am getting ready to slather on more deodorant and head out grocery shopping anyway. Trying to apply the same standards to myself that I would to a stranger on the street is a bare minimal goal, but it doesn't always work! I thought I had come to terms with having a pretty variable apparent functioning level by now, but it seems not completely. Ah, the fun of less obvious (not just close to "invisible") disabilities, and the mess of internalized BS which gets bundled with them.

At least this has provided a wake up call, making it abundantly clear that I really should slow down and take better care of myself. That is what I'm going to have to do for a while, and the omnipresent other considerations can go hang. Shame I'm going through another spell in which this kind of thing is needed for me to admit to myself that I really am dealing with disabilities--but, all things considered, it's a good thing I did get a jolt! Continuing to run myself into the ground, mainly to show myself that I can, is just plain stupid.

______
* I say "months", but this has been going on for the better part of a year now. No wonder it's catching up.
** And even more hesitant to bring some of it up to the GP, having been on the wrong end of iffy conclusions being jumped to if your problem is not a common one, way too many times by now. Watching how that kept happening with my mom did not make me any keener on reporting things like oculomotor problems, and likely being given Haldol for my troubles by the well intentioned. Especially since I'm looking more autistic these days, in part from dealing with the health issues.

Edit: This is also likely to get one's symptoms taken less seriously. Largely between "looking more autistic" and associated bad experiences, I have not hobbled screeching and whining in search of pain relief. And I manage to look more functional, and get more done, than probably 95% of other people with similar pain and other symptom levels; therefore, the pain could not possibly be that bad. Not being neurotypical--and not responding in an expected manner to high levels of pain--definitely helped my mom get into the situation she did. It's scary.
urocyon: (water)
I haven't been in front of the keyboard much in a while--mostly haven't felt like it, being sick and tired from (and of) the metformin. Yesterday was pretty bad, but today seems to be making up for it. Thank goodness things frequently work out that way.

Yesterday I was thoroughly fed up, and finally thought to try to find more info on side effects. (Don't know why I hadn't done this before, possibly out of "this will surely go away soon" denial.) Apparently, it's not at all unusual for GI symptoms to continue, no matter what pharmaceutical reps have the doctors believe. (Medscape is erratic in wanting a login, so here's a saved version.) This is not too surprising, considering how it works on the GI system--that certainly explains why the symptoms kick in within half an hour of taking the stuff. That's even without all the anecdotal evidence. Judging by other people's experiences, the lightheadedness, dizziness, and headaches are probably more direct side effects, rather than the hypoglycemic symptoms I started out assuming. It also seems that the fatigue, brain fog, general lack of energy, and some muscular pains are likely coming from B vitamin depletion--and my stores of some were just getting reestablished, from the celiac. Pretty much the same reason in both cases, but it hadn't occurred to me; maybe I should blame the brain fog. :)

On the brighter side, I did run across a lot of tips for making the side effects liveable, mainly from one PCOS forum. Some of the eating advice I'd figured out already. I'd discovered that I do need to eat every couple of hours, in small quantities, and make sure I eat something before I even finish my coffee in the morning (particularly fun, since I'm just not hungry for a few hours). If I wait until I'm starting to feel low, that's the rest of the day gone; ditto for eating very much at a time, or much in the way of carbs without tons of fiber, or much not-very-saturated fat. Yesterday, I think I got so sick from (a) waiting a couple of hours to eat, while carrying buckets of fish water in the meantime, and (b) extending some leftover goulash with too much pasta. I was glad to see some other tips on food timing and content, including taking the pills in the middle of the meal and preferably with some milk or yogurt too (if the lactose content isn't enough sugar to cause a problem). I'm seeing an awful lot of veggies and fruits--which the metformin hasn't hated, so far--in the near future, and I already tend to consume 8+ servings. I'm also going to try harder to remember to take a B complex, and hope that some of it gets absorbed, along with the magnesium supplement on top of all the legumes we've been eating lately.

As a side note, the advice I ran across--along with personal experience--makes me very glad indeed that I knew enough not to follow the diet recommended by the NHS. Besides throwing in lots of outdated "eggs are horrible, don't eat nuts, margarine is great" cholesterol-lowering advice, the handouts I got made absolutely no distinction between Type 1 and Type 2. If I were being "good" by their definition, and eating even more starchy carbs than the food pyramid suggests, I'd be about dead from the meds before now--and wondering why it was happening, in spite of my "goodness". It's particularly inappropriate, given that metformin is the most prescribed drug for Type 2, with its method of action. I only wish I were surprised at the quality of advice. :/ Unfortunately, a lot of people seem to have more trust in medical professionals, and don't do much if any research for themselves.

The metformin hasn't been very fun so far, but it still looks like the best option. Something that actually reduces the insulin resistance, rather than pumping more insulin into a wonky system, makes a lot more sense. Just seeing some assurance that things can be managed so that the effects are tolerable has given me more hope. Knowing that there's something, short of going off the meds, that I can do to help the complete lack of energy is particularly welcome. With any luck, quality of life will be looking up before too long.

That reminds me, I really do need to get over my phone phobia* long enough to call for a remedial massage appointment. The knotted up shoulder and chest muscles from that job have proven a more lingering and aggravating problem than the lower back injury. It keeps feeling like I've been trying to fly, with implausible angel-type wings, attached behind my arms. Wearing a bra really aggravates this, since I could tell at the time that doing such strenuous, repetitive work with restricted/awkward movements from a bra was causing a lot of the problem. They're unpleasant enough, at the best of times, but I'm still not entirely comfortable bucking that particular deranged social mandate. Some sports massage from someone who knows what they're doing should work wonders, though, so I really ought to make myself get on the phone soon.

* I'm still wondering about the feasibility of using TTY and/or relay; just the CAPD, which helps make me nervous since I can't understand the other end of the conversation at least half the time, constitutes a legitimate reason. The little television/DVDs I watch have been so much more enjoyable since it occurred to me to turn on the closed captioning.

September 2011

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