Sticking It to Myself

First of all, thanks for your patience in the blog host debacle.  Just goes to show you don’t miss your water until the well runs dry.  Translated that means I love WordPress as the blog host and will not be making any changes from here EVER!  Further translated that means the name of the blog will always be SlowItDownCKD and we’ll always be at https://gailraegarwood.wordpress.com. I do believe I’ve just apologized.  I seem to be doing that a lot this week.

National Kidney MonthHappy third week of National Kidney Month. Seems so odd to place ‘Happy’ and ‘National Kidney Month’ in the same sentence.  Yet, it makes sense. How can we spread awareness of Chronic Kidney Disease if we don’t have a national effort? Hmmm, that sort of makes it happy.

Okay, down to brass tacks (or sharp jabs) now. During the first week of National Kidney Month, my PCP decided it was time to deal with my consistently high A1C test results.  Good timing on her part, huh?

Let’s go back just a bit to remind everyone what the A1C test is for. On page 54 of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I wrote the following.

Somewhere along the line, one of your doctors may order an A1C test.  This measures how well your blood sugar has been regulated for the two or three months before the test.  That’s possible because the glucose adheres to the red blood cells.  This is important since quite a few CKD patients develop the disease from diabetes.Book Cover

Ah, so she’s trying to help prevent me from developing diabetes. That is the number one cause of CKD.  But I already have CKD.  Let’s see why it’s important for those with CKD to avoid diabetes, too.

I went directly to The National Kidney Foundation at https://www.kidney.org/atoz/content/diabetes for information.

With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

bladderDiabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

Oh no!  I already have kidney damage. Now I could be exacerbating it. Wait a minute.  How is this happening?  I exercise, watch my renal diet, try to avoid stress, and get enough sleep.  Am I doing something wrong?

In type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time your pancreas isn’t able to keep up and can’t make enough insulin to keep your blood glucose levels normal. Type 2 is treated it with lifestyle changes, oral medications (pills), and insulin.pancreas

This is from the American Diabetes Association at http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html  A little clarification here: type 1 is the one in which people don’t produce insulin and type 2 is when the body is insulin resistant.

Wow. Just wow.  What’s tickling my mind now is the latest information I’ve read about statins possibly resulting in type 2 diabetes by affecting insulin resistance in a negative way.  Don’t get excited just yet.  Nothing’s been verified and I’m not even sure I understand the research.

All right, jabs next.  Since this is all new to me, I was told to check my blood sugar daily.  I looked dumbly at my PCP.  She caught the look and explained I could get my supplies at the pharmacy and sent over a script.  After four days of running around after my insurance, it was determined Medicare would not pay for the supplies since I didn’t actually have diabetes.  If Medicare doesn’t cover it, my secondary insurance doesn’t. So, I paid out of pocket.diabetes equipment

Off I went to the pharmacy, where the pharmacist explained what I would need. I looked dumbly at my pharmacist.  He caught the look and offered to get the supplies for me.  I’m sure he meant well, but he gave me the pharmacy brand meter which means I can only use their test strips.  It’s sort of a forced income for them.  He also gave me lancets (I used to think that was just the name of an English medical journal. Silly me.), but they weren’t ultra-thin and they hurt.  What he didn’t give me was the lancet device.  I didn’t know that existed until the diabetes counselor provided by my PCP told me about it.

I suspect I over checked because my fingertips are black and blue.  However 2 hours after eating is the norm.  I just took a break and monitored my blood glucose. It’s 121.  While that’s low for me, normal is in the 70-110 range, so even though I took 500 mg. of Metformin this morning, I’m going to have to exercise when I’m done (Doesn’t scare me; I have to exercise for the CKD anyway.) to lower that number.

I can see I’ll be blogging about this again. There is so much to cover here!Part 2

Digital Cover Part 1I keep forgetting to ask.  Would those who you who have read The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and/or The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 please write a review on Amazon.com. I am interested to hear what you think of these books.

Did you know you can register for the Phoenix Kidney Walk all the way up until that morning, April 19th?  If you’re going to register, why not join Team SlowItDownCKD?  Here’s a link to make that easy: kidneywalk.kintera.org.

Until next week,

Keep living your life.

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It’s Still National Kidney Month

And I still have pre diabetes.  It sounds like something someone made up and maybe it is, but my A1C test result is still high and getting higher despite the changes I’ve made in my eating habits.  When better than National Kidney Month to explain why this could be a problem for those of us with Chronic Kidney Disease?kidney

We’ll need a little background here (as usual).  First, what is A1C test?  According to The Mayo Clinic at http://www.mayoclinic.org/tests-procedures/a1c-test/basics/definition/PRC-20012585,

“The A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications.”

I’m sure you noticed how often I rely on The Mayo Clinic for definitions.  I find their simple explanations make it easier for me (and my readers) to understand the material.  I also like that they explain in their explanations. These phrases surrounded by dashes or in parentheses further clarify whatever the new term may be.

Okay, so we can see why this needs to be tested.  Now, what does it have to do with diabetes and what is diabetes anyway? This time I looked for a medical dictionary and found one at our old friend The Free Dictionary.  It’s at http://medical-dictionary.thefreedictionary.com/Diabetes+Mellitus. The mellitus is there because that’s how members of the medical field usually refer to diabetes – as diabetes mellitus. This is what I found there,

“Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin.”

Book CoverIn What Is It And How Did I Get It? Early Stage Chronic Kidney Disease I define glucose as the main sugar found in the blood.  I go on to explain that in diabetes, the body doesn’t adequately control natural and ingested sugar.  The Free Dictionary definition shows us how the body loses control of insulin production and what it means for the glucose levels… which is what the A1C test measures.

So… PRE diabetes? What’s that?  Funny you should ask. The English teacher in me can tell you that pre is a prefix (group of letters added at the beginning of a word that changes its meaning) meaning before.  Pre diabetes literally means before diabetes which makes no sense to me because that would mean everyone without diabetes was pre diabetic.  It helped me understand when I was told pre diabetes was formerly called borderline diabetes (a much better term for it in my way of thinking).

This time I went to WebMD for a simple explanation.  In addition to learning that pre diabetes means your glucose, while not diabetic, is higher than normal, I found this interesting statement:

“When glucose builds up in the blood, it can damage the tiny blood vessels in the kidneys, heart, eyes, and nervous system.”  KIDNEYS!

You can read more about this at http://www.webmd.com/diabetes/guide/what-is-prediabetes-or-borderline-diabetes.

Well, then what’s a normal level you ask? According to my primary care physician, 4.8-6.0 is normal BUT this range needs to be adjusted for Chronic Kidney Disease patients.  I (what else?) looked this up at Lab Tests Online http://labtestsonline.org/understanding/analytes/a1c/tab/test and found more of a range:

  • A nondiabetic person will have an A1C result less than 5.7%.
  • Diabetes: A1C level is 6.5% or higher.glucose
  • Increased risk of developing diabetes in the future: A1c of 5.7% to 6.4%

My result was 6 in the emergency room last November.  During my regularly scheduled CKD yearly lab last September, it was 5.9 with a big H (for high) next to it.  The August before that it had been 6.1.  Back in January of last year, it was 6.  I seem to be staying in a very close range for over a year, but it’s still pre diabetes.

All right then, what’s normal for a CKD patient?  I don’t know.  Life Options says just keep it under 6.5 (http://lifeoptions.org/kidneyinfo/labvalues.php). The rest of the internet seems to think the A1C results need to be adjusted only if you have both diabetes and CKD.  Looks like my nephrologist and I will have to have another talk about this.

You would think the danger of an elevated A1C  would be diabetes, but I’m wondering if the damage to those tiny blood vessels may be worse.

diabetes_symptomsHave I raised questions in your mind?  Is your A1C normal?  How do you tell if different sources hold different values as normal?  Time to ask your doctor.  And time to remind you again, that I am NOT a doctor, just a CKD patient with loads of questions and a willingness to research some answers for us all. Something to consider.

Other things to consider: have you had your kidneys tested?  It’s a simple blood test and a simple urine test.  Sure you don’t have the time, but no one does.  Then again, it’s sure worth it to avoid the need for dialysis (now THAT takes time) and a transplant down the road.

You know that 59% of our country’s population is at risk for CKD, but did you know that 13 million U.S. citizens have undiagnosed CKD?  That’s scary.  Take the test.

Here’s a link to the letter I wrote for Dear Annie – a nationally syndicated column – for National Kidney Month: http://m.spokesman.com/stories/2014/mar/10/annies-mailbox-learn-risk-factors-of-kidney/ It appeared on March 10, 2014 just prior to March 13 World Kidney Day.Nima braceket

Above is a picture of Nima. She’s pointing to the bracelet I gave her that she’s wearing so that I would be with her on last year’s Greater New York Kidney Walk while I was actually ill back home in Arizona.

Until next week (and the last day of National Kidney Month),

Keep living your life!

A1C! A1C! (Sounds like a Cheer to Me!)

For those of you who don’t know us personally, we do a lot of eating out during celebrations.  (Is Labor Day an eating out kind of holiday?) August is full of birthday celebrations.happy birthday

We started off by celebrating Sean’s August 20th birthday early since he and Kelly were going to be in Michigan with his family on his actual birthday.  I somehow magically found Salute Ristorante Italiano (http://www.saluteaz.com/) in Phoenix which actually had a delicious meal that required no substitutions whatsoever for me… and they didn’t know that I was coming or that I had renal disease.  Hurray for them!  It was Sean’s celebration, but I felt I was the one who’d gotten a present.

Bear’s birthday was the 23rd.  On the spur of the moment, we decided to go to Buca de Beppo’s (www.bucadibeppo.com) for a late lunch/ early dinner since I had a Landmark Worldwide class that night and we wanted to do something to celebrate.  This meal didn’t turn out so well for me.

While Bear ordered a delicious meal, I could taste the salt in the cheese ravioli with meat sauce.  The meatballs weren’t salty, but they were still red meat.  Let’s see:  cheese, red meat, and salt.  Good thing Bear also ordered a salad. Then I completely blew it by having half a chocolate chip cannoli in chocolate sauce while the wait staff sang Happy Birthday to Bear.  Amazing how fast the body lets you know you’re not doing right by it.ravioli

The next day, I’d promised to take Bear to his favorite restaurant for his favorite meal before we went to hear Greg Warren perform at Stand Up Scottsdale (http://standupscottdale.com).  While Greg Warren (www.gregwarrencomedy.com) was an excellent choice, Flo’s (www.madebyflo.com) was a renal diet disaster.  This is in no way a bad review for Flo’s, but rather a bad review for deviating from the renal diet.

Once or twice a year, I indulge myself with their scrumptious house fried rice… even though it’s fried.  But not the day after a meal that did me no good!  To make it worse, they must have changed their recipe for the Vietnamese Spring Roll. It was deeply fried with a very mushy interior. By the time, Bear’s complimentary dessert of chocolate covered wonton surrounding a slice of orange arrived, I was very happy to eat just the orange.

Ah, but we’re not done.  Grown children Abby, Lara, and Lara’s sweetheart joined us for ‘The Mortal Instruments: City of Bones’ (Eh.  Maybe I wasn’t in the mood.) and dinner at Claim Jumpers (www.claimjumper.com/) afterward.  This is a place where Bear usually shares a really tasty renal diet meal with me… but not on his birthday: ribs, mashed potatoes, roasted veggies with sour dough cheese bread and then a taste of the chocolate cake a la mode.  All I have to say is, “What the dickens is wrong with me?!?!?!?!?”

sad faceMy poor beleaguered body could not keep up with so many foods I usually do not eat and I felt physically ill.  To make matters worse, my A1C will be a mess this time around.

Oh, right, A1C.  That’s the topic of today’s blog.  Let’s start the way we usually do with a definition. I picked up Amgen’s Understanding Your Lab Values: A guide for patients with chronic kidney disease. While this is a drug company (and I don’t recommend any drugs; that’s up to your doctor), their informational guides are usually clear and straight to the point.  They define A1C as, “a test that measures your average blood glucose levels over 2 to 3 months.”  Mine is evaluated via my usual quarterly blood draw.

You’ve probably figured out that this has to do with diabetes or pre-diabetes. According to DaVita at http://www.davita.com/kidney-disease/causes/diabetes/the-a1c-test-and-patients-with-chronic-kidney-disease/e/7802, people with Chronic Kidney Disease should keep their A1C readings between 4.0 and 5.9%.  Mine has been rising steadily for the last several years and is presently at 6.1, which is considered pre-diabetic.

Okay, so your glucose levels can be tested for a two to three month average and over a certain percentage is considered pre-diabetic.  What is so important about blood glucose anyway?A1C

Our old friend MedicineNet at http://www.medterms.com/script/main/art.asp?articlekey=32858 tells us blood glucose is:

“The main sugar that the body makes from the food in the diet. Glucose is carried through the bloodstream to provide energy to all cells in the body. Cells cannot use glucose without the help of insulin.

Glucose is a simple sugar (a monosaccharide). The body produces it from protein, fat and, in largest part, carbohydrate. Ingested glucose is absorbed directly into the blood from the intestine and results in a rapid increase in blood glucose. Glucose is also known as dextrose.”

Got it!  We need blood glucose for energy.  And the cells need insulin to provide this energy from glucose. Well, how is this a problem?  Wait a minute – insulin – diabetes.  Oh, my!

I’m getting close to diabetes.  All right, then let’s look at diabetes.  What’s that? Well, we can figure out it’s the body’s inability to handle a surplus of glucose in the body, but what harm is it specifically to you (and me) as a Chronic Kidney Disease patient?

According to Diabetes.co.uk at http://www.diabetes.co.uk/how-does-diabetes-affect-the-body.html, “The kidneys are another organ that is at particular risk of damage as a result of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure and cholesterol. “

I am not liking this. I’m already being treated for hypertension [high blood pressure] and hyperlipidemia [high cholesterol].  I don’t think I can afford to add diabetes to the list.  And that’s why next week’s blog will be about diabetes.

talkingstickresortThank you for all the support you’ve shown for SlowItDown, the project to bring free CKD education by trained educators to any community that needs it. It was our pleasure to be part of The Fourth Annual Men and Women’s Gathering at Talking Stick Resort this past Thursday.  This was hosted by The Salt River Pima – Maricopa Indian Community and open to all tribes.  Non-tribal members were welcome as well.

Several medical professionals, including nephrologists, have offered to help make this an interactive blog.  Please send your questions in comment form and we will answer them as quickly as possible. I’m enjoying the change of direction for the blog.

And to think this all started when I wrote What Is It And How Did I Get It? Early Stage Chronic Kidney Disease because I needed answers.

Until next week,

Keep living your life!