I had my endo follow-up appointment last Thursday, and I was pleasantly
surprised.  With all that has been going on, I had warned my endo to expect
*anything* with my a1c when I came in to the office for an appointment.  He
has been seeing me over in the hospital during my hospitalizations, but I
still needed my every three month office visits.

Another reason I needed it was because I just had run out of ideas on how to
manage my meals to accommodate about four different dietary needs.  Those
are:

1) Gastroparesis
2) GERD
3) Swallowing / choking difficulties due to myasthenia gravis
4) Mouth ulcerations requiring bland non-acidic foods

1)  We are trying to handle this without medication to keep from adding even
more to my daily cocktail.

2)  I have my no-no list for esophageal reflux such as caffeine,
*chocolate*, and I cannot remember all right now; staying at 90 degree angle
for 2 hrs after eating.  I have my post endoscopic instructions, too much to
list, plus I've misplaced it, and need to get a new copy from the
gastroenterologist.

3) This was covered by the speech pathologist last May when I began the IVIG
treatments, when I could swallow no more than a sip at a time because my
mouth and throat muscles did not work.  On this, food and drink consistency
is the primary issue, and it can change from day to day, even change within
the day due to the nature of the MG to worsen during the day.  Some days,
Cream of Wheat is about the only thing I can get down, depending on the
status of my swallowing and choking.  For instance, yesterday, I had
leftovers from Abuelo's from Thursday, having no problem at all eating it
then (veggie fajitas - one tortija, veggies by fork - I was physically
exhausted after my appointment just making eating a tiring chore, otherwise
okay - Friday, totally unable to eat the left overs because of the condition
of my mouth, and unknown reason for trouble swallowing.

4)  Still have not been able to have my mouth biopsy, but *need* to get it
done asap because I am continuing with the pemphegus symptoms with slight
bleeding sometimes, or something else that equally needs treating, just
needing to  match the time and ability to get to it.

I'm not sure if you can see it or not, but a high carb diet is best for my
physical palate, and body, but not the best for my blood sugar control.

My last a1c with semi-control with taking 60mg prednisone daily was 6.0.
Things since then have been what?  I don't know how to describe it, except I
just haven't done good counting the carbs of the foods I was eating, and my
basal setting had gotten changed while I was in the hospital sometimes.

So, what I needed Thursday was some, no LOTS of help in figuring what to
eat, and how to count it in my pump to help with my gastroparesis for the
*later on food distribution from my stomach, with  my insulin all gone by
then* causing me to have the extreme highs!).

First of all, my endo has a new nurse practioner, and dietitian.  Clicked
with the NP right away.  Talked my diabetes language.  The dietician - she
used to work in the hospital 15 miles south of us in the same hospital
system Jim worked in, and they knew each other well.  She has been a
diabetic since childhood and wears a pump, and would you believe, a purple
one just like mine.  ;)  I had never met her, but Jim had told me a lot
about her some years ago when she was at Osceola.  She and I actually met as
friends in the waiting room, along with another corporate employee who was
also there for an appointment with Latif, while we were waiting for our
appointments with Latif.

The NP and dietician had both been briefed on my status, recent
hospitalization, porta cath surgery, and what I was needing from them as a
*team* for my diabetes.  Right now, I forget my conversation with the NP...
lol   It was profitable, though.

With Kimberly, I spent more time.  I told her everything, and I do mean
everything, how I forget to test, forget to bolus, all those nasty little
things that knock a hole in fairly good control.  In a nutshell, to begin
with, we are setting every bolus of my pump to a square wave bolus
regardless of what it is.  This is used for high fat meals like the pizza
effect, giving insulin later on, and for me, she set it at 1.5 hour.  So,
1.5 hours after each meal/bolus, my pump will shoot me with more of my
programmed insulin for that meal, thus hoping to catch the gastroparesis
delay, and beating the liver dump without insulin to cover it.

Now, *to me* the miraculous news was my a1c, and that was 8.0 exactly.  I
even asked Jim afterwards if I heard the latter part correctly.  I knew the
8 was right, but couldn't believe the .0!  That was eating whatever I could
get down regardless of blood glucose effects, and without faithful bolusing.
Another reason I was surprised was because I had gotten in the habit of
snacking on some graham crackers without counting them, and I found they had
become a nervous crutch for me.  Until I get things back under some control,
and that means ME, I am going to forego my crackers.

To help Jim and me in the food department, she suggested keeping some Lean
Cuisine meals since they have the carbs counted on them.  I forgot to say
that one problem is counting the carbs of all the fresh vegetables we eat.
This is not me in the kitchen where I've been for 40+ years, where some
things come more naturally like with measuring and the like.  *Whenever* Jim
is able to be back in the kitchen once again, this will help him.  Also, the
ones I've eaten so far are in small, bite sized pieces, exactly one of the
things I'm supposed to have which is called a soft mechanical diet.

I have tired, and unable to think, so it's time to quit, and so you are
blessed!  When rested, I have even more miraculous news following up last
month's hospital's fiasco.

Have a good day!
Billie