Author Topic: Unfolded Aorta  (Read 1044 times)

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Offline Quantum Learning

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Re: Unfolded Aorta
« Reply #30 on: 07 February 2018, 03:01:23 PM »
Okay, spent 7 hrs in A&E last night with possible appendicitis but turned out to be a UTI with no symptoms other than severe pain on my right lower abdomen  ::) got AB's & can't wait to feel better.

In the meantime, DSN phoned today with my latest A1c, which is 51, not as good as I'd like but she's very pleased as she says it's very good while on insulin, she seems to think anything under 58 means less possible complications but to my mind it's not non-D levels is it?
Dropped slightly since the last one of 52 (amazing since I was ill all over Xmas & been in constant pain ever since). My Chol has also dropped from 6.1 to 5.9 and I couldn't help saying and that's on a high fat diet  8)  tried to get a breakdown but she was talking a lot so only got HDL 1.34 LDL 3.86 & gave up on Trigs but am hoping maybe Alan can work his miracles with maths & comment on them for me  :D
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline Alan

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    • Type 2 Diabetes - A Personal Journey
Re: Unfolded Aorta
« Reply #31 on: 07 February 2018, 10:14:43 PM »
Quote
My Chol has also dropped from 6.1 to 5.9 and I couldn't help saying and that's on a high fat diet  8)  tried to get a breakdown but she was talking a lot so only got HDL 1.34 LDL 3.86 & gave up on Trigs but am hoping maybe Alan can work his miracles with maths & comment on them for me  :D

The Friedewald formula may give a slightly different result to the measured trigs:

Total = LDL + HDL + Trigs/2.18
or
Trigs = (Total -HDL - LDL) x 2.18 = (5.9-1.34-3.86) x 2.18 = 1.53

Your Trigs/HDL is 1.14 (target <1.3) indicating most of your LDL is beneficial, with not much dense and harmful according to this.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Slow Cooked Beef Brisket)
Born Under a Wandering Star (Surviving Long-haul Flights in Cattle Class)

Offline Paulines7

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Re: Unfolded Aorta
« Reply #32 on: 08 February 2018, 10:04:10 AM »
Sorry you have had such severe pain QL and hope the antibiotics give you some relief soon. 

My HbA1c is usually around 50 and my GP is happy with that.  She has told me that the low 50's means less possible complications so this is more or less what your DSN is saying. 

Congratulations in getting that low especially because you have been in pain since Christmas.  Your next one may be lower still when the pain has gone. 

I had my HbA1c blood test yesterday and I will be pleased if I am still in the low 50's as I have not been as strict with my diet over the Christmas period. I find it easy to give up starchy foods such as rice, pasta, flour products and bread (though I do eat Lidl protein rolls now and again) but I am weak when it comes to chocolate and ice cream.
Diabetes Type2 diagnosed March 2014.  Treated by diet only.  HbA1c 60 on diagnosis, 52 in June 2014, 50 October 2014, 44 December 2014, 48 May 2015, 50 Sep 2015, 53 Jan 2016, 50 Oct 2016, 56 Feb 2017, 50 Jun 2017. 50 Aug 2017. 47 Feb 2018. 50 Jul 2018. Pacemaker fitted 2008 - replaced 2017.

When I get old I don't want people thinking
                      "What a sweet little old lady"........
                             I want 'em saying
                    "Oh Crap! Whats she up to now ?"

Offline nytquill17

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  • It's all in the balance.
Re: Unfolded Aorta
« Reply #33 on: 08 February 2018, 01:31:23 PM »
The closer to a non-D A1c level, the better overall. BUT there is a substantial reduction in risk for EVERY 1% (old money, roughly 10 in new money) reduction in A1c. On the order of 30-45%. But since that is a relative percentage, the closer you get to "target" the less that percentage actually represents (the same percentage of a smaller number is itself smaller). In particular, the difference in risk between non-D levels (under 6% or 42) and recommended target for a diabetic (7% or 53), while certainly non-negligible, is not all that great in practical terms. Meantime, especially for someone on insulin, the difference in effort required and misery experienced to get from 7% to 6% may well outweigh the benefits in terms of quality of life. The officially named "complications" are not actually the only complications to diabetes - we also have to watch for burnout and depression, and more generally you don't want diabetes eating up your life. We're supposed to be living WITH diabetes, not living FOR our diabetes!

So your nurse has a valid point in this case, namely that you are already in a very "low-risk zone," and realistically, you may not be able to get your risk levels any lower, given everything else you also have to manage at the same time. And it's important to know that that is actually okay! The message here is not to fixate on non-D levels as being the goal and everything else is failure and flashing warning lights. Anyway, you're not non-D, are you? You're doing extremely well, and better than most - I saw a chart in the hospital clinic the other day that said that the average A1c among type 1 diabetics (not sure if this was Canada-wide or globally) is something like 8-8.5% (64-69). Now that's not a lot of information to go on by itself (no standard of deviation, no breakdown by age or other important factor groups, no correlated data on complications or QoL) but I do think that as most T1s are not dropping off from complications left and right, so that tells us that even a quite high average A1c is fairly sustainable.

Which is not to say that we should all just go "oh ok, I'll just chill here at 9%!" and not try for any improvement! But it's important to focus on goals that are realistic and achievable and it's important to know that you can fall far short of "perfection" and still be okay. (Obligatory caveat: everyone is different, and A1c is all about relative risk and population-wide trends, and not about what will actually happen to you. Some individual people can have near-perfect control and still end up with quite serious complications, and some people can run higher and seem to experience no complications to speak of.) This is part of why the move now is towards more individualized targets based on what else is going on in your life and with your health, because ultimately it's about striking a balance between effort (what can you personally realistically do), safety (high A1c is not always the greatest health risk a person faces, a good example of this is risk of hypoglycemia in the elderly), QoL, and health improvements.


Sources:
http://www.mountsinai.on.ca/care/lscd/sweet-talk-1/why-should-my-a1c-be-7-or-less
http://www.a1cbloodtest.net/a1c-complications.php

Handy dandy conversion chart:
https://diabetessociety.com.au/documents/HbA1cConversionTable.pdf

Personalized target calculator based on various health considerations:
http://guidelines.diabetes.ca/bloodglucoselowering/a1ctarget
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Quantum Learning

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Re: Unfolded Aorta
« Reply #34 on: 08 February 2018, 02:35:55 PM »
Quote
My Chol has also dropped from 6.1 to 5.9 and I couldn't help saying and that's on a high fat diet  8)  tried to get a breakdown but she was talking a lot so only got HDL 1.34 LDL 3.86 & gave up on Trigs but am hoping maybe Alan can work his miracles with maths & comment on them for me  :D

The Friedewald formula may give a slightly different result to the measured trigs:

Total = LDL + HDL + Trigs/2.18
or
Trigs = (Total -HDL - LDL) x 2.18 = (5.9-1.34-3.86) x 2.18 = 1.53

Your Trigs/HDL is 1.14 (target <1.3) indicating most of your LDL is beneficial, with not much dense and harmful according to this.

Yay, thank you so much for this, I'm going to keep this info somewhere so I don't have to keep asking you to do it, very pleased with that result though  ;D
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline Quantum Learning

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  • Posts: 1,317
Re: Unfolded Aorta
« Reply #35 on: 08 February 2018, 02:41:11 PM »
Sorry you have had such severe pain QL and hope the antibiotics give you some relief soon. 

My HbA1c is usually around 50 and my GP is happy with that.  She has told me that the low 50's means less possible complications so this is more or less what your DSN is saying. 

Congratulations in getting that low especially because you have been in pain since Christmas.  Your next one may be lower still when the pain has gone. 

I had my HbA1c blood test yesterday and I will be pleased if I am still in the low 50's as I have not been as strict with my diet over the Christmas period. I find it easy to give up starchy foods such as rice, pasta, flour products and bread (though I do eat Lidl protein rolls now and again) but I am weak when it comes to chocolate and ice cream.

Thanks for your kind thoughts, Pauline & good luck on your A1c result. I have to admit mine was better than I was expecting considering all that happened over Christmas, still onward & hopefully downward.  ;D
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline Quantum Learning

  • Member
  • Posts: 1,317
Re: Unfolded Aorta
« Reply #36 on: 08 February 2018, 02:59:13 PM »
The closer to a non-D A1c level, the better overall. BUT there is a substantial reduction in risk for EVERY 1% (old money, roughly 10 in new money) reduction in A1c. On the order of 30-45%. But since that is a relative percentage, the closer you get to "target" the less that percentage actually represents (the same percentage of a smaller number is itself smaller). In particular, the difference in risk between non-D levels (under 6% or 42) and recommended target for a diabetic (7% or 53), while certainly non-negligible, is not all that great in practical terms. Meantime, especially for someone on insulin, the difference in effort required and misery experienced to get from 7% to 6% may well outweigh the benefits in terms of quality of life. The officially named "complications" are not actually the only complications to diabetes - we also have to watch for burnout and depression, and more generally you don't want diabetes eating up your life. We're supposed to be living WITH diabetes, not living FOR our diabetes!

So your nurse has a valid point in this case, namely that you are already in a very "low-risk zone," and realistically, you may not be able to get your risk levels any lower, given everything else you also have to manage at the same time. And it's important to know that that is actually okay! The message here is not to fixate on non-D levels as being the goal and everything else is failure and flashing warning lights. Anyway, you're not non-D, are you? You're doing extremely well, and better than most - I saw a chart in the hospital clinic the other day that said that the average A1c among type 1 diabetics (not sure if this was Canada-wide or globally) is something like 8-8.5% (64-69). Now that's not a lot of information to go on by itself (no standard of deviation, no breakdown by age or other important factor groups, no correlated data on complications or QoL) but I do think that as most T1s are not dropping off from complications left and right, so that tells us that even a quite high average A1c is fairly sustainable.

Which is not to say that we should all just go "oh ok, I'll just chill here at 9%!" and not try for any improvement! But it's important to focus on goals that are realistic and achievable and it's important to know that you can fall far short of "perfection" and still be okay. (Obligatory caveat: everyone is different, and A1c is all about relative risk and population-wide trends, and not about what will actually happen to you. Some individual people can have near-perfect control and still end up with quite serious complications, and some people can run higher and seem to experience no complications to speak of.) This is part of why the move now is towards more individualized targets based on what else is going on in your life and with your health, because ultimately it's about striking a balance between effort (what can you personally realistically do), safety (high A1c is not always the greatest health risk a person faces, a good example of this is risk of hypoglycemia in the elderly), QoL, and health improvements.


Sources:
http://www.mountsinai.on.ca/care/lscd/sweet-talk-1/why-should-my-a1c-be-7-or-less
http://www.a1cbloodtest.net/a1c-complications.php

Handy dandy conversion chart:
https://diabetessociety.com.au/documents/HbA1cConversionTable.pdf

Personalized target calculator based on various health considerations:
http://guidelines.diabetes.ca/bloodglucoselowering/a1ctarget

Thanks Nyt, much good sense as usual & some very interesting links.

I think my obsession with getting my A1c lower is as much to do with, if I don't 'aim' lower & settle for 'just ok' then I will 'give in' to temptation more often and it will creep higher.  :D
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline sedge

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  • Posts: 14,236
Re: Unfolded Aorta
« Reply #37 on: 08 February 2018, 03:13:03 PM »

Anyone who wishes to get me to stress about my A1c levels can go and take a running jump, to be polite.

Of course I prefer em to be 'in range' cos it keeps the whingers off my back, who wouldn't prefer it!  However if there is good reason why it's like that - and it's something that is now passed, a one-off - then I dismiss it.  If it's NOT a one-off and is still affecting me - then Mr/Ms Medic - I expect YOU to suggest ways for me to tackle whatever it is, if I haven't already found a way!

It's the latter we strive to do on the forum isn't it - by saying eg Oooh - that happened to me and I did this or that - have you tried those?  If people can't suggest helpful things then they are in no position to criticize and I'd tell em that quite frankly.  If it's just YOU that's putting pressure on you to be lower lower lower then it's a danger of becoming trapped in a never ending vortex - so just don't do it! 


QL - why do you believe one transgression becomes 'total' transgression?  Even addiction to nicotine isn't instant!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline nytquill17

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  • Posts: 6,769
  • It's all in the balance.
Re: Unfolded Aorta
« Reply #38 on: 08 February 2018, 04:50:25 PM »
I totally understand about the creep. I have found a good strategy for me is to sort of accept that sometimes there will be creep, and my job is not to stop it from ever happening but to check in with myself on my choices - if I indulge myself on this or that, in this moment, is that kindness? or am I making excuses and I could push myself harder here if I were really honest about it? And if my answer is "push", am I being realistic or idealistic?

Because every choice, every day is so different!

Now of course you have a way that seems to be working for you and you might as well stick to what you know works! But if you ever feel that you want other ways to think about it, one thing to consider is that you don't necessarily have to "aim ever lower" if you are getting frustrated chasing a goal that you can't reach. What about just aiming to maintain? To do exactly as you have been, a similar amount of ups and downs. That way you're not framing it as relaxing the "rules" such that you're tempted to have creep, but it lets you acknowledge that where you already are is an achievement in itself and not something that is perpetually "not good enough."
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

  • Administrator
  • Posts: 24,488
  • It's ONLY Diabetes. It could be something worse!
Re: Unfolded Aorta
« Reply #39 on: 08 February 2018, 06:47:27 PM »
Lots of sound advice and not a lot I can add (was entertaining last night and was out all day today) so forgive me for not adding anything!

This link leads you to a converter that does the work for you, rather than having to look at a chart... https://www.diabetes.co.uk/hba1c-units-converter.html

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Quantum Learning

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  • Posts: 1,317
Re: Unfolded Aorta
« Reply #40 on: 09 February 2018, 02:58:05 PM »

Anyone who wishes to get me to stress about my A1c levels can go and take a running jump, to be polite.

Of course I prefer em to be 'in range' cos it keeps the whingers off my back, who wouldn't prefer it!  However if there is good reason why it's like that - and it's something that is now passed, a one-off - then I dismiss it.  If it's NOT a one-off and is still affecting me - then Mr/Ms Medic - I expect YOU to suggest ways for me to tackle whatever it is, if I haven't already found a way!

It's the latter we strive to do on the forum isn't it - by saying eg Oooh - that happened to me and I did this or that - have you tried those?  If people can't suggest helpful things then they are in no position to criticize and I'd tell em that quite frankly.  If it's just YOU that's putting pressure on you to be lower lower lower then it's a danger of becoming trapped in a never ending vortex - so just don't do it! 


QL - why do you believe one transgression becomes 'total' transgression?  Even addiction to nicotine isn't instant!

I don't believe that but I still have an extremely sweet tooth in spite of barely eating anything sweet for the last 5 years so I feel my addiction to sugar is still there lurking in the background waiting for me to weaken & we all know just one treat today can creep up to too many.

I also still miss buttered toast, sandwiches, roast pots, chips, crisps (had a real craving for those recently) nice pastry (I do make very nice pastry) Chinese rice & noodles, Eccles cakes, nice biscuits, more or less any cakes covered with crunchy sugar or icing etc.

Now my way of dealing with this is to not even consider eating them so if they're not on my radar I won't be tempted. This worked very well when I still had a partially functioning pancreas & I achieved very low A1c's but since it more or less packed in & I'm using insulin, I have had a few of these goodies since I can inject for them but it makes me want them more.

This whole addiction thing is curious though, I smoked from the age of 13 & packed up when I was 33 & it was hard. The only thing stopping me starting again was that I kept thinking I couldn't go through this again at another time. It took probably a year before I could say those cravings were completely gone & I've had no desire to ever smoke since but sugar seems different. It seems that an addiction to sugar is possibly lifelong whether you feed it or not.

Love that converter Patti, such fun  ;D
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline nytquill17

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  • It's all in the balance.
Re: Unfolded Aorta
« Reply #41 on: 09 February 2018, 06:53:53 PM »
I think "food addiction" is really difficult to qualify because unlike other types of addictions (alcohol, nicotine, gambling), food is actually a necessary part of life and we are all biologically wired to enjoy it and to seek it out. So at what point does it go from "I find myself eating more and more sugary foods because evolution has made it so that I prefer out the most calorie-dense foods, only now there are calorie-dense foods everywhere year-round with very little physical effort to go get them" to "I'm addicted to sugar"?

Which is not to say that food addictions don't exist. But I think that's a big part of what makes it harder to turn food cravings and food dependencies OFF. You can't just go cold-turkey and the desire to consume more calories than we expend (and to seek out calorie-dense foods) IS in all of us, all the time, and normally can't be turned off. It's not part of a malfunctioning body, it's part of a perfectly normal, healthy, functioning body (in an environment that is no longer adapted).
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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  • Posts: 14,236
Re: Unfolded Aorta
« Reply #42 on: 09 February 2018, 09:31:08 PM »
We were never allowed to eat enough sweet stuff, to get addicted to it.  We all liked it but there just wasn't that much of it on offer ever!  Then I hooked up with a bloke who didn't actually like cake, pudding, biscuits all that much - his mother was useless at making anything like that - on Sunday she'd make an apple pie (never ever any alternative) using Jus-Rol pastry and I never ever saw a cake in their house.  My cakes and puds are pretty good actually but only got rolled out when we had guests and my pastry is lousy except flaky pastry - and that was for nearly 30 years.

Pete also would far rather have more dinner than any pudding - so I've quite likely had a charmed life!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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  • Posts: 24,488
  • It's ONLY Diabetes. It could be something worse!
Re: Unfolded Aorta
« Reply #43 on: 09 February 2018, 11:44:55 PM »
Sedge you are not the only one!  My cravings are for savoury stuff.

Interestingly Friday evenings are the evenings we go to the local pub... 50 yards away.  It's noted for its food quite widely, but a group of us gather around the log burner on Fridays early evening and without fail we discuss local restaurants, recipes etc and the focus is usually on savoury stuff!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans