Started Accutane

Today I saw the dermatologist again and he gave me my prescription for Accutane; so at dinner I officially started taking it. As per my last post on the subject, Accutane scares me quite a bit. But this is probably the only time I'll be able to take it, so here we go.

The biggest side effect of Accutane is that it dries out your skin so I've stocked up on moisturizer. I even found a new moisturizer by Cetaphil that is oil-free and has an SPF in it. I've had a lot of trouble finding a moisturizer with an SPF that doesn't make my skin break out so I'm quite excited about it.

I've also decided to really make sure I eat better while on Accutane. To that effect, I've sort of started Rick Gallop's GI Diet again. Well, I made some green-light cookies anyway. I've decided that I'm not going to follow it 100% - if I feel like some yellow-light stuff every here and there that isn't the end of the world. I also won't be able to follow it while skiing. But other than that I am going to try sticking to it as best as I can. It might take about a week though before I completely start following it.

The GI Diet is a really good idea for me anyway. Following it is supposed to help regulate your glucose level so that won't be a bad thing. Besides, I've managed to be reasonably active over the last month (mainly thanks to skiing and walking), so it's definitely time to add eating right to the equation.

Other than that, there really isn't much to report. I'll be updating this blog semi-regularly as things progress.

Skied With Friends

Today I went skiing with a couple of friends. Friday is cheap night at Kamview ($7 to ski, and an extra $7 if you need to rent skis) so it was the perfect night to go. We had a lot of fun.

Of course, the evening was that much better for me because it was a total success glucose-wise! I didn't have to eat anything at all during the entire ski!

I started the day out low. So I ate a small "breakfast" (what other people would refer to as lunch) and did not do insulin for the meal. I know this isn't a good plan normally, but I wanted to make sure I would be higher when it came time to ski. Luckily this worked out, as supper rolled around I was about 10 mmol/L.

After my problems last time, when I had a dinner heavy with free foods, I decided to have a carb heavy dinner. So I ate a sub from Subway (just over half of a foot long), a cup of chocolate milk, and a small piece of crusty white bread. Then I did the usual thing with my insulin, 25% of the bolus from dinner, and 25% of a basal running through until I'm one skiing (although I didn't take into account the carbs for the piece of bread). I started eating dinner at about 5:30 and started the basal just before 6pm. Once dinner was ready, I got ready and met my friends for about 6:45. The plan was to be at Kamview for about 7.

I did glucose just before I left my house and was about 13 mmol/L. By the time I got to Kamview I was now 15 mmol/L, which was great; unlike pretty much every other time I've gone skiing this year, my glucose level did not drop! We skied to the beginning of the Northern Lights trail where I did glucose again. This time my level was just above 14 mmol/L. That was fantastic, too - no big drop there either!!! So we skied the Northern Lights successfully. This was also when I saw the biggest drop in glucose, going from 14 to about 8 mmol/L during that time.

We finished the night by skiing the normal lit trail back to the chalet (no dark Jackrabbit for me this time). Back at the Chalet, my glucose remained steady. So that meant I successfully skied about 3km without having to eat anything!!!!

After dropping everyone off, I went home and did glucose again. My level had predictably risen to about 15 mmol/L. So I corrected that, then did glucose again about a half hour later, when it dropped back down to 11 mmol/L.

All in all I am extremely happy with how everything went with my glucose. I'm even confident enough to attempt Kakabeka this Sunday (although I'm only going to do a 4km trail. I don't feel confident enough in my glucose to attempt the 7km one).

Skiing Failure

This post's title is a bit of a misnomer. I didn't really fail at skiing today. It just really felt like I did.

Today we decided to take one of the unlit trails at Kamview. It's called Roadway Ramble and it's about 1 km long. It's a nice trail that brings you up to the top of the Sun Dial (now called the Sun Up Trail) so you miss the long stupid climb but get to enjoy the hill down the Sun Down trail. I was terrified that I was going to kill myself on that hill because it was so icy; luckily I managed not to fall despite crossing my skis as I snow-ploughed down the hill. Everyone met up at the end of the Northern Lights, where I did glucose once again. Unfortunately I was around 5.0 mmol/L, which I did not think was high enough to ski the Northern Lights. So I waited while everyone else did, in hopes that my glucose would stabilize so I could get back. By the time everyone else returned, my glucose hadn't done much of anything so I ate a little something then Jackrabbited back. Back at the Chalet, my glucose was fine. I did it once again and it was starting to climb (not too high though - it was still under 10 at that time) so I did a bit of insulin to correct that. Apparently that worked because my glucose stayed around the same - I didn't go high! So that was a success, eliminating the rise after I was done being active! :)

The reason tonight felt like a failure was because I wasn't able to ski the Northern Lights. After my success two weeks ago, I thought I'd have smooth sailing in that regard. I read a map though while I was waiting, and estimated what I had skied of the Sun Down trail to be about another kilometer. Including the Jackrabit bit I did at the end, I totaled about 3km (and yes, I realize a chunk of that was downhill, but I could feel my legs really working trying to stay upright, slow down, and fight to uncross my skis on the hill so it wasn't like I just sailed down, doing nothing). That's pretty comparable to how much I skied two weeks ago when I did the Northern Lights. So this wasn't really a failure at all. It just really felt like it.

I attempted to do the same thing with my insulin as I did two weeks ago. I did about 25% of the dinner bolus, and dropped my basal to 25% during the ski. I started that drop a little later though accidentally (we ate dinner at about 5:50pm, and I dropped the basal at about 7pm. I was going to do it at about 6:45pm but lost track of the time). So it's possible that I would have been fine if I'd dropped the basal sooner.

The other difference was that I ate a lot of free foods at dinner. Yes, we had potatoes (which were super good) and of course I had milk (I love my skim milk). But that was coupled with a salad (which was delicious), asparagus (also delicious), and ham (yum!) Everything was really good, but there really wasn't a whole lot of carbs in the meal. On top of that I didn't feel like eating much (I think I filled up on the salad). I think this was the least carbs I've had out of all my skiing nights this winter.

I also may have messed up the carb count a bit with those potatoes, now that I think of it. So between these two things, my glucose just didn't hold like last time.

I'm also disappointed that I probably won't be able to go with everyone next weekend. The plan was to try skiing Kakabeka, which would be a lot of fun. Unfortunately the trail we were going to ski is much longer (about 7km) than what I've been able to ski successfully this year. I'll see what I can do though - if I could carry something like chocolate milk with me I might be able to do it. Or maybe I'll go and just do a smaller loop. We'll see.

My brother also thinks that as I build up my endurance, my body should adapt and my glucose might not drop as drastically as it has. So at the very least, if I'm able to keep skiing (and if these strategies work for biking during the summer), I should be able to ski the Kakabeka loop next year.

Acne and Accutane

Ever since I was a teenager, I've had pimples. Unlike my brother at the time, my acne was never really bad. But about six months ago, I had a bad flare up that has refused to go away. Right now my face is the clearest it's been since August, but it still isn't clear. I've been taking an antibiotic to try to control it, which I have also done in the past. And while it's slowly getting back under control, like I said it hasn't cleared up. So my doctor gave me to a referral to a dermatologist. I met with the dermatologist yesterday, and after some discussion, he agreed to put me on Accutane.

I'm not going to lie, Accutane scares me. It has a lot of side effects, many of them quite serious. But while weighing the pros and cons of the drug, with both my parents and my brother (who was on the drug years ago to clear his acne up, and is a pharmacist), I think I am going to take it. I'll be on it for six months, and will have blood work every month to make sure nothing is going wrong (one of the more serious side effects is liver damage, which generally corrects itself once you are off the drug). The really bad side effect is depression and suicide thoughts (this link has not been proven and if it exists, effects >1% of people who take Accutane according to the literature I've read. It's a small chance, but it does exist). Another side effect I read about is possible decreased night vision. That one bothers me (as anything with my vision bothers me), but again, generally it is reversed if you stop taking the medication.

For people with diabetes, Accutane poses its own problems. I read online that it can make your blood sugars harder to control. That's troubling enough on its own, especially since I feel like my glucose has been alright lately (and I've just figured out skiing!) but I think I will mention this to my Diabetes Education team (and will maybe request monthly meetings with them or at the least emails, just to help me through). The other really troubling side effect for people with diabetes is that Accutane may increase cholesterol. While I've never written about it here before, my doctor has found that I have elevated cholesterol levels (because I have diabetes. If I didn't, my cholesterol levels would be on the higher end of normal. It seems to run in my family). So that was a really troubling revelation. But I found some advice on a website that eating low G.I. foods may help keep your glucose in check. Eating healthy and exercising may also help keep my cholesterol down, so I've convinced my household to get on board with that (and my dad has promised that if he's going to cheat, he will cheat outside of the home, so that will greatly help me (who has terrible willpower!)

As to the depression, I think healthy eating and exercise should help keep my mood elevated. I know I've been depressed before in the past (not clinical depression and I did not have to take anything for it. I also have never had thoughts of suicide), so I'm helping that will help. I'm also going to try to write every day during the months I will be taking Accutane. I participated in NaNoWriMo this past November, and was extremely happy and productive during that month. I am hoping that writing every day (what I want to be writing - to that end I have a couple of projects underway) will help keep my mood elevated. I will also have video games and good old reading to help in that regard. As well, my main support network either is notified or will be notified, so they will be keeping an eye on me. And since I still live at home, I'll have people around should I need help. Although my mom has made me promise to tell someone if I start to feel depressed, knowing that I tend to keep my feelings to myself.

I still have about a month to decide if I don't want to take the Accutane. But at this moment, I think that taking it is a good idea for me. Yes, the drug scares me. But I have the people and resources to help me get through it safely.

I Survived the Northern Lights!!!!

Last night I went skiing once again. And this time I successfully made it around the Northern Lights trail and back to the chalet without going low!!!!!

Last week I went out and tried the suggestions from this post I made three years ago: 25% bolus at dinner, then 25% basal while skiing. Unfortunately I still went low. But while watching how my glucose behaved during and after skiing, I hypothesized that the problem was simple: we went out skiing too soon after dinner. So this time, I made a point of eating earlier and going skiing later, giving my insulin and glucose a chance to regulate itself.

Before we left for Kamview, I did glucose and was 11.8 mmol/L. I thought that was going in the right direction so we left. Unfortunately by the time we got to Kamview, my glucose magically dropped to 9.1 (even though this was maybe 15 minutes later). Dismayed, I drank some regular pop and ate one peanut butter cookie (something with more staying power than the pop), then off we went.

I stopped right before the Northern Lights trail begins to do glucose again. At this point I had been experiencing a drop in glucose and would be hovering just over 4.0 mmol/L. This time I was 9.5! I was super excited - somehow my glucose had managed to hold steady!

After skiing the Northern Lights, I stopped and did glucose once again. This time it had dropped a bit to 8.4 mmol/L, but for all intents and purposes it was still holding relatively steady! So I skied back to the Chalet without any problems (and without having to eat anything more!) At the end of the ski, I did glucose and was 8.8 mmol/L. I had successfully skied the Northern Lights trail without going low!!!!!

I stopped the remaining 25% basal at that point (I had set it to 25% for 3 hours at about 6:45pm; it had 45 minutes left to go when I stopped it). About an hour later I did glucose and was now 16.8 mmol/L. I need to find a way to deal with that increase (and to stop it from happening), but it really wasn't as bad as two weeks ago when I went from about 5 mmol/L to 20 in an hour. But that's something to deal with next time. For now, I'm just excited to be able to ski (and hopeful that this will help me bike come summer)!