melting mama

CGMS is on the way. Now how to hold up my pants?

My eight week trial of the continuous glucose monitor is on the way, and should be here via UPS on Friday thanks to a very helpful woman at Medtronic, more helpful than my health insurance happened to be anyway.

Once it arrives, I am to literally "hook up" with an educator to teach me how to shoot myself in the gut and keep the sensors from falling out of my loose skin.  This is something I had not really thought about, my skin and the sensors.  Most of my excess skin is in my abdomen, and that is where the sensors are shown.  I hope they have alternate site placement.

Then,  off to Old Country Buffet. 

Kidding.

I have been doing really well lately, obviously while watching food intake, carb intake tends to go out the window first and those are what trigger the blood sugar the most. 

Sure, I still have major fluctuations and can't eat many normal foods (Do not give me a potato!) or any mixed meals (duh) I CAN eat a "low calorie and low carb diet" and not die.  But, my brain is still flip-flopping, and I would like to see if blood sugar is at all related to it, because I have been blaming glucose for so very long. 

I self-diagnosed since doctors wouldn't listen to me - and I called myself a "reactive hypoglycemic" a couple years ago. 

The seizures started after that in the form of complex partials, but have not been linked to blood sugar levels.

Do I think the seizure activity is related to my blood glucose levels?  I always have, but it's the what came first thing.  I just don't know.  I may never know. 

But, this trial of the continuous glucose monitor may give us insight - because it will show us a pattern of glucose levels 24/7.   

I will be able to track things for myself in conjunction with the graphs the meter saves:

• the partial seizures (any blood sugar changes before)
• any grand mal seizures (any blood sugar changes before)
• reactive hypoglycemia (when I don't have symptoms, which is the reason for the meter)

I am only alloted an eight week use of the meter.  So, I was only half-joking about the buffet.  I need to sort of trigger events.  Life happens.  So what if I have been "Very Good" for the last so many weeks?  I nearly went comatose a few times in the last few months too, and on some occasions I don't see it coming.  I cannot base my entire future with a broken pancreas on six or eight weeks of being on a diet.

______________________________________________________________________________________

When hyperinsulinemic hypoglycemia persists, continuous glucose monitoring (CGM) can give a more precise picture of the individual's blood sugar pattern. The CGM system is worn continuously for three days. It contains a small catheter that is inserted under the skin to obtain blood glucose readings every five minutes. Results from the monitor should be compared to the patient's food and activity log for those days. Blood glucose that is always low, even during fasting periods, may more likely indicate a diagnosis of insulinoma, while postprandial hypoglycemia is probably reflective of more diffuse islet hyperplasia.

Figure 2

Medtronic CGMS System Gold

An MRI or CT of the pancreas is needed to rule out insulinoma if the patient is still symptomatic after the CGM and dietary changes. There is a case report of a 65-year-old woman who suffered repeated episodes of hypoglycemia after undergoing gastric bypass for continued weight gain. Her symptoms were misdiagnosed as dumping syndrome, and a CT and MRI, which located the tumor, were done only after months of dietary intervention. It is not certain that she had the insulinoma prior to her weight loss surgery, but it seems likely, as an OGTT prior to her operation revealed hypoglycemia. Resection of an insulin-secreting tumor can be curative. In this case, after surgical removal of the insulinoma she became symptom-free and remained so going on two years.9

Figure 3

Patient wearing Medtronic CGMS

Dietary Treatment
Diet should always be addressed first. Often patients will be able to recognize some of the foods that cause them difficulty on their own. Recommendations are to eat a high-fiber diet of three meals plus 1 to 3 snacks daily, to avoid simple sugars (such as juice, soda, and candy), and to include protein with most of the meals. Protein and fat slow down carbohydrate digestion and allow blood sugar to remain more stable. Soluble fibers, such as pectin, guar, and hemicellulose, act by forming a gel in the intestine, delaying gastric emptying and prolonging transit time. Dietary recommendations to prevent reactive hypoglycemia are summarized in Table 1. Hypoglycemic attacks are treated with pretzels, whole grain cereal, or plain graham crackers. It may take 3 to 6 weeks for the diet to take effect, but often dietary changes alone can decrease the incidence and severity of symptoms.

Medical Treatment
A handful of medications have been utilized to treat this condition. Unfortunately there is a scarcity of information available on use of medications for hypoglycemic patients who have undergone weight loss surgery. Medications called a-glucosidase inhibitors, such as acarbose and miglitol, work by decreasing the absorption of carbohydrates from the intestine by inhibiting the a-glucosidase enzyme. This results in a slower and smaller rise in blood sugar. A 78-year-old man experienced unexplained loss of consciousness (LOC) associated with meals seven years after partial gastrectomy due to gastric cancer. After OGTT, his LOC was blamed on late dumping syndrome and he was successfully treated with acarbose. A second study describes six post-gastrectomy patients treated with a-glucosidase inhibitors. The medication improved hypoglycemic symptoms in all patients, but side effects of flatulence and meteorism were problematic for one patient whose dose needed to be lowered.10,11

Diazoxide, somatostatin, and prednisolone are other medications that have been used to treat late dumping. Steroid treatment was successful in one case report of a patient who was suffering from post-prandial hypoglycemia after undergoing total gastrectomy with Roux-en-Y reconstruction for gastric cancer. After being found unconscious, this 51-year-old woman was treated unsuccessfully with both acarbose and diazoxide before successful treatment with prednisolone. She was on the medication for three years until she was successfully weaned. She has remained asymptomatic and off of steroids going on six years.12

Surgical Treatment
There is a role for surgery in cases of nesidioblastosis and insulinoma.6,13 The latter is considered curative, while the former has been shown to be helpful in alleviating hypoglycemia. Selective arterial calcium injections are used to identify areas of hyperplasia. This allows for guided resection of affected areas. However, there is controversy over how much pancreas needs to be removed, due to reports of symptoms returning after subtotal pancreatectomy. It is possible that total pancreatectomy will be necessary in some cases. It should be noted that even reversal of gastric bypass may be an ineffective treatment for this disorder.6,13

Conclusion
The incidence of hyperinsulinemic hypoglycemia following weight loss surgery appears to be low, but since increasing numbers of weight loss operations are being performed around the world, we must be on the forefront when it comes to recognizing and treating the side effects of these life-saving operations. The exact etiology of this troublesome condition has yet to be agreed upon. More research needs to be done to clarify the causes and most effective treatment strategies for this problematic disorder.

Bariatric Times - ISSN: 1044-7946 - Volume 3 - Issue 9 - December 2006 - Pages: 1 - 12

Just, WTF.

Medtronic called me directly last night while I was out walking, so I called back this morning.   I thought to myself, "OMG, they're going to send me the meter and just get this DONE straight from the Medtronic factory, how neat."  I figured they had gotten all the information forwarded along from the insurance and were hooking me up.  Because, the last contact I had with anyone was a random person in New Hampshire via email that asked me for insurance information for coverage of the CGMS and THAT WAS WEEKS AGO?!

I am very confused.  As it seems they are also.

This process is just a little bit more than ridiculous, although I am not sure who is making it so complicated.

I do not know why they are calling me asking me for a letter from my doctor now, "Why do you need a glucose meter?"  I just went through an EXTERNAL APPEAL twice for this machinery.  I got an approval from my health insurer  for a "test run" of the go-go gadgetry and you want to ask me for a letter explainin' why now?

The woman on the phone says, "Well, who did you speak to previously about the meter here at Medtronic?"

"Um, no one, ever? This is the first contact I've had with your company on the phone."

Oh.  She says she'd call back in an hour, because she's covering for someone whom I do have in my email as the Medtronic Representative that I was supposed to be dealing with, and doesn't really know what's going on.

So she just called back.  Apparently, the insurance company did not approve me for ALL of the components of this continuous glucose meter.  They only had codes in/approved me for JUST the transmittal unit, not the other two parts.  (How much sense this makes?)  They gave her a hard time and tried telling her that I "can't have" all of the system.

Now, she's back trying to get the approval codes for the sensors and other bits.  We shall see how long this really takes.

I love hypoglycemia.

"But, wait, you're not even diabetic, Mrs. MM?"

Should I?

There are four roux en y bellies in our immediate family.

Myself, my husband, his mom and eldest sister.  The two girls have been really good about sugar, not so much carbohydrates, but they do not eat sugar, in fact, my mother in law is TERRIFIED of sugar.  She is so afraid to ingest sugar, that she thinks it will make her have such "heart palpitations and anxiety attacks," that she's really really good about not touching the stuff.

She listens to everything the doctors tell her and suggest, and now they have asked her to join a study. 

She's been asked to join the study I was in last fall, the one where I got to get really sick and shit myself on purpose.  What?  Well, I dumped, then got intestinally sick, then, hypoglycemic, then, I had a seizure.  (But, at that time, I did not know it was a seizure, this was two months before the grand mal seizures started.)

Now, to tell you the truth, I only joined the study because I thought I was doing it to get a diagnosis of my freakish blood sugar variations, I didn't know it wouldn't help me in any direct way.

My reason for mentioning this - is that she has no idea what she is in for.  I explained it very clearly to my sister in law, who is also joining the study, and she is well aware of what might happen during this procedure, and she is aware that I am sensitive, but I am also a lot further post-op and have eaten sugar and carbs.  They haven't.

Wait, what?

My insurer called me today - to discuss the appeal.  They wanted to me to understand what this actually meant, and the costs it is going to incur.

Oh yeah.  I hadn't thought much about that.  I really hadn't.   

My co-pays, at 10% for everything I incur, the meter, plus each sensor which is replaced every three days at $300.00?  As she explained, I was only approved for up to six weeks of the system, so, then I would have to re-appeal, because BCBS only covers these meters for persons with diabetes or for 72 hour studies.   It wouldn't be a huge deal if I were to only use the system for a limited time, we could pay the $10.00 a day for a limited time.  But, it would get insane quickly, once the co-pays for the other medical bills starting rolling in.

She asked me about the meter, if I wasn't diabetic, why was I getting one - I explained that it was probably cheaper on Blue Cross Blue Shield than having my pancreas sliced out at this time.  She said she'd never heard of this condition, I explained that I was hoping I did not have it (nesidioblastosis) but if I DID, a continuous glucose monitor would help me feel safe.

She also stated that it seemed odd that I had gotten this far without further testing.  Well, I know.

Appeal Approval.

Medtronic Continuous Glucose Monitoring CAR. (And more!) Dude.

I could use this, car.

Of course, I'm busy appealing my insurance for the denial of a simple Continuous Glucose Monitor, but THIS?  This is a CAR!  A CAR I MIGHT ONE DAY BE ABLE TO DRIVE!  If my issues are ever linked to blood sugar changes (not currently related - just coincidental that I have seizures AND I am a  reactive hypoglycemic) this kind vehicle is so freaking cool.

Medtronic says:

Medtronic Diabetes unveiled its new M-POWERED concept car at this year's American Diabetes Association (ADA) annual meeting in San Francisco, June 6-10. The M-POWERED concept car would allow a person with a continuous glucose monitor (CGM) device to receive readings of their blood sugar through both audio and visual cues from the car's dashboard.

I assume this means that the car would actually announce to a person like me, maybe in a nice English accent, like the navigation systems in many cars to:

PULL OVER! YOUR BLOOD SUGAR JUST DROPPED FROM 100 to 35!

This would be necessary, because, when my glucose is that low, I can't comprehend much - but a audible sugar level would enough to make me take action.

Fun, fun, fun.  Till the hypoglycemic seizure patient crashed her truck and has to walk to the store.  But whatever.

But, wait, there's more -

The CGM car is a concept application of our overall connectivity strategy, and our quest to apply our existing technologies to new platforms," said Steve Sabicer, a spokesman for Medtronic. "Although we don't plan to commercialize the automotive application immediately, we are exploring ways to link our therapy to other products ... like cell phones, bedside monitors and hand-held devices in the next 18 to 24 months."

Source.  http://www.medgadget.com/archives/2008/06/mpowered_car_for_diabetics.html

Thursday. Hypoglycemia Hindsight.

Weight - 161 lbs.

1. 1 packet sugar-free cocoa mix in unsweetened soy milk cappuccino
2. Green salad, parm cheese + zero calorie dressing
3. Two bites of a limp protein bar for a review.
4. 1/4 cup part skim ricotta cheese, parm cheese + 2 canned tomatoes

Exercise

• Heading out now for a walk, if I can stop bitching at my facking internet, which has been useless all day long,

WHY?

VONAGE SUCKS. 

I had to disconnect it entirely to get an internet connection BACK today.  This means, our "house phone" is not in service right now.  Thank goodness for that cell phone, eh, Bob?  My phone WENT DEAD mid-conversation, and my mother thinks I had a seizure.  THIS IS NOT OKAY.  /end rant

Numbering intake will be infinitely easier.  Especially since right now I am double inputting, writing it here and then also mostly at The Daily Plate (if I remember) for caloric accountability.

It is just that I am not a three meal a day kind of girl.  Even three meals and two snacks?  You can't hold me to it.  I won't do it.

It is not possible.  My functioning stomach pouch holds about three ounces of solid food.

Eating three ounces of solid food three times a day and calling it "enough" is calling me starved.  I am willing to bet that my body is sort of telling me that right now, in it's very special way, and will continue to tell me that. 

Obviously, aside from the first year post operatively, I never ate that little, I started "graze"-eating which is frowned upon and guilt-inducing in our community BIG-TIME as soon as I was able to. 

This is not to say that I had my hand in a bag of CHEETOS.  Most of the time, I would graze on appropriate things, or just bites, licks and tastes of things.  (Which I still do.  I will never deny myself "one bite," but I do have a "three bite rule" if I want something that bad.) 

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Cheeses, olives, meats, vegetables, generally my grazing? Is (when I have no calorie concern) a walking antipasto.  (Am I living in the wrong country?)

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It could have been Cheetos, it wouldn't have taken much.  It could have been just a stack of saltine crackers.  Or, too many of anything over the course of a day.  Too much of anything is not good.  Especially in the second year post-op, I found myself digging through cabinets, SEARCHING for simple sugars.  Because I didn't typically ever purchase that kind of food, I was always left picking through whatever we had - grazing on food that I might not even care to eat typically - because My Blood Sugar Was Fucked Up All The Time! 

I would eat through a stack of crackers over the course of a day - just because it maintained me.  Or, dig through a bag of "marshmallow cereal," eating what part you ask?  Can you imagine what would happen if I did this today?  (Just as a visual, I didn't.  This is from the day I had indulged in a piece of sugar-candy.)

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I was probably cycling so fast on low blood sugars from morning to night, that I had no idea.  It probably wasn't until I found myself shaking in front of the cabinet, eating granulated white sugar out of the 5 lb. bag when I realized there might be something wrong.

Advocating. I feel things coming.

I just called Beth Israel Medical Center and The Joslin Clinic to release my medical records.  (I have to sign a release form, and mail it back first.) 

Why am I getting these now?  Two reasons. 

First off,  BCBS and the external appeals company want see every detail, and the appeals nurse asked me to get all of it sent in.  Fine.  She said my letter is "no use on it's own."  They want to see what the medical treatment has been so far for the hypoglycemia, and what other things have happened to me in addition to the hypoglycemia, in the same time frame.

IP Address	12.11.185.229
Country	United States
Region	Rhode Island
City	Providence
ISP	BCBS RI

They came to read.  Neat.

Secondly,  I want any and all physical copies of records to back me up if I am to find a doctor to listen to me and get the seizures diagnosed and ended. 

I have been to too many specialists:

1. Neuro-psychologist
2. Neuro-psychiatrist
3. Psycho-pharmacologist
4. Neurologists, several!
5. Endocrinologists, a couple!
6. And more...

I went to ALL of these doctors with the same complaints.  I have told them that my BRAIN doesn't work anymore.  I failed cognitive testing, people. 

But, what if - this is all just as simple as a mal-absorption problem in conjunction with my reactive hypoglycemia?  Duh. 

I have nearly lost my life for this?

I know I can read.

I sent my external appeal out for the continuous glucose monitor the other day. 

The insurer called here today, with some bull-crap about how I can't "Use the company I wrote the check out to, you have to use a different company," and "Could you please send us a different check?"

"Because nobody uses that MassPro for their External Appeals." 

I know I'm a fucking hypoglycemic, but I can read. 

The letter stated, PLEASE CHOOSE:  MASSPRO or MAXIMUS for your external appeal, and send us your money.  It went on to say, if we fail to find in your favor, the money is returned.

My doctor suggested MassPro, which is why I sent the check stating MassPro.

Um, okay.  Like I know this?

low

I eat something as I go to bed every night - to ease the hole the Topamax is going to burn in my non-acid producing stomach, and, to reduce the hypoglycemia likelihood in the night.

It didn't work tonight.

I just had a good low.  I'm up here, shaking, gnawing on my glucose tablets.

One hour ago:  I had eaten about seven whole grain flax tortilla chips with two slices of American cheese, on purpose, with my pills, to go to bed.

When I realized I was low, my sugar was at 50 mg.  I think I would have gotten much lower without any symptoms other than complete stupidity.

(I sent out the check for the external appeal today.  I'll hear back in ten days about the external glucose monitor.)

If you give Beth some sugar? She's going to need an ambulance.

If you give Beth some sugar?  She's going to need an ambulance., originally uploaded by Melting Mama.

I got little warning of this low.

I felt no symptoms, other than a slight confusion, and I couldn't calibrate my new container of strips.

Had I been alone, I might have had a serious problem. Right before I tested my blood, I felt like I could pass out.

What was the trigger?

Previous to this low, I had been sitting in the car, waiting at a car dealership, waiting for the husband to quit haggling with a car salesman, for a couple HOURS.

I ate probably the equivalent of two servings of "Dots" chewy fruit candy while sitting in the car - and some vegetarian soy jerky. I was hungry, and there was nothing else in the car - I wasn't really thinking that it would cause a problem. Of course it could, sugar makes me react, obviously.  Had I not been sitting there, sort of trapped with two small, tired kids, I might not have eaten them, but I did, and it's passed, and I'm alive, but WOW.

Studies Test New Approaches to Islet Transplantation

Studies are underway for pancreatic islet transplantation.
Source:  http://www.nih.gov/news/health/may2008/niddk-01.htm

"The protocol greatly benefits some patients with severe type 1               diabetes, but two or more infusions of islets are usually needed,               and the islets tend to lose their insulin-producing function over               time.  Participating in an islet transplant study is appropriate               for people with severe hypoglycemia (dangerously low levels               of blood sugar) and for those with type 1 diabetes who have had               a kidney transplant to treat kidney failure, a complication of               diabetes."'

I've pasted the entire release below.

External Appeal For Continuous Glucose Monitor?

The doctor from The Joslin Clinic sent me a letter regarding Blue Cross Blue Shield's repeated denial for the  Medtronic Continuous Glucose Monitor.  She says that she spoke with the medical director at my insurance company, who feels that with an "external appeal," the unit would be covered, due to my "rare" condition.  It's a bizarre issue that needs to be looked at from an outside source. 

External appeal means, Beth pays for it.  I've got the paperwork coming to me, because I shredded it all previously, I had not wanted to go that far - I assumed it would get expensive.

Also, I have had a few people e-mail to say that after self-paying for the device, they have had sub-optimal, if any success with it - and ended up quitting it within months.  In the history of Beth, I can see where it would end up. 

Sure, I want peace of mind to get some freedom back - and to drive - but - what if it did not work? 

PS.  The chief complaints from other people where that it did not catch proper lows - and alarmed at all hours - keeping them awake.

This denial stuff is giving me a complex.

My 2nd level appeal was denied for the Medtronic Mini-Med continuous glucose monitor.  They stated again today, like the first two letters, that it basically, "won't help fix the problem."

I totally have a product idea - a car - that comes with a continuous glucose monitoring system! 

Because, I have to buy both products at this point, and I need one to use the other, and I am going to have to finance BOTH.

You think Medtronic has zero-percent financing no payments till 2011 like the furniture store?

Gulp.

A friend of mine, another roux en y'er, just got back from her testing for her hypoglycemia issues, and it's confirmed:  She's got nesidioblastosis, and she's scheduled for a partial pancreactomy next week.

"Hyperinsulinism is a disorder in which the insulin cells of the pancreas (beta cells) secrete too much insulin and at the wrong time. Excess insulin causes low blood sugar. Ordinarily, beta cells secrete just enough insulin to keep the blood sugar normal. With HI, the secretion of insulin is not properly regulated, causing excess insulin secretion and low blood sugar.

Normal blood sugar is 70 - 100 mg/dL. Anything less than 60 mg/dL is low, although severe symptoms due to hypoglycemia are not likely unless the blood sugar is below 50 mg/dL. Prolonged or severe low blood sugar can cause seizures or permanent brain damage."

That's a partial explanation for babies that are BORN with this disorder - it's not something that adults generally ever have - unless they were born with it.  It's a genetic disorder, except in the cases of the adults that are popping up that happened to have roux-en-y gastric bypass, because this unique metabolism situation triggers hyperinsulinism in some of us. 

She and I have been commiserating via MySpace messages - because we have the same symptoms - she says the way I describe it is much more severe.  The diagnosis follows a calcium stimulation test - among other things - but I'm waiting to hear back from her about how it all went, and if the surgery is "voluntary," and what happens next. 

Update:  She says the docs have told her that it's not going to go away, it's only going to get worse, so she can choose to wait until it does, or deal with it now.

..and then of course, I'm wondering: 

Do I want to get tested - and if I do - and it turned out that, "Gee, you do have this, Beth," wouldn't it be funny because I self-diagnosed what, more than two years ago? 

The next step is the invasive testing, IF dietary changes and carb-blocker pills didn't work, or the hypoglycemia becomes worse.  I do not know if it will increase. 

At this point, it's pretty severe, and I eat around it, planning not to eat food that will make me drop unless I am "supervised."  If I eat a normal diet, like any other typical post-RNY'er, I'm crashing all day long. 

Normal isn't ever going to work.  But, life without parts of a pancreas, like 70% of one?  Is that normal?

Uh oh.

I can't find my flippety glucose meter.  I've been toting it along with me on my walks - which is a necessary evil - 'cept - I think I lost it - and this was a new one with a new prick, er.

Denial.

My appeal for the continuous glucose monitor was denied, not at all a surprise, considering that BCBS doesn't approve monitors for diabetics either, because: "there is a lack of clinical data demonstrating that the use of these devices is associated with an improvement in final health outcomes (ie., improved diabetic control, based on either decreasing hemoglobin A1C values and/or decreasing incidences of hypopglycemia.)"

Duh.  A battery operated machine cannot STOP the problem of post prandial hypoglycemia.  BUT, it could help warn me of an oncoming low and help keep me safe.  It could warn me that my glucose is probably too low, and that I should probably not drive, or put the child in the tub, or walk into oncoming traffic.  I can't tell when my sugar is low sometimes until it's close to comatose-low.

But, whatever, that's good times.

There IS no curing reactive hypoglycemia caused by gastric bypass - unless *light bulb* we remove most of my pancreas.  I would prefer to keep it at this point, seeing as I am not yet comatose.  When that day arrives, if it does, take my damn pancreas, slice it, and serve it au jus.  (And, who pays for partial pancreatomy?  Right.)

Upon reading the letter again, I missed the part wherein it reads that my case is being sent for a second level specialty appeal.

P.S.  $1339 for monitor, transmitter, charger, and 4 sensors, then $35 per sensor?  Nope.  Not with the way I break things, not without insurance coverage.

Sweet n Low.

Seeing potential for a blog title right there.

Twice today. 

Just now, laying in bed, watching a movie.  Shaking, sweating, "poop, sugar is low."  A few hours ago, in a store, "We need to leave, I have to test RIGHT NOW.  I have to eat RIGHT NOW."  Both times, 50ish mg.

Okay, still shaking, having just had to eat half of the fridge, goodnight.

Appeal-ing.

What follows is the quick letter I just sent off to BCBS in regards to their denial of a Continuous Glucose Monitor for hypoglycemia. 

Just for the record, the same insurer approved me for plastic surgery, a panniculectomy, after my first-letter of appeal a few months ago.   If you are a new reader, I never got to HAVE the plastic surgery, because I had a grand mal seizure in front of my plastic surgeon during a visit on January 10th.  I'm very good about timing.

Yes, I am fully aware you are not supposed to blog about your insurance on the internet, because adjusters can look this stuff up and deny you based on things you say, but it's all here.  Every. Detail. Is. Already. Here.

"To Whom It May Concern:

I am writing this letter to appeal the decision of BCBSRI which denied coverage for a Glucose Monitoring/Continuous Glucose Monitoring System.  The letter dated March 20, 2008 stated that "there is insufficient clinical evidence...to support a conclusion concerning the heath outcomes or benefits associated with this treatment," however, for some like myself who is UNAWARE of oncoming reactive hypoglycemic events, the benefits would vastly outweigh any costs involved.

On a daily basis, I am dealing with low blood sugar levels multiple times, during some of which I have enough symptoms to warn me to get out the typical finger-stick meter and test, but others, have had catastrophic consequences.

I do not have diabetes.  I have a condition, triggered by Roux en Y gastric bypass surgery, that causes me to have reactive hypoglycemic events after eating.  I drop into the 30's, 40's, 50's or 60's if I eat any mixed meal.  This means, I do not eat meals.  I am eating several snacks all day long, trying to stave of hypoglycemic events, because I cannot be trusted alone if I eat a meal and I am not supervised.  This is no way to live.

When I had the gastric bypass, I was not warned of this potentially life-threatening side effect.

In the last year, I have had at least three automobile "crashes," one of which was directly related to my blood sugar  (I tested at 38 mg,) the other two are unknown because I was not able to test my blood glucose at the time.  Had I a continuous glucose monitor - those instances may have been entirely avoided.

In the last three months, I have had two grand mal seizures, and while we still haven't linked these seizures to blood glucose, I am sure that my seizure threshold is LOWERED SIGNIFICANTLY by my constantly dropping blood sugar levels.

In the last week, my glucose has dropped into the 30's and I have had three complex partial seizures, I do not know if they are related, but they are becoming more frequent.

I am not so sure that before long  I'll be coherent enough to test my blood glucose at all when it starts to drop.  How safe am I then?

Please reconsider your initial denial for a Continuous Glucose Monitoring System, perhaps using one will save me from heading towards potential pancreatic surgery."

I didn't forget, but my brain did.

I didn't forget about the contest.  Winner posted in a bit.

Mr. MM had the day off - so we usually treat these days like the weekend - getting errands done and whatnot.  Also, I got the special added bonus of The Sick.  I have some sort of bug and I am not a happy camper right about now.

The car didn't get fixed, because the rental car situation wasn't prepared for, and the other party has fourteen days to deal with the insurance company before they'll just go ahead and cut us a check for a rental car.  Bob called the guy to ask him, politely, to talk to the insurance company - and he again suggested "bringing the car up to some garage on a Saturday and getting it done in a coupla hours."  Uh, no.  Why can't things be simple?  Ever?

Unrelated -

I've had a couple of weird-o swooshies lately - I can't tell you if they're seizure activity or blood sugar related