Sane, and diabetic – or not but also not.

I have Bipolar (Type II) disorder, and while I am low enough on the spectrum that as long as I am aware and careful I can be a mostly functional human without meds, I still have bad episodes that are much more in check when I am on the correct medication.

“Correct Medication” being the key, and the hard part. When I was first diagnosed, back when it was hard to be a functional human because I had no idea what ‘normal’ felt like, we played “Wheel of Medicine, turn turn turn, tell us the side effect we should learn!” Depakote was the first and worst, turning me into a lazy zombie who only had awake and crying or asleep as my two modes. Over time we tried a variety of things, with varying success, and eventually found Wellbutrin, for all it’s problems, was the most reasonable. On the downside I lost medical coverage, but Wellbutrin had an advantage of being able to help pull a depressive episode short with only one or two pills, so I carefully rationed my supply and watched myself closely for quite a while.

When I went back into psychiatric care we decided to try the wheel again, and gave it a good spin. After some misses, and some major scaling back on the dose, we landed on Abilify. Normally an anti-psychotic it can be used, at a micro dose level, for bipolar. I’m taking the smallest micro dose possible (I even have to split my own pills) and it works very well. I still occasionally stray from center norms, but not so far that I can’t control it with talk and behavior adjustments. It allows me to be aware of my condition, which I can fail at when unmedicated. Trial and error even found a sleep med that, while not quite allowing me to sleep like a normal person which will likely never happen for me, seems to work to give me closer to average rest that I need when my brain won’t otherwise let me.

So let’s sail along for a while on that, just until I’m good and comfortable with how sane I am, in comparison to my unmedicated self, at least. Make sure I feel reliable enough, then let’s pull the rug out from under me!

What rug? The one with my blood sugar, apparently – which is more of a flying carpet given how high it is. Congratulations, I went from pre-diabetic to diabetic and had the doctors all very worried given how crazy high my A1C (measure of average blood sugar over the last three months) was. Granted, the doctor I had when I got this diagnosis is pretty terrible in his own right, something that deserves an entry of it’s own, but his declaration is that we should try to manage it, in one month, on diet alone – with no actual guidance on diet other than “plants are good.”

Needless to say, I did not succeed in erasing three months of blood sugar record in one month with no help and a doctor actively discouraging me from using my blood meter after meals, but I made a dramatic change. And in another month, sure enough I was under the diabetic level! But it was taking a very strict measure of diet, and was discovered right as I switched doctors away from the problematic one.

Why problematic? Because certain key things weren’t mentioned when I was given the diagnosis, including the fact that Abilify will raise your blood sugar. I found this out during my next appointment with my shrink, who assumed my doctor had told me and passed it off casually as an “Of course you know…” kind of comment.

I DID NOT KNOW!

In fact, one morning after I forgot to take my night time dose of Abilify, I discovered my blood sugar lower than it had ever been to date (not actually low, but lower than I had seen). Just from missing one dose. It is likely that the reason I am diabetic now, and not later in life, is my psych meds. The ones I love, because they work with minimal side effects and minimal interference in my life. The ones that let me be so stable I only have to see my shrink (now) once a year, just to check in.

But without them, I am probably not diabetic. I am not on this strict diet. I am free from blood tests all the time.

So every now and then I have to ask myself again about the trade offs.  Sane and diabetic? Or not, but also not?

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