Friday, August 23, 2013

Lab results from islet cell transplant at five years

Here are the lab results at 5 years post transplant.

Chemistry tests.  
Cholesterol is 181.   HDL is 84.   LDL is 87.
These are all good and an improvement from last year.

AST is 23.   Normal is 10-42  
All my hepatic function tests were normal
Total protein is 7.1 and Albumin is 4.2    both normal

My potassium is back to normal now and I no longer have to take kaexolate to lower it.  I am still following a low potassium diet, but not as stringently.

Kidney function tests.
Microalbumin is 0.7    Normal is less than 1.9

Creatinine is 1.6  Normal is 0.5-1.3  At 4 years, it was 1.7.  So after all that I've been through this year, I'm back to where I was before it began.

Glomerular Filtration Rate is 34    Normal is greater than 60.  At 4 years, this was 31, so again slightly better
This puts me into the bottom of Stage 3 Kidney disease.  Its based on the creatinine level which is elevated.
My Blood pressure was 110/70.

WBC is 4.2 and absolute neutrophils is 2.6

Hemoglobin is 12.8   normal is 12-16
Its good to see this number back to normal after my experience with anemia

Islet function tests
A1c is 7.1  This is higher than its been this year.  Its most likely due to all of the infections that I've been fighting this year.  (5 UTIs, recent one on my hand, and the kidney viral infection).  

Before Breakfast:   BG is 153.   C-peptide is 0.2
After Boost:            BG is 313  C-peptide is 0.4
Compared to last year, the post prandial is much lower.  This is disappointing and worrisome.  My blood sugars are running much higher and my insulin requirements have increased.  This could be the reason.
I now take about 14-15 units of novolog/day.

My tacrolimus level was 2.2   normal is 5-10

Because of the viral infection, I have to remain at this very low dose.  Dr. Bellin says that increasing my immunosuppression would most likely allow the virus to gain strength and we can't allow that to happen.  It is certainly a worry especially while my blood sugars are increasing.  There is nothing I can do except to try to manage them as well as I can.  I'm trying to look at it as positively as I can.  Instead of worrying that I'm rejecting now, I'm saying why am I rejecting now after all this time at the lower dose?  

Needless to say, I hold my breath at each BG reading.
At 4 years, I was taking 10 units of lantus and 1 unit novolog/meal.  So that's really not that far from where I am now.  

My BK viral titers have been fluctuating, but trending downward.  The latest test showed undetectable in the serum and 2.6 in the urine.

Friday, August 2, 2013

Islet Cell Transplant at 5 years

Its a cold rainy day in early August and a good day to sit down and ponder this last year.

This last year has been all too eventful.  I've seen the down and dirty side of immunosuppression and its side effects.  I'm a long way from mouth sores now!  I've had anemia that led to getting a transfusion of 3 units of blood.  Diarrhea that led to a colonoscopy.  And a viral infection in my kidney that led to an inpatient antiviral infusion and then more as an outpatient.  Immunoglobulin therapy. Two kidney biopsies.  And finally, the drastic lowering of my immunosuppressant doses and hoping for no rejection of the islets.  I've now had 5 urinary track infections and just recently an infection on my hand that led to the ER, three different antibiotics and some more time off work.  I started back on the pump and have watched my blood sugars go crazy through out all of this.  And rightly so.  I also am trying symlin to help keep my morning post-prandials lower.

I now have a endocrinologist, nephrologist, infectious disease dr, and of course my transplant and general doctors.  I'll be adding a urologist next week because of the UTIs.  I did have a hematologist, but have been released from her.  So, I've had a few doctor appointments this year as well as a few urgent care visits and two stays in the hospital.

While I'm at it, I've also had some shoulder muscle strains that had me almost immobilized for awhile and a strange pain in my foot that really bothered me and sometimes still does. I've had to adopt a low potassium diet which I hate and which runs counter to a low carb diet.  These things along with the UTIs really bothered me more than the other things because it just seemed so unfair to have them while I was already dealing with so much. I don't really mind the things that are directly involved with or caused by the transplant.  None of that will ever offset the positives that I have gained from the transplant.  And I do think that some of the things that have caused me pain and harm are adding to the wealth of information on the whole process.

Its still amazing that I haven't totally rejected my islets throughout all of this.  I have all but given up hope several times.  And they keep coming back.  Even now my BGs are running high and I'm wondering...

I'm very pleased and proud to have made it this far.  My islets are tough, but I think I have learned a lot about keeping myself strong and healthy in the face of adversity throughout this year.  It hasn't been my easiest year, but I honestly have no regrets.  I'm very luck to have the good insurance coverage that I do.  I don't think I would feel this positive if I had to carry the financial part of this experience.  I'll give them a shout out after the statute of limitations runs out.  I'm thinking I might be flying under the radar now:)  And of course, Gary has been so strong and supportive throughout each turn of events.  I couldn't have done this without him.

July 21, 2013
So, happy 5th anniversary to me and my new islets.  As crazy as this year has been, and reading back over what I have just written has caused me to gasp a little, I still say this is easier than a year with Type 1 diabetes.  I never once lost my ability to concentrate at an awkward moment, or had to stop playing a game or enjoying a conversation or stop what I was doing at work.  And more importantly, I have hope for the future that I didn't before my transplant.  Hope can make the little things seem tiny.

I'll be posting my 5 year lab results soon.  Hopefully, on a warm sunny day.