Thursday, December 30, 2010

WTF?

A lot of pregnant women with diabetes discover lots low blood sugars in the first trimester.  Then the numbers start to rise until their insulin demands skyrocket later on.  It's a common pattern.

So far?  My body's like, "screw common patterns!"

Like last night, I was craving seafood fried rice something awful.  I often make my own brown fried rice with fresh veggies, and a very small amount of oil at home...  But that's so not what I was craving!  I wanted oily, over-seasoned, totally unhealthy fried rice with a mix of oily seafood including unidentifiable bits that are probably squid or octopus, but maybe not.  You know the stuff, if you've done a lot of oriental food joints!  So we slipped down the road to Thai House and I ordered up that giant plate of Seafood Fried Rice.

But that's a lot of carbs and fat, so I was very deliberate about this.  I looked up the average carbs for shrimp fried rice before it arrived, evaluated the food when it got there and determined it probably didn't have as much seafood in it as the average shrimp fried rice and bumped the carbs almost all the way up to what a cup of what nothing but rice would be, delivered an 85/15 combo bolus (going closer to the 50/50 I was taught usually makes me go high), carefully spooned a two-cup portion onto my plate (in two piles, until each looked like the size and shape of my over-turned 1 cup measure), and dug in.

I suspected, if anything, that I'd go low.  I'd definitely erred on the high side of the carb count because I did not want to go high.  I feel, right now, that having to drink a box of juice to head off a low is worth avoiding highs.

But by the time we got home, probably only an hour later, I'd spiked to over 200 and dexcom was showing me a straight upward pointing arrow!

I had a lot of insulin in my system and had only eaten a short time before, but I just couldn't stare at that and do nothing!  I took another very small bolus and didn't allow myself to slug out on the couch.  I didn't feel I could exercise (I felt pretty crumby), but I tried to keep moving around and working on this little gift project for some friends.

And within like another hour, my blood sugar was perfect.

What?

Yeah.  This one may have been extreme, but these spikes and drops are my common pattern right now, and they are killing me.  It tends to happen even when I do everything right by choosing foods that have a good balance of healthy carbs, protein, and healthy fat (unlike the seafood fried rice!) and waiting 20 minutes between bolusing and eating.

FRUSTRATING.

It seems like I'm slowly eliminating foods that are mysteriously worse than others (goodbye fried rice), and relying a lot on foods that have the least spike (hello salad with protein and fat, but no cheese, because for some reason shredded cheese is totally gross to me right now).  I'll get this figured out... and then it'll probably all change!

Monday, December 27, 2010

Endo Appointment Number One, Down

I met with my endo and thought it was fairly productive.  I just hope this whole every-two-weeks schedule continues to be useful through the pregnancy!

The main issue was a few unexpected highs I've had, for which she also did not see a pattern.  One was an infusion set preblem, the others were all after foods with carbs I thought I knew.  I'll be keeping a food journal and testing some of my basal rates.  In the meantime, she's having me adjust my nighttime basal rates to nudge my fasting blood glucose under 100.

I'll be counting every carb and watching my numbers like a hawk.  I'm hoping things are going to get better on their own, because I've actually had weird weeks before where my glucose just makes absolutely no sense and then goes back to normal.  I guess being pregnant doesn't exclude me from the "WTF?" qualities of this disease.

Saturday, December 25, 2010

Merry... Merriness! (And not so merry highs.)

Merry Christmas, or whatever holiday you choose to celebrate!

Our Christmas day has been quiet and lazy.  We spent Thursday night with Chad's family, and last night with my parents.  The baby received it's first gifts from Chad's mother (diapers, wet wipes, and a box of gender-neutral linens).  The two big gifts Chad and I received were Rock Band (from my parents), and vent-free gas logs for our fireplace (from Chad's parents).  Two awesome practical gifts I received were a Waterpik from Chad (because even my dental hygienist said it's tough to floss my teeth!) and a food scale from Mom.  There've been many times where I had to do some tricky stuff to figure up serving sizes while counting carbs, and this will really help me measure the stuff that's listed in grams.

I also had a Christmas Eve gift I did not want: A bad infusion site and a blood sugar of over 280.

do not want
see more Lolcats and funny pictures

Normally, something like that frustrates me.  While pregnant, it makes me question every single little action I've taken all day, blaming myself for the high blood sugar that could do harm to the baby.  Even though I logically know that no pregnant woman with T1 diabetes is safe from mistakes or accidents, it sure makes me feel like a failure.  And though I've read that an occasional, brief high blood sugar won't hurt the baby, I can't help but feel that it's really horrible at such an early stage.  After all, women with diabetes have an increased risk of miscarriage.  Even though she'll probably be understanding and simply talk to me about future prevention, I'm embarrassed for my endocrinologist to see that BG number on Monday.

But on the flip side, my numbers are normally fabulous and I've done a good job of avoiding the things that really give me trouble.  On the whole I'm doing a great job, but a high like that makes me wonder when I qualify as not doing a great job.  One high?  Two? Ten? Once a month, once a week, once a day?  I know there's no set answer, but I fear crossing this imaginary "line."

So far, no crazy symptoms, diabetes related or not.  My blood sugar hasn't started going low like it apparently does for most, and I haven't started having the typical morning sickness.  My mom told me last night that she never had much morning sickness, so I'm hoping I take after her in that respect!

No mystery food cravings or aversions, though I'm definitely more hungry than usual.  I'm trying to avoid the whole "eating for two" thing while still letting myself have a little bit extra.  Everyone has to gain weight while pregnant, but the fact is that I'm already overweight and need to keep my weight gain to whatever range my OB will recommend.

I do know that I need to start getting more active again, too.  My walks have become less frequent as the days have gotten colder, so maybe it's time to keep sneakers at the office and go walk the treadmill during lunch.

Sunday, December 19, 2010

Will there ever be a cure?

Will there ever be a cure?


It's a hot topic on D forums and blogs.  I think I most often see people say something like, "Probably, but not in my lifetime."

I'm not a naive and wishful thinker, but I'm not as jaded as a lot of veteran PWDs yet.  I haven't heard the repeated "just 5 more years" from multiple doctors.  In fact, I haven't heard that even once from a doctor (and I'm glad, because I don't think there's any way they can promise something like that right now).

My point is, I think it'll happen.  I don't actually know when, but I wouldn't be shocked at all if it happens in my lifetime.  (Not shocked, but ecstatic!)  If an actual cure doesn't happen, I am confident that diabetes care will be improved so significantly that it will almost be as good as a cure.  Maybe we won't get our beta cells back, but maybe we'll only have to give ourselves one or two injections a day to achieve healthy, steady blood sugar levels.  (I'm looking at you, SmartCells Inc.)  Or maybe someone will figure out how we can be given new beta cells that our immune systems won't attack on sight. (Russia, bravo for fearlessly exploring that frontier!  And you scientists at Washington School of Medicine, keep it up!!!)  Or maybe after the artificial pancreas becomes a reality that can be continually improved upon, someone will also develop an even faster acting insulin to pair with it, and that artificial pancreas will be developed to the point where it can function real-time based entirely on the rise and fall of blood glucose (with no need to enter carb values or temporary basal rates).

I just see so many promising ideas.  Any of these could be the development to change the lives of PWDs forever.  Maybe no one is going to hand me a pill that will cure my diabetes next year, but I do think I'll be given some life-changing treatment options in my lifetime.

Balancing Indulgences and Blood Sugar

One aspect of pregnancy that I'm finding a little bit challenging to balance so far is the food.  I try and eat mostly healthy food that treats my blood glucose well, but I also think there's no problem with a little indulgence (pregnant or not, diabetic or not).  If I were pregnant and not diabetic, I'd just treat myself while making sure I don't overdo the "eating for two" thing.  But when that giant cookie is staring me down in the store, even if I've been very good all day, I have to take pause and wonder, what will it do to my blood sugar?  Is it OK if I'm a little out of range a little of the time, or am I a bad mother if I don't make every possible effort to stay in range, such as passing on every cookie I see?  And if I can tell I'm just going to "have to" eat a baked goodie that day and I know it's better to have that cookie (which also happens to be organic and vegan) than get back to the office and end up eating a damn donut or two or three or ten, can I time my insulin just right to avoid the spike?

In that particular instance, I got the cookie, bolused for half of it and gave the insulin a few minutes to get in my system... then got weak and ate all the cookie and bolused for the rest with what turned out to be miraculously perfect blood sugar results later!  (That could certainly be a fluke, but I'm thinking of stocking up on a few of those for the next time I have an uncontrollable urge to eat a giant cookie!)

On the other hand, I gave into a craving for popcorn shrimp last night and, because a combo bolus hadn't worked for them at all once before, I did a regular bolus.  This sent me a little low, then higher than I felt at all comfortable with during pregnancy.  Cue rage bolus, which happened to slowly bring me back down into range and hold me there.


Balance is so important.  I need to keep my blood glucose down, but that doesn't mean never indulging.  It means, rather, that I have to find the indulgences that don't destroy my efforts.  Big fraking vegan cookie containing more carbs than I typically consume in an entire meal?  Win.  Reasonably sized plate of popcorn shrimp?  Lose.  Duly noted.

On an only vaguely related note, I'm having to correct a couple bad habits like not bolusing before I disconnect from my pump in the morning.  My evening basal rates are so low that disconnecting doesn't seem to make an ounce of difference, but my morning basal rates are almost 4 times higher.  If I take my shower in the morning, my BG goes up.  It always has.  My endo recommended I bolus before a morning shower, but even then I only gave myself a tiny bolus and corrected the difference later for fear of going low in the shower.  But now that my range is so much tighter, I can't afford to slack on the bolus.  It's either that or shower while connected, which I've never liked at all.  Bolus it is.

Saturday, December 18, 2010

Life's Never How You Picture It.

I haven't been to either of my doctors yet, but I've made appointments with both (already well over a dozen with my endo!) and spoken to my endo's nurse.  My blood glucose goals are now below 100 before meals, and below 120 two hours after meals.

I'm actually very close to those goals even when I don't quite meet them (and I've just made a change to my insulin pump's "target" that should finally nudge the less than perfect numbers under), and I've managed to get my spiking blood sugar to chill the hell out.  Primarily, I'm figuring out that I need to have a little more protein and healthy fat with my breakfast (when things are most likely to spike), and the same true to a lesser degree with lunch.  Dinner is never a problem.  If I eat pretty well, my evening numbers are always fabulous.

I can totally do this.

For the most part, I feel pretty good about things.  I had one night where I felt very sorry for myself...  I was realizing that this pregnancy isn't going to be "what I always wanted."  Not that I've ever been the "daydream about pregnancy and babies" type, but I always had a basic picture of how things would be:

I'd enjoy my pregnancy, dealing with whatever minor inconveniences (like morning sickness) come my way and feeling a little like an earth goddess as I bask in the miracle of creating life and letting my body do what it was designed to do.  Then when delivery came around, I'd labor at home for as long as I could, go to my hospital, and labor naturally until my doctor said, "It's now or never for the epidural."  (You see, though I fully believe the female body knows how to do this stuff on it's own, I'm way too much of a wimp to accept the level of pain that comes with pushing!!!  :p )

That's not the picture I see before me now.  I'll probably have something like 20 or 30 doctor appointments between now and then, tests that aren't normally done on "healthy" mothers, there's probably no way any OB will let me carry to full term and labor when my body decides to do it naturally, and there's likely to be much more monitoring and a higher chance of a C-section.  It's like my body is a liability instead of a miraculous tool for creating life.

Sounds crappy, doesn't it?  But it's the most bleak view (short of imagining all the things that could go wrong will go wrong).  I totally let it get to me the other night and I cried all over Chad.  (He's so sweet.)

But now, I'm realizing that everything's been pretty normal so far, so and I don't have a reason to believe that everything will be horrible the second I set foot in a doctor's office.  Yes, things are likely to be more medicalized than I want.  I accept, grudgingly.  But I can't focus on that; I have to keep it all a part of what supports me and a healthy baby.  Just like diabetes management isn't the focus of my life, but part of what supports it.

I'm also looking into having a doula, a trained professional who is there to support mom, dad, and baby through pregnancy and delivery (and sometimes for a while postpartum).  I think it would both help me focus on the wonderful things that are happening, and stay more informed and in charge during delivery.

As everyone says, the thing that counts most is having a healthy baby in the end.  I agree with that, but I also believe that is most likely to happen if the pregnancy and delivery are no more medicalized than actually necessary.  (Thank god we have OBs and the interventions that are sometimes necessary, but the US has both incredibly medicalized births and some of the worst birth statistics of the industrialized countries.)

I'm saying all this like I'm afraid I'll be swept into an O.R. the second I arrive at the hospital, but the truth is that I'm going to do everything humanly possible to keep my blood sugar normal and my OB has never given me the impression that she's big on intervention for intervention's sake.  For all I know, she'll support me in my desire for normalcy to every extent she is able.  I meet with her nurse practitioner on the 5th of January, so I'll have a better idea then of what is in store.

Sunday, December 12, 2010

Bolusing for Two!

I'm not sure I've ever mentioned that, before I was diagnosed with diabetes, my husband and I had been trying for a baby for over a year.  Not like, counting cycle days and taking my temperature to catch the moment I ovulate then calling my husband home for emergency baby-making, but we weren't preventing... and, being a little older than most first-time parents, I was starting to wonder if it wasn't time to start "really really trying" when I discovered we had to stop until I had my blood sugar under control.  Not an easy thing to be told.

And then, about a month and a half ago, my endo told me it was safe to start trying again.

Well, my body apparently agreed with her!

Friday, I was sitting at my desk at work with a pile of tissues and couple boxes of cold meds when I thought, "You know, I was supposed to start my period yesterday."  It's not so weird for my period to be late once in a while, but I realized that I was about to pop more cold meds when it was possible I could be pregnant...  So I decided I'd pick up a pregnancy test during lunch just to make sure everything was cool before I took my afternoon dose.

It was funny, sitting there eating my lunch in my car with a pregnancy test sitting on the seat next to me.  I hadn't picked it up because I thought I was pregnant, rather because I wanted to make sure I wasn't going to pickle a baby with cold meds, but it still gave me some of that giddy nervousness.  "I totally could be," I thought several times.  "It... feels like I could be."

But that still didn't mean I expected to see two lines begin to form almost instantly! I stood in the bathroom with my hands covering my mouth as the "result" window began to color even before the "control" window was touched.  "Holy crap, holy crap, holy crap!!!"

I made myself stop watching it until the two minute mark, then began my "holy crap" chant all over again.

I mean, HOLY CRAP, guys!!!

I held it in all afternoon, tempted to call my mom or post to a message board... but I couldn't until I told Chad, and I had to tell him in person!  So once I was home, he got an early Christmas gift and we were soon on the phone with our families.

Things I've observed so far:

  • I don't "feel pregnant," yet I do.  I think there was a tiny little part of me that already knew.
  • I'm excited... But others seem to be more excited for me! My theory is that this is because they aren't the ones who are going to swell up over the next 36 weeks then spend many painful hours squeezing out a baby that's going to change everything forever!  (It's all going to be worth it, but let's face it, there's also plenty to be scared of and it's only Chad and me who have to face the scary parts.)
  • Girls squeal.  :)
  • Though I don't get to enjoy the quirkiness of pregnancy yet (the belly, the cravings, the "glow"), I do get to "enjoy" all of the restrictions!  I have a cold and am on no cold meds (real Sudafed is supposed to be safe, but isn't recommended this early).  I'm developing a cold sore, but I'll just be picking up some lemon balm chapstick for that (it looks like Abreva and a couple oral meds are "category B," but I see enough discouragement online that I'd want to ask my OB first).
  • People like to joke about alcohol, tell you not to drink alcohol, or say it's so said you can't drink alcohol.  I just wish they'd stop talking about alcohol!  (Not because it makes me miss alcohol, but because it pisses me off that even those "jokes" are basically telling me what to do instead of assuming I'm an intelligent enough woman to make my own sound decision based on medical research.)
  • So far, I haven't run into any, "Are you going to die like in Steel Magnolias?!" or, "Your baby is going to be HUGE!" or, "Diabetic women shouldn't get pregnant!"  One friend asked if pregnancy might improve my diabetes, and my grandmother-in-law simply asked how it would affect things, and then asked if the baby would get it since I have it (a valid question, to which I said the baby couldn't catch it from me, but that there would be a small chance [1/100, in our case] of developing it later since it's genetic).  But from everything I've read, I probably will run into some of the more fearful comments.  I won't let it get to me, and I'll educate anyone who seems to be saying it out of concern but blow off anyone who seems to be saying it as a criticism.
So far, I'm most frustrated with blood sugar spikes.  I have to get those down, which means avoiding problem foods (why the hell did I eat that piece of delivery pizza?!?!?!) and giving myself plenty of time between the food bolus and eating.  I'll be making appointments with my doctors tomorrow, so I'm sure my endo will either have some more detailed advice or refer me to the CDE who specializes in pregnancy at her hospital.  I know the target numbers for pregnant women tend to be pretty low (I read in Balancing Pregnancy with Pre-Existing Diabetes that a common goal is no higher than 120 an hour after eating!!!), so I've gone ahead and reduced my overall target number a little bit...  It seems like a good start.

OMG guys, this is going to be wild!

(And, for the record, I really think I wasn't getting pregnant before because my body knew it wasn't healthy enough!)

Tuesday, December 7, 2010

Back on Track

It feels good to be back on track.
 And that highest peak wasn't actually as high as it looks, according to Ping.

My weekly average, according to Ping, is also back to 125 (it was creeping up into the 130s, which isn't so bad except that I'm trying reallllly heard to keep things closer to 120 while trying to conceive).

But I'm not going to get cocky about it.  Things are good, but they'll only stay that way if I keep a close eye on my BGs, count the carbs in those game night snacks, and watch for troublesome foods and habits.

Oh yeah, and watch the pizza.  Two plus slices of delivery pizza, with the crust dipped in garlic butter, is not beneficial to my BG numbers no matter what combination bolus I've tried!  But half an Amy's pizza, without additional fat like garlic butter, seems to be an acceptable indulgence.  (One slice of delivery pizza, with no garlic butter, also seems to be reasonably acceptable with a combo bolus... but it's sooooo hard to stick to one slice!!!)

Wednesday, December 1, 2010

Too Good to Last

Despite having a lot of insecurities, I also tend to be very proud of the things I do well.  Just recently, I got into a very comfortable, pleased-with-myself state of mind regarding my diabetes care.  I do this stuff really well.  Not only was I on top of things, but I significantly improved my morning numbers by myself, through two morning fasts and two basal adjustments.  I was coasting for a couple of weeks on numbers that never seemed to rise much above 140.  Things were... too good to last.  :(


Yep, that's a 286 staring back at me.  The past week, maybe two, have sucked.  That's the second 200+ number I've had, and possibly the highest number I've had since starting intensive insulin therapy (certainly the highest since they got my initial ratios close to what I needed).

What the hell?!  Things have been running generally higher, as they always tend to when hormones change at about the middle of my cycle, but worse than usual this time... and the past couple of days have gotten even worse... then a 286 for this morning for the exact same breakfast and bolus that went over perfectly yesterday morning?!  And I thought, hmm, maybe it's the infusion set or site, but no!  Everything appears fine, and my correction bolus is bringing my BG down at a rate that I would expect.  Bad insulin?  Well, it seems to work just fine on correction boluses, and I've had a couple mealtime boluses with perfect results... but I may try a new batch if things continue to look bad.

I may uncover some underlying reason, but until I figure it out, I'm just using a stronger basal dose and watching Dexcom like a hawk... and believing my fellow D bloggers more and more when they say things like, "Sometimes, this disease just makes no sense."

------

On a related note, while waiting for my BG of just over 200 to come down last night, I was talking to my husband about having read that a lot of PWDs tend to have some control issues, maybe even some OCD.  I totally get that now.  If I'd grown up putting so much importance in a number on a screen multiple times a day, feeling like that number is a pass or a fail, I'd probably have some sort of control issue, too.

Thursday, November 11, 2010

My First Scare with Diabetes

I had a really weird encounter with possible diabetes once before in my life.

It wasn't me.

It wasn't a relative.

It wasn't a friend.

It was... My cat.

  

Meet Ali (pronounced like "Ollie").  She's an adorable, spunky, defiant, hyper little princess of a cat.

She's also one of my favorite photography subjects, so excuse me while I indulge a little.


But back in September of 2007, we noticed over the course of a couple days that she was barely eating or drinking and had became less hyper... then less spunky... and she finally didn't even have the energy to be defiant, so we knew something was very wrong.  I got up early to take her to the vet and Chad pulled her out from under the bed and put her into the carrier with no more objection than one of the most miserable meows I'd ever heard from her.  It broke my heart.

The drive to the vet was horrible for me, and filled with tears.  Could it be cancer?  FIV?  Leukemia?  Should I have taken her in earlier?  Was it now too late for her?

She had no symptoms other than the lethargy and lack of appetite.  The vet ran bloodwork and said that her blood sugar was higher than usual.  A urine sample also showed slight ketones.

The diagnosis: diabetes.

She stayed at the vet overnight to make sure the insulin dose the vet chose was OK, and the next day they taught me how to give her insulin and sent us home with a vial, box of syringes, and special diabetic food... and one still lethargic and unhappy cat.  She was slightly better than before, but all I could get her to eat were a few bites of her favorite people-food (turkey cold cuts).  Over the next three days, she continued to get worse and worse even though I did everything the vet had told me.  I spent a lot of time on the Feline Diabetes Message Board, which was full of helpful and knowledgeable people who told me about glucose monitoring (not something vets push with diabetic pets), diet, etc.... and they started telling me that things with Ali just didn't add up.  She didn't have high BG numbers, she was getting worse despite the insulin, and she had never had the classic symptoms of diabetes.  Several of them told me to take her back to the vet, and I agreed once I realized she was definitely getting worse, not better.

I went back to the vet 4 days before her 1-week follow-up visit was supposed to happen, armed with a little log book of glucose readings.  A different doctor (at the same clinic) ran bloodwork again and, this time, what stood out was her astronomical white cell count.  She was absolutely septic, and the vet was amazed she could even lift her head.  She was put on IV antibiotics, taken off of insulin until there was evidence of real need for it, and kept for a couple days.

When we visited her, we could tell we were finally on the right track.  She was moving, struggling to get to us, and very vocal.  When we brought her home, she was almost her old self... only very, very thin and much weaker.







But that IV wrap came off only moments after we got her home, she chowed down on food, fought with renewed strength against being fed antibiotic pills, and slowly regained her normal weight and spunk...  And defiance!





On our follow-up appointment at the vet, I was once again armed with a little log of totally normal blood sugar numbers... and insisted they refund me for all of the diabetic supplies (which they did).  She was a happy, healthy kitty with a happy, healthy pancreas.  Her blood sugar was merely elevated from such a horrible infection (that's common).

And thank goodness, because testing her blood glucose was not an easy task!

Something rather sweet was, after she came home from her extended stay at the vet, she became incredibly affectionate.  She snuggled every chance she got, and she never wanted to be away from us.  We think it made her a sweeter lap cat, to this day.



But don't underestimate her... There's a reason we don't let her be DM in our Dungeons and Dragon's games!  She is, at heart, a fierce killer!!!!

Rocks fall, everybody dies!!!!

Sunday, November 7, 2010

Hind Sight...

I'm pretty sure that I actually had diabetes for a couple of years before diagnosis (which has also lead me to wonder if I have 1.5 or LADA rather than plain type 1).  There are a couple reasons I'm so sure of it, but I won't go into it right now.

So, knowing what I know now, I look back at so many things and shake my head.  Getting up in the middle of the night to pee, when I never had before?  *shakes head*  Having days when I absolutely couldn't quench my thirst?  *shakes head*  Eating tons of food and feeling physically full, yet still ravenous?  *shakes head*

One thing I've been thinking about lately, because I've been considering going on a Diet with a capital D, is when my husband talked me into doing South Beach with him.  As we did phase 1, which means no carbs other than most vegetables (and beans, I think?), I started out hating it... but then I got to the end of the week and felt so much better!  In fact, look at the following portion of an entry about South Beach from my now-defunct livejournal:

"I think this is a good experience for me, because I've never known what it's like to not eat grains. Seriously, I don't think I'd gone a whole day without some sort of grains since infancy, and I tend to eat a lot of them. Now, without them, I'm amazed to discover the beneficial changes in my hunger patterns. I've never in my life understood people who claim they "just forget to eat," because I'm normally thinking about food an hour after I finish a meal and my blood sugar drops not too long after that (even though we're pretty good about sticking to whole grains most of the time). Now? None of that."

And there are other entries in that general time period about how I'm ALWAYS STARVING.  I think my body was already unable, in 2008, to really regulate my blood sugar levels.  Doing South Beach gave my body a respite from allllll the carbs I was normally eating, and my blood sugar must have been lower than it had been in a long time...  So I felt better.  (This makes me think about the fact that, back before the days of extracted insulin, people with type 1 diabetes were put on a "starvation diet" that was very high in protein and pretty much zero-carb.  This allowed them maybe another year or two of life.)

And I never went to the doctor about it, even though I knew more about diabetes than the average person.  To be honest, I often had the thought, "Maybe I'm pre-diabetic."  But pre-diabetes?  You can fix that through diet and exercise.  Oh, little did I actually know!

Saturday, November 6, 2010

Awkward Moments with the 'Betes

Low blood sugar while shopping plus discovering you forgot to refill your glucose tabs means getting stared at by little old ladies while you rip into a package of juice boxes without even trying to get through the line and pay first (with the full intent to pay after, of course).

Lady, STFU.

-----------------------

Me: *tests blood sugar*
Coworker: That's not... for... diabetes?
Me: Yeah, it is.  I have type 1.
Coworker: Oh...
*insert awkward pause here*
Coworker: Well, thank goodness it's at least not type 2.
Me: *blink*
Coworker: Isn't that the bad one?

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Various people at various times with various sugary treats: "Here, would you like a... oh wait, you can't eat these, can you?"

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For no reason other than seeing me and knowing I'm diabetic: "How's your blood sugar?  Are you OK?  I have food if you need it.  Do you need to test?"

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Former coworker seeing going-away cake on my desk: "Now, you know you can't be eating these things anymore."

Yes, diabetes sure has its fun moments.  And while we're at it, why don't you check out this video on the Big Blue Test, in honor of World Diabetes Day, coming up on November 14th?  Every time it is viewed, money goes to help give insulin to children who need it.


Tuesday, October 26, 2010

Victory!

Less than six months after diagnosis, I had another appointment with my endocrinologist yesterday…  And it was full of awesome!

It addressed a lot of things that have been frustrating me since my diagnosis.  The most obvious issue is wanting to be healthy and have my blood glucose under good control, and I found out that my A1c has come down to 6.1!!!  That’s down from 13.4 when I was diagnosed!!!

*happy A1c dance*

Another huge issue for me is being in control of my own health... and I don’t necessarily mean “in control of my health despite diabetes.”  I mean something more along the lines of, “In control despite the fact that my life now contains a menagerie of medical professionals telling me what to do.”  I am so glad those medical professionals are there, and I know I could not have gotten so under control so quickly as I did if I hadn’t followed their instructions to the letter, but I couldn’t help but feel that they were in control of my health... and sometimes, I was waiting and waiting for confirmation on a change that I already knew I needed.  So I thought, once and for all, that I was going to ask my endo for official sanction to make adjustments to my treatment myself.  I went armed with a bookmarked copy of Pumping Insulin and lots of explanation as to why I could safely and effectively make my own decisions.  When she asked if I was still working with my CDE, this gave me the opportunity to explain that I was still working with her, but I wanted some more freedom to make my own changes.

“Oh yes, absolutely!”

Oh.  OK.  That was easy!

She gave me some guidelines for making decisions, told me I can fax her numbers anytime I need help, and said she was completely comfortable with me making these decisions.

*happy victory dance*

And another biggie…  Something I was sure I wouldn’t hear her say considering the numbers I was showing her included two highs over 200 and one bad low of 43 this past week…  She told me that it’s safe enough for me to go ahead and start trying for a baby whenever my husband and I decide to!!!  (She understood that last week was a weird one for me, and said, "With type 1, it's never going to be perfect.")

*happy baby dance*

I feel like I’ve reached important goals and blown hurdles right out of my path.  Life is good, and I believe I have the ability to shape my future the way I see fit instead of around my disease.

Saturday, October 23, 2010

Not the Only Villain

Sometimes I forget that I struggle with more than just diabetes. There's also chronic depression. And, honestly, I forget it largely because I'm so much happier than I was about six months ago. I have a job I like more, I have a career goal and am working toward it, I no longer feel crappy because of undiagnosed diabetes, and getting diagnosed with diabetes has honestly given me a lot of perspective and direction in life.

But chronic depression isn't a direct result of the state of your life, it's a direct result of your brain chemistry. (Though it's admittedly also affected by the state of your life).

So when I started feeling almost weak on my feet, unsteady, and almost unwilling to take the next step and then another, I kept repeatedly checking Dexcom and my meter to see what my blood sugar was doing. I really felt that it must me low or plummeting, but how could two separate meters and a CGM be wrong? I did eventually sink to the 70s at one point and, still feeling awful, I opted to go ahead and drink a juice box since I was slowly moving downward...

But that juice box and my rising blood sugar did not help the way I felt. Searching for my stupid devil horns in boxes we still haven't unpacked since the move was an effort in that my hand barely wanted to move items aside, and my knees wanted to let me sink to the ground. I should have known what was going on when I finally lay in the middle of the floor because I didn't even want to drag myself to the bedroom or couch to lie down... That's something I used to do all too often, when things were much worse in life.

And when friends arrived to pick Chad and me up for Ghouls Gone Wild, I found myself almost in tears over wanting to go enjoy the parade yet knowing that I would not enjoy it and quietly blaming myself for letting some sort of mysterious diabetes symptom keep me from having fun. Walking three or four blocks? How would I put one foot in front of another so many times if I barely had the energy to move from one room to another in my own home? Standing there for an hour watching floats and costumes, many of which are very cool and impressive, how could I focus on anything like that while trying not to freak out about the crowd and the noise? I'd have to stay home... but maybe I shouldn't stay home alone--because what if something was really wrong with me--but how could I ask my husband to also stay home because of my disease?

That irrational argument against asking Chad to help keep me safe is what caused my confusion to lift. This was not some mystery symptom of diabetes, this was a far more familiar companion: depression.

Oh yes, hi, I know you all too well. I had not thought to look for you, because you are not the greatest villain in my life anymore, but I recognize you. You are sneaky, conniving, and cunning. You caught me off guard, but I am much better equipped to deal with you now. You know what I've learned from my diabetes? Management, and the acceptance of What My Life Is. I'm always diabetic, but I keep my blood sugar under control without despair at the thought of having to do test after test, bolus after bolus... and the thought that diabetes will still throw me a curve ball every now and then. Likewise, I am always dysthymic but will keep my depression under control without despair at the thought of having to manage it for the rest of my life... and that you will still throw me a curve ball every now and then.

But neither will get the better of me ever again. Period.

This is one of the many positive ways that diabetes has impacted my life; it's made me better equipped to face long-lasting struggles and not feel like I'm struggling. It also caused me to go to counseling to help adjust to the changes in my life, which has taught me how to look at my thoughts from the outside and recognize that I am not my thoughts. (An odd concept, I know, but it made perfect sense as I recognized that totally irrational thought.)

So hi, depression. I acknowledge you. Now I'm going to manage you, and this time, I am going to get the better of you.

Sunday, October 3, 2010

Brownies = Better than Pigs.

Brief attempt to be healthy at the Target food court:

A turkey & provolone sandwich, please. What? The only sandwiches you have left have pork?

Ew....

I'll have that bigass brownie.

*bolus*

Tuesday, September 21, 2010

The Eye Exam

I finally got to an ophthalmologist today. It'd been a long time since my last eye exam anyway, but I also needed to get my eyes checked for retinopathy. Oh boy, and I thought eye exams were fun before! There's nothing more pleasant than having your pupils dilated as wide as possible and then having the world's brightest frakin' light shone directly into them!

And I learned another diabetes factoid: Diabetics' eyes dilate slower than those of non-diabetics. Huh!!! (It has to do with higher sugar in the irises, but he didn't explain any further.)

The second worst part of the exam wasn't even the eye drops. It was that he'd been saying "good" every time he looked in an eye... until he started looking at the retinas. At that point, he was silent... which I couldn't take as a good sign. (Honestly, I started getting a little scared at this point.) After shining that Brighter Than The Fraking Sun Light in every corner of my eyes, he grabbed his little standard light scope thing again and said, "I need to take another look at this one spot in your right eye." Um, GULP?! So I stayed quiet through some more shining, peering, and eye-watering until he stopped, flipped the lights back on, and said, "I see one little spot in your right eye from when your sugar was out of control that's going to heal up, but you essentially have no retinopathy." Then he started writing in my chart.

Ummmm, not a good enough explanation, Doc. "So, is this spot like the beginnings of retinopathy that's stopped now that my sugar is down?"

So he righted the situation by putting his pen down and actually explaining things. He described how retinopathy starts: Basically, your eye isn't getting enough oxygen and starts to grow new blood vessels in your retina to try and make up for that, but those vessels are fragile and tend to break or burst. That's when the real problems start, because blood in your eye and damage to your retina is bad. (mmmkayyy?)

(In fact, really bad retinopathy can even cause retinal detachment.)

"I can see a spot where there's damage from that lack of oxygen from when your blood sugar was out of control," he said. "It's like a tiny little scar, but it's going to get smaller and smaller. You don't need to worry, you just need to keep control of your blood sugar. And watch your blood pressure, too."

It immediately became my goal to get rid of that damned little spot. Next year, I want to hear him tell me my retinas look perfect.

And then I drove home wearing those cool, granny-sized, plastic "sunglass lenses" tucked behind my glasses. Yeah. SEXY.

Sunday, September 19, 2010

Diabetic Super Hero at the State Fair

I went to the State Fair on Thursday evening. And about the State Fair, let me say:

OMG Funnel cake and fried cheese!!!!!

Neither of which I ate this time around. I opted, instead, for fried shrimp on a stick. Not significantly healthier than fried cheese, but I could judge the carbs much more easily. I may not have been able to even resist the fried cheese though, except I made sure not to go hungry.

Me: Let me eat something before we go, so I don't eat a bunch of junk.
Chad: Will it bother you if I eat a bunch of junk?
Me: Nope. In fact, I may have a bite of your junk... Oh my god! I did not just say that!!!
Chad: Oh my god! I am so tweeting that, right now!

So, after about 5 minutes of uncontrolable laughter, I ate a whole-wheat Lean Pocket and we left for the fair.... which involved sitting in a very long line of cars, and then standing in a very long line of ticket-buyers.

But I had one of my proudest diabetic moments in that long ticket line. A girl, probably around 18, was walking up and down talking to people. As she got closer to us, I heard her say, "Do you have any candy? Anything? My friend's blood sugar is getting low."

At which point, as she turned away from someone with a look of clear concern, I made a B-line straight for her.

Me: Your friend's blood sugar is low?
Her: *With her face brightening.* Yeah!
Me: I have glucose tabs.
Her: Oh, great! Hey, *whatever her name was*, hey! She has glucose tabs!

We walked over to a group of teenage girls and the group parted as one stepped forward with both of her hands held out in a gesture of questioning, and with an expression of embarrassment on her face.

Me: Is it your blood sugar that's low?
Her: *nodding*
Me: *Pulling out my tube of glucose tabs.* Here, I have glucose.
Her: Oh my gosh, could I have one, please??? I mean, two... I mean, can I have...
Me: Of course, here.

I plunked a few tabs into her hand, received thanks from her and her friends, and I smiled as I walked back to Chad... who welcomed me back with a fist-bump.

I don't know if she was actually diabetic or just having a serious sugar crash, but I felt so awesome for being able to help. Like a diabetic superhero!

Wednesday, September 15, 2010

Don't Knock the Bad Habits

You know, bad habits get kind of a bad rap... But I've found that some bad habits have occasionally been what's needed just to keep me going. Like for a while, I almost totally stopped prepping my skin with alcohol before shots. But OMG, I was so completely sick of shots at that point! But that bad habit, which I knew plenty of other veteran diabetics did safely enough, made the shot process more tolerable during that difficult phase... and I got back on track before too long.

And then, there was when I got way sick of spending so much time doing test after test! I stopped properly washing my hands or cleaning my finger before hand and resorted to just licking it and wiping it off (maybe marginally better than just sticking your dirty finger). But at least that kept me testing, and now that habit is gone as better control and my Dexcom have helped reduce the "extra" tests and as I've learned better shortcuts (like dunking the finger in a glass of water instead of licking it, or rubbing soap and water between just one finger and my thumb if I want to take less time and mess than a full hand washing).

So while breaking them is advisable, don't always knock the bad habits, especially when you see them in others. Maybe it's an alternative to a much worse habit... like not injecting or testing at all!

Sunday, September 12, 2010

You've Got to Move It, Move It!

Over all, I'm not a big exerciser. I did, however, manage to get into a good exercising habit for a while before I was diagnosed... which stopped when I caught a cold that turned into a cough (which was typical for me, but I hope it won't be now that I'm healthier), and the rest I took for healing time broke my good habit. Then I found out I was diabetic, and was told not to exercise, then to only do light exercise on a regular basis instead of the twice-a-week-average that had been my good habit... and I was both out of the habit and scared of lows.

But now that I know I generally feel a low pretty quickly and have my trusty Dexcom, I don't think I have any more excuses when it comes to going low. And that every-other-day-light-exercise-only rule is probably the ideal plan, but you know, I'm not the ideal person.... Despite my GP declaring I'm the ideal patient. Getting my butt moving, even if it's only one or two times a week and whatever exercise appeals to me at the time, may just be the best I can do at this point. In the grand scheme of things, despite the fact that sporadic exercise habits can make for sporadic insulin needs, some exercise is better than no exercise.

I hereby give myself permission to be a less-than-ideal exerciser. And if I get into the groove and become a more regular exerciser, hey, all the better! But I need to start where I need to start.

Bonus: I've discovered an awesome little park near where I work, which will be perfect for brown-bag lunch and a short hike. I'm so glad I found this place, because I learned long ago that staying at work during lunch, even if I'm not working, does not give me the proper mental break I need to stay sane... and a nice, quiet walk through a shady wooded area is very good for my sanity... while also helping me get a little extra exercise.

Friday, September 10, 2010

Because I Like Having Pretty Feet

Maybe I'm just spoiled by being such a newbie with no complications at all, but I sometimes read the dos-and-don'ts of diabetic self-care and I'm like, WTF? I'm not made of glass!

Like this "Treat Your Feet Right" quiz on dlife. Sorry to spoil some of the answers for you, but never go barefoot on the beach?! (Are you really knocking sand for being "ground up rock?") Don't get pedicures?! Oh, and cut toenails about once a week?! (My toenails would be itty bitty nubs if I tried that!)

Yeah, OK, I get that you could step on something sharp in the sand. And I'm sure there are a few rogue pedicurists out there who turn the water too hot (check it first!) or are careless enough to cut you with their germy nail clippers, but I wouldn't think of a pedicure at a clean and reputable salon as dangerous.

What it comes down to, I think, is calculating your risks and deciding how much precaution to take. For example, having phenomenal circulation, all of the feeling in my feet, and pretty decent control of my blood sugars, I don't think a cut toe will put me at great risk of anything serious (as long as I care for it or get it taken care of, whichever is called for). So, on the rare occasion that I go to the beach, I'm going to walk barefoot in the sand. And I'm going to get a cute pedicure once in a while, because I can never keep up with all that dead skin myself. (But, at the recommendation of my CDE, I won't let them use one of those scary callus razors anymore.)

Now, if my condition changes in the future and I become more prone to infections or lose some feeling in my feet, that risk level becomes a little too high. I might wear sandals on my beach stroll and just dig my toes in the pre-checked sand at the foot of my towel... but I'll probably still get an occasional pedicure!

I think this is exactly the kind of stuff that makes a new diagnosis so hard to deal with. You're faced with a complicated treatment program, a complicated diet, and lots of complications living life (basic exercise shouldn't be potentially dangerous, damn it!). And then you're thrown alllllll this nit-picky stuff that could possibly be more of a risk for a new diabetic, and it starts looking like diabetes is taking over every single nook and cranny of your life.

Don't get me wrong, this information is important. I should be reminded that injuries to my feet are now more serious than before, and that barefoot walks on the beach and pedicures carry some risk of injury... but being told I simply shouldn't do those reasonably safe activities anymore flat out doesn't cut it for me. I'll do my best to manage this disease well, I'll take every precaution against wounds becoming infected, but dang it Diabetes-Care-Powers-that-Be, I'm pretty dang healthy and normal so, you leave my pedicures and tropical vacations alone!

My feet are freeeeeeee!!!!!

Thursday, September 9, 2010

How Much Disclosure?

I've started a new job... my first job change since diagnosis (aka, D-day). While I'm neither advertising or hiding my diabetes, I've had a couple struggles about how much to volunteer.

First of all, lunch time is more social. Today, a group went to a Chinese buffet. There are certainly some Chinese dishes that could be reasonably compatible with carb counting and a diabetic-friendly diet... but that doesn't really describe most food on a Chinese buffet. Plus, even if I found a couple acceptable items, OMG YUMMY CARBS ALL OVER THE BUFFET! Yeah, I love carby, fatty Chinese food. It would be very hard to resist the bad and hard-to-count stuff. So I did not join the lunch outing. I wasn't brokenhearted about it myself, but I do want to make a good, friendly impression with my coworkers.

Then one of the Big Bosses was handing out chocolate chip cookies from a bakery with no nutrition label. I could have looked up the "average" carbs for most chocolate chip cookies, but my blood sugar was already on the higher side... I didn't want to take the risk of miscounting and going even higher (or bolusing for both the high BG and the miscounted cookie, possibly making me go low). No thank you... but really, I appreciate it!

A few coworkers know I'm diabetic, and so does one of the Big Bosses, but I'm not in favor of labeling or limiting myself in their eyes. I don't care if everyone knows, but I don't always want to explain why I'm turning down a cookie today, but don't stop offering them to me because I really can eat them! Or that I'm not being snobby about your choice of lunch cuisine, I just find it very tough to eat Chinese food right now, but really, I can eat any kind of food! I'm just making a decision that is best for me today.

They're also putting together an emergency info list with everyone's important medical info and emergency contacts. This included any medical conditions that could be relevant. The "keeper" of this document is someone I'll work with pretty closely, so I went ahead and showed her that I keep a glucagon kit in my purse, in case I'm ever unconscious and someone around is comfortable enough to use it on me (and if not, then 911 is the answer)... but also followed that up with a disclaimer that, oh, I've never needed it, probably never will, because I don't want her thinking I'm going to keel over dead on them! I debated whether to tell her about the kit at all, but decided in the end that it's best for her to know in case there's a situation where 911 isn't an option.

Just feeling this stuff out... What's the balance? I want to be seen as independent and normal, but I also want to be safe and understood.

Nothing about this disease is easy.

Wednesday, September 8, 2010

A Meme!

I've never been one to pass up a meme, and this one's just for us people with diabetes (PWDs)!

What type of diabetes do you have:
Type 1

When were you diagnosed: May 3rd, 2010

What's your current blood sugar: Dexcom says 158 (about an hour and a half after my late-night dinner)

What kind of meter do you use: One Touch Ping. (And sometimes a Freestyle Freedom Lite, simply because I still have strips for it.)

How many times a day do you test your blood sugar: 8 on a steady day.

What's a "high" number for you: I'm unhappy with 160 +.

What's do you consider "low": 70 or under, obviously, but 80s and 90s could be "too low" for certain times of day (in relation to meals).

What's your favorite low blood sugar reaction treater: If I have my choice of any treatment, I go for a toddle-size box of 100% juice. I also keep starburst around for when I want something a little more junky, but not so tempting that I'll eat them when not low.

Describe your dream endo: I don't think I've known enough of them to say. Mine is pretty cool. I suppose my dream doctor in general would have more time to spend with me than doctors ever do.

What's your biggest diabetes achievement: So far, on this very short journey, I'd say simply coming to terms with my disease. I'm aware that there will be times when diabetes really gets in the way, but I'm feeling pretty happy despite all of this.

What's your biggest diabetes-related fear: Shortly after I was diagnosed, I would have said "dying in my sleep from low blood sugar." Now? Becoming a burden later in life because of complications... or dementia that me unable to manage my own disease.

Who's on your support team: My husband and my mom lead the team, and all of my close friends are key players.

Do you think there will be a cure in your lifetime: I don't think a cure is around the corner, but perhaps "in my lifetime" is a possibility. More likely, I think we'll have a really awesome treatment within the next ten years... something that takes significantly less maintenance than current options. Maybe an artificial pancreas that can really, truly act "real time" on its own.

What is a "cure" to you: Either transplanting a pancreas/islet cells without the need for anti-rejection drugs and stopping the immune system from killing off the new cells, or an artificial pancreas that is inside the body and somehow "makes" insulin (yeah right).

The most annoying thing people say to you about your diabetes is: I've only had one person tell me what I "can't eat" anymore, but I do have a lot of people ask, "Can you eat that now?" It's normally just out of curiosity, but I hate having to explain that I can eat anything I want... but that some choices aren't as good as others so I should limit them.

What is the most common misconception about diabetes: There are tons. None have really shown up as one I run across often, though.

If you could say one thing to your pancreas, what would it be: It's not your fault. It's not our fault. And all in all... things could be worse.

Monday, September 6, 2010

In Which I Say BACK To Dexcom, "???"

I've had my (non-trial) Dexcom since Thursday evening. The first sensor was crap, apparently. The trial one from the previous week had gone so well (after the first night, which was crazy), but this one seemed to give me numbers not even remotely related to the ones my meter showed me (Dexom 44, meter 126?! Dexcom 250, meter 160?! ), and it gave me ??? errors a couple times, plus a long and inexplicable out-of-range error... so after another insanely inaccurate reading followed immediately by ???, I finally ripped it off and started a new one Sunday afternoon.

I also wasn't especially pleased with the new sensor the first day and started wondering if it could be the transmitter or receiver... until that evening, when everything started going smoothly. And now, it's damn near perfect, staying well within the acceptable variations (20 points off on the low side, 20% off on the high side). Even over the first night (which gave me trouble on the trial sensor), it didn't throw me any usual numbers, and my fasting numbers matched pretty closely.

Ahhh, CGM bliss. I'm hoping Dexcom will replace that crazy sensor (I tried contacting them, but you know, it's Labor Day weekend). In any case, I'm once again so glad to have this tool. It's just too useful... when it works.

Friday, September 3, 2010

What to Eat?

Since diagnosis, I've struggled with what I should eat in my overall diet. I don't believe anything is 100% banished from my kitchen, but I have struggled with whether or not I should limit carbs in general.

I already eat far fewer carbs than before I was diagnosed, but that's largely because:
a) I was so freaking hungry all the time!
and
b) You can't mindlessly snack on carbs as a diabetic. You have to be deliberate enough to measure and bolus. So no box of crackers next to me, thanks. I'll count out my portion and put them on a napkin.

And I'd probably have gained way more weight if I'd kept eating the way I used to... now that my body can use and store carbs.

Which brings me to one reason why I think a lower carb diet is a good one to consider...

Fewer carbs helps maintain (or lose) weight. Aside from a potential reduction in calories, and the theory that our bodies' metabolisms work "properly" when we consume fewer carbs, fewer carbs also means less insulin. I am skeptical of this next point, but I've read over and over that "insulin causes weight gain." I'm not so sure about that... It seems more likely, to me, that insulin allows us to gain weight from what we eat. After all, you take more insulin because you're either eating more carbs, or because your carbs aren't being properly absorbed with smaller doses. But still, it's a theory that worries me.

And the other significant reason for considering a lower-carb diet...

Smaller mistakes.
If you're eating something high-carb, that calls for more insulin. So if you get the portion size wrong for something carb-dense, your dosage error could also be pretty significant. Take that piece of cake I had yesterday: I was guessing at the carbs, based on how many carbs are in other frosted cakes I've had before, and gave myself three units of insulin for the piece I ate... but I guessed wrong, my BG (blood glucose) dropped quick, and I struggled for the entire afternoon to keep my numbers up (which meant consuming a lot of unwanted calories, tying back to my first reason!!!). Let's compare that to if I'd eaten, say, a sugar free cup of yogurt. If the nutrition label was torn and I couldn't look up the brand, I'd remember that my usual sugar-free yogurt cups are about 7 carbs and (assuming this cup is the same size) given myself anywhere between .65 or .8 units of insulin (depending on my insulin-to-carb ratio for that time of day). My guess might be off, but I doubt it would be by more than .2 of a unit. As long as my BG was at a pretty safe number in the first place, an error of that size isn't going to hurt things much. Unlike the cake, for which I probably gave myself one whole extra unit (if not more).

I love carbs, and I believe everyone should be able to enjoy cake once in a while... but I know from experience that I can eat a generally lower-carb diet and feel satisfied. But that was a few years ago... If I can just get back into that mode!

Thursday, September 2, 2010

Cake Will Make You Go... Low?

Today was my last day at work (I start a new job Tuesday!), and some coworkers were sweet enough to bring me a yummy red velvet cake. I admit I gave in to the "obligation" to eat a piece right then and there, but whatever, I can just bolus for it, right? No biggie.

Except I apparently suck at judging the carbs in cake. Like, really really suck. A lot.

I should have known sooner that my blood glucose was dropping, as I felt an odd anxiety creep in. But I knew by the time I was actually low (caught it at 68), and I downed a juice box... then ate my lower-carb lunch with no insulin... then drank a carrot-apple juice box... Then later, a couple random bites of cake again... then more cake yet again, with almonds for some staying-power. All without insulin. I'd get up to a reasonable number, then go right back down!

And it's not like I gave myself some amazingly huge bolus for that cake. I most certainly ate more than enough carbs afterword to account for that insulin. But they say that once you go low, you're more likely to go low again over the next few hours. Weird. Why can't it be simple? Take this much insulin, consume this many carbs, and all is fine. But no, it can't be that simple. And my last day rather sucked because of it.

Maybe this cake was made of anti-carbs. Like anti-matter. Only... not as deadly and destructive.

Tuesday, August 31, 2010

OW!

Nap? Check.
Snuggles with the cat? Check.
Lingering too long in the shower listening to Radiohead? Check.
Most painful freaking moment since starting insulin treatment, followed by blood? Fraking CHECK.

Screw you, Diabetic Powers That Be, for throwing a major kink in my nice, relaxing evening in.

To hell with it, I'm having ice cream... After I bolus. I'm such a rebel.

Sunday, August 29, 2010

Dexcom, Weddings, and Alcohol

I absolutely love this thing.

It's a Dexcom reciever. Part of a Continuous Glucose Monitoring System. The sensor and transmitter are pretty small, and currently attached to my abdomen. Every 5 minutes, the Dexcom gives me my glucose levels.

These are not yet accurate enough to totally replace traditional glucose meters. Before you ever give yourself insulin based on your current BG, you have to stick your finger. But the number on the screen isn't what's so awesome about this device. What's so awesome is that you can see where your blood glucose is going!

Three examples of when I loved this thing this week:

Wednesday: I was driving to an appointment when Dexcom buzzed to tell me my BG was dropping fast. I knew (and it showed) that my numbers weren't high enough to stand such a quick drop for long, so I chowed down on some glucose tabs. 5 minutes later, I could feel that my BG was getting low... but very shortly after that, the glucose tabs kicked in and I felt better, and Dexcom showed my BG starting to slowly rise to safer levels.

Friday: At my birthday party, I decided to have some wine. I rarely do this for fear of what it'd do to my blood glucose levels, but I had Dexcom to tell me about any sudden drops... which I did not have. Dexcom gave me a view of my BG trends all evening, and I kept it where it would wake me if I went low during the night. I didn't have to stress.

Saturday (last night): I went to my cousin's wedding with an already elevated blood glucose due to eating fast food for lunch. At the reception, I gave myself insulin and made myself wait until Dexcom showed my BG starting to lower before beginning to eat my dinner (thus avoiding an even worse spike). This meant that, when it came time for cake, I didn't feel horrible about eating sugar. Again, I took my insulin a few minutes before eating the cake and saw that my numbers were starting to come down slightly before I ever put the first bite in my mouth. In fact, after that cake, I finally saw my numbers begin to return to a healthy range. Then, about three and a half hours after the cake, Dexcom buzzed me and showed a sharp drop in BG. What?! I tested to confirm and yes, I'd had a sharp drop. Aided by Dexcom (and the occasional finger stick to confirm whenever I was shocked to not see a rise in BG), I started consuming carbs. A small cookie... nothing. Another cookie... nothing. A 10-carb box of apple-carrot juice... A slight drop?! Glucose tabs... a slight rise, so wait and see.... no change? Finger-stick shows a BG of 88, which is too low for bedtime with such a downward trend and the knowledge that I'd had alcohol two nights in a row! I ate a 16-carb South Beach bar and sleepily watched Dexcom's numbers rise to almost 100 (with a slightly-upward trend arrow) before nestling it next to me and going to sleep. Dexcom shows I reached the 190 range in the night (which, I've discovered, means I was probably closer to 170 or 180), but the glucose meter showed me a 112 (Dexcom showed 130) when I got up late in the morning. I'd rather not go that high, but I think two evenings of alcohol threw my system through a loop, and it was necessary.

I've found the Dexcom numbers off by 20 points pretty often, but it's been an invaluable tool already. This was just a "trial" week, required by my insurance before they'll actually cover Dexcom, and I'm now more convinced than ever that I want one. It's helped me learn more about the timing of my insulin (I'm now trying to take it 15 minutes before I eat, when I can, to avoid spikes) and has helped me live a slightly more normal life (normal for me!) without worrying that I'd have a middle-of-the-night emergency. (I also learned that something last night didn't work for me. Was it two nights of wine in a row? Or did I guess horribly wrong about the carb content of cake? Or did even that small amount of dancing bring my BG down? I'll now have a much more watchful eye on all of those elements until I figure out what the problem was.)

Dexcom, you rock.

Saturday, August 28, 2010

The Other Side of 30

So today is my 31st birthday, and last night was a celebratory game night with close friends (which wound up feeling more like a party than I expected, which was cool!). I opted against the rather large parties we tend to have partly because I still occasionally feel frustrated when faced with some food and drink situations, but also partly just because I wanted a smaller get-together.

Food and drink awesomeness:

  1. I made low carb peanut butter balls, which took a little modifying (1 oz of chocolate was not enough!) and recalculating but turned out great and made 35 small balls at 1.3 carbs each (mmmm!).
  2. Two desserts arrived with me in mind! Jenn brought cupcakes (with sugar-free penutbutter cups in them, FTW!) and told me upfront how many carbs were in them, and Jess (quite a famous chef in our group!) brought a low carb plumb tart with an almond crust. Yum!
  3. I had three glasses of red wine and, while I let myself run slightly on the higher side for the evening, I wasn't afraid of dropping too low since I have a trial Dexcom unit this week (what great timing!).
  4. No one brought anything super hard to "count," and I didn't feel pressured to eat out of courtesy.

Rock!

Other awesomeness:

  1. GAMES! We played Ultimate Werewolf and Quelf, both of which make for goofiness and fun!
  2. Friends! I felt really loved.
  3. Fun and thoughtful gifts! One of the things Jenn and Bonnie gave me was a set of Russian nesting dolls that double as measuring cups!!! As Bonnie is also type 1, they probably knew how handy it is for me to have plenty of measuring cups around (and these are so cute!!!). Liz and Matt also gave me some cool vintage fabric with the thought that I could use it for making purses or meter cases to carry all my stuff, and Melissa and Jade gave me a copy of Quelf!
  4. A really awesome husband! It was Chad that arranged all of this, and it turned out to be perfect. He's so sweet. :)
It was an awesome birthday celebration. I have to admit that, a couple months ago, I worried my birthday would be depressing. But surrounding myself with just my closest friends and not facing down a giant, sugary cake (and happening to have a Dexcom to help make drinking safer!) worked out beautifully. I felt normal, and yet not pressured to be normal.

Chad has commented a couple times that, after this diagnosis and some other less than pleasant issues this past year, we should be glad to say goodbye to 30. I think I agree with that, but I also think I've come out the other side of 30 in better shape than I went in. I suspect I went into it with this disease already in development, and now I've finished it with it under pretty good control and... overall happiness.

This was not the most pleasant year for me, but I think I'm better off for having gone through it.

Monday, August 16, 2010

T1 vs. T2

I've noticed something, ever since I was diagnosed as a type 1 diabetic: We T1s tend to be defensive.

We don't want to be confused with type 2 diabetics, we don't want people to think we could get better "just by eating right and exercising," we don't want people to think we take insulin because we don't take care of ourselves. All understandable. I remember, in particular, seeing a mother on a message board say something like, "some people think my child got diabetes because I gave him too much candy." The very thought makes me so angry for her!

But let me flip this around... When I first knew I was probably diabetic but was still assuming (before further tests) that I was type 2, I was kind of embarrassed. Even though I lead a healthier lifestyle than what usually triggers T2, I felt I had done this to myself. I'm a little overweight (actually more than a little, according to height/weight charts), I lovvvve carbs, and I don't exercise as regularly as I should... and I suddenly felt like these were sins for which I was being punished. Then once I knew I was T1, I didn't want people to confuse it with T2.

So, here's that flip (finally): What does all of this T1 defensiveness say about people with T2? It says, "They do it to themselves. They could prevent it. They are being punished for their gluttony and sloth."

And that's not true.

"Hold on!" you cry. "All the experts say it's caused by poor diet, lifestyle, and obesity!" But actually, those are some of the triggers (sort of like T1 is "triggered" by an illness that throws the immune system into overdrive). T2 is hereditary, and far more common than T1. There are even athletes who develop and live with type 2 diabetes, and I'm not about to tell them they did it to themselves. (I have no doubt they could totally pound me!)

And what if someone's poor choices moved them further down the path toward T2 diabetes? Are we going to judge them for it, when their habits may not be any different from those of someone more fortunate in their genetics?

Yes, poor diet and lifestyle can trigger or worsen T2 (those things can also worsen T1). Yes, some T2s can (and some do!) control their diabetes through exercise and diet (this also helps T1s manage diabetes). Yes, some T2s are non-compliant and allow their condition to get worse and worse (there are also T1s who do this). But that doesn't change the fact that they have a disease, and one very closely tied to our own.

We are on the same team. The diseases, triggers, and treatments may not be identical, but we're all facing many of the same challenges and dangers.

When I encounter someone who makes assumptions about me based on T2 information (which is, understandably, much more commonly distributed than info about T1), I will strive to educate them without pointing fingers at people with type 2 diabetes. It will be, "Actually, I have to use insulin no matter what because being type 1 means my immune system killed all of my insulin-making cells." It will not be, "It has nothing to do with how I eat! That's type 2!"

Because I'm not going to talk smack about my teammates.

Monday, August 9, 2010

Smoothing Out the Seams

I think I’m beginning to incorporate diabetes treatment into my life more smoothly. Even with the pump being so new, and even with other new things (CGM) on the way, it’s all starting to blend in. All of the actions are inspiring less, “Let me stop my life for 5 minutes to test my blood sugar and take an injection,” and more, “I hope I don’t look too inattentive while I test my blood sugar and listen to this person talk at the same time.”

The most invasive daily activity at this point is counting carbs, even though the pump takes care of some of that for me. Even if the database were easier to browse, some foods are just always a mystery unless you make them yourself. There could be sugar in your sweet corn, flour in your omelet, or (on the flip side) far more fiber in that dinner roll than is typical. And what is the tuna-to-pasta ratio in that tuna casserole??? It helps, when dining out someplace without a nutritional guide, to stick to simple foods. I’ve been eating a lot of poultry and seafood with rice and veggies or salad lately... The meat has little to no carbs (as long as it's not battered, and depending on sauces and glazes!), I can pile rice or veggies into a mound and judge which of my measuring cups it would likely fill, and side-salads with creamy dressings (ranch or Caesar), a few croutons, and no fruit have pretty reliably acted like about 10 or 15 carbs (depending on size). I’ll probably branch out into more combination foods as I get a better feel for carb content, but simple and familiar foods make life a little easier when there are no hard numbers to rely on.

Making food at home is easy. Meals for just myself are usually packaged and frozen (I love Kashi meals for lunch!) or routine enough that I know exactly how many carbs are in the final product as I always make it (my usual PB&J sandwiches are 34 carbs). If it’s a more complex meal for my husband and I, I usually try to cook exactly enough for both of us. I jot down carbs on a scrap of paper as I choose ingredients, total it up, then divide by two to determine the carbs in my half of the meal. (Or, more likely, I take a look at the carbs for one serving of a frozen “meal for two” I’ve just sauteed!) I test my blood sugar while the food is in the last couple of minutes of cooking, then punch the carbs into my meter-remote for my bolus calculation as soon as we sit down to eat. I’m already eating the first bite before the pump has finished its bolus. (So much faster than taking a shot!)

So it’s all falling into a rhythm. I’ve had to make some adjustments to my routine to more seamlessly incorporate treatment (eating simple foods at restaurants without nutrition guides, taking a few extra minutes every third day to put insulin in my pump and insert an infusion site so I don’t have to take a shot 5+ times a day, buying a more organized purse to easily carry and find my gear, buying some 1-cup tupperware bowls so I know exactly how much cereal I’m eating without breaking out the measuring cup...), but the treatment itself is also becoming easier to adjust (the pump means less time and mess before meals, I can use my glucose monitoring kit more quickly and without taking every little thing out of the case now that I’m used to it, and I don’t have to do as much math to give myself insulin anymore).

I still have these surreal moments when I realize, “I’m diabetic. I have a chronic disease. I have to take medicine multiple times a day to stay healthy and alive.” This strikes me especially hard when I wrestle with the tube of my pump while changing clothes, but then the pump disappears quite effectively under the front of my bra, and I only occasionally talk to it for the rest of the day through what looks pretty much like a fat little PDA... and it talks back to me from beneath my shirt through the quietest whisper of a *click* when it gives me a basal dose of insulin, and through a rhythmic vibration that translates into, “Bolus insulin for 41 carbs coming right up!!!” And I can hear the quiet twist-and-deliver as I enjoy the first bite of my meal... and then I think about other things.

Every now and then, I’m amazed by the things I do automatically. The seams are smoothing out...

Sunday, August 8, 2010

Pumping It Up!

OK, so here's the pump update!

I started on Wednesday. The frustrating thing is that the CDE, who I had never met before, kind of started from scratch on a lot. Like, though I knew I needed lower basal rate in the afternoons and evenings, she still set the same rate all day. Maybe that's standard for starting on a pump, but I kept wishing my usual CDE were there instead.

But, over two hours (which could have been more like one hour, if she weren't such a chatter!), she got me started and set up. I was nervous about inserting the needle/cannula for the infusion set, but discovered that it hurt less than some of my insulin shots do! It was a little awkward, but generally easier and less invasive than I thought it would be. My mom, who went with me and is a nurse, was concerned that the cannula was too shallow and started making suggestions about angling it differently next time... But the CDE assured her that it was in exactly right, and my later numbers showed that the insulin was indeed getting into my system properly. Pretty cool.

This really is kind of like starting from scratch, though. The CDE seems pretty happy with where my numbers have started (some people's blood sugar does crazy stuff when switching treatment methods!), but we're still having to adjust for evening and afternoon lows. A total pain. But it's interesting to watch my insulin needs go down so much on the pump! She commented that they start a new pumper on a slightly lower basal rate than they'd had because most people weren't getting every little last drop in their system when doing shots. And I believe that, because I usually saw a remaining drop (maybe two) come out of my pen needles even after the recommended count-to-ten.

Wearing it has been no problem. It's a little surreal to be hooked up to a medical device, but it's small and cute. So far, I've worn it:
  • Clipped under the middle of my bra (I'm glad I'm endowed, now!).
  • Under my waistband.
  • In my pocket.
  • Clipped inside the front of my nightgown (around the house and in bed).
  • Clipped to the side of my underwear (in bed).
(Under my waistband.)

Pretty simple. I dig it!

Saturday, August 7, 2010

What Diabetes Has Changed

I suppose I should be doing a post about my first three days on the pump, but that will have to come next. (But I'll say, it's going pretty well!) This list is what's been bumping around my brain this morning...

What Diabetes Has Changed:

  1. Let's get the biggies out of the way and move on to the more "fun" ones... It's brought my mortality to my attention. Health was never a concern beyond needing to eat less and exercise more, but now it will be a very prominent part of my daily life.
  2. I used to be terrified of needles. I'm still nervous about intravenous needles, but too a lesser extent... and I never thought I'd be OK with sticking my stomach or thigh with a needle multiple times a day... Or, as the case is now, sticking a needle into my stomach and leaving behind a cannula. If you'd told me that four months ago, it would have freaked me the hell out.
  3. My nutrition label review used to go: calories, ingredients, types of fat, amount of sugar. Now, it's: carbs, fiber, sugar alcohols, ingredients (for types of grains & sugars), amount of fat, types of fat, calories.
  4. I carry a much bigger purse, and it's about to get bigger again!
  5. When I got distracted by the internet, it was usually over something crafty or geeky. Now, it's usually over something diabetes related.
  6. I used to think an insulin pump was a sign of very hard-to-control diabetes. Now I know it's a sign of better diabetes control for that person's lifestyle. (And I think they're pretty cool!)
  7. I have better knowledge of how the glycemic index works. I knew that lower-GI foods were better because they caused fewer sugar spikes and drops, but now I'm even developing a feel for how quickly different foods raise my blood sugar.
  8. I eat less, but weigh more... both thanks the the ability to use and store carbs again. *sigh*
  9. I want to exercise more than I ever wanted before, but I almost never do now. I seem to trend low for a lot of various reasons, which makes me less inclined to go do something that will make me go even lower. (This will be less of an issue once they "approve" me using temporary basals on my pump, and once I have the Dexcom CGMS.)
  10. Other than stress symptoms and occasionally feeling low, I feel better. It wasn't one of those night-and-day things where I took my first shot of insulin and felt like a new person, but there's definitely a difference.