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.

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.

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.

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.

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...

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!

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.