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.

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!

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!

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.

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!!!!!

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.

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.

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.

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!

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.