Sunday, January 30, 2011

The Logistics of Pumping with a Growing Belly

I realized recently that I won't have as much fatty space on my tummy once my tummy starts to get big, so I'm going to have to start using other areas for insulin infusion sites just so I can "rotate" my sites sufficiently.  Dexcom sites are only supposed to be on the abdomen, technically, so I figure I may eventually have to put all of my infusion sites on other areas if I want to keep my Dexcom in "regulation" areas.  (Plenty of people put Dexcom in other areas, but I seem to do OK rotating it on my abdomen so I haven't tried anything else just yet.)

So when I changed my site yesterday, I decided on the upper area of my butt cheek.  I've done this before with success, but it's still a little tough.  I use the Inset 30 infusion set, which works really well for me but takes two hands when removing the applicator.

First I started with the left side, and I decided, no, this is way awkward.  So I went with the right side and that was fine, but I still really had to reach in order to make my left hand available to remove the applicator.

"Crap," I thought.  "When my belly is huge, there's no way I'll be able to put this back there by myself.  Putting it on the back of my arm means no second hand, too.  That pretty much leaves the sides of my belly and the thighs, and my thighs are actually pretty muscular."

So, what?  Have Chad help almost every time?  I told him I'd probably be needing one of his hands and he agreed with a laugh.  But I really like being able to change any time I want, lickity split.  So I think my next order for supplies will be for the regular, straight insets.

I've heard they tend to kink more often than the 30s, but they're supposed to be easy and totally one-handed.

I was tempted to try the stainless steel Contact Detach set, which the local Animas trainer said is just a teeny little metal needle you push in instead of a cannula with a fancy applicator, but I have nickel allergies and have reacted to some "stainless steels."  (Stainless steel isn't guaranteed to be nickel free, just to contain so little of it and to contain it well so you're not supposed to react.)  So, inset it is.

And the long tubing this time.  I figure the longer tubing will allow me to cross the tubing over my big belly if I have to in order to hide it someplace tricky, like in my bra!

Thursday, January 27, 2011

Better Than Therapy

Going to the endocrinologist is good for me. I don’t just mean it helps me stay healthy, I also mean that it helps me stay sane.

I’d gotten reasonably zen about diabetes management, especially since I was doing really well. Then I got pregnant, and zen immediately slipped from my grasp. My control on my blood sugar suffered, not due to any lack of effort or education, and my stress went through the roof in response.

In a zen state, I’d have said, “OK, my blood sugar is going higher than it should. All I can do is what I can do. Crying and feeling guilty just wastes energy.” But I was not in a zen state. You see, not only was I hormonal and dealing with life changes, but I was also reading blogs, forums, websites, and books on pregnancy with diabetes.  Everywhere I turned I read about all the horrible things that can happen if your blood sugar is high, and a high blood sugar seemed to pretty much be anything out of that super tight range for pregnancy.  I seemed to absorb other women's obsession or anxiety over this, as if I didn't have enough of my own. Though my endo’s office had called me back right away with my new blood glucose goals (under 100 before eating, under 120 two hours after), it was the internet that made me scared of higher numbers. Not even counting the occasional and mysterious 200+ number that happened even when I did everything by the book, I felt like a horrible mother who was actively mutating my own baby whenever I decided to indulge in a treat (say, a small ice cream?) and came in somewhere closer to 150 two hours later.

*cue internal freak-out and self-guilt-trip*

But visits to my endocrinologist have put things in perspective every time, so far. Never once has she criticized me, never once has she told me that a number is dangerous, never once did she suggest I need to try harder. No. She even told me the first time I came in with numbers that upset me, “I’m not worried.” She doesn’t worry, she deals. “Numbers like these will happen, but we need to figure out how to keep them from happening too often.” Then we’d discuss a game plan.

Yesterday’s visit with her was fabulous. I handed her a sheet with numbers that were much improved, but definitely not even close to perfect. We were both on the exact same page about how to fix them, and she made some adjustments to my morning basal and evening I:C. She said that I was really doing well overall, and I walked out feeling not like I had failed with those less-than-perfect numbers, but that I had done a great job of improving them and was leaving with a plan to make them even better, maybe even get them in line once and for all… Well, once and until my insulin needs change again! Damn hormones!

Friday, January 21, 2011

In Which I Lament the Loss of My Turkey Sandwiches

Pregnancy food restrictions make me realize, sheesh, simply eating with diabetes is nothing.  Yeah, you have to figure out carbs and either avoid or account for high fat, and you may find certain foods that don't work well for you individually, but you can still more or less eat anything.

Let's count out anything diabetes related first and take a look only at the four pregnancy related food restrictions that bug the hell out of me:
  • No deli meat.  At least, not unless you heat it up to the point of "steaming" first.  It's more likely to have listeria, a bacteria (that causes food poisoning) that's pretty deadly to an unborn baby.  (From what I've read, the chances of it happening are incredibly low, but the consequences are so dire that the risk isn't recommended).  By extension, cold meats that you wouldn't think of as "deli meat" are similarly restricted.  No more turkey pepperonis as my mindless, carb-free snack on the couch.  I tried microwaving them first, as I have tried with cold cuts for sandwiches, but the texture becomes way gross.
  • Big or predatory fish, including tuna, is to be avoided or limited due to higher levels of mercury (recommendations from different sources vary, but one serving a month seems common).
  • Anything with raw eggs, including Caesar salad (traditionally, the dressing will have raw egg).  The chances of salmonella is the problem here.  I still eat Caesar salad on occasion though, because I love it so very much, because I think salmonella is a crap shoot (I've heard about more outbreaks from vegetables, like spinach, than from pre-made products like dressing!), and because raw egg is in more foods than you're likely to expect.  Ever had a really high-end frosted cake, like at weddings?  You may have eaten raw egg in the frosting.  Good mayo or aioli?  Raw egg.  Eggnog?  Raw!  Eggs Benedict?  Raw egg in the Hollandaise sauce.  I won't even go into the many desserts.  Unless you're allergic to egg (or are a vegan), you probably have no clue how to completely avoid raw egg.  In the grand scheme of things, I doubt a Caesar salad with properly handled dressing is more dangerous than simply not being vegan.
  • Soda.  I'll also include caffeine in general here, but aspartame (ick!) in diet soda is also a general concern for women who didn't avoid it before pregnancy.  These are not on the universal "don't" list, and my own OB says that having one or two a day is fine (though some OBs recommend against it entirely, and any visibly pregnant woman drinking soda or coffee is probably going to get some uninvited advice!).  My biggest issue with this one is iced tea... I love the stuff!  It's my drink of choice when dining out, and I've started carrying Splenda in my pocket since not all places offer it (neither the pink or blue packets are recommended during pregnancy).  But since I start my day with a cup of tea or coffee, no refills for me.  (On the soda front, Diet Rite is a sanity saver.  It has neither aspartame or caffeine.  I keep some in the house at all times, if I can.)
There are a million other little restrictions.  Soft cheeses that aren't pasteurized (unpasteurized cheeses don't seem as common as the APA seems to think, though), unwashed produce, sushi with raw fish (understandable, though Japanese women continue to eat it!), undercooked or rare meats, etc. etc. etc...  Add to this anything that causes my blood sugar to spike (which is somewhat unpredictable these days), like pizza or white rice.  Eating "not good for your blood sugar" foods on rare occasion isn't so horrible... until you're pregnant.  (Then it's both bad for your baby and filled with guilt and stress.)

Those don't sound so terrible, right?  I didn't think so either... until I realized it counted out most of my convenient lunch options.  No deli meat sandwiches has been the biggest issue, for my lunches.  Also, the little pre-made salads you can buy in stores usually have deli meat in them.  We don't have a break room here at work, and I probably wouldn't stay if we did (psychologically, I just need to get away from work for an hour), so this leaves very few no-cooking options for me.  Combine this with the fact that I've had like, zero energy or motivation (due both to typical pregnancy fatigue and to some depression), and that results in lots of fast food lunches.  Not nutritious, but at least it means getting out for a little while, almost no effort, and not consuming something on the kill-your-baby list.

Diabetes?  It's not easy to live with, but it's not so bad on the diet front.  It didn't eliminate my convenience foods at all.  Convenience foods come packaged with a nutrition label, and I just opted for the versions that helped avoid blood sugar spikes (like whole grain Lean Pockets instead of the non-whole grain ones).  But pregnancy?  It's thrown a major wrench in my lunchtime convenience.  I have to figure out a super-low-effort solution.  Maybe zap a Lean Pocket before I leave for lunch?  Use bagged salad and veggies on Sunday to make a week's worth of little salads to eat along with my lunches?  Keep chicken salad around for sandwiches?  I have to figure it out, because I do think fast food makes me feel more like crap.

It's just awful timing.  Depression has been a major issue for me lately, and this makes me lethargic and supremely unmotivated.  I need a new game plan until I'm able to pull myself out of this emotional mess.

Sunday, January 9, 2011

Melodramatic Dexcom

Here's how things go sometimes:

Dexcom: BUZZ BUZZ!  You're blood sugar is 15 million and 20!  You're going to DIE!  You're going into DKA!!!  Oh my god!!!!!!!!!!!!!!!!!!
Ping Meter: BEEP!  Eh, you're at 160.  Just take some insulin.

Dex, I love you, but you're a little off base and melodramatic once in a while.

Thursday, January 6, 2011

Diabetic Super Star!!!

OBs and their staff are all probably somewhat familiar with diabetes, but primarily gestational.  I felt ever so slightly like a diabetes super star at my OB's office yesterday, with my fancy equipment and good control.

First, while I was giving my health history to the nurse, my Dexcom vibrated in my pocket.  I glanced, saw a 68, and wondered if I should wait until the questionnaire was over (68 with a steady line isn't so horrible).  But then I thought, wait, she's a nurse, she's not going to be the slightest bit phased if I check my blood sugar.  So I said, "Don't mind me, I'm just going to test.  My CGM says I'm low."  But outside of the diabetes community, I guess "CGM" doesn't mean much.

Nurse: Wait, what told you?  You mean you feel it, right?
Me: No, my continuous glucose monitor buzzed.  (I placed it on the desk for her to see as I dug for my meter.)
Nurse:  OH!!!
Me: There's a sensor that takes my glucose levels all the time, and it's not as accurate as a meter, but it'll tell me what range I'm in.
Nurse:  And what?  Did it beep?
Me: It vibrated, but it can beep too.
Nurse: Wow, like a phone!
Me: Yep.  At night I can set it to beep, but I keep it quiet during the day.  It's GREAT.
Nurse: No kidding!
Me: (Lancing my finger.)
Nurse: Jeez, you do that like it's nothing!  I'd probably still be squirming!
Me: You get used to it.  It doesn't hurt much.  Oh, 64.  Not too bad.  (Pulling out glucose tabs.)
Nurse: Oh, those are HUGE!  I'd just drink pop!

It was kinda fun.  And I was amused by the idea of a nurse being scared of a little lancet, when nurses have been jabbing me in the crook of my elbow with bigass needles for months, now!

Then the nurse practitioner (who handled this appointment, though I got to chat with the doctor a couple of times) asked if my endocrinologist had me keeping a log, because they'd like to see my numbers as well.  When I showed them to her, she was clearly overwhelmed by the abundance of information.  It does, after all, also include all of the food I'm eating.  She showed me the chart they use.

Me: I'd be happy to just transfer my numbers onto here for you at the end of they day, if that'd be easier.
NP: That would be great.  Does is match what Dr. Kennedy has you doing?
Me: That's the testing schedule I already use.
NP: And then... AM insulin and PM insulin... But you... That's not how you do it.
Me: No, that chart's not set up for a type 1.
NP: No, it's for gestational.  They only take insulin once or twice a day.  Maybe you could put... Hmmm...
Me: I could just look at my total daily dose for the day on my pump and put that down?
NP: Sure, that's probably as close as it gets.  Now, I'm not sure what Dr. Kennedy has told you to do, but what we normally tell our gestationals to aim for is a fasting number below 90 and never anything above 135.
Me: She has me at a fasting below 100, then below 120 two hours after a meal.  Do you want me to ask her about the below 90 goal?
NP: No, no, 100 is fine, and I love the 120.
(Later, while she's explaining that they don't induce diabetic mothers early unless there are signs that it's necessary...)
NP: Or if it looks like you're growing 10-pounder already, we might need to start discussing it.  But seeing your numbers, you're doing great.  Honestly, for as little time as you've had diabetes, I'm very impressed.  You take better care of yourself than most of our gestational patients, that's for sure, and she rarely ever puts them through early induction.

So I felt pretty stinkin' good about the pregnancy and about myself as I left.  I felt like, yeah, I am doing well!  Not only am I not having those unexplained 200+ highs anymore (those were total WTF!), but I've also really gotten my numbers into the ranges my doctors want.  At worst, since adjusting my lunch I:C, I've had a 122 after a meal.  That's pretty badass!

I am starting to suspect the trademark lows of early pregnancy may be approaching.  I had two slight lows like an hour before meals twice yesterday, and an almost-low that I headed off today.  If I have another day like that tomorrow, I'll fax my numbers to my endo and see what change she recommends.

Yay!  It's about time I started feeling good about this.  :)

Wednesday, January 5, 2011

When I don't have all the facts, I tend to worry, anticipate the worst, and fill in gaps with educated guesses that lean toward the pessimistic.  So when I finally face reality, 9 times of 10 I'm going to be relieved.

I should have kept that in mind as I went to my first prenatal appointment today.

Everything went really well, I was not made to feel like my body is a liability, and I was reassured that I'd be treated as an individual case rather than "a diabetic patient."  Most importantly, they will not induce me early unless they see evidence in the baby or pregnancy that induction is needed.

Rock. On.

From reading books and websites, and from talking to diabetic women who have gone through pregnancy, I heard so many stories about interventions that probably weren't necessary, or simply pregnancies/deliveries that were super medicalized (not my cup of tea).  Even from the people who were upbeat and encouraging, I there was still some message of, "Here's what's in store for you, like it or not."  After a while, I stopped reminding myself that it's all good information to have, but that every woman and every diabetic is unique, as is every medical professional.  I honestly started thinking, "Why did we bother?  If my body isn't trusted to do what it was designed to do, maybe we should have just adopted."  But, since the medical professionals I'm working with are willing to treat me instead of my label, I feel pretty confident that I'll be allowed to have as normal/natural an experience as my individual case allows.

That's all I ask.  Thank goodness we have interventions available to us when they're needed, but let my body do what it can do on its own.

Oh, and I got to see the baby!  I had been told we'd just hear the heart beat on this visit, but they did an ultrasound.  (S)he was like a little peanut with a tiny flutter for a heart!  Wow!

Tuesday, January 4, 2011

It Looks Easy, Until You Look Closer

I recently had a moment when the gulf between me as a type 1 diabetic and someone else as a non-diabetic widened significantly.

A coworker started trying to figure out a food alternative for me.  She'd planned on pizza for a staff lunch, and I told her I couldn't eat delivery pizza and would just go pick something up for myself.  (Pizza isn't on some diabetic no-no list, but it's a tough food that doesn't work out for me.)  She immediately said, "Well, what can you eat?"

Enter another complication: my own fear of being an imposition.  I'm pretty much never going to say, "Let's get such-and-such food instead of pizza," in a situation like this, so I ventured, "Where are you ordering from?  I can look at their online menu and see if they have something like a good salad."

But she had no clue where she'd order the pizza from yet, and really just sought after a more general answer that would basically let her order like, "Hi, random pizza joint I picked about 5 seconds ago?  I'd like three pizzas, and do you have any salads?  OK, yeah, send a salad."

So I explained, "Well... it's just that I have to know what I'm getting, because I have to know how many carbs are in it."

So she asked again, "Well, what can you eat?"  And I think, fine, I'll give you a shot.  And I attempted to explain what, to me, has become a subtle and mostly quick process...

"There are a lot of factors, but it helps if it's not both high carb and high fat.  It's even better if it's not either."  Already her eyes started to glaze, probably from trying to think of convenient foods that are neither high carb or high fat.  "But the most important thing is that I know how many carbs are in what I'm eating, so I have to be able to either look up the nutrition or order something simple enough that I can make a really good guess based on the portion size."

Her eyes glazed further, and I knew it was time to stop.  She was staring at me across this great gulf of diabetes management that suddenly made me feel rather... separate and different.  I don't really expect others to know what my food and insulin involve, but I also didn't expect someone to look utterly at a loss when told the basics.  (And, honestly, I also wonder if she thought I was intentionally being difficult.)  So I let her off the hook (the hook she'd asked for!) with, "I can eat almost anywhere.  If you just tell me where the pizza's coming from, I can pick something else off the menu."

But she backed off of that hook even further with, "Why don't you just go pick something up?"  To which I gladly agreed.

The fact that this woman knew I'm diabetic and had eaten meals (which includes testing and bolusing) with me before yet seemed baffled by the simplest explanation of how I choose my food reminded me that, when I was first learning this stuff, I was so impressed by the people with T1 diabetes that I've known; they made all that stuff look so easy!  But the truth is that they'd simply incorporated it into their lives.  The decisions and calculations that were so new and awkward to me were just a part of their routine, so I had no idea how much went into them.  Had they started explaining everything to me (before it applied to me), maybe I'd have glazed over.

As I've said many times, diabetes management is doable.  I can do it, and you can do it if you have to (and I know some of you do!).  But it's still complicated and difficult, and even those people who make it look easy have a hard time of it once in a while.

(I wonder how my coworker would have reacted if I'd mentioned fast-acting carbs vs. slow-acting.  Her head might have exploded right then and there!)