Monday, March 28, 2011

A conversation with Dexcom, with a sensor on its last legs:

Me: 152.
Dexcom: 208?
Me: No.  152.
Dexcom: 255?!?!
Me: No!  152!
Dexcom: OMG!  OMG!  283!!!!!!!  OMG!!!!!!!!!!!!!!!!!!!!!
Me: No, I said...
Dexcom: ???  (Translation, "OMG, I'm so freaking confused my circuits just almost exploded!")
Me: Sigh... OK, I think 8 days was this sensor's lifespan...  *stop sensor*

Sunday, March 27, 2011

Sugar: The Bitter Truth

I've been posting this video on Facebook and message boards, and discussing it with the one friend who was interested enough to watch the whole thing, so I thought, duh, I should post it on here, too.

It's about how sugar is metabolized and why fructose in particular is so bad for you.  It's not really about diabetes (though he touches on type 2 diabetes), but about how anyone's body (with insulin, natural or not) would work with sugar.  It's long and there is a point at which is gets pretty sciency (but not so sciency that I, as a layperson, couldn't get the gist of what he was saying), but I think it's fascinating.

Since the actual sugary "sweets" I eat are limited (though not eliminated) by how I choose to treat my diabetes, and since regular soda is almost non-existent in my little personal bubble, the primary thought I had was: Should I reconsider how I treat lows?  If juice is available, that's what I normally use.  My theory is that it helps replace some of the fruit nutrients that have been reduced now that I don't drink juice just to drink juice...  But it's a ton of fructose with zero fiber.  Could changing my low treatment perhaps reduce my triglycerides?  My cholesterol is in the "safe" range for a non-diabetic, but maybe that could be part of a plan to get it down to "safe for a diabetic" levels without having to take statins later.

Honestly, really interesting stuff.  It's much more revealing than the news reports that just tell you that sugar becomes belly fat and that makes you insulin resistant.

Friday, March 18, 2011

The Short and Long Haul

Things are still going pretty well.  My blood sugars are mostly within range, with those not in range not lasting long at all (except for one amazingly stubborn high a week ago, which was a slight mystery.  DO NOT WANT!).  I met with my endo yesterday and we adjusted my basals slightly to help me avoid going low right at the beginning of lunch and dinner, like I have been, though I still went low by dinner yesterday.  I'll give it another day or two to see if the change is enough before I lower it even more.

It feels really good when you have it under control, but I've learned not to get too pleased with myself.  Next thing you know, my hormones will change and I'll be looking at another mystery number.  In any case, it's probably only a matter of a couple weeks before the usual insulin resistance of pregnancy will kick in, and I'll have to keep upping my insulin over and over to keep things in check.

I also went for a weigh-in at my OB's office yesterday.  All I do on these visits is give the nurse my blood sugar records, then step on the scale and let her write down what I've gained.  Then the nurse tells me when to come back for another weigh-in.  The general routine if everything is going well is to weigh every two weeks.  If there's some kind of concern (usually no weight gain), then they have you weigh again in only one week.

I'd gained two pounds in two weeks.  My thought was, "Well, that's more gain per week than what my OB and I want me to average, but it is still within what she said is healthy."

But the nurse's reaction was twofold.  First, she exclaimed, "Two pounds!  You did good!"  Then she looked at my chart and said, "I'd better have you come back in next week so we can make sure you're still gaining."

I asked why, and she explained that I've only gained about 5.5 pounds total in three months.  So I said, "But the doctor said last time that I was right where I needed to be, and I've gained two pounds since then, in only two weeks.  Her exact words were 'You've gained three and a half pounds, so we're winning!' and said anything from a quarter of a pound to a pound a week is fine."

The nurse seemed a little confused and was looking over my chart and pointing out numbers in a scattered sort of way, and then said, "Five and half pounds in three months?  Is that good?  Is it because of your diabetes?  Is that why it's good?"

I was just kind of at a loss, because I'm pretty sure it has nothing to do with diabetes (though gaining too much would probably make things harder to control).  I was annoyed and tempted to say, "It's good because I'm already fat!" but that's really true, either.

But luckily the nurse practitioner was there, took a look at my chart, and said standard procedure was fine.  I could wait two weeks.

I'm also always surprised by the different reactions to my blood sugar that I see from different medical professionals.  When you're insulin dependant, weird things are going to happen with your blood sugars no matter how on top of them you are.  Pretty low lows are one example.  When someone like my endo or a CDE sees, say, a 46, the reaction is a calm, "Do you know what caused it?" followed by any discussion of how we might be able to prevent that situation again.  When anyone at my OB's office sees it, including my OB, they give me a shocked look and say, "What happened?!?!" with a slightly panicked voice.  I'm always slightly tempted to blink and say, "I'm insulin dependant.  That's what happened."  People who work with T1 diabetics on a regular basis see a number like that as serious, but not in the least bit surprising.  People who don't work with T1s on a regular basis see it and picture me teetering on the edge of death from some kind of bizarre twist of diabetes fate.

And, for me, 40s are rare and really really sucky, but not terrifying.  At those levels, I'm still physically and mentally together enough to treat myself.  I couldn't do algebra, hold a complex conversation, or go for a brisk walk, but reaching into my purse for glucose tabs or walking to the kitchen for juice?  Not a problem at all.  (And I do so ASAP, before I get to find out how functional I might be in the 30s.)

On the flip side, my OB doesn't even bat an eye at the frequent 60s I've been having before meals, but my endo sees frequent lows of any level as a concern.  "It is too early int he game for you to risk letting yourself become desensitized to lows.  You do not want that."  Slightly different perspectives and priorities.  My OB is primarily concerned with the health of me and the baby during my pregnancy, but my endo looks forward at the decades to come, during which I will still have diabetes (barring medical breakthrough) and have to live with any consequences that may come due to my habits today.

I'm in this diabetes thing for the long haul.

Monday, March 14, 2011

First Major Ultrasound

We had the first ultrasound today, other than the quick peek they took at my first prenatal visit when the baby was about the size of a peanut. It was totally fun to watch, but let's get the big part out of the way first:

The doc said, "Everything looks great."  *sigh of relief*

The size is right, resulting in an estimated due date at August 15th.  That's a mere 3 days earlier than the due date my OB gave me based on the date of my last period.  He did a great job of explaining what he was looking for regarding abnormalities, and confirmed that everything he saw pointed toward normal development.  He wants to see me again in six weeks so he can get a better look at the heart after a little more development, but said it currently looks great, too.

On to the fun stuff:  It's a boy!!!  I had actually suspected as much, because I noticed some of my body hair getting a little more noticeable and remembered my mom commenting that she'd noticed darker hair on her face when she was pregnant with my brother.  I guess it's all the testosterone it takes to turn a boy into a boy.  It'll have some effect on the mom, too.  Chad and I really didn't have much preference for gender (I've always said I'd love to have one of each), so the cool thing about knowing it's a boy is that we can really start working on names and pick out some boyish stuff for the registry.

He was a mover, too!  He kept kicking those little feet and thrashing those little arms, especially when the tech tried to get him to open up a hand.  This matched right up with his over-activity at the last OB's visit, while the nurse tried to get a count on his heartbeat.  He was just pushing himself all over the place!

We did have a little diabetes gem with the doctor.

Doc: So, tell me about your diabetes?  How long have you had it?
Me: I was diagnosed in May, so less than a year.
Doc: Uhuh.  And they thought it was type 1?  (Sounding skeptical.)
Me: Yeah, I was making hardly any insulin at the time of diagnosis.
Doc: That's interesting, because you're not the typical age to get type 1.  (Sounding even more skeptical.)
Me: Well, I'm not the typical age to get type 2 either, which is probably why my doctor decided to test for the type.
Doc: And who do you have as your endocrinologist?
Me: Dr. K.
Doc: Good.  (He finally sounded satisfied here, so I guess he trusts her judgement.)

After the doctor left the room, Chad gave me a patronizing look and said, "Are you surrrrre you're type 1?"  I could only shake my head and say, "Yeah, like they pass out type 1 diagnoses willy nilly to 30 year-olds."

This stuff is part of why I advocate; my pet cause is telling adults to never take it for granted that it's type 2 based entirely on age.  It's actually not uncommon for adults to get type 1 (just not as common), but even a lot of medical professionals are really quick to assume type 2.

Oh, and those 4D pictures?  Cool, but also kinda creepy.
(They seem to be extra creepy at this stage, because a baby doesn't have much fat at 17 weeks and so looks a little skeletal.)

Sunday, March 6, 2011

Camping with Diabetes

I camp.  At least once a year in the fall, and sometimes a spring trip as well, with a very large group of friends.  In fact, we have our Spring camping trip coming up next month.  I thought I did a post about my first experience camping with diabetes last year but see it nowhere.  Suffice to say, I ate a lot of candy to keep from going low from the added activity (despite using temporary basal rates), but everything went really well... especially since I have a camping buddy with T1 who told me ahead of time to bring more stuff to treat lows than I thought I'd actually need.  Best. Advice. Ever.

But one of the tougher aspects of camping with diabetes is that I love to cook while camping, and I also love to sample the stuff my foodie friends create over the campfire.  I bring a cast iron skillet and a heavy dutch oven and get creative...  But last year, most of my creativity had to happen at home before heading out to the wilderness.  I ended up taking a lot of stuff that was already portioned in baggies with the carbs written on the outside.  I also made sure to know exactly how much my bowls and mugs held to aid in carb counting.  Like I always make an awesome vegetarian chili, so I counted up the carbs for the entire pot as I put cans and seasoning packets into a container, then divided to find out the carbs in one cup of that chili... and found out which of my tin mugs held about a cup, so I could easily portion myself a serving of chili without breaking out the measuring cups.  (Knowing exactly how much fit in our various sized mugs was also completely invaluable for sampling other people's goodies and making an educated guess at the carbs.)

The plastic baggies are an awesome camp cooking tool actually, especially since I usually only have the motivation to make one really fancy camping meal per trip.  I like to relax while I camp, too.  Though I will usually sizzle up some turkey sausage and other goodies on the skillet once Chad is awake too, I like to have something simple and tasty to eat when I first get up.  My solution is to bring plastic baggies of interesting home-mixed oatmeal in a plastic baggie, usually a recipe from Lipsmackin' Vegetarian Backpackin'.  All you have to do is pour in some hot water and let it sit for a few minutes.  These are already portioned for one (though some of the recipes in the book need to be cut in half), so I just wrote the carbs on the outside of the baggies last year.  There are lots of other variations on this, including instant rice, mixing batter for breads or skillet cookies, etc. (I know there might be health concerns when eating out of hot plastic, so the baggie could also just be used to transport the portioned dry ingredients before mixing it with hot water in a bowl.)

One thing I miss is the ease of campfire pancakes, though.  For a couple trips before my diagnosis, the perfect solution for easy pancakes was Batter Blaster, pancake batter that's dispensed out of a whip cream style can.  (These also make for great entertainment, as someone always wonders why you're putting "whip cream" on a skillet!)  But it's been impossible to find the whole wheat version, plus the carb counting based on the diameter a pancake is spotty at best (as I proved to myself a couple weekends ago with diner pancakes and a blood sugar of over 220).  I also don't like mixing batter in a bowl while camping because it's just too messy, so I didn't consider making my perfectly portioned whole wheat recipe last year.  This year, my plan is inspired by the Bisquick Shake n Pour canister.  I'm saving and washing one or two squeeze dispensers like the ones my usual reduced sugar jelly comes in.  I'll put the dry ingredients for two portions into the bottles at home, add the wet ingredients at the campsite, shake the hell out of it, squeeze the batter onto the skillet, then divvy half to Chad and half to me.  Tada!  Perfectly portioned whole wheat pancakes without a bunch of hassle and carb counting at the campsite.  I think it's going to be awesome.

Saturday, March 5, 2011

Prenatal Visit #3

My third prenatal visit went well enough.  The best part was when the nurse was trying to get a count on the baby's heart beat with the Doppler.  We heard it clear and strong last time, but I really got a kick out of it this time because the baby was on the move!  She'd find the heart beat, then it would just vanish and she'd be like, "Oh, you're just gonna kick away again, huh?" and start moving the Doppler.  This went on for a good 5 minutes, and she asked, "Are you feeding this child sugar or something?!  It won't stay still!!!"  It just makes the baby a little more real and interesting to know (s)he's moving around so much in there, even if I can't feel it yet.

The heartbeat was good, my belly measured at 17 weeks (I'm at 16 weeks), and I gained an appropriate 1 pound (in about two weeks).  I asked her at what rate I should gain since I'm already overweight, and she said it's the same as with any woman: anywhere from 1/4 pound to a pound a week.  She said 1/4 pound a week would be ideal, and I said that I'd really like to avoid gaining more than I need, so I'm going to think of 1/4 to 1/2 pound a week being right on target.  I don't feel like I need to worry too much, actually.  I let myself eat more than before pregnancy, but I think I keep things reasonable simply because diabetes means I can't mindlessly eat half a bag of chips or something.  I'm very conscious of every little thing I put in my mouth, so I don't think this is going to get away from me.

There was an interesting moment where that gulf I sometimes feel between me and someone without diabetes opened up.  My blood sugars have been mostly good, but I had one really crumby day on the two-week log I brought with me.  My OB asked about the high I'd had after brunch, and I explained that I'd had pancakes at diner without nutritional info, and I could really only chalk it up to those pancakes being higher in carbs than the "average" I looked up for their size (plus the fact that non-wholewheat pancakes tend to cause a bit of a spike for me, anyway).  She continued to look at that day and noted that I'd gone quite low (42, I think) after that high.  "And what happened with dinner?"  I had to pull my food log out for that one, because nothing about it stood out in my memory.  It turned out to be a meal I made at home with a known amount of carbs and a pretty reliable track record, but I went up to 160-something afterword.  But when I'd started eating, I was still in the 60s while recovering from that 40s low.  So I said, "Nothing happened, I knew the carbs in that meal.  I probably just went high because of the low.  My body can still have a glucagon reaction to a low sometimes."

She looked up and blinked in a way that made it clear she was really processing this statement.  That's when I felt that she was looking at me over that gulf.  I realized she probably technically knew this stuff, that the body makes glucagon to bring up a low blood sugar and that function isn't 100% gone in diabetics, but she's never lived it.  That 160s blood sugar was barely a blip on the radar for me because the cause was clear, so I just bolused to bring it down and moved on.  But as someone who is neither diabetic nor an expert in diabetes, she just saw a number and wondered what I did to cause yet another high.  She didn't see the pattern like I did without even trying.

I'm no expert in diabetes when you compare me to a veteran who's had it for years or a specialized health care provider, but managing type 1 diabetes for the past 10 months made me the expert in that room even though I wasn't the one with the medical degree.  It's amazing to look back to the first week after diagnosis and remember how little I really understood about my new treatment.  I've come such a long way in less than a year.

Thursday, March 3, 2011

Yet another appointment... but a good one.

I had a appointment with my endo yesterday, and all was well.  Since getting pregnant, I always feel like my blood sugars are doing horribly, but when we look at them, I usually realize they're not nearly as bad as I think.  She confirmed this and said I'm doing great.  I'm out of range every now and then, but they aren't terrible numbers and I always bring them right down.

I asked that they go ahead and do an A1c every other visit since my OB simply isn't interested in learning to use Fructosamine results.  My endo simply said that's fine, but the nurse seemed a little baffled that my OB is so insistent on having an A1c every month when she knows I have an endo who's in charge of the diabetes side of my care.  She seemed practically flabbergasted when I told her that my OB had commented that she might want to make changes to my pump settings at some point.  I shared in her annoyance (because it felt good!), but I really just chalk this up to the fact that OBs normally working with mothers who get gestational diabetes.  In those cases, I'm sure it's almost always the OB who's in charge of that care.  She's just used to it.

My endo said toward the end of the appointment that she thinks I'm doing great, especially "for a true insulin dependant diabetic."  I smiled and said, "Well, I suspect I still get a little help from my pancreas."  She said, "You know, I think you're probably right, and that's really great that you still have some back-up for pregnancy."  I then mentioned to her that I sometimes suspect I'm actually a late-stage 1.5 or LADA, because I'm pretty sure I had symptoms for a couple years before diagnosis.  She said with both type 1 and type 2 in my family history, she wouldn't be surprised at all.  We then chatted a minute about how easy it is to misdiagnose a diabetes, especially by assuming someone must have type 2 if they're adult of obese.  I really am very lucky that the GP I went to not only tested my blood sugar in the first place, but also bothered to run tests to figure out what kind of diabetes I had once it looked inevitable.

I have a visit with my OB this afternoon, and I'm hoping it goes just as well.  I forgot to pay attention to my weight at the endo's office yesterday, so I'm curious to see if I've gained anything this time.  I hope I've gained at one or two pounds so she doesn't have me coming in for weekly weigh-ins again... That was way annoying.