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."

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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.

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.

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!

Robo-Pancreas!!!

Look what I have...

That's right, I have an insulin pump!!!

It's an Animas Ping... A pink Animas Ping! I used to hate pink, but I now really appreciate it when it's an unexpected color... like in the case of a medical device.

I'm not using it until Wednesday, when I'll meet with my CDE and get the official "training." I've been playing with the functions, with a cartridge and tube full of water. Tonight, per my CDE's recommendation, I'll tape the tubing to my stomach (pump attached) so I can figure out how I'll want to sleep with it.

Aside from how awesome it is that I'll soon have more precise blood sugar control and will just have to push buttons instead of giving injections in public (not that it's embarrassing, just a hassle), I'm totally drawn in by the fun that comes along with a pump! It's a medical device, yes, but it's a gadget. It's advanced, cute, and it makes fun noises! Oh, oh... AND IT DOES MATH FOR ME!!! Sold!!!

I keep reading about T1 girls struggling to "hide" their pumps, and I'm sure I'll get tired of the questions and start tucking it away into my bra, but I currently have no anxiety over the prospect of it being visible on my everyday outfits. It's cute, and I imagine a lot of people will assume it's an MP3 player of some sort. For those who ask, my current plan is just to tell them and to answer any other questions.

I should also comment that my insurance has all worked out remarkably well! Blue Cross Blue Shield approved this earlier than their policy normally allows, and Caremark agreed to cover vials of Novolog for me right away even though I very recently refilled my prescription for the Novolog pens (technically, this was like trying to "refill" my Novolog prescription too early). I still think the system needs reform, but I have to say that I'm pleasantly surprised by how relatively few roadblocks I've hit.

And, in general, I have to say things are pretty good right now!

Numbers and a trip to the endocrinologist

My blood sugar numbers have gotten pretty good, and I really hope my Diabetes Educator lowers my target numbers.  They're currently 130 (before meal) and 180 (after meal), but the general range I'll be shooting for eventually will be between 70 and 140... or 70 and 120 when I get pregnant.  Most of my numbers are generally between 100 and 150 right now, which isn't too far off from that long-term goal range!

I went to the endocrinologist yesterday, which I'll talk more about later.  But she told me three things that make me very happy:

1. I should go ahead and start the paperwork necessary to get an insulin pump.  I may not be able to get it until I've met some time requirements set by my insurance (6 months), but starting now means less waiting when I get to that point.
2. She doesn't see any reason why I shouldn't be healthy enough to start trying to get pregnancy again by the end of the year, maybe even by fall.  (Also, planning a pregnancy makes getting a pump approved much more likely!)
3. She thinks we should see how much my improving blood sugar lowers my cholesterol before starting cholesterol medication.  She seems to think there's a chance I won't have to take any at all until I'm older.  *This is quite different from my GP's statement that she's never even known a diabetic who had their cholesterol sufficiently under control without medication.  If my cholesterol improves enough that my endo doesn't think I need meds, I may take the middle road:  Wait until I'm done having babies, then take the meds if my GP still thinks it's warranted.)

So far, I'm leaning toward an Animas Ping insulin pump.  (Medtronic's Paradigm is a close 2nd choice.)  I'm already looking forward to the greater precision of a pump!