Argh ... pick just one thing?  Diabetes makes us too self-deprecating, with all of the variables we "supposedly" have control over, and now I need to nail down just one little ol' thing to improve?

Sigh.

What needs to be worked on ebbs and flows in accordance with whatever my goals are at that time in my life.  Prior to becoming pregnant, I was all about fine-tuning my diabetes to nail down a solid and safe A1C for conception.  During pregnancy, I was a bonafide stalker and stalked the shit out of my blood sugars. 

But now, what I'm aiming to do is make the most of the tools I have available to me.  Namely the magical diabetes math machine that is my insulin pump. 

I wear an Animas Ping, and that little sucker comes with a lot of bells and whistles (hello, waterproof and can be worn in a swim-up bar in the Dominican Republic), but the main thing I need to use with more precision is the bolus calculator.  I have my insulin:carb ratios stored in my insulin pump, so my pump knows I need one unit of insulin to cover 11 grams of carbs.  My pump also knows that one unit of insulin brings me down about 55 mg/dL.  And it also knows how much insulin I have on board, it's good about keeping me from rage bolusing if I have that HULK SMASH desire to stack boluses when a high blood sugar is being super stubborn. 

But all of this information goes pfffffft if I don't actually make use of the bolus calculator tool.

I have a baaaaaad habit of using my brain to calculate meal boluses/correction doses, which is foolish because math is not my strong suit and my brain is mostly clogged with other, far less useful, stuff.  I have this device literally at my hip, and it's capable of doing so much of the thinking for me.  So why am I using this ... this fluffy gray matter between my ears?  Why am I not using this silver gizmo at my hip?

That's my one (of many) thing(s) to improve, and I'm going to try and start making that change today:  I'm going to let my insulin pump "do the math."  Because God knows I could use the freaking help.  ;)

[Animas disclosure]

I don't have anything figured out, in full. 

Except that concept of "keep swimming."

Birdy's new favorite character is Nemo from Disney's Finding Nemo.  (Which is a favorite cartoon movie of mine, and I remember seeing it in the theater with a guy I was dating, the two of us sitting amongst a pile of parents and kids.  Slightly awkward.)  She hasn't seen the movie in full, but she's caught a few scenes here and there, and she thinks Nemo is "So cute, my Mama!"  (Calling me "my mama" is also a new thing, as of this morning.)

And in that movie, there's the bit with Dory - beloved blue fish devoid of short term memory, who should get a Polaroid camera like the guy from Memento - where she encourages her friends to "just keep swimming" when things get challenging.

That's the one thing I think I'm good at, when it comes to diabetes.  Regardless of how hard or easy it is on any given day, I'm good at pushing forward.  Moments of extreme blood sugar happiness?  Pockets of diabetes burnout?  Tired of devices?  Wishing for better math skills?  Celebrating that moment when you wake up in the morning and see the nice, flat line on your Dexcom and the shiny 100 mg/dL on your meter, but nervous that it's fleeting?  Trying to fine-tune insulin:carb ratios?  Negotiating insurance coverage issues?  Working to financially maintain an expensive and chronic condition?   Trying to keep emotions in check? 

Keep going, keep trying, don't give up.

Diabetes seems to be all about moving forward, in pursuit of good health, even when there are moments that trip us up a bit. 

Just.  Keep.  Swimming.   

When I started blogging, I could count my diabetes blogger counterparts on one hand.  Now, over seven years later, there are more diabetes blogs and diabetes social media resources than I can count, nevermind keep track of.  So many people telling their individual stories ... it's amazing. There's truly something out there for everyone to identify with.

I've highlighted some of these bloggers in the past, but wanted to give them an extra nod for today's D-Blog Week post, because this week, I'm keeping it Rhody-local with some of my favorite Rhode island diabetes bloggers:

Bigfoot Child Has Diabetes:  Written in a style that's in homage to Graham Roumieu, Bigfoot has a child with diabetes who was recently diagnosed.  Her writing is funny, poignant, and whenever she mentions some of my favorite Rhode Island spots, I want to hug her. 

The Diabetic Cyclist:  Ryan and I actually went to school together (he's a few years younger than me, and his wonderful older brother was a classmate of mine), and I remember meeting him just after I was diagnosed.  Decades went by before we reconnected, and it was after he had been through some tough times with diabetes. Now he's making changes for the better and has a story that inspires the hell out of me.

Tales of Swagging: Even though Ashley isn't currently living in Rhode Island, she's all Rhody at heart.  From our shared love for Bess Eaton coffee and synthetic insulin, her blog is about her diagnosis at the age of 25 and her ambitions of becoming a healthcare professional.  

Nicole on Blogabetes:  Nicole was one of the very first PWDs I met, in person, after starting my diabetes blog, and she's remained a friend and an inspiration over the last seven years.  She currently writes, beautifully, at dLife's Blogabetes meta-blog, and her words are never short of inspirational. 

There you have it.  Some of my favorite diabetes bloggers, hailing from the land of coffee milk, Del's, and lovely beaches.  Rhody pride!

• Things have been very, very busy here in Sparlingville lately, with distractions and obligations of all kinds, leaving us at the close of each week feeling like Monday through Friday ran by and each slapped us with a giant, floppy fish. 
  
• As a response, I'm spend the day snuggling my daughter, and am up late into the evening working on stuff.  It's made for some serious eye baggage, but I'm also finding some really great music while the world is asleep.  (Yet the Internet never is ... go figure.)
• Which explains why I'm immersing myself in music like Tiny Ruins & a Singer of Songs (addictive little EP, and the song "Running Through the Night" is gorgeous), but it's in stark contrast to Quakers (35 member hip hop collective that does an incredible workup of Radiohead's Fitter, Happier).  Or the Arctic Monkey's new track, R U Mine, which is on rotation as well.  (This muddled playlist makes for some really tangled story-telling late at night.)
• But writing is good.  As are prompts to help keep things moving along, which is why I'm very excited for this year's Diabetes Blog Week, which starts on Monday.  My lovely friend Karen (who blogs at Bittersweet Diabetes) is organizing the third annual event, and you can find out more details - and sign up! - by visiting her website.
• Also, the good folks at the Diabetes Hands Foundation are petitioning Google to create one of their magical little homepage doodles to mark the birth of Dr. Frederick Banting (aka "the guy who discovered insuiln").  There's a petition you can sign to show your support, and help bring diabetes awareness to a whole, new, Google-y eyed level.
  
• Birdy and I ended up in an argument about the number eleven this morning. I told her it was the number that came after 10, but once she saw it written down, she kept saying, "Not eweben.  One! One!  Two ones, mama!" "No, that's the number eleven. It's one more than ten."  "Nope, mama.  Two ones." This went on for five full minutes. Finally, I gave up and said, "Okay?" to which she gave me a sidelong glance, knowing she had my brain in a vice grip.
• If you're attending the Detroit JDRF's 5th Annual Diabetes Today and Tomorrow conference, please be sure to say hello!  I'll be doing a morning session on transitioning diabetes care from parents to kids, and would love to meet you. 
  
• The Sanofi "Discuss Diabetes" blog is running a week's worth of mom-related posts in honor of the upcoming Mother's Day holiday this Sunday.  Yesterday, they featured a bit about Birdy and I. They've also featured Wendy, Jacquie, and Joanne. Check those posts out for a little CWD and PWD mom-perspective.
  
• Currently, I'm rooting for Siah to win her fight against the neighbor's cat ... despite the fact that's it's happening through the glass doors in the kitchen, leaving Siah bristled and meowing wildly while throwing herself against the glass, with the other cat outside on the deck, staring in, all wonky-eyed.  I'd open the doors and let her out, but I'm laughing too hard.
• And lastly, it's one thing when you watch one of those videos where a cute little kid belts out a song with incredible poise and amazing talent.  It's quite another thing when that cute little kid is your lovely niece. Check her out!
  

Bullets done. 

Pump spottings in the wild are some of my favorite moments. This post was originally published back in February of 2011, but I still stalk pump people these days.  ;)  

A few weeks ago, Chris and BSparl and I went out to dinner.  Dining out with our little bird is a bit of a tangled experience, and we don't spend as much time people watching as we used to because we're very preoccupied with the baby wrangling. 

That night, though, we were sitting and settled and throwing gluten-free puffs (yes, all of us) around the dinner table like confetti when I saw this woman walk in with her family.  She settled her family in at the table, and then reached to remove her coat, revealing a beeper clipped to her pocket.

Only it was one of them fancypants beepers with the tubes and the buttons and the accompanying not-making-insulin pancreas.  Reckon it was an insulin pump.

Immediately, I wanted to swing mine over my head like a lasso and say "OMG lady, me too!!!"  I've had this feeling before, of wanting to sidle up next to someone and say, "I like your pump; want to see my pump?" but to me that sounds more like an awkward attempt to flirt instead of a moment of diabetes bonding.  Living in a very comfortable bubble of diabetes advocacy makes me think that everyone who has a visible "symptom" of diabetes wants to talk about it.  I have to remind myself that some people just plain don't want to talk about it.

But since I still wanted to say something, I targeted Chris instead.  

"Dude, 12 o'clock.  Actually, my 12 o'clock, your six o'clock.  Minimed pump on that lady."  I said to Chris without moving my lips, as if a pump sighting was a covert Navy Seals operation.

"Six o'clock?  Okay, do you guys know one another?  And why are you whispering?" he whispered back.

(I love that because she and I both wear pumps, we must know one another.  I've brought him right into this bubble with me.)

"No, I don't know her.  I have no idea who she is.  But I just saw her pump."  I paused, still whispering.  "And I was like a toddler, wanting to wave my arms around and say 'Pump! Pump!'"

He laughed.  The waitress came over to bring our food, and the two of us were immediately distracted by keeping BSparl's grabby little hands away from the hot plates. We had a nice dinner, and I sort of forgot about the fellow Navy Seal at the other table.

... Until we were leaving the restaurant, when I saw her glance at my hip (where my Animas Ping was tucked away), nudge her husband, and give a little nod. 

And within an hour, it was done.  It's that strange voice of diabetes, where it's screaming in your ear one minute, nearly deafening, but then slides back into a whisper.  I was back up to 130 mg/dL. Within a few more hours, the low hangover had passed, and I felt like a human being again. 

And the beat goes on.

"My name is Kerri.

I could go through the hassle of establishing a nom de plume, but I wasn't thinking when I set this up and I signed in with my real name. Note to Potential Stalkers: Please don't.

The purpose of this is to make contact with other diabetics. It's one of those diseases (or maybe they're all this way, I'm not sure) where even if you have the mechanics of it completely mastered, the psychological battle is just as daunting. Every time I test my blood sugar, the result stirs me up emotionally. If I'm high, I feel guilty. Or surprised. Or angry. If I'm low, I feel anxious. And slightly panicky. Or confused. A normal reading level might make me feel cocky. Or successful. But they all make me feel something. And it's not just physiological. There is so much involved in the daily maintenance of diabetes that a support network isn't just nice, it's necessary.

Reach out. Ask questions. Answer the litany I'm sure to ask. Network network network. And when that doesn't work, just repeat repeat repeat."

Seven years ago, I felt alone with diabetes.  But now, as I begin my eighth year of blogging, I don't feel alone at all.  The Internet has opened up a world of support that I wish existed back when I was a kid, as it's had such a positive influence on my overall health.  Your support empowers me to take better care of myself, and you guys are an integral part of my healthcare team.  Just knowing you're out there makes a world of difference.

There's something really powerful about that.  And something really awesome.  

Thank you so, so much for reading over the last seven years!!  I'm so proud to call you friends.

That whole afternoon, and evening, was spent watching the Dexcom graph holding this frustratingly steady line above 200 mg/dL.  My numbers were impenetrable to boluses, injections, etc.  I tried to blamed travel, or exhaustion.  Whatever - I'd be fine in the morning, right?  That night, I went to bed with a fair amount of insulin on board, the Dexcom in a glass by the bed, and my alarm set in anticipation of the low blood sugar I was sure was coming.

Only it never came.  And I woke up at 221 mg/dL.  

I spent the day at home yesterday, trying to bring my blood sugar down.  Changed out the infusion set on my insulin pump.  Swapped out the bottle of insulin I was using for a fresh bottle.  Exercised on the stupid ellipmachine for an entire episode of Glee (don't judge - I wish I hated the show but I don't ... yet).  Drank lots of water.  Ate less-than-carby things like eggs and tea and green beans.  Blah, blah, blah.

But I stayed high all freaking day.  And for the first time in a really long time, I was mad.  Being at an elevated number for over 24 hours had my head pounding and my legs feeling like they were saddled with brick-laid shoes.  I didn't feel energetic.  I had a hard time keeping up with the happy play schedule of my daughter.  I didn't want to be chatty with my husband.  I was pissed that this streak of highs was so hard to break, even though I was doing a lot of the "right" things.  I was angry at diabetes for derailing two full days, without a break.  Diabetes and I don't normally have a contentious relationship, but I could have put the whole mess through a meat grinder yesterday.  (Or made it stick a fork in a plugged-in toaster ... not that I haven't thought about that for it before.) 

I wanted to go upstairs, get into bed, and sleep until I was back in range because it was clear that my efforts to fix the numbers were falling flat.  

Some days, I look at my blood sugars and I know why they're where they are.  I know when exercise causes a low.  I know when alcohol influences one, too.  I know when I've miscalculated carbs by accident or eaten more than I originally bolused for.  But there are days when I look at the numbers and just throw my hands in the air (waving them, like I just don't care) and say, "Screw it."

This morning, with the same infusion set and I:C ratios and basal rates and insulin as the day before, I woke up at 121 mg/dL.  Much, much better.  But how?

Diabetes, you are a fickle one.

We spoke at length about how some companies in the diabetes space have really become engaged with their patient audience, citing my partnership with Animas as an example.  "They trust me - despite the fact that I'm a 'blogger' - and our work together shows that relationships between customers [patients] and companies doesn't have to be contentious.  It can be supportive and tuned-in, with integrity and full-disclosure paving that path.  It also shows that real patient experiences are what resonate for real patients."

I know it's important for patients and caregivers to acknowledge the psycho-social aspects of a health condition, but knowing there are people within pharma organizations who view patients as important stakeholders in the discussions makes me feel hopeful that there's enough common ground to make a real difference in health outcomes, and not just bottom lines. 

After all, we're all patients. 

Mandatory "red phone booth" photo

[Disclosure:  Many thanks to BI, Animas, and the Pharma Times for their hospitality!  Boehringer Ingelheim doesn't make (at least to my knowledge) any of the diabetes devices or drugs that I use.  Animas does, however, and they were kind enough to provide my travel, lodging, and an honorarium for appearing at the meeting.  My full sponsorship agreement with Animas is outlined here.   Also, it rained a ton while I was in the UK.  That's unrelated to this disclosure, but still worth mentioning.]

It's the most wonderful bag.

Which is why last Wednesday, as I was walking along a footbridge towards the London Eye and the strap of my bag snapped away from the metal hold piece, my heart sank as quickly as the bag tumbled off my shoulder. 

This is how the bag should look.

"You okay?" my friend asked as I clutched the bag with both arms.

"Yeah, I just need a quick second."  Pulling the belt off my raincoat, I snaked the belt through the loops that should have been connected by the metal latch until it held tight.  "It's fine now."

Improvisation.  It's sometimes the name of the game when it comes to diabetes.  Ladies with insulin pumps have surely Macgyver'd their way in a few little, black dresses.  Runners with diabetes have found ways to keep their supplies and their feet light.  Ever had a low blood sugar where you find yourself eating 18 month old fruit snacks from your glove compartment?  Ever had a high where you have to pull a rogue unit or two of insulin from your pump reservoir and shoot up with a syringe?  Plan ahead all you'd like, but there will be diabetes moments where you just have to wing it.

It makes sense: our pancreases go pfffft and we're charged with finding ways to keep going without producing our own insulin.

Locked and loaded until the bag can be properly fixed

Stuff breaks?  Find a way to bandaid it.  It might not be a permanent fix, but it's enough to hold until there's a better option.  Sometimes you have to improvise.