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June 29, 2012

Rage Bolus Redux.

I love seeing Diabetes Terms of Endearment popping up in mainstream diabetes information sources (and it's even better when the terms are capitalized, as if they're proper nouns.  Proper Nouns!) 

Like this Glu question from last week:

"Rarely."  These days.  Last year, the answer would have been "all the freaking time."

A little rage bolus action, anyone?  Maybe SWAG bolusing will be next.  :)

June 28, 2012


Dear lovely Bird,

You have officially lost your little Birdy mind.  And with that little mind went your verbal filter, because good Lord, you have started talking.  And you haven't stopped.  Not even when you sleep, because in the thick of the night, you break through the silence with a rousing rendition of Chicka Chicka Boom Boom or your garbled version of a lullaby.  

Like your mama, you love carousels.

"Mama, you took a train from Pennsylvania to Rhode Island! That's nice."
"Mama, the beach.  Let's go?  Okay!"
"I saw a bird in a tree and it was in a tree a BIRD!"
"What Prussia doing?"
"I don't want to wear socks. I want to wear my buss-a-rye wings."  (Butterfly wings.)

And your learning curve about diabetes is growing by leaps and bounds.  I took a few days off from pumping (Impromptu pump vacation, born out of frustration with a dress I wanted to wear.  A few days of Levemir injections and Humalog pens wore thin, so I reconnected this morning.), and you noticed right away. 

"Pump, mama? Where your meh-cine?"

"I took it off for a few days.  It's okay.  I'll put it back on soon."

"Okay," you said, absently.  And then about twenty minutes later:  "Mama, your pump is for diiiii-aaaaaah-beeeee-teeeees!!!" 

"Diabetes" has a very specific vocal range, when it comes from you.  It's a song, it's a command, it's something you say with your thumbs jutted out and your mouth in a wide grin, having no idea what it means but you like the way it sounds.  "Mama's meh-cine for diabeteeeeeeeez!"  This statement is usually followed by a dance, with your elbows out and your knees bobbing.

Dancing is your other passion these days, aside from talking incessantly.  You dance everywhere.  We went out to eat last night and you were up on the booth, dancing at the very concept of chocolate cake.  "Choc-it cake, mama!  Yay!!"  And out come the wild elbows and assorted Birdy dance moves.  (Your moves are enviable.  And videoable, when your mom and dad are able to stop laughing for long enough to switch on the camera.)

My badass little Bird.

Oh wait ... you have one other new passion.  Tantrums.  Epic, insane tantrums that convert me from calm Mom to Mayor of Crazytown.  You yell "NO!" with such precision that it snaps my eardrums into two and makes me sweat instantly.  In the last few weeks, I've started speaking in those maternal interrogatories.  "Do you want me to turn this car around?"  "Do you want leave the store now, because you're acting bonkers?"  And the classic:  "Do you want to go in time out?"  (You put yourself in time out now.  And sometimes, you put me in time out.  We're all in a learning curve here.)

You make my life interesting.  You stress me out in ways I didn't think were possible.  And you make my heart explode when you say something as simple as, "Yes, please, mama."   I love you bunches, Birdy.  But please, slow down; I can't keep up.


June 27, 2012

From Abby: Jinxed It.

Abby jinxed herself.  ;)

*   *   *

This is what I used to keep my insulin in ... actually, I used to keep it in my pancreas.Ever get in those ruts of weird blood sugars that just don’t make sense and you know it’s because you have recently told someone that you’re in really good control, so you basically jinxed yourself?

Yeah. That.

The past week I have woken up around 3am with a BG over 250mg/dL four times. There is absolutely no pattern to why this is happening. Other than a week and a half ago I told someone that I was doing a really good job with my diabetes. This is the only logical explanation.

Last night when I woke up at 4:00 am and I tested and saw a 301 mg/dL I realized diabetes karma was kicking my ass, and my kidneys, heart, micro-vascular system, etc. I corrected through my pump site and laid back down. Only to sit there and think, "Hmm, I put this site in on Friday night. It is now Wednesday at 4am. That’s disgusting, and clearly not okay. I should check my ketones."

Sure enough, that strip turned raspberry pink faster than I could even look at it.

So I stumbled back to my bed, grabbing pump supplies, insulin, and a syringe on my way. I re-corrected with the syringe (and put a juice next to my bed because clearly I’m an idiot and shouldn’t have corrected through my pump) and ripped out my site. The old cannula looked great, the site looked great, but I realized I went to the beach all day on Saturday with this insulin and it’s probably all sorts of denatured and as good as water at this point.

This is when I thought of this brilliant plan (at 4:00 am, mind you) to fill my reservoirs only ¾ full since 180 units is lasting me way too long now that I’m exercising more and eating summer time foods that don’t have as many carbs. Also, my pump is exposed to much hotter temps so my insulin isn’t going to last as long. (This all went through my brain, I’m not kidding you. I should work nights, because I am not this smart during the day.) So I did just that. Filled up the new reservoir to about 140 units and put a fresh Mio into my arm (where I get great absorption and killer tan lines).

... the 44 mg/dL that hit me at 6:00am was a good one though. It was a stuck to my sheets, room spinning, juice drank in record time kind of low. But it was expected, and I didn’t freak out. While lows are never fun, feeling guilty about organ damage at a BG of 301 mg/dL is worse – for me.

So there’s my story about how I need to stop being an idiot and trying to reduce all the waste that a pump site change generates and take care of myself. Hopefully this new tactic will reduce the weird highs I’m having at night, or at least I’ll figure out what’s causing them, other than angry dia-gods.

*   *   *

Do you have different ways of managing your diabetes crap during the hot, hot heat of summer? I'm with Abby on the "filling the insulin reservoir only 3/4 of the way" methodology.  Any tricks or tips that you use? 

June 26, 2012

Dexcom and Earthquakes.

Earthquakes + apps = diabetes?At the ADA Scientific Sessions two weeks ago, I ended up in a conversation with Tom Karlya about the Dexcom and how sometimes the alarms don't wake me up when I need them to most. 

"Which is why it ends up in a glass on the bedside table almost every night," I said to him.

And then he told me about this iPhone application, iSeismometer, that was created to detect earthquakes and alert people at the very first vibration, letting loose with an insanely loud warning alarm.  Loud.

"But if you put the Dexcom receiver on the same table, and the Dex starts to vibrate in response to a low or high, the iSeismometer picks up the vibration.  And you won't sleep through that alarm," he said, chuckling.

The app is free, it's smooth and easy to set up, and the accidental application for diabetes is priceless.  (There's an option to Report an Earthquake, which I have switched to "off" since I'm using it for Dexcom alarms; otherwise, there's going to be a sharp increase in "earthquakes"reported  in Rhode Island.)  

So can earthquake apps be cross-posted in "Health" in iTunes?  Yup.

June 25, 2012

This Sucks.

Abby the Cat has been missing for several days.  We've called the local shelters, we've alerted all of our neighbors, and we've checked everywhere in our backyard.  This sucks, because the more days that go by without finding her, the less hopeful I feel.

This cat is awesome.  I've had her since my freshman year of college, she's a wonderful head warmer, and she's my living, breathing CGM.

Abby the Cat

I hope she comes home, safe and sound, very soon.

June 22, 2012

HCPs, Patients, & the Web: An Interview with Dr. Berci Mesko.

Dr. Berci Mesko.  That guy.  You know him.Berci and I 'met' online seven years ago, I think (which equals out to about four hundred in Internet years), and had the opportunity to toast in person a while back.  I've been following his progression in medicine through social media, and I'm proud to be chatting with him here on SUM today, looking forward to what's next for this socmed trailblazer.

Kerri:  You've been a strong voice for social media being part of the health care system.  What initially ignited your passion in this space?

Berci:  My answer is quite simple. I have been a geek for a long time and when I had to face the old structures of medical communication and education, I was surprised I couldn't use my well-designed online methods to solve my challenges in medicine and healthcare. So I started working on new solutions that could be implemented into healthcare. I first became active in the medical segments of Wikipedia, became and administrator there, then I found out a blog could be the best platform for my online presence so I launched Scienceroll.com. Later when I tried to find quality social media resources focusing on my fields of interests such as genetics or cardiology, I realized how desperately we need a service that curates medical social media channels for free, this is why I launched Webicina.com.

As you see, I had very clear reasons to become more and more active and to find my own solutions as a geek.

Kerri:  Why do you think it's important for health care providers to be involved in the social media space?

Berci:  It might be a surprise, but I don't think all of them have to be involved. There are a lot of patients who do not use the internet in their health management and do not require their doctors to communicate online. But as the number of e-patients is rising rapidly and as the amount of information we have to deal with is growing day by day, social media can offer great solutions for simple problems such as being up-to-date or communicating with peers.

Basically, using social media is the same as having a real life conversation only with a few exceptions therefore I think the same rules should apply for social media as for offline communication even in medicine. Be respectful, listen closely, be consistent when publishing online and always think twice as whatever content you publish online as a medical student or professional will hunt you down.

Otherwise, social media can be a huge help for physicians by using online platforms, crowdsourcing and other extremely useful features if they know exactly what they want to achieve and know the rules and limitations.

Kerri:  Where is medicine going, in a social media sense, and how can patients be more actively involved, in your opinion?

Berci:  The only thing we don't have to deal with right now is the way patients use social media. Their motivation is clear: they have a medical condition and need information. The easiest way nowadays to get information is to turn to the internet. There is no question, they will use it more and more frequently in the upcoming years.

On the other hand, this is the job and responsibility of medical professionals to become their guides when it comes to the assessment of quality information online. Physicians should be able to meet the expectations of e-patients. As Farris Timimi, MD of Mayo Clinic Center for Social Media said, this is now part of their job. Medical professionals are natural communicators and now social media is a a huge platform used for that purpose and they have to know the tricks and potential dangers. The only way to do this properly is including digital literacy in medical curriculum just like I did when launching the world's first university course focusing on social media and medicine for medical students and also when I launched the global format of this course so then every medical student in the world can get this kind of knowledge even if they don't have such a course at their medical school.

Kerri:  How does Webicina help bridge the gap between health care professionals, patients, and the web?

The mission of Webicina is to curate the medical social media resources in many platforms, from many perspectives and in many languages. Coming up with the most relevant social media channels focusing on a medical condition or specialty is extremely difficult. The process of curation consists of 3 steps: 1) crowdsourcing through our social media channels that have been built for over 5 years, 2) the Webicina Team designing a collection based on the results of the crowdsourcing, and 3) checking each resource again and providing the reasons why it was selected.

Through PeRSSonalized Medicine, our users can follow the latest updates of any social media channels dedicated to medical conditions and specialties in the simplest, customizable, multi-lingual social aggregator in which if you click on the e.g. German flag, not only the platform will be in German language, but the resources included in the database will be the best German ones. We work with international collaborators to ensure the amazing quality of these collections.

We also provided an award-winner iPhone and Android medical app with a special health 2.0 quiz. Of course, everything is for free on the site.

Then we managed to crowdsource an open access social media guide for medical professionals and pharma.

We try to help e-patients and medical professionals use social media efficiently in as many ways as possible.

Kerri:  And to cap this off on a less structured note, what are the top three social platforms you're fiddling with these days?

Berci:  I would say I'm using Google+ these days quite frequently, but regarding other new platforms, I'm not really convinced those would help me do my job better so even if I gave a try to Pinterest and others, I keep on using those communities I've been building for years to filter the information for me every day (Google+, Facebook, Twitter and Friendfeed).

*   *   *

By way of disclosure, I am on the Webicina Advisory Board.  I have no clue how to function on Pinterest.  And also, I've got legs.

June 21, 2012

From Abby: Sodatastrophe!

The Great Soda Switch?  Could it happen to you?  Does this sound sensationalistic enough?  ;)  Abby experiences it firsthand.

*   *   *

Don't let Sodatastrophe happen to YOU!(A recent Facebook status update from our favorite diabetes ninja convinced me to write this story. I wasn't going to bring light to it, because I didn't think it happened often, but apparently it can. And does!)

I don’t put much faith into fast food joints. I order safe things (if I even go) that I pretty much know the carb count of, or can look them up online, and I stick to things that are tried-and-true for me.  Basically, I eat the same things, from the same places, when I'm eating fast food. 

So a few weeks back, I was traveling home from a really fun (but blood-sugar-havoc-wreaking) trip to Rhode Island (No, not to see Kerri and the Bird, unfortunately [Editor's Note:  Next time!!]) and we stopped at Panera to soak up some veggies and bread. I sauntered over to the soda machine and put my cup under the Diet Coke (the caffeinated one). What came out, you ask? Bubbly water. No Coke whatsoever. Lame. I walked up to the counter and politely said, "Um, excuse me? The Diet Coke seems to be out of ... Coke. It’s just soda water." And the woman responded, "Oh, really? Okay,  I’ll have someone check on that right now. Sorry!"

And so I proceeded to fill up my cup half way with Diet Caffeine Free Coke. Or so I thought.

Another woman came out about ten minutes later and put a sign on the regular Diet Coke button that said “Out of Order”. Imagine how bummed I was, since we had another two and a half hour car ride back home. So I finished my meal, and filled up my cup with the not-as-tasty caffeine free Diet Coke on my way out.

And then chugged the whole cup in the car.

An hour later, Dexy is screaming at me that I’m 350 mg/dL with an up arrow. To which I responded, "What the heck? I always eat that food at Panera, and I know I bolused right.”

Finger stick confirmed: 372 mg/dL. This is when I realized that I probably didn’t notice the weirdness taste of the must-have-been Regular Coke I’d clearly chugged since it was supposed to be caffeine free and I chalked up the weird taste to that.

A quick stop to a gas station (to pee, of course), a liter of Aquafina, and a hefty correction bolus later, we were back on the road.

Moral of the story: Even the soda you get by yourself from the machine isn’t always a safe bet.

(Disclaimer I freaking love Panera and have been back since. This will not hinder the fact that their Asian Chicken Salad and Broccoli Cheddar Soup are downright delicious. I’m just going to stick to lemon water from now on.  Safer.)

June 20, 2012

Gritty Little Infusion Sets.

I love the beach, and it seems that I've given birth to a little beach blanket Birdy.  We've spent some time on the shore so far this summer, and we build sand castles and play in the ocean and make a proper mess of ourselves.  But all the sand and salt water can do a number on my infusion set, namely clogging it up and making it hard to disconnect/reconnect at will.

This sandy little Bird makes for a messy insulin pump.

Quick fix?  A splash of bottled water to rinse out my infusion set.  Takes away that gritty, sticky feel from my site and makes reconnecting a snap.  (Puns.)

(But a fix for keeping the Dexcom sensor tape intact through a few days at the beach?  No clue.  I've yet to find a good solution.  The beach melts sensor adhesive like it's made out of Popsicles.)

Mmmm.  Popsicles.

June 19, 2012

Visual Reminders.

There are approximately 1,152 grams of carbs in a bathtub full of Golden Grahams. That's without taking the plumbing into account.A deck of cards.  A baseball.  A pair of dice and you only look at one of them. (Sorry for the clumsiness; I think it's weird to write "A die." as a sentence.  Looks odd.)  A tennis ball.   A hockey puck.  

The things that health-related articles use as "visual cues" for portion sizes and serving sizes makes me wish I was more athletic, because then I'd have a really strong feel for the size of these different balls, etc.  (Sidenote:  Hey. Ever write something you want to immediately delete but then you keep it and just wish your brain was less daft?)  But these visual cue things are helpful for me, because if I don't take note of just how big "one small apple" really is, it's easy to lose track of how much I'm eating.  I need to constantly refresh my eyes on serving sizes, which in turn helps me better estimate carbs when I'm SWAG (aka Scientific, Wild-Ass Guessing)'ing it.

(Second sidenote:  The hamburger pictured here looks exactly like a fudge-drizzled chocolate cookie, which is making my brain very confused.)

Which is what I spent part of my morning doing today:  busting out the measuring cups in my house and reminding myself what certain foods look like when properly measured out.  I'm not shooting for serving sizes or anything FDA official.  I needed to do this purely for carb assessment reasons.  What does 35 grams worth of Rice Chex measure out to look like?  How much salad dressing is 10 grams of carbs?  Brain, be reminded of what 28 carbs-worth of banana goodness looks like!!

Birdy thought I was a basketcase this morning, measuring things out and then putting them back.  "No eat banana, Mama?"  "No more cereal and milk, Mama?"  "That chicken is very good, right, Mama?" By the time I started eye-balling the lunch meat and measuring it on our kitchen scale, she threw her hands up in disgust and went to find her Thomas trains.  (Tertiary sidenote:  Spencer, the silver, streamlined diesel train, is the same size as 15 grams worth of banana, dagnabit.)

But now my brain is brought back to reality.  Less guesstimating and more true and proper estimating, which should help me fine-tune my boluses a touch.  Reminders like this are helpful in keeping me from sliding down that slippery slope of eating 18 lb apples and bathtubs full of Golden Grahams.  

(Last sidenote:  I'm sorry that only 2/3 of this post made sense.)

June 18, 2012

Pushing Through.

Old timey!!Before the Bird arrived, making regular exercise part of my routine was easy ... ish.  Since I wasn't responsible for anyone other than myself, I could structure my visits to the gym around my work schedule.  And since I spent most of my 20s working a very regimented 8 - 5 work schedule, going to the gym after work became a routine.  It was a boring, predictable routine, but at least I could lay claim to exercise more often than not.

But hey!  Things are decidedly less predictable these days, with my schedule completely dominated by that of the Bird and the fact that I work from home.  In theory, it sounds like I should be able to plan my day and have a reasonable schedule, and that was the attempt, at first.  But Birdy doesn't always wake up at a predictable time.  And I definitely don't always go to bed at a predictable time.  The contents of the hours in between are all over the map - in a good way - but not in a scheduled way.  One day can include a series of conference calls book-ended by laundry.  Another day might include bringing the kid to the beach for the morning, and then trying to meet deadlines while she's taking a nice, long afternoon nap.  I spend lots of time playing with my child, and also working on work things. 

But working out?  Pfffft.  That's no longer a daytime event.  I've become a creepy version of cardio-Batman, working out in the basement late in the evening with my pump clipped to my hip and the Dexcom balanced on the ellipmachine.  (And a cape.  How else can I be a crusader?)  The ellipmachine and I are very good friends these days, and as previously mentioned, I catch up on missed episodes of Colbert (NATION!) on Hulu as often as I can.  Keeping exercise as part of my regular routine has been a big challenge, but thanks to Chris and his flexible schedule, it's not about carving out the actual time.

It's more that the 'actual time' is after 9:30 at night.

I don't mind a late night workout.  It wakes my brain up and helps me mentally organize the things I'm working on.  But it's tough to fall into bed at midnight after a 9:30 pm workout; I'm more inclined to go outside and grab the saw and take down some pesky tree branches that have been bugging me.  (I love sawing down branches.  Love.  I wish I was Paul Bunyon.  Maybe Siah will dress up as a big, blue ox?) 

Working out late is contributing to a bit of insomnia, and it's also making me wary of middle of the night low blood sugars.  Thankfully the Dexcom helps me make clearer sense of what a 140 mg/dL before bed might mean (140 and dropping? 140 and holding steady?  140 and double arrows up?), and the context it adds helps me make better nighttime decisions.  But still, the later I work out, the more I'm a little nervous about the 4 am time frame, where nightmares sometimes include juice and graham crackers.

From past experience, I know that once I do the late night workouts for a few weeks in a row, my body will adjust.  And I'll figure out what/where/when to tweak.  In the meantime, it's setting an alarm for 3:30 am and doing a quick finger stick, just to make sure.  

... maybe I can teach Siah the Big Blue Ox to help out with that wee morning check.

June 17, 2012

Father's Day.

Happy Father's Day to the man who shows his daughter how much he loves her, every day.

We love you, DaddyMan.

Your Girls

June 15, 2012

The Friday Six: Phil Donahue.

The Friday Six:  June 15, 2012 editionThe weather here in RI (or so I've been told - haven't been home much lately to see for myself) has been decidedly un-summery, with rain and temperatures in the low 60's.  Which is why today, a day with sunshine on tap and the promise of reaching 80 degrees, is a good day to bunk off and go to the beach with the Bird. 

But first, some Friday Six links:

1.  Today is the last day for the public to vote for the DHF Seeds grant recipients.  There are some excellent projects up for consideration, and you can find out more/view videos/vote by "Liking" on Vimeo here

2.  Today is also the one year anniversary of Kim's You Can Do This Project, and in the last twelve months, this video project has served to inspire, empower, and rally the diabetes community.  Thank you, Kim, for creating something that truly makes a difference.  We love you!!

3.  I'm very happy to be home with the family, and it cracks me up that Birdy is keeping a running, slightly inaccurate mental log of where I've been.  "Mama, you took a plane?  From Californana.  And then you were in Pennsylvania."  "And where in Pennsylvania was I, Birdy?"  "Phil Donahue."  "Or ... Philadelphia - close enough, little Bird."

4.  Have you seen Snapseed?  It's a photo application for the IOS platform, and it makes photos look awesometown.  There was a promotion a week or two ago where you could download the app for free (thanks for the advice, Karen!), but it's definitely worth paying for, too.  It made a photo of the Grand Canyon that I took from an airplane look actually grand, from 36,000 feet up in the air. 

5.  And have you also seen this piece on A Sweet Life by Alex O'Meara, talking about Why Do People Get Diabetes?   This line alone is worth the read:  "One way to explain that disparity is that most people simply don’t believe diabetics deserve more investment in a cure. After all, they’re already getting what they deserve."  (Make sure you read the whole article before you form your own opinions about the writer.  ;) )

6.  And lastly, a friend of mine has a friend of his who was recently diagnosed with type 2 diabetes.  She's looking for the best resources for someone who's completely new, but in need of some support.  I'm more familiar with type 1 resources, so if you have advice/bloggers/websites/resources you can offer up for a newly dx'd type 2 in their early 40s, please share!

Time to grab the sand pails, sunblock, and Birdzone.  Off to enjoy as much of this summer as I can!

June 14, 2012

Diabetes UK: Type 1 Aware.

As a person with type 1 diabetes, it's hard for me to not see the symptoms of diabetes.  It's like when you're pregnant, and suddenly you see pregnant people everywhere.  (Like that first week I knew about Birdy, but we hadn't told anyone, and I saw seven different pregnant women walking toward the train station near my office in Westport, CT.  I was convinced there were multiple baby showers taking place on the Metro North.)  When people talk about excessive thirst, exhaustion, and frequent trips to the bathroom, my ears perk upon behalf of my lazy pancreas. 

Which is why I like this campaign from Diabetes UK, about helping raise awareness for type 1 diabetes.  Check out this video:

This video is plain and simple, and doesn't make the symptoms confusing with careful language.  My only addition would be to say that type 1 diabetes doesn't just affect children; it's a disease that doesn't care to discriminate, and can be diagnosed at any age.  (I learned at the ADA Scientific Sessions that the rate of T1D diagnosis is rising alarmingly - more on that later.) 

The campaign from Diabetes UK is looking to have a million video views by November 14th (World Diabetes Day). I've already watched it twice.  ;)

June 13, 2012

Lows in Public.

"No alcohol, please!"I heard the Dexcom BEEEEEEP!ing in that frantic, "you're low" kind of tone and my brain was swimming with confusion, so I went to the bar at the dinner event and asked for an orange juice. 

"Do you want vodka in that, as well?"

"No, definitely no thank you.  Just juice, please."

The bartender filled up a small tumbler with orange juice and I downed the contents of the glass in one giant gulp. 

"Thanks," I said, and wandered off, fishing my meter from my bag to get a true assessment of how far down the rabbit hole I'd fallen.

There isn't ever a convenient time for a low.  I suppose the ones that happen when I'm at home and are only in the 60 mg/dL range and can be treated with the logical and tempered rationing of glucose tabs are better than the ones that happen in public.  When you're at a dinner event and you're trying to meet people and make a favorable (or at the very least, coherent) impression, it's not the most opportune time for a 38 mg/dL to make an appearance.

Once I saw the number on the meter, I became this strange, hypoglycemic bear, foraging for food and ready to growl at anyone in my way.  The very nice waiter who was bringing appetizers around to the attendees ended up with an empty plate after I had my way with him.  (Which sounds worse than it actually was; he only had three snacks left, but I snagged them and might have bared my teeth at him in the process.)  My low symptoms were peaking, with tears in my eyes and confusion on my tongue and every skin cell buzzing with panic and adrenaline. 

I do not like being low in front of people.  I don't like that momentary weakness and the vulnerability and that empty, lost look I've been told takes over my eyes.  I don't like that lack of control.  I don't like when my knees buckle while I trying to keep myself upright.  I don't like the look of "Are you okay?" that comes over the faces of most people, because it's one of the very few times I have to answer, "No, I'm not."

Thankfully, I was at a diabetes-related event, surrounded by people who either had diabetes, cared for someone with diabetes, or worked to cure diabetes.  So when I casually mentioned to Jeff Hitchcock that my blood sugar was tanking and I didn't know what was going on, I was ushered quickly and covertly to a seat at a nearby dinner table so I could make sense of things.

"I'm fine, you know.  I had juice.  I'll be fine in just a few minutes," I said, folding and refolding the napkin on the table while I waited for my blood sugar to respond to the juice.

"I know," he said, his voice calm and reasoned.  "We'll wait."

As it always does, the panic subsided.  My blood sugar came back up into range (and went up just a bit more than it needed to, thanks to downing that whole glass of orange juice).  And I was able to rejoin the dinner conversation without needing a three-minute lapse between thoughts, thankful for people who "know."

June 12, 2012

Shake Shack.

Only at a diabetes conference can you connect with a fellow DOC'er (hi, Bennet!!) and go here:

Shake Shack for the win

And eat this:

Yes, I eat a burger with a knife and fork.  Don't judge.

And still end up with this:

Holy post-prandial, Batman! 

This year's Scientific Sessions worked me over both in information overload and lots of walking.  (I think my total daily dose for the last week has been almost entirely basal.)  But I'm looking forward to sharing what I've learned ... and I'm also considering petitioning for Shake Shack to bring its tasty little self up to Providence.

June 11, 2012

Looking Back: These. Are. KETONES!

Today I'm looking back on a post from July 2010 about ketones.  Because I still like saying, "These.  Are.  KETONES!" in my head, and then mentally pushing diabetes into a bottomless well.

*   *   *

I have no idea how it happened, but yesterday was a crummy day, diabetes-wise.  Somehow, early in the evening, I heard the Dexcom singing from the kitchen countertop, and BSparl and I went over to investigate.

"High."  With a long line at the very top of the Dexcom screen.

"Hi, to you, jerkface," I said, pulling out my meter to see just what the greeting was about.  And I saw a sticky 451 mg/dl blinking back at me.

"What the fern?"  I couldn't figure out how I ended up so high, especially since after lunch I was 174 mg/dl and flatlined on the Dex.

And I was so angry.  How does this happen?  Did I eat the wrong thing?  Take a shallow bolus?  Is the pump ferning with me?  Could the insulin have spoiled?  Did I just lose track of everything and my numbers went berserk on me?

I was beyond battling with variables.  High as can be and sporting ketones?  I wanted this fixed NOW.  So BSparl and I went into the bathroom to do a full once-over.  Brand new pump infusion set, brand new bottle of insulin, and I took an injection from a syringe instead of bolusing, to make sure I'd come down within a few hours.

I did a ketone check and confirmed my suspicions:  small ketones.  Oh for crying out loud.  I felt like I was in a battle against 100,000 variables, and all I had were these remedial tools with which to battle back. 


A few hours later (and after a nap and after skipping my workout and after explaining to BSparl why her mommy keeps peeing on a stick), I was back down to 213 mg/dl and still falling.  And when I woke up this morning, it appeared that I had fallen to about 90 mg/dl and held there all night long.  Lucky save.

I am not a fan of these kinds of glitches on the battlefield against diabetes.  (But I do love me some Photoshop.  Because there's something so fun about arming King Leonidas, and his mega-abs, with a syringe.)

June 07, 2012

Linkable Diabetes Moments.

I'm headed to the ADA Scientific Sessions today (currently on a flight from LA to Philly, cruising at an altitude of some specific height but I can't remember it because I picked up a wicked case of poison ivy on my arm just before I left home, so now I'm blogging and itching like mad and I tried to pretend I was contagious but I still ended up in the middle seat), but thanks to in-flight wifi, I've spent the last hour or so combing through blog posts and Facebook updates that I've missed.  Which brings me to the end of this paragraph, and also to the links I wanted to share:

  • This is the most riddddiculous (the extra D's are in homage to the grammar and spelling found in this "article") diabetes write-up I've seen in a long time. Someone please send them a dictionary. And a proper photo of Bret Michaels. And maybe a punch in the nose, but I'm not sure how well those travel. 
  • But this post, from Wendy at the Candy Hearts blog, is beyond lovely, and a great reminder that we are more than all of these diabetes bits and pieces.
  • There's a TuDiabetes meet-up happening at ADA's Sci Sessions this year, and it's taking place on Saturday, June 10th.  Click here for more details.
  • My Canadian friend, Buzz Bishop, is raising awareness and funds for Team Diabetes using just a few words.  Actually, he's only using 140 characters, making the most of a Twitter hashtag campaign.  Read more about his efforts for the diabetes community on his blog.
  • Zakary explains type 1 diabetes with brevity, simplicity, and accuracy by showing notes from her daughter's recent endocrinologist appointment.  WTF indeed.
  • In support of my friend who lives with type 1, married a man with type 1, and is raising two kids with type 1, please show some love for her son Ryan P in his ambition to become a Downy Little Champ and score a trip to London for the 2012 Olympics. The whole family is incredible - please vote for Ryan!
This concludes today's blog post.  Please return your tray tables to their full and upright positions.  And other plane stuff.

June 06, 2012

Literal Lifesavers.

I've had a lot of diabetes-related interactions with people that have been crummy, miserable experiences.  But I have been fortunate in that so many other moments of discussion and disclosure have been informative and supportive ... and sometimes there's a bit of free candy thrown into the mix.

"I spied the bag of Skittles in a display behind the counter.

“Actually, can I also add a bag of those Skittles, as well?”

The girl shot me a confused glance. “You want Skittles and the fitness center? Doesn’t that go against the whole ‘working out’ thing?” She wasn’t being rude; she was genuinely bewildered."

The rest of this story is over at Animas.  :)


June 05, 2012

Looking Back: Insomnia.

After the kid was born, insomnia wasn't a problem for me because I was so exhausted on a regular basis that I would fall asleep at any and every given opportunity.  (Which was frustrating at the movies, because nothing sucks more than paying $20 to take a nap.)

But now, two years later and with more of a predictable schedule, insomnia has set back in, and I'm awake at all hours.  The toll on my diabetes management isn't as steep as it was a few years ago, but it does do a number on my numbers some days.  Today, I'm revisiting a post from 2008 about the importance of sleep and diabetes.

*   *    *
My cats used to sleep with cartoon bubbles over their head.  But alas, they stopped doing that.Back in high school, I used to have wicked insomnia.  I would lay there in bed for hours, unable to fall asleep.  Then I'd get stressed out because I couldn't fall asleep, which kept me awake longer.  Reading a book didn't help.  Watching TV didn't help.  Warm milk is gross, so I didn't even try that.  And some mornings, I would fall asleep during anatomy class.

But my insomnia spells were limited to my senior year of high school, and in college, I fell into a more predictable, comfortable pattern of work-class-party-sleep.  I thought this insomnia crap was behind me.

Last night, though, it came back with a vengeance.

Part of what keeps me up at night is the spin-cycle of my mind.  (The Internet doesn't help.)  I'll start thinking about something I'm writing, or something I want to talk to coworkers about the next day, or how I forgot to call my friend back, or how I need to pick up my prescription from CVS, or the emails I keep meaning to answer ... and then I'm cycling and spinning and afraid to look in the mirror for fear of seeing smoke wisping from my ear.  Add in the viewing of a few SNL political clips and checking the Election feed on Twitter, and I'm officially Sleepless in Western CT.

Chris was away on a shoot, so I was by myself in the apartment.  Silent night.  Holy cats splayed out everywhere,, with Siah purring from the pillow next to me, Abby on the floor underneath the window, and Prussia standing guard at the bedroom door.  The sheets were crisp and clean, the bedroom was that perfect "sightly chilly with a chance of sleepy," and it was one in the morning - so I should have fallen right asleep. 

Instead, I relaxed against the pillow and closed my eyes ... only to have them spring open like window shades.  I could not sleep.  One thirty came and went ... two o'clock ... and I was still awake.  My blood sugars were solid (and holding - the Dexcom confirmed a flatline), my stomach was full (yum, lentil soup), yet my brain was wide awake and refusing to let me sleep.

Facing a sleep deficit is something that's always taken a huge toll on my body.  I don't require a ton of sleep - six and a half hours is comfortable for me - but anything less than that has me dragging myself around the next day.  Sleepiness doesn't seem to affect my blood sugars (woke up at 100 mg/dl this morning), but it definitely affects my overall ability to manage diabetes.  Like this morning - I showered, dressed, and was making breakfast before I realized I hadn't reconnected my pump.  I also went all the way out to my car and started it before realizing the Dexcom receiver was on the kitchen counter.  I forgot to bolus for my snack this morning.

Being sleepy = being absentminded.

Being absentminded = dodgy diabetes control for the day.

Does a crummy night's sleep cause your day to get all mixed up?  Does your diabetes suffer?  Is there any way we can Zzzz ... zzzzz ....
*   *   *

June 04, 2012

Insulin Pump on the Beach.

"Oh, it's like what Cindy has!  That's what Cindy has!"

The lady was about twenty feet away from me, stage-whispering to her husband. 

"Is that the pump?  The insulin pump thing?"  her husband asked, gesturing toward me.  

I lifted the beach blanket by its corners so it would spread out nice and flat.  "It is an insulin pump," I said to them, waving, unaware until that moment how obvious my insulin pump was, clipped to the bottom of my bathing suit, the tubing tucked in kind of haphazardly; it was a diabetes Bat Signal.  "It's nice to meet you!" 

The woman came over, her hands fluttering and her mouth talking and smiling all at once.  She was so excited ...

"... to see a real insulin pump!  My daughter went on one a few years ago, but I've never seen anyone else with one.  And at the beach!!  She's going to love hearing this. Your pump looks different from hers - is it?"

(I loved that she automatically assumed I knew what kind of pump her daughter was on, as if there was a community of people with diabetes who are in constant contact with one another and comparing notes ... wait a second ...)

"Mine is an Animas pump.  Is hers Animas or Medtronic?  Does it have tubing?"

"Yes, it has the wires.  Hers is the Medtronic one.  She really likes it.  How long have you had diabetes?"

"Twenty-five years.  How about your daughter?"

"About twenty years.  She's 31.  She's trying to lose weight and be in better control.  I don't know half of what she does, but I know she's always trying to do better."  The corners of her mouth tugged into a brave smile.  "She doesn't know I worry but I worry all the time."

"My mom does, too."  My mother and Birdy were a few yards away, building a sand castle.  "She worries.  But she knows I'll be okay."

Beach blanket Birdy"Is that little one your daughter?"

"Yes.  She's two."

The woman smiled.  "My daughter would like to have a baby.  That's part of why she went on a pump.  You know."

Birdy came running toward me, her ponytail bouncing and covered in sand.  "Ocean, Mama!!"  The bucket of sand in her hand spilled as she lifted her arms excitedly.  "Sand!  I has sand!"

I gave the woman a big grin as my daughter tornado toddled up the beach, her arms outstretched. 

"I do know."

June 01, 2012

The Friday Six: My Snuffy Has a First Name.

Today would be a good day to go to the beach.  And for a Friday Six, because there are so many links roaming around unsupervised in my brain that I need to let them out:

1.  On a recent episode of Sesame Street (tv show du jour in my house these days), I learned that the Snuggleupagus has a first name ... and it's not "Mister." I saw his full name written on a piece of mail he received from The Mail It Shop, and a quick Wiki search confirmed it.  Snuffy's first name is ... Aloysius.  It's so close to Dumbledore's first name that I can't stop smiling.

2.  Every actor should be judged by his "see a birthday cake" face.  I've learned this from books.  (And if you haven't read Graham Roumeiu's Me Write Book: It Bigfoot Memoir, you're totally missing out on some excellently bizarre storytelling.)

We practice this at home.  "A birthday cake?! For me?"

3.  Did you know the Russian smiley face emoticon often goes sans colon?  Just a parenthesis. (How on earth does it conduct its business?)  Oh Wikipedia ... you color my world.

4.  The American Diabetes Association 72nd Scientific Sessions are taking place in Philadelphia, PA next week, and I'll be roaming around with a battered copy of the aforementioned Bigfoot book, glucose tabs, and a red moleskin for taking notes on the sessions that are sure to fill my brain with information.  If you'll be there, please say hi O hai.and point me in the direction of coffee.

5. Taking place today, at 10 am EDT, is a live chat on TuDiabetes with CDE extraordinaire (and Philadelphia 76ers fan) Gary Scheiner.  Gary wrote the book Think Like a Pancreas and has some great information for people who are living with diabetes ... because he is also living with diabetes.  Nothing like chatting with a medical professional who "gets it" on more than one level.  Tune in at 10 am!

6.  And lastly, the FDA has improved the first outpatient trials of the artificial pancreas project.  According to the JDRF website, "The approval of this milestone study follows a major 18-month long effort by JDRF and allies to ensure a clear and reasonable regulatory pathway for outpatient artificial pancreas studies, and ultimately for AP systems to be approved and made available by the FDA."  This is incredible news, and you can read more details here

That's all she wrote.  For now. 

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