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July 31, 2012

Looking Back: Paint By Numbers.

I'm scared of sharks.I see blood sugars everywhere.  (Street signs, clocks, doctor's offices ... everywhere.)  And today I'm looking back at this post from 2007 about how diabetes sometimes feels like a "paint by numbers" exercise.  (Also, I'm not sure I have had a bagel since 2007.  Sigh ...)

*   *   *

I looked into the bottom of my purse and saw the Cliff bar and a pack of gum.  "46 grams of carbohydrate."

I poured a cup of coffee this morning and added a little cream and Equal.  As I stirred the contents of the cup and chatted with co-workers, I thought "0.2u of insulin for the 2 grams of carbohydrate."  I eye-balled the bagels being offered up and watched as one morphed into a whole-wheat "8" and another into a sesame-seed covered "0."  80 grams of carbs.

The kiwi fruit, sliced and captured in a tupperware container, looked ripe and grass-green through the plastic window.  It would be a delicious morning snack.  Ten grams of carbs.

Nineteen carbs in that yogurt, five grams in a fistful of almonds, fifteen in that slice of whole-grain toast.  Convert how many units of insulin that I need to cover X amount of carbs.  Base these values on previously calculated insulin-to-carbohydrate ratios.  Make sure you take recent and future activity levels into account, in addition to factoring in some cushion time for the insulin to work.

It's a lot of math for this intrinsic English major to handle.  If I keep my brain tuned into the numbers only, I'm admittedly rattled and overwhelmed. 

Instead, I picture the culinary world as one, big paint-by-numbers picture.  Carbohydrate content calls out a value and insulin is my paint.  Some days the portraits are just breath taking, a sea of yellows and blues and a smattering of greens, blending together and keeping my blood sugar numbers from spiraling out of range. 

It's tough to keep my hand steady some days, especially now with all the holiday treats on every counter top, but I'm doing my best to stay within the lines.

*   *   *

July 30, 2012

From Abby: Little Diabetes Tricks.

I'm on the road again today, heading to Indianapolis for the 4th Roche Summit (you can follow on Twitter at #rds12, and through the blogs of the attendees - more on that later) and then the AADE Annual Meeting.  Abby and I have been talking about the "little diabetes tricks" we use that are sometimes completely random and slightly off-label, but help us make sense of diabetes. Today, she's sharing a few of her favorite tricks.  :)

*   *   *

I'll be the first to admit I don't follow all the rules of diabetes. I think it's only fair because diabetes doesn't follow my rules. (See also:  the definition of diabetes equals the one for insanity) I know everyone has their own little tricks - there's no way to survive diabetes without them. Things our doctors don't tell us, our CDEs don't know about, and our DOC friends have yet to discover. Some of these I learn from others, and some I just invent. So here's a little list of weird tricks I use to keep my diabetes tame-ish. They may or may not work for you, and they don't ALWAYS work for me - but I figured I'd share.Tools.  :)

Gatorade - I got this idea from a teacher in nursing school. When I'm doing some sort of endurance exercising I drink watered-down Gatorade. This works especially well during runs, hikes, bike rides, etc. I make Gatorade in a water bottle about half strength and take sips every 10ish minutes and it keeps my blood sugar nice and steady, while also keeping me very hydrated.

Medic-Alert Hiding - I got this idea from my years as a cheerleader. When I go for a run or somewhere I don't want to wear a bracelet I hook my medic-alert bracelet on my sports bra strap. It's safe here, and will be found in an emergency, and doesn't annoy me as my arms are flailing about Phoebe style listening to Justin Bieber.

Breakfast Bolus - I've been square waving my breakfast bolus about 45 minute before I eat, for 30 minutes. This gets REALLY tricky and I warn you to be very careful. About 1 out of 20 times I end up low, but the other 19 It wards off a huge post-breakfast spike. (I also eat things fairly low carb and high protein, because breakfast hates me.) And I drink a lot of water before I eat. Hydration is key for me.

Tabs on the Ankle - This is the nerdiest one. I've been wearing an iPod holder on my ankle with one of those four-packs of glucose tabs and a tube of glucose gel in it when I run alone. It stays out of my way, and is easily accessible if I need it. It also looks wicked cool.

 *   *   *

Is watered-down Gatorade nasty?  Like, does it taste like a glass that had juice in it but then you drink the juice and then fill it back up with water without rinsing it first?  (I have done that with milk before, and it's horrible. /digression)

July 27, 2012

Diabetes Typos.

When I go to write this:

A-NI-MAS.

I always, and mistakenly, write this:

A-NI-MAL!!!  (See also:  Woman! Woman!)

(Close, but no cigar.  Also:  "BOLUS! BOLUS!")

 And when I go to write this:

PUMP.  Say it with me:  Insulin PUMP.

I somehow manage to eek this out instead:

Pimp.  Holla.

And I thought diabetes typos were only limited to the bolus/blouse conundrum.  

July 26, 2012

Fifteen Carbs.

At least it's not a glass of pee."It takes more willpower than carbs to properly correct a low blood sugar."

This goes through my head every time my blood sugar is below 65 mg/dL.  I talked about lows with my endocrinologist a few weeks ago, and how when I'm excessively low (the ones that tangle my tongue in my mouth and leave cotton balls in the place where my brain should be), it's very hard to measure out fifteen grams of carbs, then eat, and then sit patiently and wait for my blood sugar to rise.

"Usually, I measure out fifteen hundred grams of carbs, usually in the form of an entire bottle of grape juice, and then consume the whole lot in a matter of seconds.  Then I end up haphazardly bolusing to cover the extra carbs.  Usually, I end up much higher than I was aiming for, mostly because I'm in a freaking panic and treating the low as fast and desperately as I can."

She and I talked about how panicky lows often lead to over-treating, which leads to highs, which leads to rage bolusing, which leads back to panicky lows.

"Fun vicious cycle, that is," I said.  "I do notice that the more stable my blood sugars are, the more stable they remain.  It's once the bounce starts that it becomes gross. My Dexcom graphs start looking like giant letter Ms."

"Not over-treating a low is very important, but I know it's a tough thing to avoid.  That panic drives you to eat until you don't feel low anymore, which can take up to twenty minutes."

"So I need to distract myself while low?"  (Like I'm not already distracted enough at a blood sugar of 40 mg/dL.) 

"Whatever you can do to treat the low without overdoing it, yes.  It can help stop that vicious cycle."

Lows aren't as prevalent now as they were a few months ago, but they do hit every once in a while.  (As irony would have it, I'm writing this blog post while low.  But I only had three small sips of juice.  And now I'm waiting patiently.  PATIENTLY.  SEE HOW PATIENT I AM?!)  I'm trying to be patient while low, and waiting out the panic until blood sugar serenity sets back in.  I thought about crocheting while low, but decided that would be an epic exercise in dropped stitches.  Thought about jumping on Twitter while low to pass the time, but that would end up looking too much like drunk Tweeting. And I can't whistle, or else I would fashion up a low blood sugar tune to pass the time.

So I'll try to sit.  And wait.  And pretend that my brain and my body aren't freaking out while I wait for the glucose to hit my blood stream, the same mantra running through my head while the adrenaline runs amuck in my body:  "More willpower than carbs.  More willpower than carbs."

July 25, 2012

Apple Juice? Flat Beer? Pee?

Chris and Birdzone and I took a quick trip to Oqunquit, Maine (mostly because Chris saw that it was ranked "Best Beach Town" in his beloved Yankee Magazine, which meant "we had to go") for a few days, enjoying some of the beautiful Maine coastline. 

But, as with all travel comes wonky eating schedules.  Which meant that by the time we rolled into Maine, breakfast was several hours behind me and my blood sugars were starting to tank.  We headed to a little pizza place near our hotel (Pizza Napoli - good white pizza!), where I ordered an orange juice to take the edge off the 53 mg/dL.

"We don't have orange juice.  But we do have apple juice," said the waitress.

"Sure, apple juice would be great," I replied, handing a bag of crayons to Birdy and watching her set upon putting polka dots ("pokey dots") on a picture of a dinosaur.  Which is why I can't blame the waitress for bringing the juice back in a plastic cup with a lid and a straw, thinking it was for my daughter:

Cheers!  (Ew?)

I took a few sips from the straw - just enough to bring me back up into range, for once, instead of downing the whole glass in two gulps - and set the cup aside.

"It looks like flat beer," Chris said.  "Or urine."

"But definitely not apple juice," I said.  

"Nope," he replied, smirking.  "Definitely not."

And there we sat, our daughter happily coloring, our pizza in the restaurant's brick oven, and a suspicious glass of what could have been mistaken as urine on our table.

(Cheers!)

July 24, 2012

Looking Back: Found.

Even though I don't mind the pump or CGM being visible (good thing, since we've been at the beach a lot this summer), I am grateful for the moments when my diabetes hardware has been seamlessly integrated into my clothing choices.  Today, I'm looking back at the day I found my wedding dress.

*   *   *

"Just lift your arms up and ... okay, dive in!"I can't wait to post a real picture here!  (Only not for 7 more months.)

She held the seemingly endless yards of flowing fabric above my head, with her arms through the middle to guide me to the top.  The rustle and shuffle of silk and taffeta undulated by my ears until I had shimmied into the dress.

And I walked out to where my mother was waiting, the train of the dress following patiently. 

"Oh, that's the one.  That's it."  My mother started clapping softly, then realized it was an odd thing to do, so she just folded her hands in her lap and grinned.

I turned to face the mirror and, despite the exhaustion from the whirlwind weekend and the day of working remotely and the strong scent of Starbucks coffee, I felt pretty.  All in an instant, I didn't want to wait another seven months to be his bride. 

"Oh, that's the one."  My bridal consultant had patiently helped me try on over two dozen dresses and she showed no signs of slowing down.  But this one was it.  Hands on her hips, she followed the lines of my body with her eyes and nodded her approval.  "It fits you perfectly."

I nodded in agreement.  She leaned in to my mother.

"Let's get the pump and I'll get the seamstress, so we can see how we'll work with this."

My mother unearthed the pump from the depths of my purse, where it had been stashed during this dress-session, and handed it to me. 

The seamstress came out and gave me a coo of approval.  "Oh honey, you look beautiful.  Now what are we looking at here?"

"This is my insulin pump.  I need to have a pocket or something created in the dress so I can access the buttons here," I gestured to the front face of my pump, "and then the tubing needs to funnel through the dress layers to a port on my outer thigh."

"No problem, honey.  No problem at all.  Let's see this."  She reached out her hand and I placed the pump on her palm.  "Not too heavy at all.  We make a little pocket along the seam here," she pointed to the side of the dress, "and then we'll just tunnel through the layers to meet up with your leg.  A small bit of velcro to keep the pocket shut and viola!  You're a bride with a beeper."

"A pump."

"Pump."

The seamstress patted me on the arm.  My bridal consultant helped me slip out of the dress and I put my own skirt and shirt back on.  I looked at some options for my bridesmaids and ooohed over dresses for my flower girl (little MP).  We talked about when the dress would be ordered and how long it would take to come in.

And if I closed my eyes, I could still feel the weight of the train and the way the beading felt underneath my fingertips.

I can't wait until May.

*   *   *

July 23, 2012

Guest Post: Jennifer Shine Dyer, EndoGoddess.

PWD and PWCaPWD (Person who cares about people with diabetes)I can't remember where I first met Dr. Jennifer Shine Dyer, but I do remember immediately liking her.  Because she, like so many other medical professionals who decide to focus their talents on diabetes, really cares about people who are living with diabetes.  (Also, if you follow her on Twitter or add her on Facebook, you'll see that she's got her finger on the pulse of the DOC and fashion … which makes me wonder why she's not designing clothes that conceal insulin pumps … /digression)  Jennifer is an active participant in the diabetes-specific conversations taking place online, showing PWD and their caregivers that she's part of a new solution for people with diabetes, by way of her work in the medical app field. 

Today, Jennifer is guest posting about her medical app, EndoGoddess, and how people can support her efforts to improve health outcomes for people with diabetes. 

*   *   *
In the past, people with diabetes have not been at the table to decide what new technologies and improvements should be funded…unless they happen to be a hospital executive, pharmaceutical executive, or health insurance executive. However, a new crowd-funding platform called MedStartr allows people with diabetes and those who love them to decide what new technologies they’d like to see further developed by voting with their donations. People with diabetes can even submit their own projects!

The launch on July 11th has received a lot of media attention and a lot of investors are excited to see what happens. If the projects are successful, it will not only mean that the projects for the new technology get done but it may also mean that investors will likely invest more than they would have in these projects because they know that people with diabetes want them and will use them. It’s a win for everybody!!

That is why my project, the EndoGoddess Diabetes App (and the only one in the diabetes category currently), is so important.  The EndoGoddess App is a self-entry glucose journal that not only keeps patients healthier, but also enables them to earn rewards for healthy behavior. As most diabetics know, checking their glucose four times a day and writing it down to give to their doctor and keep track of their sugar levels is a complete drag, but it is very important to avoid emergency trips to the ER or worse yet, hypoglycemic shock and the fainting spells it can cause, which can be extremely dangerous. Our Application not only automates this recording and communication process, it also lets patients earn rewards for their good sugar tracking. No more paper journals!

The project donation ends in late August so please consider donating before that, even just $1. You’re donating to a larger cause and to show that people with diabetes have a voice that should be heard!!!


You can find the EndoGoddess Diabetes App Project here (and you can also back the project, if you'd like).

*   *   *

Jennifer Shine Dyer, MD, MPH, is a stylish pediatric endocrinologist, social media enthusiast (@EndoGoddess), app developer, and mobile health entrepreneur in Ohio looking to make health outcomes better for people living with diabetes. She blogs at EndoGoddess.  Thanks for sharing your project with us, Jen!

July 20, 2012

Insulin Pillow.

If Bed, Bath, and Beyond had a "diabetes" aisle, it would definitely include these insulin delivery pillows. 

Two king sized insulin packs?  Okay!

Thankfully, this "pillow" protects the vials of insulin from the excessive New England summer heat!

July 19, 2012

J&J Enters the Patch Pump Market.

J&J is adding a patch pump to their arsenal. Actually, it's a patch pen, used to deliver mealtime insulin. Wicked!  I just received this info from their communications team:

"On Friday, July 13, LifeScan, acquired Calibra Medical, Inc. of Redwood City, CA. Calibra Medical is the developer of a unique, wearable three-day insulin patch designed to offer a convenient and discrete mealtime insulin dosing option for people with diabetes who take multiple daily injections (MDI) of insulin. While not yet available, this new insulin patch is intended to make it easier for patients to adhere to their prescribed mealtime insulin therapy and help them achieve and maintain good diabetes control.

We’re committed to providing patients with innovations that help improve their lives at every stage of their diabetes management.  The acquisition of Calibra Medical represents an important addition to our portfolio of insulin delivery offerings that include the Animas family of insulin pumps.
 
Calibra was a privately held venture and this is an early stage acquisition.  The terms of the acquisition are not being disclosed and we are not commenting on when we expect the product will be available.  There are a number of milestones that must be met before the product can launch."

The info I found for Calibra Medical Inc.'s patch pump looks a little generic, but I'm excited to see where this goes.  I love seeing more options on the insulin delivery table.  I'll definitely be following up with more details as I scout them out. 

Edit:  Bernard had a great post a few years back about this pump, with more detail.  :)

Twenty-Seven.

Dear Birdzone the Clown,

(Yes, it seems like I just wrote you a monthly letter.  That's because I'm a lazy bum and I was way late on the last one, making this one seem early.  I'll be back on track next month. What do you mean, you don't care?  What do you mean, you're only two and you don't read blogs and you didn't notice and what's a blog and you need a diaper change?)

Kid, you're making me into a crazy person.  I find myself having conversations with you that I couldn't have predicted, not even if I was a hybrid of Tim Burton, Roald Dahl, and Neil Gaiman (ooh, that might be the best hybrid person ever).  The questions you ask me confuse my already-tangled mind:

"I can't find your butterfly wings.  Can you wear your bird hat, instead, and maybe put some pants on?"
"Do not lick the screen again; not until you've found the other pumpkin."
"The toilet doesn't eat poop."
"Trees aren't made of paper ... well, they kind of are.  Can I explain that later?"
"Please only put these crayons up your nose, not those."

I can't take this.  It's like every cartoon in my mind is coming to life and spilling out of my mouth.  You spend your days coloring paper bag puppets, making pretend salads for Siah (she's yet to try one), and dragging your Mickey Mouse doll all over creation.  You ask so many questions in the course of one sentence that you actually run out of breath, leaving the end bit to sound like, "... and where Abby go on vacation and mommy's car is black, right? and daddy's car is silver and ..." where you have to pause and gulp in a big gasp of air to finish the ten thousand thoughts you haven't yet purged.

Sometimes, you rock out so hard that I can't stop laughing at you:

Other times, your imagination is in full force, finding magic in its fledgling form.  We watched an episode of Sesame Street that showed your beloved Elmo playing a violin.

"I want to play violin, mama!"

I need to work on my cardboard skills, but they're coming along. By the time she's 23, I'll be able to make a spaceship.

While you and Daddy brushed your teeth for bed that night, I made you a quick violin out of a cardboard box, a Sharpie marker, and a pair of scissors.  And now, for the last few days, you've been dragging around this tattered "violin" everywhere you go.  Like today, when we went to the grocery store, and you offered to play the deli guy a "song on mine's violin and you give me the cheese?" 

Needless to say, that slice of cheese was hard-earned, as you pretended to drag your bow across the "violin" while Mommy hummed loudly beside you.

You are quickly leaving behind your days as "the little baby" and are becoming my friend.  We go to the beach together.  We make grocery lists together (though you repeatedly insist on "choc-it pun'ing," fearful that I'll neglect to grab your favorite snack).  We sometimes talk shit about the cats ("Tell Siah to stop picking the screen or she's going to have to eat green beans for dinner!"  "Yeah, green beans for the CAT - that's silly!").  And those moments when you laugh so hard that you double over and almost touch your toes are worth the moments when you're trying to stick test strips into my ears.  ("You hear the meh-cine, mama?")

You are the child of a dozen faces.  A hundred questions.  A thousand hugs and kisses.  And a million reasons that my life is best with you in it.  Mama loves you so much.  In first and in third person.

xo,
Your Mom

July 18, 2012

Beaching It (with Diabetes).

Living in Rhode Island, I grew up going to the beach all the time.  Seeing as how you can drive across the whole state, stem to stern, in less than an hour, and it's dotted with beaches the whole way through, it's easy to find a place to put your beach blanket.  We're the Ocean State, for crying out loud, so this makes sense.  ;)

This video is about the diabetes-at-the-beach routine ... and also what part of my diabetes supply arsenal I'd chose as Tribute, if we went all Hunger Games about things:

July 17, 2012

Totally Looks Like ... Hammer Edition.

"[Profile of a] dude with a mohawk, with a booger flying out of his nose."

Photo courtesy of Josiah Hammer.  Description courtesy of Josiah Hammer's strange brain.

TOTALLY looks like that.  And now I can't un-see it.  (Much like the giraffe, or the Arby's hat.)

Thanks to Josiah "The Hammer" Hammer, of Dexcom and Insulindependence fame, for texting me this photo of his Dexcom graph.  It's awesome!

July 16, 2012

Learn As We Go.

During the discussion at Friends For Life about being a parent with type 1 diabetes, the topic of "telling" came up over and over again.  And not "telling" as in "I'm telling on you, Panc, for being a lazy slab of cellular mass," but more how to tell my daughter about diabetes. 

The people in the session had varying opinions, ranging from having a sit-down discussion about what the impact of diabetes may or may not be to introducing diabetes on a bit-by-bit basis, and all the gray area in between.

I definitely fall into that second camp, as a parent.  My daughter is two years old.  (Technically, twenty-seven months old, thank you very much.)  I don't want to have a formal sit-down chat with her about her mommy's diabetes, because a. it won't matter a lick to her unless it involves Thomas or watering the flowers outside and b. she has absolutely no concept of what "chronic illness" means.  She's two.  Red Sox for the win.  Hopefully. ;)

However, like most kids, she's perceptive.  She's been watching me test my blood sugar since she was able to hold her head up, and she has a sense of what it means to "check my finger" because she's also had her blood sugar checked a handful of times.  She knows it's not a fun moment.  ("That's mama's meh-cine.  Not mines.  You keep it.") 

Lately, she's been asking to see the numbers as they count down.  "Five, mama!  Four!  Three!  Two!  One!"  And when the blood sugar number pops up, she reads that back to me.  "Two eight, mama!"  At which point I correct her:  "No, you're reading it backwards.  Eight two. Eighty-two."  "Eighty-two!  That's nice."  (Every number is "that's nice."  212 mg/dL?  "That's nice."  182?  103?  Eleven million and seven?  "That's nice."  I like that she thinks they're all nice.  Makes me less insane about them.) 

"Twelve!  You has a twelve, mama!!  That's nice."  She looks at my meter and announces the result proudly.

"One hundred and twelve, kiddo.  You have to give the whole number, or mommy will freak out."

She is learning about how the Dexcom receiver and the sensor on my thigh work together, especially now that it's summer and my sensor sometimes peeks out from underneath my shorts or dresses.  "That's Dexcom."  She picks up the Dexcom receiver.  "That's Dexcom, too.  Two Dexcoms!"  Pause.  "Ah, ah, ah!!"  (We watch a fair amount of Sesame Street, and The Count is a fan favorite.)  But last week, when the Dexcom alarmed for a blood sugar over 160 mg/dL, she grabbed the receiver off the kitchen table and said, "Mama, time for check your meh-cine!"  The BEEEEEP!s now mean something to her.

"Diabeeeeeeeetes."  She knows the word.  She knows that all of my medicine bits (the pump, the infusion set, the Dexcom, the sensor, the glucose meter, the glucose tabs ... all the "stuff") are related to this thing we keep calling "diabetes."  She has no idea what it really means (pancreas kaput, etc.), but she is beginning to understand that it makes me do things differently than some of the other mommies. 

My little Bird will make sense of my diabetes breadcrumb by breadcrumb, learning from the information I share with her.  Eventually, as she grows older, we'll gently teach her what to do if Mommy needs help.  She'll understand that I wear certain devices and take medicine before I eat and I sometimes wait a few extra minutes before we play outside, waiting for my blood sugar to come up.  She'll know what she needs to know, but I don't want her to know any more than she needs to know.  The parts of diabetes that scare me will be shielded from her for as long as I can, because there's no reason to make her worry.

My job is to love her.  To play with her.  For my husband and I to raise her as best we can, so that she becomes the best she can.  My diabetes may impact certain moments, but it doesn't change the course of she is.  Or who she will become. 

July 13, 2012

Pick Up the Pieces.

Keep calm and carry a clipboard?Heading into my endocrinologist appointment a few weeks ago, my expectations were non-existent.  My diabetes management has been consistent, quiet, and the last thing on my mind lately. 

My endo and I did a rundown of what's been going on since I'd last seen any member of my diabetes team.  The last few months have been especially challenging, as my family has been dealing with some health issues outside of the regular roll and tumble of diabetes.  Thankfully, we've all three emerged intact, and are more than on the mend.  But there was a lot of stress.  And anxiety.  (And stressandanxiety, which is the compounded version, when the two emotions butt heads, mush together, and produce cortisol, which has a less-than-calming effect on my blood sugars.)

I've been on autopilot for so many things, while we dealt with the health issues at home.  Work was still due and travel was still scheduled, but I was going through the motions.  Somehow, diabetes fell into the same category.  I didn't stop taking care of myself.  Instead, test strips and carb counting became part of the chaotic blur.  (I think it was partly because I've become accustomed to testing regularly, logging, etc. and partly because I needed my health to be as optimal as possible in order to deal with what was going on at home. Slacking of any kind wasn't an option.)

Before my appointment, they ran lab work, and my doctor and I reviewed the results in her office.  When my A1C result came back in good form, I was pleasantly surprised.  Actually, all of my lab work came back good, from A1C to cholesterol to thyroid to microalbumin. 

"That's good.  This is all good."  My endocrinologist said, checking through all of the results, but then reading the expression on my face.  "Why aren't we celebrating this?"

"I don't know.  I think I feel like that A1C result isn't reflective of my actual control.  My standard deviation is much tighter and my overall control is steadier, but I'm having a lot of 160s and 180s.  And very few lows."  I paused.  "Not that I want to have lows. I'm terrified of lows, honestly.  I just feel like that A1C boasts control better than what I actually have.  It's been a crummy few months."

My endocrinologist is fantastic, because she really understands that diabetes control isn't simply a matter of "following the rules."  She helps me find the underlying issues sometimes, when I'm so mired in the forest that the trees become a blur.

"You keep mentioning lows.  Was there a low in particular?" she asked.

I thought about January, when I had a low blood sugar episode that frightened me worse than any other I've had in recent memory.  And I thought about how much I never, ever wanted to experience that feeling again, because I felt so helpless and lost and too close to a point I couldn't return from.

"There was one.  I was traveling. I was by myself.  And I was completely out of it, worse than I've ever been that I can remember.  Coupled with all the health stuff going on outside of diabetes, I have been really wary of running on the low side.  Honestly, I avoid it."

"Your blood sugar goal, in your pump, is 100 mg/dL.  That's what we were shooting for when you were pregnant, and I don't think we ever changed it.  Maybe that's not the right goal for right now, especially since you're dealing with some things that make you very concerned about low blood sugars.  Let's update your pump to reflect a goal of 140 mg/dL.  Would that work for you?"

"Definitely.  I like where my A1C is now, but I'd like it to be a little lower, without toeing the line of wicked hypoglycemia.  You think this would help?"

"I do.  You've had more than the usual going on this last round, and I think a small change like this could help you feel more comfortable, less vulnerable to hypos.  Your progress has been really, really good these last few months.  I just want you to keep doing what you're doing, and feel safe.  And to be able to take care of your family."

"Got it.  It feels like a really small change, but it could make a big difference."

My A1C is close to where I want it to be, but I'm not elated.  Or frustrated.  I don't want to lament this number, or post it on my fridge in celebration.  It's just a number.  No emotions assigned to it this time, which kind of feels good.  Freeing. 

I just want to pick up the pieces of the last few months, be thankful for the good health of my loved ones, and keep doing what I'm doing.

July 11, 2012

From Abby: Robot Runner.

Abby is the runner of this team, mostly because I just despise running.  (I'll go hiking for hours, or walking, or shopping [shopping is a sport, no?] ... but running?  Not for me.)  Today she's talking about being part cheetah, part robot while exercising.

*   *   *

Sometimes I feel like a robot. Okay, all the time I feel like a robot, but sometimes more than others. Sometimes I'm pretty sure people are on the verge of stopping to ask if I need help, mostly in part because of all my robot things.  I don't exactly pack light.

For example, when I go running outside by myself, I am carrying a ton of stuff. I live in a very populated area. Nothing bad has ever happened during a run (knock on virtual wood). I have had lows, but I've always been prepared for them, because I always take way more crap than I need with me.  It's probably the nurse in me.  Or growing up with a nurse for a mother.  Or I'm well on my way to Mary Poppins Mom Purse status. [Note from Kerri:  It happens to the best of us.]  Whatever the reason, I bring the following things with me while running by myself:

  • Pump
  • Dexcom
  • Glucose Gel
  • Glucose Tabs
  • Keys
  • iPod

And this is why I have achieved robot runner status. I hold my keys and iPod in my hands. In my tallygear is my pump and Dexcom. Around my ankle is an iPod case with glucose tabs and gel in it (this is my newest idea and it's great, until you get home and it's soaked with sweat and your ankles are swollen and that thing is practically glued to your skin).

But the point is, I make it home safely.  I'm prepared for lows or highs.  I plan for the weird circumstances, like when I decide to stick to a route that's closer to home because I don't want to bring my phone. (Droids are great phones but freeking ginormous).  Regardless of the route,  get some good exercise and head clearing time.

So robot I will be, because the alternative is dangerous. And unlike Simba, I do not laugh in the face of danger. I run away.  With my robot parts flapping in the wind.

*   *   *

This is one of the things that makes outside exercise challenging for me, because I wish I was part kangaroo and could just shove stuff in my (icky?) pouch.  Melissa, who let me share her tricks here, travels smart but light.  Abby travels mostly-robot.  How do you manage your diabetes crap while on the move?

July 10, 2012

CWD FFL 2012: Parenting with Type 1 Diabetes.

The first time I sat in the Parenting with Type 1 diabetes session, I was a first time mom, and a new one.  My daughter was about 14 months old and I was just starting to process the fact that I spent years planning for my pregnancy but I hadn't thought much about what to do once she had escaped my womb. 

This year, I was able to function during this session without crying.  (Which is a good thing, since I was part of the faculty leading the sessions, along with Scott Johnson and Stefan Rubin.)  I'm not sure why it was easier this year - nothing has changed in terms of me being more or less emotional.  I still feel weak when I think about how diabetes might affect my daughter.  I still feel lost when I think about the hypoglycemic episodes my own child has experienced.  But maybe that's what makes it easier, in a sense.   She's been in my life for over two years, and we've had some health issues (like Pukefest 2012), so I'm not as scared of "what to do."  I've already had to do a few "things."

But it is so comforting to talk with other parents who understand that delicate balance between diabetes and their child, especially at a conference where the focus is, more or less, on parents of children with diabetes.  (Though that perception is changing, thanks to the adults with type 1 session track and the droves of adults with type 1 who attended the conference this year!)  In this session, it was about being a parent with type 1 diabetes.  We talked about things like handling lows when we're in charge of our children, or how to talk about our diabetes with our child.  (We take it slow and steady here in my house, explaining things as needed and without too much fanfare.  More on that later, too.)

This session was a safe place.  Some of the sessions at Friends for Life are so intimate, where people are sharing their concerns and fears (and if you're me, many unexpected tears), that it's not meant for "live-blogging."  Sometimes you need to be able to sit in a room with your peers and really talk, without fear that someone is Tweeting or making it public.  (Which is a far cry from the session that Scott and I lead about Twitter and the DOC … more on that next round.)  

This year, I saw a lot of hope in that room.  There were more of us, more parents who were living with diabetes.  Some of us have children who are not diabetic.  Some of us have children who wear the same green bracelets at Friends for Life as we do.  Some of us haven't yet taken the leap towards parenthood, but are thinking about it.  (And in the case of one of us, motherhood was just a few weeks away.)  The discussions weren't rooted in fear, but more in hope.  It was a room full of people who were sharing how they are parenting, or working towards the goal of parenting, and it wasn't about our fears.  It was about our hope. 

Parenting is complicated, regardless of what kind of health history you're wrangling in.  What's important is that hope.  And that room, with all of its different personalities and circumstances and situations, had two common threads:  diabetes ... and hope.

A whole pile o' hope.

So much hope.

July 09, 2012

Team Green.

We are Team Green.  The ones who trot around Friends for Life with the green bracelets, letting those who need to know that we're living with type 1 diabetes.  Those of us who are kids were in Sports Central or on day trips with the CWD staff members.  Those of us who are adults were in sessions talking about burnout, parenting, exercise management, and ... Twitter?  (Yes.  More on that later.)

(We're also the ones you saw in the lobby of the Marriott, sitting in a group of about two dozen and with our noses in our computers for the Wednesday night #dsma chat.)

Team Green can't function without Team Orange - the members of our immediate and then extended family who wear the orange bracelets and live with diabetes, albeit from an insulin-producing vantage point.  (And I'd be lost without Team Orange.)  For me, my Team Orange includes my daughter, who is very slowly learning the bits and pieces of what diabetes means to her mama, and my husband, who manages this condition alongside me every day.  It includes my mom and dad, who learned about type 1 diabetes and then helped teach me how to live with it. And it includes the friends I've made along the way - the ones I've made for life - who understand that even when this bracelet falls off, I'm still wearing it. 

I'm still part of Team Green. 

Thank you, Friends for Life, for giving me another week where diabetes is "normal."

July 04, 2012

Happy 4th of July!

Celebrating the 4th in Orlando with a bunch of busted pancreases? 

Don't mind if I do.

July 03, 2012

100.

I'm heading down to the Children with Diabetes "Friends for Life" conference today, to spend the week amongst a bunch of green bracelets and the orange bracelets who love them.   I love this conference.  I wish it had existed when I was a kid, but I'm just as happy to reap the psychosocial benefits now that I'm a grown-up (ish). 

It makes me feel like I'm 100 mg/dL all day long.  :)

July 02, 2012

Interview with A Ninja Warrior: Kyle Cochran.

American Ninja Warrior is a show I had never heard of before, but then Facebook exploded with this buzz about "some guy on the show wearing an insulin pump." After Abby conducted a little research, it turned out the rumors were true:  there WAS a guy on ANW who has type 1 diabetes. His name is Kyle Cochran, he was diagnosed at the age of five, and he's the first person on an insulin pump to qualify for the show.  Kyle was willing to hop on the phone with Abby for a quick chat, to talk ninja-chop-shop about diabetes and the show. 

Abby:  What was your impetus for doing American Ninja Warrior, and was diabetes your biggest challenge while training for the show?


Kyle:  I have always loved obstacle courses ever since I was little. When I saw ANW, I immediately knew that I would be on it one day. [Abby's note - I used to sit on the monkey bars and play sticker club on the playground - guess we're not all destined to be ninjas.]  One of the main factors that drove me to compete on the show was to encourage other people who may have diabetes or other disabilities to overcome their own personal obstacles. It really upsets me when I see diabetics using their diabetes as an excuse not to do something that they love to do. Hopefully seeing me on the show and pushing through the obstacles will inspire other diabetics to push themselves in their own lives.

There is no way of really denying that diabetes will have an affect on athletes competing at high levels. The need to take breaks for high or low blood sugars is inevitable.  However, my Animas pump has made a huge difference in my athletics. Before I got the pump, I was 5 feet tall and 100 lbs as a sophomore in high school. The year I got the pump, I grew 9 inches and put on about 50 lbs. [Kerri's note:  Going on an insulin pump will not make you grow nine inches and pack on the muscle.  But it does make you a cool robot.] The amount of time I spent on the sidelines of sports checking my blood sugar and correcting dropped dramatically. When most people find out that I have diabetes now, they are usually shocked.

Abby:  Where do you keep your pump while ninja training? We saw it was off during the episode, but you surely can't have it off all the time while practicing those crazy tricks?

Kyle:  I typically train a couple of times per day. When I am weight training I keep my pump on me with a sports strap. If I am doing some of the higher intensity/movement training, I suspend the pump and keep it near me.

Abby:  What was your last meal before the ninja competition?

Kyle:  Haha! I actually get that question all the time. I try not to eat anything heavy before I compete so my last meal was carrots with some natural peanut butter and grapes. (Another Abby note: he does not eat the grapes with the peanut butter. But I did suggest grapes with ranch dressing, which is delicious I swear.)

Abby: How did you manage/keep track of your blood sugars during the ninja competition?

Kyle:  To be honest, I was pretty nervous during the competition so it was a little more difficult for me to feel whether I had a high or low blood sugar. I basically just tested constantly to be safe. When I am competing, I try to keep my blood sugar levels a little higher. Between 150 and 180 mg/dL is what I shoot for. I've found that for me, I perform best in that range.


Abby:  What was the most difficult obstacle in the ninja competition?

Kyle:  The most difficult obstacle for me in the regional runs was the spinning log. Most people can't believe that that was the hardest, but for me it was by far!

Abby:  Haha, the one with the bar where you had to jump up the levels - that was ridiculous.


Kyle:  That was called the salmon ladder. I trained a lot for that one so for me it wasn't too hard. [Abby's note - yeah I mean, of course, that one was really easy. Psssh.]

Abby:  During the episode it was mentioned that you wanted to inspire kids to do anything they want with diabetes; have you thought about visiting camps during the summer to talk to kids with diabetes?

Kyle:  I actually have thought of this. I recently became one of the Animas Heroes so hopefully I can schedule something through them. I remember diabetes camps from when I was a kid and I would love an opportunity to go talk and hang out with them!  [Abby's note: I may or may not have asked him to come to CBC and Joslin at this point. Shameless Pluggery is my middle name. I lured him with the high ropes course.]

*   *   *

Kyle is currently a junior at San Diego State University and is an amazing athlete involved in many high intensity and extreme sports (coed Cheer Team took 2nd in the world, expert skier, accomplished paragliding pilot, rock climber, dirt bike rider, basketball player). He has refused to allow his diabetes be an excuse for sitting on the sidelines.  Kyle is also active in his church and a straight A student, studying physical therapy.  Oh, and he's a ninja warrior.    

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