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October 31, 2012

Halloweaned.

Chris bought Whoppers to hand out to the local trick-o-treaters.

Whoppers.

No offense to those who wake up on Halloween morning, stretch their arms over their head, and yell, "I want the original malted milk balls in my mouth!" but Whoppers are horrible candies.  Right up there with Almond Joys and Werther's Originals as things to never, ever give out at Halloween.  That's the kind of candy that gets your house egged or your mailbox smashed. 

Reese's Peanut Butter cups are where it's at.  And candy corn - I know this might not be a popular one for many,  but I think candy corn is quality.  Three Muskateers.  Snickers bars.  M&Ms.  Starburst candies.  (Am I making friends or losing them by posting my favorite candies?  What, you guys don't like the creamy center of a Three Muskateers bar?) 

But we have a bowl full of Whoppers to hand out, because Chris and I were determined not to eat all the Halloween candy before the Big Day. I acknowledged his clever strategy when I came home and saw the bowl.

"Ah. Whoppers. Hmmm ... those are Whoppers."

He grinned.  "Exactly.  So we won't eat them."

"Good plan."  (I think we high-fived at this point.)

About a week later, I found myself at the store, worrying about the fact that I didn't have a Halloween costume for Birdy yet, or a pumpkin for the pumpkin carving contest that my best friend holds every year.  I feel like fall smacked me in the head with its sudden presence, even though I was still cleaning sand out of the beach toys in the back of my car.  (Scatterbrained?  Me.)

I thought about the Whoppers.  And how, growing up on a very quiet street in a very small neighborhood, Halloween wasn't a big event.  We never had anyone trick-or-treating at our door (except the one time my friend Krista showed up - Hi, Krista!!), so we rarely had candy to give out.  

Which is how I ended up with a bag of Reese's Peanut Butter Cups in my shopping cart.  We have a neighborhood!  With kids that trick-or-treat!  Willpower - argh, willpower! - we were giving out quality candy, for crying out loud!

 

The Reese's Cups are safely nestled in the candy bowl, amidst the crappy Whoppers.  And I have yet to eat any of it.  (This is a real triumph for me, because Reese's Cups are to me what hamburgers are to Wimpy.  But once I pop, I can't stop.  And now I'm mixing up food taglines.)  I feel sufficiently Halloweaned from the temptation, and my blood sugars are thanking me for it.

Oh, and we grabbed a pumpkin, too.  We're properly prepared for Halloween now.


Happy Halloween, everyone!  Stay safe!!

October 30, 2012

Storm Aftermath.

We watched the storm through social media channels while it swirled outside.  The photos on Twitter and Facebook were devastating and amazing, all at once (except the one about the shark - which is FakeTown the Clown).  What we experienced at our house was mild, especially when compared to the chaos just a few miles down the road (where the seawall was breached and the roads became rivers, not to mention the destruction that took place at my father's home, where several gigantic trees went roots-up).  We're grateful that we were not in the direct path of this superstorm's strongest arm, and our thoughts are with those who were.

Hurricanes are serious business.  As a proper New Englander, I've seen several in my lifetime, and the destruction they leave in their wake is more than just grabbing a rake and cleaning up the yard debris.  And for people with diabetes, there could be the destruction of insulin or test strip supplies in addition to all the other chaos. 

If you can, place make charitable donations through the Red Cross or other disaster-relief organizations.  Even though the actual storm has passed, there are still so many people weathering it. 

October 29, 2012

36 Hours.

My Dexcom data is important to me because of my body's reluctance to throw symptoms when my blood sugar is falling (CGM said 68 mg/dL, meter said 58 mg/dL):

Falling slowly.

But in approximately 36 hours, I had a nice, itchy rash crop up underneath the sensor (despite clean skin, alcohol wipe before application, Opsite Flexifix tape as a full barrier beneath the sensor, and a healthy dose of Yosemite Sam muttering as I applied the new sensor):

Oh the frigging ITCH!!!!  Let's add some more exclamation points, for good measure:  !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Which means I had more dead strips in my meter case, after having to pull the sensor:

The first rule about the Dead Strip Club is that you don't talk about the Dead Strip Club.

I'm hopeful (crazy hopeful, like fingers-crossed-spit-over-my-shoulder-is-that-a-real-thing?) that the new G4 sensor from Dexcom will cure what ails me, but in the meantime, I've hit up a dermatologist for assistance (will let you know how that goes - issues with Hurricane Sandy have derailed my ability to make my follow up calls this morning). Because without the Dexcom on and with lows that are all-too-often symptom-free, I feel way too vulnerable.  

October 25, 2012

Looking Back: The Ellipmachine.

I go through cycles of using and not using the elliptical machine at our house, but I do appreciate the fact that I have a go-to cardio option for those moments when I'm stuck at home/can't get to the gym/being stalked by high blood sugars.  Today, I'm revisiting a post from March 2009, when the ellipmachine entered my life.  :)

*   *   *

When I was preparing for our wedding last year, I spent a lot of time at the gym.  A.  Lot.  As in, too much.  If I wasn't at work at dLife or doing wedding-esque things like cake tastings, dress fittings, and bridal shower fun, I was working out and doing mI love this thing.y best to keep the stress from fattening me up.

Fitness was my priority.  

But after the wedding, other stuff started to crop up.  Weekends home in RI.  Travel for work.  Writing projects that required lots of attention.  New focuses at dLife.  Every day was this whirlwind of chaos and while I've been having fun and being very productive, my days at the gym were harder to come by.  Before, I was working out faithfully Monday - Friday after work.  But "life stuff" kept cropping up, and suddenly I found myself at the gym only four days a week.

Then it all became a perfect storm of distraction.  I was working late on dLife initiatives.  I was answering emails from my Blackberry into the wee hours of the night and sleeping less.  My wrist exploded in a fit of tendinitis and low blood sugars returned to my life with a renewed sense of determination.  Piles of snow kept falling and the gym kept closing, and on other days, I worked too late to get to the gym before it closed.

My time at the gym went from frequent and intense to only four days a week and pretty remedial.

Not okay, because my body wants to be fluffy.  It may be a family gene pool thing and it might also be exacerbated by diabetes factors, but if I sit still and let nature take its course, my body wants to be a happy 15 lbs heavier.

I, however, do not agree.

But I was frustrated because between feeling stressed and having lows again, my caloric intake far exceeded my burn off.  Thus, I lost any semblance of abs.  (Shame, too, because I liked them while they were there.)  So, in effort to reclaim my abs before I get pregnant and become a happy beach ball swallower, I did my part to stimulate the economy:  I bought an elliptical machine.

Or, as I keep calling it by mistake, an "ellipmachine."

It was delivered and assembled last Monday morning, and I called Chris (who was on business in California last week) to tell him it had arrived safely.  

"It's here!  The ellipmachine!"

"The what?"  

"I mean the elliptical."

It's a nice machine - very smooth and not clunky as to annoy our downstairs neighbors (I do not want to become Shoes) - and I used it every day last week for an hour.  Now I'm able to go out with my coworkers after work for an hour or two and still manage to slide a workout in.  I am also hoping to use it in the mornings (provided I'm able to get to bed at a reasonable time and eek out a 20 minute workout in the am).  My main hope is to reclaim the level of fitness I worked so hard to achieve before the wedding but lost a bit due to that pesky "life stuff."  

Last week, while Chris was out of town, he called one night and I answered, panting.  

"Hey baby ... what are you doing?"

"Dude, I'm on the ellipmachine."

I could hear him laughing.  "The ellipmachine, eh?"

"Oh you know what I mean."Here's hoping that the ellipmachine can help me get a workout in even when my schedule wants to thwart my good intentions.  I'm ready to battle.

(Take that, early gym closings!  En garde, late nights at work!  Pffffft, snow days!  Come back, sort-of-abs!) 

*   *   *

How do you keep yourself moving?  Ellipmachine?  Raking leaves?  Chasing the hedgehog that lives underneath your deck (this is a real thing, unfortunately)?

Guest Post: Reviewing the tSlim.

I haven't had a chance to wear the tSlim myself, but I did receive an email from Chad Oswald from Louisiana, who made the jump from Medtronic to Tandem.  He's 43 years old, living with type 1 for 17 years, and is on the board for the NW Louisiana chapter of the JDRF.  He wanted to share his first impressions of the tSlim, bullet-point style. 

Chad, the floor is yours, and thanks for sharing today!

*   *   *

Image from TandemDiabetes.comLet me just say, I’m not that young nor very "hip," so change is not something I readily embrace.  However, since I took my Medtronic insulin pump for a swim this summer, I’ve been forced to get a new pump.  Having pumped for over six years, I have my routines pretty much nailed down.  To be clear, Medtronic has always been great, they even over-nighted a loaner pump for 90 days when, due to my stupidity, it became waterlogged.  Still, I wanted to see if there was any new technology that would make managing this frustrating disease just a little easier.  

Taking a Chance
I decided to take a chance on the new t:Slim insulin pump by a new company, Tandem Diabetes.  I loved the look of the pump, and who wouldn’t? It is iPhone-like in terms of clean lines, slim form factor, and a touchscreen to boot! Honestly, I was tired of the old pump designs that exist currently; I didn’t want to waste my upgrade on the same old thing IF this new “sexy” one was any good.  I did my research the best I could and spoke with the company, but even so, I had many concerns: 
  • Tandem is a New Company - I was apprehensive about placing my health care and quite possibly my life in the hands of an unknown entity.
  • Durability – Was this just a cheap knockoff of the iPhone design craze? Could it hold up to the abuse of daily use for 5+ years?
  • Rechargeable Battery – Would it live up to the billing and how long would I have to wait to charge it, and would it deteriorate over time.
  • Cartridge & Reservoir  - Insulin delivery is different than Medtronic and I wondered how cumbersome the change out process would be
  • Quick Bolus – I primarily do manual “quick boluses” and didn’t want to lose the ability to bolus without having to look at the pump.
  • Menu/Data – Is the menu a maze of confusion and would I be able to find all the data I prefer to look at?
Relief
As I opened the package, I was excited and relieved at what I found.  The pump was even smaller than I imagined and more than anything it had a quality build and substance about it.  After 3 weeks of use, I’ve had the following impressions about my concerns:
  • I spoke extensively with the company and was encouraged by their friendliness and patience with my questions.  They handled the paperwork quickly and efficiently, and had the pump in my hand within two weeks.  In the end, it’s a leap of faith in a way, but if the company could design, build, get this kind of product FDA approved AND to market, then I’m willing to give them the benefit of the doubt.  
  • Durability WILL NOT be an issue.  This pump is substantial in build quality and in materials used.  It’s tightly constructed and the quality is evident.  However, it is not completely waterproof, it’s rated water-resistant or IPX7 standards, 3ft of water for 30 minutes.  So, I’ll still have to be aware of water!
  • The screen is AWESOME – Bright, sharp and the touch sensitivity is just right.  It also auto locks to prevent accidents.  It’s legible in daylight and comes with a screen protector from the factory.  I’ve read some complaints about not seeing the clock on all the time (oh please!) with the press of the “screen lock” button (the only button by the way) the clock and all important data appears in it’s colorful glory.  The home screen shows, battery life, insulin in units available, clock, date, as well as an alert symbol for anything that needs attention, and most importantly with a glance it shows the insulin on board (IOB), as well as how much time is remaining for it.  I cannot stress how much I LOVE not having to scroll for numbers!
  • The high tech lithium polymer rechargeable battery has been terrific, as advertised.  In fact, I love it.  I haven’t really let it drain all the way down, and probably have spent about 10-15 minutes a week to charge it back up.  It charges fast and I’ve been shocked at how long it’s lasted.  I’m hopeful it stays this good over the life of it.  
  • Changing the cartridge is different than I’m used to.  You fill the reservoir with a supplied syringe, and have to be careful NOT to jab the needle too far in the first time.  However, after doing it twice, it’s very easy and with the onscreen “checklist” makes sure nothing is done out of order.  Overall the process is a bit slower than my Medtronic, but not irritatingly slow, yet.  The reservoir holds 300 units, which is nice.  I’ve read some concern about air bubbles and not being able to see the actual insulin in the reservoir.  I’ll just say, I have not seen a single bubble after the initial tube filling. It’s possible I’ve missed one, but I saw more with my Medtronic.  It would not surprise me to see the reservoirs come pre-filled with insulin at some point.
  • Quick Bolus is AWESOME.  It can be done without having to look at the pump.  Press and hold down the ONE button on top of the pump, after beep, press again for each unit (or preselected increment), then pause, wait for confirmation beeps and then press and hold again, presto, bolus is given.  Each sound is unique for added help. 
  • All menus just make sense and are easily escaped by tapping the “T” on the right of the screen, which takes you back to home screen.  The bolus screen allows you to bolus by grams, which when entered turns the screen into a numerical pad with a +/= sign so you can simply enter the carbs for each food and let the pump do the math! 
  • The basal rate menu is terrific, very easy to see what your doing. You can create up to 6 unique “profiles” for each basal rate routine you may want.   Also, the profiles can each be customized for a different carb ratio or correction factor.  
  • Great collection of data and history, all with graphs that show usage patterns and averages over multiple time frames.  Again, the vivid screen makes these more pleasant to look at.
  • Safety – You can read on the Tandem website about the micro-delivery system they use that provides a level of added safety to the actual delivery of insulin. The system can deliver as small as .001 unit increments.  Also, to protect against an over-bolus the numbers will “grey” out after the first number is selected.  So, lets say you are going to bolus 3.5 units, after you press the “3”, all the other numbers will then grey out with only the decimal point being active to press.  This way you don’t accidentally skip the decimal and bolus 35 units (of course it sets a limit on the maximum bolus amount in the settings menu anyway).  I thought having to tap the 1-2-3 onscreen buttons to “unlock” would get old.  But it’s so fast and well done, it’s a non-issue and I’ve been thankful it exists on more than one occasion.
One Complaint
My lone complaint is the belt clip is a bit bulky, but luckily the pump is so thin I just keep it in my pocket.

Not every pump will be perfect for everyone’s needs and lifestyles. However, I would not let the fact that this is a new company or new product scare you from trying it.  This design will force the competition to get off their duffs and start innovating with more attractive and user-friendly devices.  Just like the iPhone has done for cell phones ... after all, how many of you are still using an old flip phone?

*   *   *
Thank you, Chad, for your insights.  I'm looking forward to reading more from people using this new insulin pump.

October 24, 2012

Diabetes Grab Bag.

My glucose meter bag used to be the one the meter came in - black, boring, and exactly the size for the meter ONLY.  As my needs have changed/expanded over the years, I realized I wanted more of a diabetes grab bag than a meter case, something that had all the necessary accoutrements for some of my daily diabetes duties.  Which prompted me to buy a random bag and cram it full of supplies.

So what fits, exactly, into a small polka-dotted carrying case?

My diabetes grab bag.  On a hotel desk.  Because I don't live at home anymore.
  1. This is the case itself.  It's a make-up bag I bought at Target a few years ago, and the colors were bright enough so that I can fish it out of even my biggest purse.  (Which, if you've met me, is gigantic.  I hide medium-sized hedgehogs in it.)
  2. I keep an insulin pen with me at all times, because I never know if/when my pump will break/I'll leave the house with a less-than-full reservoir/etc.
  3. Oh hey, Delica lancing device!  I like you.  You're nice to my fingertips.
  4. Some spare lancets, because I actually change them now.  Daily.  I know.  I've lost my PWD street cred.
  5. The One Touch VerioIQ meter.  It's my weapon of choice.
  6. This is the smallest pile yet of dead test strips.  Usually, they spill out of the bag when I unzip it, and for whatever reason, I shove them all back in.  I'm a pack rat when it comes to the grossest things.
  7. A quarter for changing out an insulin pump battery.
  8. And here's the AA battery.
  9. Good ol' bottle of test strips.
  10. Lip gloss.  It's not diabetes-related, but it's always in there, so I'm counting it.
  11. Insulin pen needle tips. 

This doesn't count the jar of glucose tabs rolling around in purse every day, or the spare infusion set pod thingy.  Diabetes doesn't travel light ... or maybe I'm just over-prepared?  Possibly.  I have nightmares of being stuck in a subway car and having to eat a fellow passenger due to hypoglycemia (completely by-passing the possibility that they might have Lifesavers in their pocket).  Either way, I'm developing a definitive slope to my shoulders due to all of this stuff, and fast-becoming a potential cannibal.

Digression.  Whoa.

What's in your diabetes grab bag?

October 23, 2012

I Am Fine.

Bridging the gap between fine and better."You have diabetes?  You seem fine."

"I am fine."

On an average day, diabetes falls under the "annoying but tolerable" category.  I test my blood sugar, wear any combination of continuous glucose monitoring device/insulin pump technology, do the insulin-to-carb math, eat decently, exercise as often and as hard as I can ... blah, blah, blaaaaaaaaah.  For the most part, I don't see extreme hypoglycemia or excessive highs, and even though I see bits and pieces of diabetes in so many of my daily moments, it's not something that keeps me from pursuing the better parts of the day.

But on some days, diabetes falls into the "eff the effing islet you refused to ride in on" category.  Those are the days when my infusion set cannula kinks up underneath my skin and sends my blood sugar cruising into the 400's.  Or the days when a blood sugar of 38 mg/dL serves as a sweaty and panicked wake-up call at two in the morning.  Or I let my brain wander around the fact that I've had this disease far longer than I'll ever have anything else, and I fear the impact of these fluctuating blood sugars on my quality of life, and longevity, going forward.

It's this weird dance, the one between feeling like diabetes profoundly affects my day-to-day health, both emotionally and physically, and the feeling that diabetes is just a blip on my daily radar. 

"You seem fine."

I am fine.  I think?  I have a chronic illness - a disease - that compromises the function of my pancreas to the point where I need synthetic insulin daily, and even with dedicated management, I may see serious and debilitating complications in my lifetime.  That's part of the dance - feeling and seeming fine and actually being fine, even though my body is dealing with something serious every moment of every day. 

Is it an invitation for a pity party?  Nope.  But it's a reminder that even though I feel fine, and I mostly am "fine," there's a part of me that permanently needs tending to, and ignoring it only leads to tougher roads.  The lows, the highs feel like they're ships passing by, but what they may be leaving in their wake scares me.  I don't live with any difficult diabetes complications at the moment (aside from closely-monitored and currently non-progressive retinopathy), and my A1C is at a comfortable constant, so diabetes does feel quiet and well-behaved at the moment, even after twenty-six years. But I know what it can do, and has done, and what it's capable of.

"I am fine." 

It doesn't mean I want people to ignore the severity and pervasiveness of this disease.  I don't want people who might be thinking about donating their time, energies, and finances to type 1 research, funding, and advocacy to be deterred by the fact that sometimes we look fine.  What those outside of this condition need to understand is that this perception of "fine" is all relative.  One day you can be fine, and the next, things can be deeply and profoundly changed. 

For November, the focus of the nation (and some parts of the world) will be pointed to diabetes.  Diabetes will be in headlines, and on television shows, and health and mainstream media websites alike will turn their attention on the disease so many of us live with and care for every day.  It's in those moments when we need to show the world that even though we seem fine, we still need better treatments and a cure for this mess.  Advocacy is important, and we can make a difference in diabetes in our lifetimes.  Fine is status quo.  Fine is living with insulin therapy. Fine is tolerating stereotypes instead of changing them.  Fine is waiting patiently for things to change.

But we can do better

October 22, 2012

Trying Again.

I have missed my CGM.

Over the last few weeks, I've pulled back considerably on my Dexcom use, solely because of the crazy rash that was cropping up underneath the sensor sites.  (And a quick Google search confirmed that I was not the only one who has gone through this issue - Lorraine at This is Caleb had a very informative post about Caleb's similar reaction, and also had some tips on mitigating the issue.)  This rash has been an issue since I was in San Diego at the end of August, and after trying different skin locations, application methods, etc. to the max (to the max, yo), I ended up taking the sensors off completely a week and a half ago.

I did a removal/long break because my skin needed a "full heal" first.  My preferred sensor spots, on my outer thigh, were red and scaly from repeated pockets of itchy rash, and they needed to mend entirely before I felt comfortable slapping another sensor on there.  (And yes, I have tried other locations for my sensors, but have had the same reaction.)  But, thanks to time off from the adhesive/transmitter and the rapid-healing baby lotion that we use for Birdy's sensitive skin, my sites were soon back to normal. 

The first few days of the Dexcom "forced vacation" were particularly crummy, because I have been so used to the steady stream of data over the last five years.  I didn't like not being able to check the receiver before I did certain things, like after breakfast or getting behind the wheel.  Even though I could always check my blood sugar using my glucose meter, it wasn't the same kind of reassurance as when I could see the number plotted within the graph of "where the hell it's been and where it's going." 

Using this photo again because I love, love, love this graph.  "Makes me feel potent."  Which is a great line from "Dead Poet's Society."  Which is a great movie.  Holy digression.

But there are two moments when the Dexcom means most to me:  during exercise, and before bedtime.

The Dexcom during workouts helps me figure out how to best stay active as safely as possible.  I feel confident jumping onto the treadmill for a run if I'm 119 mg/dL with an upward-sloping arrow, but I'll drink some Gartorade if I'm 119 mg/dL with a downward-pointing arrow.  And if I have a 119 mg/dL with two double-down arrows, I'll delay the workout and hit some glucose tabs.  It's not about the number, for me, but the context.  

And before bedtime has been dodgy, for the same reason.  I hate not seeing the mg/dL "breadcrumb trail" before going to sleep.  I didn't realize how reliant I was on the graph until I didn't have access to it.  This is uncomfortable for me in my own home, but when I'm traveling, it's reason enough for a 3 am wake up call to test my blood sugar.  The past few weeks, with excessive amounts of travel and a variance of time zones, have made me miss, and appreciate, the Dexcom even more.

Today, I'm giving it another go.  I'm hoping that the sensor, applied to healed skin, will not cause the itchy, hive-like rash I've been experiencing since late August.  (Because nothing says "hey, I'm healthy!" quite like aggressive, weeping rashes.)  I'm hoping I can return to regular Dexcom use, without this weird reaction.  I'm hoping to return to normal, with the sensor hanging on for as long as it can, instead of me ripping it off so I can rake my nails across the skin in relief.  As you might be able to guess, I'm wicked hopeful.

I have missed my CGM.  

Let's hope it missed me.  :)

October 19, 2012

Even the Fridge.

Diabetes is pervasive in my household, from the sharps container in the laundry room to the small cache of used test strips littering the floor near the garbage can (so close, yet so far).

Even the refrigerator is in on it:

For real?  Yes, for real.  Fo' realz.

Yes, little doggie who commands the alphabet.  I'm always thinking about my A1c.

October 18, 2012

Timesulin: Informed MDI'ing.

During my short experience back on multiple daily injections (MDI), aka "pump vacation," I made frequent use of the Timesulin pen cap.  This sample was sent to me by John Sjölund, CEO and co-founder of Timesulin, and since I received a few samples, I passed one along to Christopher Angell, in hopes of sharing perspectives from someone who was moonlighting as an MDI'er (me) and someone who is a full-time MDI'er (Christopher). 

For me, the Timesulin pen cap was a fantastic transition tool for me because it helped bridge the information gap.  When I'm using my pump, I have access to information like the amount of insulin on board, the bolus calculator, the ability to micro-dose, etc.  Going from pumping to pens is a tricky transition, because injections don't allow me the ability to fine-tune the way I'm used to.  But this Timesulin pen cap thing helps my brain out, because it provides the basic information of "when did I last bolus?"

That, for a scatterbrained mess like me, is crucial.  I have a tendency to rage bolus when I'm high, and this pen helped me avoid stacking boluses.  I also have a tendency to forget when I last bolused (see aforementioned scatterbrainedness), so the history screen/status screen on my Animas Ping is essential to sanity.  This is where the pen cap comes in, because after being uncapped for 8 seconds (which, according to their research, was the average of how long it took to take a pen injection - we are a fast crew, it seems!), the timer resets, letting you know when you last used the pen.

In my world, the size of the pen/cap didn't register much for me, because it lives in my meter case (a small, but long, makeup bag I bought at Target last year), so it fit fine in there with all of my other supplies (meter, lancets, pump battery, a quarter to change the battery, and spare pen needle tips). 

Christopher also took this pen cap for a test drive, and he was struck initially by the size of the thing (and we'll put his comments in italics, so I don't get tangled):  At first glance, I thought the cap looked comically oversized, as though someone had hit my original cap with a hammer and it had swollen to twice its normal size, or the insulin cap equivalent of the foam novelty hand often seen in football stadiums.  Timesulin (my initial reaction notwithstanding) did a very good job of matching their cap to my Humalog Kwikpen™.  If anything, I would say they did too good a job.  The longer I used it, the more likely I was to simply grab the pen and uncap it, without looking at the timer screen, before remembering that was, in fact, an option.  While I understand the impulse to try to blend it in with existing equipment, a more contrasting/eye-catching design would have kept me more aware of its presence/function, and allowed me to take greater advantage of it.

The timer impacted him, as well, but in a slightly different way: If anything, I would say that Timesulin made me aware of how often I truly forget whether or not I have given an injection.  Not once in the 2+ weeks that I have used it have I used it for that purpose.  That said, it's an important enough piece of information that even needing it and getting it once or twice a year is more than enough to justify the unobtrusive accessory.

What I found myself using it for more than anything (outside of general curiosity about how long I might have gone between injections) was as a timer for showing me how long it had been between bolus and meal.  It was a very helpful reminder to try to pre-bolus for meals I knew were likely to spike me, such as chinese food, as well as a convenient way of tracking when that pre-bolus may have been too "pre" and I ought to consider finding something to pre-empt a pre-meal hypo.  I would leave the pen on the table until my food arrived, so I could keep tabs on the life of my freshly introduced insulin.

Overall, I think this concept is brilliant, in both its simplicity and execution.  Even though I'm back on the pump and have retired my bottle of Levemir back to the fridge until my next MDI dabbling, I still keep the pen cap on my backup pen.  This tool is a powerful, yet straightforward, weapon in my diabetes arsenal. I really liked, and like, having it on hand.



And, for the record, it tracks up to 99 hours and 59 minutes, at which time it sits quietly.  Which makes me uncap it and restart the timer, because I can't help myself.  If you want to check this out for yourself, you can buy one through the Timesulin web store.

October 16, 2012

Portion Control.

Portion sizes/control is something that diabetes has made me hyper-aware of, both in terms of carb-counting accuracy and weight management.  I know that a bowl of anything served in a restaurant is most likely supersized when compared to actual, recommended intake. 

Which is why the lunch at today's Digital Pharma conference is cracking me up.  Because while grilled cheese and soup wouldn't ever be my first choice at home, at least it's the most wee ickle sandwich/soup combo EVER. 

I also had a strawberry that was shoved inside of a thimble.  Cute!

(Test strip bottle is in there for perspective; I didn't eat my test strips.  But I might later, when I get hungry.) 

October 15, 2012

Thirty.

My littlest Bird,

"Tomorrow you go to Germany!  And get treats [read: chocolate] and maybe a present, okay, Mama?"



"Yes, exactly.  And then where will mommy be?"

"Then in Texas!  And then you be home."



Discussions about 'where mommy is' have dominated our conversations for the last month, and that breaks my heart.  After spending many weeks together at the end of the summer/beginning of the fall, going to the beach and playing outside, I've been traveling pretty consistently for the last three weeks.  While I enjoy the work and I like seeing different places, I miss you.  I miss you a ton. 

We bought this giant throw rug that has the continental United States on it, in addition to a world map stuck to your wall, so you have some kind of idea where I go when I'm not at home.  (Because I don't like the idea of you thinking I've disappeared in the backyard for a few days at a clip; I want you to know I'm somewhere else, and not hiding from you and daddy in a tree.)     And while I don't take pride in all of the time I have spent away from you this month, I am very proud of your knowledge of geography, and how you apply it to your everyday life.  

"You went to California!"  And you'll run like hell to the large yellow state on the far left side of the colorful map.  "And I like Texas.  Let's change my diaper on Texas, okay?"  And we'll swap out your undergarments while you plant yourself on the large state, setting your shoes carefully within the borders of "New Mexico, right there, aw-wight?"  You know where Rhode Island is on the world map, along with most of the states on the rug.  And you can find England, Germany, and Australia without too much trouble.  Thank goodness.  I still don't know my left from right, so I'm glad you're cultivating this global sense of where things are.

Twins.

New obsessions this month include Coldplay's Charlie Brown ("I sing Charlie Brown now!"), Adele's Rumor Has It, and alt-j's Breezeblocks, in addition to the international penguin sensation known as Pingu.  (Pingu isn't educational, and won't groom you in any way for higher education, but he makes us laugh like hell.  And his father doesn't smoke his pipe, but instead seems to stick it into a hole in his throat to smoke it, leaving his beak available for flapping.  Amazing claymation going on there.  Pingu rules.) 

You sing The Wheels on the Bus (a lot - those wheels go 'round and 'round and freaking 'round in our house) and The Farmer in the Dell, and you confuse me by insisting that Old McDonald has a butterfly on his farm because how am I supposed to make a butterfly sound?  Or a spider sound?  Come on, Birdy.  Can't you go easy on your old mom?

I only know the song Baby Beluga from an old episode of Full House.  "You got it, dude!"

I love you, my strange little friend.  Daddy loves you.  Your grandparents and aunts and uncles love you.  So do your friends.  And so did this beluga whale from the aquarium.  You're a likable chum.  (Get it?  Terrible pun.)

Be good while I'm traveling, my love.  I'll be home soon.

Love,
Mama

October 12, 2012

Looking Back: Zombie Lows.

I'm in Vancouver, BC today for the 15th Annual CDA/CSEM Annual Meeting and will be presenting about diabetes, pregnancy, and the influence of the Internet on patient care.  Which means that I've been on a plane for ages, getting from Rhode Island to Vancouver.  Which also means I'm in zombie-mode.  Which lastly means that it's time to pick back through the SUM archives for something about zombies.

Oh hey, Kevin James.

*   *   *

Yes, this.The BEEEEEEEEP! woke me up from a dream about having my arm chewed off by a zombie that looked like Kevin James.  (Zombie dreams are common in my house, apparently.)

I wasn't sweaty and my skin didn't have that flushed, clammy feel, but my whole body was extra-sensitive and jittery.  Like being covered in sand, only every granule was touching a nerve.

For once, I didn't bother testing.  I knew I was low.  The Dexcom was howling from underneath the bedside table (where I must have lobbed it like a softball when it went off the first time.)  The display kept glowing "LOW."  I reached into the drawer of the bedside table and retrieved a tube of cake frosting.  Red.   

It's been a while since I've had a low in the wee hours of the morning.  I've woken up on the lower side a few times in the past several weeks (morning numbers in the 60's and 70's - too low for me), but there haven't been any low messes at 3 am. 

Until last night, of course.

Still unnerved from the Kevin James zombie dream, I consumed some cake frosting and let the sugar settle into my system.  It was absolutely silent -  not a sound coming from the roads outside or the cats milling around in the living room - and my brain kept screaming for more sugar.  

This is where I get stupid every time.  The frosting I ate was enough to cover my reaction.  After I tested, I saw that I was 45 mg/dl.  I'd already eaten about 20 grams of carbs, which would have brought me up nicely to about 100 and left me there.

But I had a brain full of zombie nightmare panic and low blood sugar, so I stumbled out into the kitchen. And proceed to drink about three cups of juice to quell my anxiety, checking in the hallway for zombies after each gulp.  It's so psychological, the way that juice calms the "low feeling" faster than anything else, purely in my mind.  Even if my blood sugar doesn't budge a bit, just drinking something sends my brain the "it's going to be okay" message.  (But I hate over-treating, because then I just end up high. See also: This morning's waking 290 mg/dl blood sugar.)

I wander back to bed, Abby circling my feet like a shark while I walk.  I'm starting to feel better, even though it doesn't dawn on me yet to maybe bolus for all the extra juice I drank.  Running my toothbrush under the water (because I can't stand waking up with that juice taste in my mouth and yes, this post-low dental hygiene thing happens all the time), I look into the mirror.  My hair is a disaster.  My eyes are wild, like a child who has been locked in a closet for days on end, pupils darting from side-to-side, panicked.  The bags under my eyes are distressing and apparently packed for a long trip.

God, I look awful.  Is this what a low looks like from the outside?

I remember the zombie dream and realize how ridiculous it was.  What kind of person dreams that Kevin James is gnawing off her arm?

I smile.  

And am startled to see my red teeth grinning back at me, stained from the frosting.

*   *   *

October 11, 2012

Scrutiny.

Here.  Read a book up close, if that's your thing."One diet doesn’t rule us.  One meter doesn’t rule us.  One doctor doesn’t rule us.  The diversity in treatment options and methodologies is amazing.  And with so many variables, there’s still the common thread that with even the same arsenal of diabetes management tools and strategies, two people can have entirely different results from the same therapies.   In the diabetes community, there isn’t one voice, or one perspective, or one way of doing things that dictates the actions of a community. 

Diabetes is as diverse as the people who have it.  There are so many voices because there need to be so many voices."

New column up at Animas today, and it's about Scrutiny

October 10, 2012

From Abby: That Time I Ran a 5k-ish.

Abby tackled her first 5K last week, and she's proud.  As well she should be!  Today, she's posting about how she doesn't love to run, but she refuses to let diabetes keep her from sitting on the sidelines.

*   *   *
I ran a 5k.

Ok, I ran most of a 5k. And, admittedly, it was 3.66 miles so that's like 6k?

Yeah! I ran/walked a 6k!

I hate running. I've been running since July-ish, and I started with a couch to 5k program which was really great. And by 'great,' I mean I didn't die from running all summer, so that's good. I did quit around week six because I was struggling with getting past the 2 mile mark, so I decided to just "take it from there." (If you ever do a c25k program, I highly discourage this.)

As far as diabetes went during this process, I just took it one day at a time. I tried different things with my basals - how much reduction, and how far before I ran. I also played with food and realized I CANNOT run in the evening without eating dinner first without reaching the 35 mg/dL mark rather quickly. I also found out that running during the day is way better on my blood sugar, but I can do that only on weekends ... and let's be real - I don't like to run early in the day on weekends.

A week before the race, my running buddy (who is also my best friend and stuck with me during the "wait, I need to stop, I'm 54 mg/dL" run breaks all summer) and I decided to go for a really long run, in the rain, on a Saturday morning. You know, to practice for the real thing. It felt great, my blood sugar was hovering between 110-125 mg/dL the entire time (no, I'm not kidding, it was a miracle) and we went the distance that our actual race would be. Long story short - my ankle got a little weird that day. And by a little weird I mean as I'm writing this I'm pretty convinced it's a stress fracture but I haven't seen my own doctor about it yet.

So I took the week before the race off to rest my ankle. And on race day was really worried about how my body would deal with this 3.66 mile WICKED HILLY course on a week of rest. I ate a bagel on the way there, drank a bunch of water, and when we arrived about an hour early I was 215 mg/dL. I left it alone, because Dex had decided to play the ??? game with me that morning and I had no idea where I was headed. Instead we walked to the course, registered and by the time we got back to our car to get ready I was 132 mg/dL. I ate three Glucolifts, and put my basal at 60% for an hour, with the race starting 20 minutes later.

And guess what?  I ended the race at 83 mg/dL and a big fat "Sensor Fail" on my Dexcom.
Take that technology. I don't always need you. (But please come back - you make me much less nervous.)

Moral of the story is that this journey I went on in July to run a 5k is completed... sort of. Due to ankle issues and not running in a week and my general lack of a running body I had to walk up the hills but I ran the rest of it. My goal was to finish in the allotted time which was 50 minutes. I crossed the finish line at 45 minutes, and it took us about two minutes to get out of the gate.

And diabetes didn't stop me.

The afformentioned best friend and I, immediately post run, and immediately disgusting.

Abby The Runner - 1
Diabetes - 0

(Now I'm taking some time off of running, and starting a month long yoga class. Which I'm hoping to hate a lot less than running. And I'm hoping my body will hate it less too. I'm also under the impression I will look like a movie star in four weeks because they all do yoga, right?)

*   *   *

Have you ever challenged yourself to go a bit farther and try something outside of your exercise comfort zone?  What's on your fitness "to do" list?

October 09, 2012

European Blogger Summit: Berlin, Germany.

Despite the fact that we came together from different countries, speaking different languages and bringing out collective diversity to the table, the common thread of diabetes brought comfort and community to a tableful of otherwise strangers.

Last week, while in Berlin, Germany for the EASD conference, I had the pleasure of meeting with and facilitating a discussion with many members of the European diabetes social media space.  Actually, let me rephrase that:  I had the freaking honor of being part of and completely inspired by this discussion.  I've never been in a room with so many strangers at once that I felt completely in awe of and wanted to hug, simultaneously. 

We had dinner the night before the summit, and about forty of us gathered into one room, comparing pumps and meters and guesses on the meal's carbohydrate content.  I remain amazed at how universal the language of diabetes is - even if we don't full understand the words we're using, a beeping Dexcom or a mention of a blood sugar of 300 mg/dL makes everyone nod in effortless empathy.

The presentation I made was centered more in the why I started blogging, and how the emotional aspects of life with diabetes are often more challenging than the physical task of testing blood sugars and taking insulin.  I talked about some of the relationships I've found in the diabetes community that have become honest and life-changing friendships, making "people from the internet" into actual influences in my "real life."  (Plenty of shout-outs to my American blogger friends.)  But what I really wanted to drive home was the point that the diabetes community isn't just something unique to the United States; it's a global community, and reaches far past the boundaries of the country I call home. 

We talked about the what.   What brought us to this space, online?  What made us want to share our stories?  Some were there because of their own diabetes, like Danie, Bastian, and Iris, and others were there because of the diabetes of someone they love, like Daniella.  But we were all in that room together because we were sharing our diabetes lives online, in efforts to connect with our peers, both locally and globally.  And these stories brought us together for just a brief moment, so we could raise our glasses to one another in person.

We talked about the how.  How some are using personal blogs to tell their stories, sometimes working alone, and sometimes as an inseparable team.  Others make use of forums and communities.  Some use film to share their tale, like Bastian who takes to the sea with his meter and insulin pens on board.  It wasn't about the medium, but more about the stories we're telling, and why they are important to share.

And we talked about the why.  Why diabetes can be frustrating.  Why it can be empowering.  Why it brings together a group of strangers who may have otherwise never known of their respective existences.  Why it's important for us to come together as a community, respecting and embracing differences but finding strength in what we have in common:  this constantly shifting disease. 


Standing in that room, I was among "strangers," by standard definition.  I didn't know everyone's name, and I didn't know anything about their family life, or favorite band, or most loathed candle scent.  (It did cross my mind, wondering if anyone else in the room couldn't stand the smell of vanilla candles.  Digress much while jet-lagged?  Yes.)  But they weren't strangers.  Not by a long shot, because they have an acute and intimate understanding of this disease I live with.  The people in this room understood things about me in minutes that it's taken my closest family members decades to wrap themselves around.  And seeing that bond play out in an international sense showed me that what happens in the U.S. isn't unique - it's standard fare for people with diabetes. 

We're in this together. 

"A rising tide lifts all boats," was a message I included in my talk, and  I firmly believe that's the way the diabetes online community should work.  We should support one another in any way we can, because it's through our raised voices that our community truly becomes heard outside of this bubble.  Together, we're a strong, global community that's capable of great advocacy, support, and camaraderie that can change the way the world sees diabetes; at the very least, it can change the way we view ourselves. 

*   *   *

Here are most of the websites written by the attendees.  And I've been happily burning a hole into the Internet using Google translate, trying to keep up with this wonderful new cache of diabetes advocates and storytellers.

www.mein-diabetes-blog.com
www.diabetes-zentrale.de
www.diabetes-index.de
http://nicht-noch-ein-diabetes-blog.blog.de
http://tadorna.de
https://mysugr.com/en/website/eating-diabetes.html
www.klaeui-web.ch
www.portalediabete.org
www.lambertini.net/diab
www.gbdoc.co.uk/gbdoc/Welcome.html
www.thedaniediaries.com/
www.ninjabetic1.blogspot.co.uk/p/home.html
www.diabetogenic.wordpress.com
www.mydiabetesdigital.com

Thanks to the global Animas team for bringing us together, and making this off-line meet-up possible. 

[SUM disclosure]

October 08, 2012

Dexcom G4 Platinum APPROVED!

Pretty colors ...I've been using a Dexcom for the last five years, and I'm absolutely thrilled to see that the new Dexcom G4 Platinum sensor has been APPROVED by the FDA.  (Yes, you just saw "approved" and "FDA" in the same sentence.) 

According to the press release:

"Clinical trials report up to approximately 19 percent improvement in overall accuracy for the Dexcom G4 PLATINUM compared to the Seven Plus, and approximately a 30 percent improvement in accuracy in the hypoglycemia range (i.e., when blood glucose is less than 70mg/dl). The overall accuracy and ease of use for the Dexcom G4 PLATINUM sets a new standard for commercially available CGMs, making the Dexcom G4 PLATINUM the most-advanced CGM system available.

'Improved accuracy in the critical hypoglycemic range is most important from a life-saving point of view,” said Terrance H. Gregg, Dexcom CEO. “The Dexcom G4 PLATINUM fulfills the promise of CGM for people with diabetes by providing accurate and reliable real-time performance.'"

As far as what's new/updated, here's a snapshot:

YES

"The Dexcom G4 PLATINUM offers not only outstanding accuracy and performance, but many new capabilities, including:

  •     Longest transmission range, enabling improved patient flexibility and convenience
  •     A smaller, discrete profile that fits busy lifestyles
  •     A first-of-its-kind color LCD display for easy viewing
  •     Customizable alerts with specific tones
  •     'Hypo alert' setting at 55 mg/dl that provides an increased level of safety — a feature that no other device has."

I'll be updating this post with images and information later in the day, but for now, I'm having a celebratory cup of coffee and really, really looking forward to the new G4 sensor being part of my diabetes management plan.

Update:  Here's a video introduction to the new G4.  

October 05, 2012

Scenes From Berlin.

Pictures are serving as a few thousand words while I fly home.  :)

 

 

European Blogger Summit 

October 02, 2012

Reconnected: Shots, Timesulin, and Public Druggery.

The first few days back on shots were awesome.  I haven't done anything "new" in my diabetes management in a while, not since switching to the Verio meter, so the novelty of injections was shiny.  There were some definitive pros and cons, though, and it only took me a few days to miss that little pump thing.

MDI PROS:

  • It was really, really nice to wear a dress and not end the day with the buttons on my pump etched into my sternum. Or to grapple with ye olde disco boobs.  Or to feel like I had another thing to be a bit self-conscious about. 
  • Birdy was a little disconcerted - "Where your pump, mama?  In the dryer?" because that's where her favorite blanket always is when she wants it most - but eventually we were both used to having mommy take an injection instead of a pump bolus.  And it was comfortable injecting in the privacy of my own home.
  • I loved sleeping with out the pump attached, because sometimes I wake up in the morning and feel very "princess and the pea," having spent the better part of seven hours with my hip smashed against the pump housing.
  • Packing on MDI was pretty easy - I threw a Humalog pen into my meter case and the bottle of Levemir into my medical travel bag, along with a handful of syringes and some needle tips, and I was good to go.  Bit of a lighter fare than bringing along pump change supplies, etc.
  • Timesulin.  This thing is awesome.  I know it's a product that's been around for a while, but this replacement pen cap for my Humalog pen saved my brain from guessing when I last bolused, as it keeps track of that "last bolus" moment.  More on this pen in another post later this week, but having a bridge between the information stored in my pump vs. the lack of information stored in my syringe use was very helpful.
  • And this excursion into MDI confirmed for me that I do best splitting my Levemir dose every 12 hours.  So at 10 pm, and again at 10 am, I would take 8 units of Levemir.  According to my Dexcom, this was the right dose to keep me steady without significant peaks and valleys. 
  • And I was happy to finally be able to travel with my insulin bottle "koozy," which is a simple tool I learned about from Jim Turner during my days at dLife.  This little bottle traveled safely and soundly on a quick business trip from Rhode Island to Philadelphia, and I didn't have that fear of the bottle cracking and exploding against the bathroom tile.
Snug as a bottle of synthetic hormones in a rug.

PUMPING PROS:

  • I missed my pump a lot in the morning, when my dawn phenomenon would kick in and cause my blood sugar to jump a few dozen points.  This meant I needed to consciously bolus before the upswing would begin, and taking a half unit bolus with an insulin pump felt like a frustratingly unnecessary, yet very necessary, needle poke.
  • And I missed it a lot at night, when I would remember to take my Levemir injection in a swooping moment of "Oh shit, did I take my Levemir yet?"  Having the pump on me 24/7 makes forgetting my insulin pretty difficult.
  • See also:  sleeping in.  My MDI experience was the first time in a while that I had to set an alarm solely to wake up and take an injection. 
  • But I missed it most when I was at the ePatient Connections conference, listening to presentations and attending meetings for two days.  I did not enjoy injecting in public.  I know that my past includes a lot of public injections, and I didn't care about it at the time, but I've spent the last eight years discreetly bolusing with my pump, and I like that discretion.  I like not having to push a needle tip through my clothes.  Busting out the syringes and pens for a few days made me long for the convenience of my pump.
  • Basal rates with the pump are just plain easier for me.  Negotiating the morning "spikes" attributed to the dawn phenomenon is easier with the basal rate profile on my pump.  I went on the pump for two main reasons:  ability to micro-dose down small high blood sugars and the option to increase basal rates during different times of the day to avoid lows/highs.  Levemir works well for me, especially with the dose split, but I did see some pre-breakfast highs that I would prefer to manage with a bumped up basal to fix the problem before it starts, versus taking a correction injection.
  • And yeah, those little highs.  Like the 140s and the 160s that I take half a unit to correct down to 100 or so.  The pump is brilliant for fixing those little suckers.
  • But most of all, I like the pump because it's one less needle.  I didn't remember the discomfort of injections until I was a few days into my MDI cycle and saw the small bruises popping up on my injection sites.  For me, I prefer putting a pump site in every few days rather than taking a needle every few hours. 

Insulin pumping isn't magic.  It's not like going on a pump automatically creates better diabetes control - it's just a different way of delivering insulin.  But for me, it's a tool that does make diabetes management easier, and more convenient.  I'm glad I took a pump break, because I now feel more confident bouncing back and forth between injections and pumping, as needed.  Or chosen. But I do prefer the pump over injections - it works better for how things roll out these days.

Options are nice.  I really appreciate them.  Almost as much as I appreciate coffee.  Almost.

October 01, 2012

No D-Day: A Lighter Note.

SuperG said it's time time to take a day off from talking about the D Who Shall Not Be Named.  And for once, I'm doing what I'm told.

I do what I'm told.  :)  For once.

I love music.  Even when I worked in an office setting, I was constantly listening to music all day long (and often infecting the ears of my coworkers ... thankfully, dLife had a kickass and very tolerant editorial department who didn't mind Beyonce bursting from the speakers now and again.).  Now that I'm working from home, it's a rare day when there's silence in my home.  The notes of a song are always streaming out from speakers somewhere, and thankfully, Birdy is a tolerant coworker.

Most of the time, I lean towards music that's moody.  Evocative.  Stuff that favors minor keys and sort of makes you want to write, or go for a quiet hike, or hug someone close for a really long time.  I also like rappy-type stuff (stop laughing at me, Linds), or stuff that fun to run to (if anything makes running fun, that is), or stuff that i if I play it, it makes me feel peppy.  (Yes, that whole sentence was hijacked by the 90 year old woman who lives in my head and says words like "peppy," dagnabit.  Oh, and like "dagnabit.")

So, for No D Day, I wanted to share some of my favorite tunes that are populating my Spotify playlists.  I've mentioned some of these before, but they're all on constant rotation either in my ears or simply in my head:

What are your earworms?  (And please don't say the theme song from Daniel Tiger's Neighborhood.  That is completely stuck in my head at all times.  Ugga-mugga.)  I'd love, love to hear any musical recommendations you have that are topping your playlists.  I am always on the hunt for something new to play on repeat to the point where Chris knows all the words without meaning to. 

(And hooray for No D Day!  Thanks George, for organizing this, and for writing another one of my favorite songs, Not By Choice.)


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