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February 28, 2013

Rising.

Sometimes just waking up in the morning and thinking about breakfast is enough to give my blood sugar a boost.  

RISING!!!!  And stuff.

Oh blood sugars ... you are so sensitive.  And you hate when I think about Golden Grahams. 

(Just thinking about them, not eating!  But I can think about them, since they are so delicious and are easily the best cereal on the face of the planet and even when they get mushy from the milk, they are still excellent.  I can't remember the last time I had a bowl of Golden Grahams ... or when I dared to even have a box of them in the house, due to aforementioned tastiness.)

February 21, 2013

A Real A1C.

Last week, I had lab work run to review with my new primary care physician (my previous one, after only a year, is leaving the practice, which sucks because she was great, but thankfully, the new guy seems cool, only he wears a bow tie and I'm not sure how I feel about that, or how I feel about this massive run-on sentence).  It was standard stuff, including an A1C, and my new doctor and I reviewed all of the results at my appointment this week.

And for the third time in a row, my A1C is at a level I'm happy with.  It could drop a small bit, but if it stayed where it is for the rest of my life, I'd sleep fine.  But what makes this recent run of decent A1Cs different is that this time, the number is reflective of real numbers, instead of the averages of highs and lows. 

Here's what I mean:  I've had A1C results that were higher, but that number was a reflection of a lot of normal to high blood sugars (100's to 160s), with some true highs thrown in (over 160), and very few lows.  Conversely, I had really, really low A1C results during my pregnancy that were the direct result of running low all the time.  (ALL THE TIME, like bowls of cereal eaten without a bolus and I'd still end up at 60 mg/dL kind of lows.  Crazy hormone town.)  After a low over a year ago that really threw me for a loop, I was very edgy about low blood sugars and actively avoided them.  This meant a higher average run, and few lows due to a lack of aggressive corrections. My endocrinologist  suggested that I raise my blood sugar "correct to" goal to something in the 140 mg/dL range, instead of 100 mg/dL (where it was before, during, and after pregnancy). 

Over the course of a few weeks, that hypoglycemia fear eased back a bit and I felt comfortable with a lower blood sugar goal, but I was still edgy about lows.  I started being more vigilant about tracking and correcting highs (thank you, Dexcom, for giving me a heads up on those highs as they start to creep in, versus finding out about them once I'm already high), which began a steady, but slow, decrease in my A1C. 

Visual courtesy of one Birdzone

And this is why I'm fine with my A1C result, as it stands right now.  Because it's not an average of a pile of lows and highs and some in-between numbers.  It's a reflection of blood sugar values that are, for the majority of the time, in a range that's on target, without throwing in a bunch of lows to cause the drop.  It doesn't mean I have anything remotely close to figured out, but for this moment in my life, I'm not actively fretting about my A1C.  (This is a novel feeling.)

"So what you're saying is that you're fine with this number?  Because I'm fine with this number," my doctor said, fiddling with his bow tie.  And then he paused.  "Not that I need to be fine with it, though.  This is your diabetes."

This is why I'm okay with my A1C right now, and with my new primary care doctor.  

Only I'm still deciding how I feel about the whole "bow tie" thing.

February 13, 2013

Down the Stairs.

What, you didn't want to eat the glucose tabs sitting right there, on the bedside table?  WTF IS WRONG WITH YOU?It was a weak alarm, but I still heard it.  I forgot to take the Dexcom receiver out of its case before I went to bed, so the vibrations weren't directly against the wooden nightstand, but the repeated BEEEEEEP!ing was enough to rouse me, after about fifteen minutes. 

"LOW BLOOD SUGAR UNDER 55 MG/DL GET THE HELL OUT OF BED" the screen screamed at me.

"Sure, yeah."  

I clicked my pump (aka 'my watch') to see what time it was - 2:32 am - and I tried to run my hand through my hair to get it out of my face, but my fingers ended up stuck in the mess of sweat-matted, tangled hair.

The lamp switched on after some fumbling, and I stood up gingerly, removing the brace from my foot (thank you, plantar faciitis) so I could walk.  The walls of my bedroom seemed like they were throbbing and pulsing, like I was standing inside of someone's beating heart.

My meter showed me a "34 mg/dL," like it was a prize I won for being so sweaty.

Despite the bottle of glucose tabs on my bedside table (open, and ready, but ignored), despite the sleeping and capable husband in our bed, and despite the fact that I was walking on a compromised and even-more-clumsy-than-usual foot, I decided to go down the stairs to get juice.

Foolish.

And despite the fact that I actually looked at the juice bottle to calculate (ha?) how many carbs would be in a glass, I still drank too much of it.  And then, fueled by adrenaline and bad decisions and the desire to not feel like the kitchen floor was made of shifting sand, I also grabbed a handful of gum drops from the bag in the fridge.Not smart.  Not even a little bit smart, especially because as I was chewing, I was calculating a correction bolus for the overtreat, but then forgot to dial it into my pump.  It was a perfect storm of bad decisions, with a brain slogging through hypoglycemia at the helm.

Such a strange hypoglycemic aftermath: put the juice glass in the dishwasher and then, for whatever reason, decide to finish loading the rest of the dirty dishes in and set the dishwasher to cycle, then go upstairs to blow dry my hair in an attempt to ward off the chills that were already setting in from too long in damp, low-sweaty clothes, then brush my teeth, then check on Birdy to make sure she's okay ... what prompts this routine?  Is this the way my body calms down after being jolted from sleep by panic?  

After about 45 minutes, I felt normal.  I saw 99 mg/dL and an arrow pointing up, so I figured I was safe.  

But the rest of the night was spent listening to the Dexcom BEEEEEEEEP! because my blood sugars were cruising up, up, and away, ready to greet me with a "HIGH!" in the morning. (That, and Siah was nose-to-nose with me this morning, which made me happy and grossed me out, all at once.)

I should have just stayed downstairs and started my day at 2:30 am, because there wasn't going to be any sleep after that moment, anyway.  Besides, there's someone always awake in the DOC, isn't there?  All hours of the day?  

* You don't keep a bag of gumdrops in the fridge?  Just me?  They were on sale at CVS. Happy Valentine's Day?  Go spare a rose instead.  Gumdrops are the devil's work.

February 06, 2013

Context.

Out of context, this early morning Dexcom graph looks like things are all figured out, with barely a bite into the hypoglycemic range.  It makes diabetes look easy.  It makes blood sugars look like they are something you don't even have to think about.

Hey, this looks okay ...

Until you see the whole picture, in context:

... oh, I get it now.  Yesterday you were high all day.  That blows.

Yesterday was miserable, blood sugar-wise, with numbers cruising around in the high 200's and not budging for hours, despite rage-bolusing.  I felt sluggish and exhausted, my brain cells thick with sugar and every word in my mouth swiped by hyperglycemia.  Hours with high blood sugars are The Suck.  It took a full infusion set change (new insulin bottle, new site, new location) and some exercise to bring things back into some semblance of "control." 

The big picture sometimes isn't pretty, but it's real.  And today will be better.  (I'm saying this over and over in my head, with my shiny new infusion set and this morning's Dexcom graph that's more seascape than mountain range, thankfully.)  Today will be better.

January 18, 2013

In the Trenches.

What was different about yesterday?

Oh.  Hey.  You suck.

At first, I thought the Dexcom sensor was quitting.  It was Day 8 of this sensor, but even though the adhesive was hanging on by a thread the day prior, the results were so matchy-matchy with my glucose meter that I was reluctant to pull the sensor.  (That, and it didn't itch at all, so if it was spot-on and not giving me leg leprosy, I was all in.)  I slapped on some Opsite Flexifix tape around the edges, in hopes of grabbing a few more days.

"GIVE ME YOUR BLOOD" the receiver shouted (or offered up the little blood droplet equivalent of that demand).  It wanted to be calibrated way more often than normal, so I figured the sensor was finally quitting.

Only every time I tested, it was right:  I was low.  Again.  Repeatedly. 

WHY?  I'm not sick.  I didn't eat something strange and new.  I didn't push through some foreign and difficult workout.  The infusion set wasn't new.  I'm not pregnant.  (Repeat:  I am not pregnant.)  I wasn't stressed.  I didn't treat that first low at 7 am with a bowl of Rolos and then a massive bolus.  Nothing was different about yesterday that should have warranted this series of hypoglycemic events.  Yet there were five of them throughout my sensor's "last stand." 

The sensor yawned off my leg last night, and I made the rotten decision to put a new one on this morning.  Which, of course means that I was 47 mg/dL at 3 am.  (My poor liver, even with a shock of carbs, couldn't rebound me out of that one.  And yes, I had an alarm set for 2:30 am, based on the history of lows I had that day.  And yes, I slept through it.  Yes, I'm pissed off about this.)

The definition of diabetes is doing the same thing over and over again and getting wildly different, and sometimes frustrating, results. 

But the definition of a person with diabetes is someone who keeps trying, despite the ironic insanity.

January 09, 2013

:: Head Explodes ::

 BLEEEEEECH.  Blech.(Or at least I wish it just WOULD already.)

I've never had a sinus infection before, but I've heard the rumors.  Some family members of mine have been plagued by this sort of this their whole life, and they describe the swollen head feeling with their hands almost touching their temples, as if connecting their fingertips to their head will ignite the switch.  Until yesterday, I was as empathetic as I could be, from my ivory tower of inexperience.

But hot damn (one), I've earned some stripes in the last 24 hours.

Something not unlike a brick has taken up residence behind my nose and eyes, surprising me when I look in the mirror and I don't see my eyes bugging out like a cartoon wolf.  With this comes a headache (no surprise) and a fever, and the stupid, head-shaking high blood sugars that require a 185% basal rate and some aggressive bolusing to bring back into some semblance of range.  This sinus brick plague also requires acetaminophen, rendering my Dexcom useless for the time being.  Trace ketones hung tight for the majority of the day, and overall it was a strange battle of hydration, sinus pressure relief, and blood sugar stalking.

Last night was the peak of my desperation.  The Vicks vapor salts or whatever they are called worked to relieve the pressure for a few minutes.  A steaming cup of tea provided ten minutes of proper breathing.  And a hot shower helped a little, but the effects were temporary.  What worked best was a short clip of cardio exercise.

"What are you doing?"  

"I'm going downstairs for like five minutes to use the ellipmachineI read online that it could clear my sinuses."

Despite the fact that it was 10:45 at night, Chris just nodded his head.  "Go for it."

And hot damn (that's two), it worked.  After a few minutes on the elliptical, the brick in my head shifted a bit and let me breathe like a human.  The benefits of exercise rear their arrogant heads once again.  (YAY!) 

I climbed into bed that night, armed with Kleenex and a humidifier and other assorted bits of hotness.

"If you wake up and I'm not here, don't be alarmed.  I might be downstairs on the elliptical," I said to Chris.

He laughed.  "Whatever it takes."

"Dude, I'll use that thing all night if it's the only way I am able to breathe."

This morning, the sinus pressure was significantly reduced, the ketones were MIA, and I'm hoping this means I'm on the road to having a brickless-head.  The faster this mess mends, the sooner I can put my Dexcom back on and reassign my workouts to normal hours of the day.

Hot damn.

January 08, 2013

Hypoglycemia Hangover.

Wash, rinse, repeat.  Oh, and grape juice.The 48 mg/dL I had the other night wasn't the lowest I've ever been, or the most 'out of it' I've been in the middle of the night.  Getting out of bed and not being able to stand without swaying, forcing me to wake my husband and ask him for assistance isn't the best, but it isn't unfamiliar.  And the fact that my washing machine doesn't have a "hypoglyemic sweat-and-grape-juice removal" setting for my bedding the next day isn't new, either.  (Though I wish that setting existed.)

What's new in the last year or two is the hypoglycemia hangover that happens after a middle of the night low.  

Years ago (as far back as I can remember), low would come swooping in, be treated, and then would take off again.  There wasn't much of a lasting effect, so even if I had a nasty low in the morning at school, I was fine within a few minutes.  A couple of years ago, when I was working at dLife, I had an intense low before I left for work in the morning, and I needed an extra 30 minutes to get my act together ... and at the time, I was mortified because diabetes rarely affected my ability to get to work on time.  (Thankfully, the phone call to my editor at the diabetes media company that started with, "I had a really nasty low and I am going to be about 30 minutes late," was met with a very understanding, "That's fine.  I hope you're feeling better; we'll see you when you get here."  I could not be more grateful for my former boss.  /digression and office-longing)  The majority of the time, a low sucked, but I could bounce back from it without too much issue.

Now?  Bah.  I'm a waste of space for at least three hours in the morning following a visit from the hypo fairy.

The aftermath of severe hypos is me, struggling to pry my eyes open after a gross low but needed to eject myself from the bed to rescue Birdy.  She runs through the house, arms over her head (E.T. style), happy to be awake and shouting about "it's a sunny day!" and I'm switching on the coffee maker with one hand and debating sunglasses though I'm indoors.  It's a headache that pounds not right behind my eyes but right in the middle, like someone slapped a slice of toxic cheese on top of my dome.  It's these chills that set in on the overnight, the result of falling asleep in hypo-sweat-soaked clothes, making me shove a sweatshirt into the dryer for a few minutes before putting it on, craving some kind of comfort cocoon.  Kind of like the flu, but more like just my brain has the flu, and not my entire body.  It's a lingering feeling of exhaustion and soreness, not like the aftermath of running a marathon but more like someone ran a marathon ON me. 

But it passes.  And I feel normal again, with energy and brain function and the ability to process more thoughts than just, "Should I test?"  Instead, I'm back to playing, and working, and putting the sheets back on the bed and wondering if the sheets would ever get changed, were it not for the lows. 

January 02, 2013

Diasend.

Paper blood sugar logbooks were my arch nemesis when I was a kid (and I'm fairly certain my mother wasn't a fan of them, either).  My mother and I used to slap together my logbook the night before my endocrinologist appointment, using different colored pens to make it seem like we'd been tending to this data stream for weeks. In the days before meters could be connected to computers and when "clouds" were simply indicators of precipitation, logging the numbers and seeing the trends in my blood sugars wasn't the most streamlined process in the late 80's.  

When I was pregnant, the magic of the Kevin spreadsheet kept me in line best, because I was hyper-focused, but after the baby was born, maintaining a spreadsheet was much harder because I wasn't ever sitting at the same computer, meter in hand, for more than a few minutes.  As much as I love, love Kevin's spreadsheet for precision log booking, I am more consistent when I have a plug-and-play system to use.

Image credit to www.Diasend.com.  Or Microsoft ClipArt, which is what it looks like to me.

I've been fiddling around with Diasend for about two years, but haven't really dedicated myself to it until the last five or six months.  There are months when I upload once a week (my meter and my pump), and then there are months where I only log in once and dump all the data.  (And then there are months when I skip it completely.)  It wasn't until I switched to the Verio meter, and then figured out how to make my CGM data show up on the Diasend cloud, that I was going through the motions of data review more often.  (You need to have your clinic ID number configured as part of your Diasend account; otherwise, the CGM tab remains gray.  Getting your clinic ID number means you have to call your clinic, or in my case, you need to find the little freaking red moleskin book it was written in YEARS ago.  My organizational skills need some help, but I appear to be a professional packrat.)

I uploaded my data to Diasend yesterday for the first time in a few weeks month, and it was sobering to see the numbers in black and white (and red and light purple, indicating highs and lows).  I haven't had too many issues in recent weeks with extreme highs and lows, but it is annoying to see more 200's than I thought were there.  At the same time, it was really nice to see that in four weeks, I've only had five meter results under 70 mg/dL, and that's with a fair amount of cardio exercise, so I'm okay with that.  

When it comes to the dance of the A1C, I'm less all over the floor now than I have been in the past.  I don't see fluctuations in the numbers, but the closer I get to my goals, the harder it is to see bigger changes ... kind of like trying to drop those last few pounds of baby bump flump.  For the last year, I've been working hard to tighten up my standard deviation and weed out as many lows as possible - especially after a low blood sugar last January that stuck with me, mentally, for months - to make my A1C result a reflection of actual control and not just an average of highs and lows with some shiny 100 mg/dLs stuck in for good measure. 

While Excel spreadsheets have helped me in the past, I'm hoping that the ease and compiled nature of Diasend will help me take these blood sugar numbers I'm routinely checking and make changes that improve my health. (Because otherwise, I'm sitting at my kitchen table with all these stupid wires and machines and making up my own curse words.)  Part of my goal of finding balance this year means using the tools available to me to make sense of this disease that sometimes doesn't even make a lick of something sensible.

December 17, 2012

Gangnam Style.

Blood sugar of 60 mg/dL before bed, with a steady Dexcom arrow?  Just needed a touch of sugar to keep me steady through the night?

Hook 'em?  Hupp 'em?  Huppen?  I cannot figure this out.

I treated that low Gangnam Style. 

(Thanks to Bigfoot for the cookie.)

September 14, 2012

3 am Eternal.

The Dexcom was buzzing, but from across the bedroom floor, where it had shimmied itself into a corner after BEEEEEP!ing and vibrating for close to an hour.  Without the silicone case around it, the housing vibrated loudly against the wood floors, but it still wasn't what woke me.

"Mama!!!"  Birdy's voice rang out through the video monitor on my bedside table, waking me instantly.  I listened for another minute, but she had re-snuggled herself underneath the blankets in her crib, and I could see that she was asleep.  

I then realized my shirt was stuck to my body, damp with sweat, and my hair was tousled (read: sticking straight up in the air, in crazy directions) and slick with perspiration. 

Normally, my low blood sugar symptoms are such that I can self-treat.  During the day, I don't get too dizzy or rattled, and I'm able to chomp glucose tabs or take a swig of juice without disrupting the flow of things.  But the nighttime low symptoms are strange.  Maybe it's because those lows are more sustained, and I don't catch them until I've been hypoglycemic for some time.  Maybe it's because I'm deeply asleep, and not reading any of the physical cues, like sweat or confusion.

Whatever the case, this low had me so dizzy that the room started spinning as soon as I attempted to sit up, like I was in the Gravitron at the fair. I quickly eased myself back onto the pillow, and my arm swung out and tapped (read: smashed) Chris on the shoulder.  

"You okay?"  (Poor Chris.  It's like he wakes up already halfway with his hand in the fridge, foraging for juice.)

"Wicked low.  Can you help?"  The words sounded slurred, like they'd gone through a blender before hitting my mouth.

He was already out of bed before I could mention the glucose tab jar on the bedside table.  But he was back in an instant with a glass of milk and some honey. 

This low took forever, and the clock minutes never seemed to tick by.  Every time I looked at my pump or my phone, it was 3 am.  And every time I looked at my Dexcom graph (after it was recovered from the floor), it was hollering "LOW" with that stupid flat line of hypoglycemia.

BIG truck.The milk and honey became a peanut butter sandwich.  And then some glucose tabs.  In all, I consumed over 80 grams of carbohydrate, but I was willing to correct the wake-up 360 mg/dL rather than continue to hover in the slick sweat of this low.

I woke up at 169 mg/dL.  Without bolusing for all that crap. The only evidence of the low was the trench on my Dexcom graph and the rogue sandwich plate in the kitchen sink. 

Oh.  And the fact that I feel like I've been trounced by a large truck. 

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.

May 31, 2012

Dream World.

In a perfect (diabetes) world, every menu would come with a nutritional breakdown, all handy and listed right there for carb-count, insulin ratio mathification. 

I'd like to teach the world to carb count, in perfect harmony ...

That is all.

January 06, 2012

Drink the Juice.

Drink the juice, Shelby!Every person with diabetes experiences low blood sugars differently.  There's that line in Fight Club: "You are not a beautiful and unique snowflake," but in the case of low blood sugars, they are like snowflakes.  Or fingerprints.  You can read the list of hypoglycemic symptoms backwards and forwards, but if you have diabetes or love someone who does, you know there's always that rogue one.

"Dizziness?  Check.  Shakiness?  Check.  Wait ... they don't have 'numb tongue' listed on here ..."

A few days ago, my family and I were in Los Angeles for a photo shoot for a diabetes-related project.  (Details to be shared when I can, but since I can't find the non-disclosure agreement, I'm erring on the side of shhhhh.)  As someone who prefers to be behind the camera, and not in front of it, the whole "make up and hair" experience was a first for me.

"Just sit in this chair and we'll start with your hair," the very nice stylist said, easing me into one of those black, swiveling chairs.  

"And Birdy will be here in the room with me, so I can spy on her?"  That was the plan, anyway.  Since Chris was in meetings while BirdZone and I were doing the diabetes thing, there was someone who offered to help bird-watch while I was being all done up.

"Yes.  She'll either be in here with us or out there with [name]. She's in good hands."

"Okay."  

So they set to work on me, with gigantic rollers and make up sponges and tubes of things that leave me clueless.  And as we're talking and exchanging our diabetes stories, someone asks me if the toddler just outside the room is mine.

"Yes, that's my daughter."  I feel myself smiling, even though the make up lady asked me to keep my face still for a few minutes.

"It's good to see a happy mom and a happy baby. Steel Magnolias is one of my favorite movies, but not when it comes to thinking about my daughter and her future children."

"I know, right?  I love, love that movie ... except for the whole diabetes part." 

Time passed and my hair grew in volume.  And I heard the Dexcom BEEEEEEEP!ing from my purse on the floor.

"Would you mind handing me that blue receiver thing in my purse?" I asked the girl who was arranging her work station for the next person.  And two quick clicks showed me at 54 mg/dL with two arrows down.

The irony was too much.  Did the mere mention of Steel Magnolias make my blood sugar plummet while having rollers set in my hair?  I grabbed a bottle of juice from my purse and drew a few long sips.  The make up girl blotted my forehead with a make up sponge.

"Is it a little warm in here?  You're sweating a little.  Do you need anything?"

I knew Birdy was in capable hands, and I knew the juice would hit my system in a few minutes.  I just wanted to sit tight and let the sugar magic happen.  After a beat, I started to feel a little better.  And once the Dexcom showed that I was on the climb, I relaxed.

Not every person with diabetes experiences low blood sugars the same way.  They manifest in their own, strange little ways.  But sometimes you manually refrain from touching the rollers in your hair because you don't want a Steel Magnolias moment to be the "rogue" symptom.

Besides, you never want to ruin the epic work of a talented Truvy.  ;)

October 24, 2011

The Return of Low Blood Sugars.

For a good, long time, I ran higher than usual on purpose because of my focus on the baby and my fear of low blood sugars while I was responsible for her care.  In the last few months, I've started to lower my blood sugar goals to reclaim a little more control and tighten up that freaking standard deviation.

Which also means that my sensitivity to low blood sugars is tossed out the window once again, along with any whisper of a symptom.  ("Pssssst.  You're low.")

So these lows are starting to creep back into rotation.  For a few weeks, it was the 60 mg/dL range that had me sweating and shaking and reaching for juice before bothering with my meter, because the symptoms of the low were so intense.  Those lows were weird because I wanted to drown myself in grape juice, even though I really only needed a few sips to bring me back into range.

But now, with my control slightly better and my meter average down a smidge, I'm back to the Symptom-Free Zone, where lows are caught more by the Dexcom and less by my actual body.  In the last week alone, I had:

  • a 48 mg/dL at 4:30 in the morning (wherein I started texting people back about random things, in my low stupor, and when I woke up, I had to ask people if I really had a text conversation, or if it was something I dreamt);
  • a 44 mg/dL which had me so disoriented that I fed the cats before getting my own juice (see also: casual low);
  • a 39 mg/dL after sleeping-in one morning, where my only symptom was confusion about who I was.  (I had to remind myself: "I'm a person.  I'm a person named Kerri.  Hello, Kerri!  Those are glucose tabs.  Eat them?")
Lows bug me out.  They are unnerving moments in my diabetes management when, even after all this time, this disease can grab me and shake the leaves off my mental tree.  And the lack of symptoms seems to be a strange reward for achieving tighter control, which is so counterproductive that it makes my liver throw its hands up in frustrated disgust.  ("Seriously?  Now I work harder?" while my pancreas happily sips on a mango margarita and plays soduku.)

I want that middle ground.  That place where lows aren't so dramatically low (I'd love a good 65 mg/dL as a trade for these 30's) and the rebound highs are so sticky.  Where troubles melt like lemondrops, and my blood sugar is 130, tops  ... something something. 

For now, I'm testing a freaking ton and relying heavily on the Dexcom as I make adjustments to my basal rates.  And I'm keeping my phone in another room while I sleep, to keep the 'texting while low' at bay.  ;)

October 12, 2011

Cleaning Crews.

The urge to clean grabs me by the throat, and I find myself spritzing Clorox on the counter and rubbing frantically with a fistful of paper towels.  Once that task is accomplished,  I notice that the floor just below the refrigerator door is sticky with juice or something, so I kneel down and scrub that, too.  And then suddenly the fridge door needs a scrub down, and I should probably grab all the sweet potatoes that are growing actual faces there on the back shelf and I think there's a jar of minced garlic that's spilled somewhere in there and ...

... all while the Dexcom wails, shouting "LOW!!  KERRI!!  STOP FRIGGING CLEANING AND EAT SOMETHING!!!"

I look at the graph and see the double-down arrows, and confirm the low with my meter.  But it takes an awful lot of self-control to stop scrubbing and drink some grape juice.

Why am I struck with that urge to clean when I'm low?  I do not understand what it is about the Low Cleaning Crew that moves into my brain when the sugar apparently moves out, but they are a merry and manic mix of maids.  When my blood sugar is in the absolute trenches, I get these cleaning fits.  Emptying the dishwasher, folding laundry, picking up the piles of Bird toys that little the floor ... it's like the slow ebbing of glucose from my blood stream makes my body feel so disorganized and rattled that I search and destroy all external messes to level the proverbial playing field. 

(And I am clearly not alone in this affliction.  Scott posted about this the other day on Facebook, and the flood of comments was just enough to make my low blood sugar cleaning crews grab a mop.  This apparently happens to a lot of PWD ... so explain why my house isn't cleaner on a regular basis?)  

Usually, it's the beading of sweat on my forehead that makes me stop cleaning and acknowledge my blood sugar.  A lot of times, that cleaning fit comes with a frantically panicked mindset, where my brain is racing to think as many thoughts in as little time as possible, my hands shaking open a new garbage bag or sliding silverware into its place in the drawer organizer.

"Did you have a low?"  Chris asks, looking at the gleaming kitchen and the piles of folded clothes.

"How could you tell?"  I responded, wiping the glucose dust off the kitchen counter with a swipe of my sleeve.

"Wild guess." 

August 01, 2011

A Casual Low.

Casual blood drop"Mama?  Ma.  Ma.  Ma.  Ma.  Dumbledore.  Ma." Her voice comes over the monitor, stumbling me from sleep.  

"BEEEEEEEEEP!!!"  The Dexcom wails at me from the bedside table.  

"[insert the sound of my awful alarm clock noise, which is actually this song and makes my whole head spin with cat rage]" 

"You people all want me awake right now, don't you?"  I grumbled, reaching for my meter, despite the fact that my eyes weren't even close to open.  Damn it, the meter is in the bathroom.

I moved casually from the bed, down the hallway, and into my bathroom.  The fog is apparent at this point; I know I'm low, and now it's almost a guessing game as to just how low I really am.  My eyes are sharp and focused on the black meter case on the bathroom counter, but all of my other senses are tangled.  The floor feels harder than normal against my feet.  The sounds of the birds outside the window sound louder, filling the room and blasting their trilling pattern into my brain.

I pricked my index finger and squeezed the blood onto the test strip.  A result of 39 mg/dl yawned back at me.

"Okay.  There you are," I replied, licking the blood off my finger.

Seeing the number usually brings the symptoms of the low on full-force, but this time, everything was in full-on casual mode.  My knees were weak and my hands were shaking, but for some reason, I felt the need to casually brush my teeth.  And then I casually brushed my hair.  And then, only then, did I venture downstairs to casually grab some juice from the fridge and treat my low blood sugar.  

In the kitchen, I downed a few sips of juice.  But once I was back upstairs, I realized how bad this felt.  Every symptom hit at once, and I felt like a boat being tossed around in a storm.  The shakiness.  The dizziness.  It wasn't casual, it was desperate. I needed just a few minutes to let this sugar hit and bring me back into range.

The baby was still happily chattering away in her crib, from what I could spy on the monitor.   I tried to tap my husband gently on the shoulder, but instead smacked him on the back kind of aggressively, my hands a little slack and unresponsive.  He woke up instantly, to see his zombie-low wife standing at the edge of the bed, swaying slightly.

"Can you get up with the baby?  I'm 39."  So casual-sounding. 

He was standing up before I finished my sentence.  "Did you have juice? Do you need juice?"

"No, I already had some.  I just feel too low to get her out of her crib, and I need a few minutes to let this mess finish."  I tried to smile, knowing it was more of a Novocaine-esque grimace due to the low.

"Okay.  I'm on the Bird," and he started to head downstairs.

I sat on the edge of the bed for a minute, letting my body catch up.  After a few minutes, the symptoms of the low started to fade, and the low hangover set in (that subtle, mowed-over-by-something-substantial feeling that follows a low and leaves you out of sorts for an hour or two).  My meter and my Dexcom both confirmed I was moving in the right direction, and seeing those numbers brought me back to a feeling of security and safety.

By the time I went downstairs to join my family, it was like nothing happened.  Totally fine.  Totally casual once again.

May 31, 2011

Exercising My Right to Loiter.

The Dexcom said 177 mg/dl and dropping, but after a full 60 minutes of cardio, I expected the graph to show a lower trend. 

"Whatever," I said, a little confused because my pre-workout blood sugar was 143 mg/dl.  Felt foggy, but I was a little dehydrated so I figured I needed to get home and relax.  Ignoring the cotton-ball haze I felt encased by, I grabbed my keys and gym back from the locker room and walked out into the parking lot.  After trying to get into someone else's black Honda Civic (forgetting, in my fog, that we replaced my old car for the Mom Car), I put the key in my car's ignition and sat there for a few seconds.

And then a few seconds more.

It wasn't until I was out there for about two full minutes that I thought "Hey, might want to double-check that Dexcom reading" with my meter.  The receiver was now showing some double-down arrows.  And my glucose meter confirmed with a bright, shiny 35 mg/dl.

"Oh, you suck," I said directly to my diabetes.  And like a fast, hot breeze, all the symptoms of the low hit in full force, as though seeing the number made it actually real.

Now that the weather is warmer, glucose tabs are all I keep on tap in my car for lows, but since I felt like a pile of crumbs, I thought it would be safer to go back into the gym and let someone kHi!  I'm Victor the Velociraptor.  And I have "low face."now I was having some trouble.  Because if I passed out, for the first time, in my car, it would take a long time for someone to find me.

On autopilot, I went back into the gym.  The guy at the counter was checking in some new members, but he looked twice at me as I grabbed a bottle of orange juice from the cooler and leaned heavily on the counter, downing the majority of the bottle in a few sips.  

"You okay?" he asked.

"Not really.  I'm having a very low blood sugar moment right now and I didn't want to sit in my car alone, in case there was a problem."  I tried to smile, but I was so jerky and unsteady that I resembled a hungry velociraptor more than a woman.  All teeth, stretched smile, and my eyes were trying to find something that was roughly 1,000 yards away.

"Okay.  We'll wait until you're up again."  He finished signing in the new members and I tried to convince myself I was at a bar instead of the gym.  ("How you doin'?  Sure, you can buy me a ... a bottle of juice.")

For about fifteen minutes, the gym guy chatted with me about how diabetes - both type 1 and type 2 - has infiltrated his family.  Grandmothers on both sides, aunts, cousins, his sister, his father and his mom ... the list of affected family went on for the duration of my low blood sugar.  So many members of his family were dealing with some version of this disease.  He knew exactly how diabetes could ruin your day.  And he could see how it was ruining mine.

"I am sorry for taking up so much of your time.  I feel much better now.  Thanks for keeping an eye on me, and I h" I said sheepishly, back up to 98 mg/dl and feeling more human and less dinosaur-y.

"Any time.  You were exercising your right to loiter," he said.  "It's a good way to cool down after a workout, right?"

"Sometimes it's the only exercise I get these days."

May 06, 2011

Bandaids.

September will mark 25 years for me with type 1 diabetes, but I still haven't learned that an afternoon of lazy 200+ mg/dl's that won't budge, even after multiple boluses (and one really solid rage bolus where I actually grunted "You. Frigging. Diabetes." as my fingers mashed the buttons), after repeated tests that showed climbing numbers ... wouldn't you think I'd inspect that infusion set?  Maybe just give it a peek?  See how things are doing there, on the back of my hip, where that 6 mm cannula is resting (hopefully) comfortably?

Oh, you mean I shouldn't have waited until I smelled that distinct scent?  The one that smells like a cross between bandaids and the dentist's office?  And then, when I dabbed at the gauze patch around my site and felt the dampness, I still didn't really hone in on it because I was so high that everything was on like a 20 minute delay?

Wait, you mean this isn't normal?

Yes, I should have responded to the alarms on my Dexcom but I was so spaceshot, I didn't.  Instead, I regrettably spent over three hours at about 300 mg/dl (the Dex was off, saying I was 400 mg/dl plus when I was actually 304 mg/dl). With, of course, the corresponding morning low this morning:

It's like watching my diabetes fall off a literal cliff.

And then the slight bounce after over-treating the low by about two sips of juice.  I understand the "glucocoaster," but this is frigging ridiculous.

Today is a new day.  Today is a new day.  Today is a new day.  (I need to have that tattooed on my hand.)

April 28, 2011

The Pinging and the Ponging.

Target lows struck again yesterday, only in the form of a "didn't test until after I ate and was only 53 mg/dl" sort of thing.  (Which made me wonder how low I was as I stumbled through the aisles of the store.)  I had BSparl with me, strapped into the shopping carriage, so I opened and consumed half a package of orange slices (happened to be in the party aisle I was perusing) without blinking.  With sugar-coated teeth, I smiled at my The pinging and the ponging and the game, set, match of diabetes bullshit.daughter, assuring her that I was fine.

"Mama is totally fine.  We're going to rock this low right up into the stratosphere with those candies.  Mama is going to need a whole bottle of insulin to fix this!" 

(She clapped her hands and cheered at the word "bottle.")

Low blood sugars have always frightened me because of the immediacy of their danger.  A blood sugar of 70 mg/dl can (and for me, often does) tumble into the 50's.  And 30's and 40's can quickly become part of the party, too.  Lows feel tangled and confusing.  I know they don't look too intense from the outside, but the panic and delayed response of my body that's internalized is exhausting and scary.  My body, and my brain, don't react accordingly to extreme lows.  While I should have found somewhere to sit down and eat, instead I felt a weird burst of energy and pushed the cart around with vigor while my blood sugar was in the trenches.

But what scares me even more is the rebound high that comes with such a scrappy low.  The lows that hit while I'm outside the comfort of my home - particularly when I'm solely responsible for my daughter - are the ones I over treat the most, because I just want to be high again.  I would gladly trade a 28 mg/dl for a 228 mg/dl.  But the reality is, I most often trade a 28 mg/dl for a 328 mg/dl.  I mean, we can talk about willpower and carefully calculated carb dosing, but what really happens is that when I'm excessively low, I eat anything I can get my hands on.  And fast.  And without wondering how many carbs are in it or how high the rebound might be.  I will do anything to make the tunnel vision and the shaking hands and the cotton-encased confusion STOP.

Yesterday's Target low rebounded up to 408 mg/dl.  I haven't seen a number that close to the gas prices in several months.  "Whoa," I murmured when the number flashed up at me from my meter.  "Hang on a minute, let's check that again."  323 mg/dl this time.  (I love how this passes for "accurate enough" in glucose meter technologies, but that's an entirely different post.)  My Dexcom looked like a carnival ride.  My mouth was now wearing the warm, wooly sweater of high blood sugar.  And I was pissed at diabetes.

I hate the pinging and the ponging.  Honestly, I'd rather hang out at 140 mg/dl all day long and take whatever consequences come as a result of that, instead of this wild swing of multiple hundreds.  Bad lows wipe me out, emotionally and physically.  As do their often-corresponding rebound highs.  And in the middle rests that guilt of "if only I had the restraint to not over-treat," or "if only I had checked my Dexcom earlier and caught that low."  

Diabetes isn't a perfect science.  Not even for a second.

Instead, I feel like I'm a mad scientist.  ... does this gives me license to work on an evil laugh?

April 19, 2011

Below the Line.

I think I know who has finally and precisely perfected inhaled insulin.  No, not a pharmaceutical company - Target.

The photo quality is kind of crap, but I was in my car, my blood sugar was 54 mg/dl, and I was sitting in a sunny parking lot.  Not the most ideal photographic circumstances.  Also, this alt text is longer than the blog post.

What is piped through the air ducts at Target?  What is it that makes me go into that place and immediately my Dexcom starts hollering?  It's not like I'm running around the joint, flailing my arms and burning as many calories as contained in the candy aisle.  And I'm not secretly bolusing, for sport, before I go shopping. 

What gives, Target?  How are you sending me "below the line" so often?  Why do you make me so low?  And how can I replicate your efforts during, oh, let's say a post-Cheesecake Factory lunch?

April 07, 2011

From Abby: SugarStats.

I suck at logging my blood sugars.  I've tried so many times to get into a good groove with keeping tabs on my numbers (I even had a logbook with logs on it), but the only time I was really successful was when I was pregnant, and I used the "Kevin" spreadsheet. 

But thankfully, logging is possible.  And Abby has proven it.  She's been using an online service to track her numbers, and she's sharing her experience with it today.  Get along, little Loggy.

*   *   *

Old timey log booking.  With old timey loggers.  You can tell it's "old timey" by the sepia tones.  Duh.Logging. It’s a scary word. It could mean a dangerous occupation of cutting down giant trees and magically turning them into paper products (I have no idea how that works). It could mean using a tiny little book filled with tons of boxes to write down lots of numbers that most 13 year olds [Editor's note:  Or 32 year olds] make up two hours before their endocrinologist appointment (been there, falsified that).

Or it could mean SugarStats.

(Sidenote: I use a Minimed pump, so my endocrinologist can download two weeks worth of numbers/insulin when I go to her office, but frankly that’s not really good enough for me. I want to see what happens the other 2.5 months with my diabetes, so I can make changes, or ask her to make changes if necessary. And yes, I’ve used the CareLink program, and hated it.)

I found the SugarStats website from a camp friend who posted it on Facebook, and I decided to give it a shot. I have to admit at first I was very overwhelmed. The site is kind of confusing to navigate (although, I’m fairly un-skilled at such technology things. See: my computer is from 2005 and my phone doesn’t have the internet.) but once I got signed up and started, it wasn’t so bad.

The actual process of logging the numbers is a little time consuming, but they have an “add multiple entries” option which is super sweet, because you can list all your blood sugars at the top, then all of your insulin/medications at the bottom on one page. Easy-peasy.

On day two I was a little annoyed at how many times I check my blood sugar and take insulin, since now I have to type that all in. Fifteen boluses per day is probably a bit excessive. And then on day three, I began to love this wonderful website.  Mainly because I have a graph proving that I really am working hard and it’s paying off.  [Editor's note:  Visual aids for the win.]

Now this is where I might lose you, but stick with me; I'm going somewhere with this.  At the moment, I consider myself in pretty good control. My last a1c was 6.7, I rarely go over 200 mg/dl … I’ve hit kind of a good-rut with basal rates and insulin-carb ratios and such, and I thank the dia-gods daily for this success. That being said, I’m still incredibly pessimistic because of years of not-so-successful control.

My endocrinologist actually said to me, “You’re being too hard on yourself! You’re doing a good job!” at my last appointment. And this is where the logging website comes in.  SugarStats came into my life at the best time possible. I can now look at my numbers, see that graph, see the color code, and realize that I am doing a good job at managing my diabetes. I have the proof right in front of my face.

But since I’m sure my pancreas is reading this, tomorrow my basals will stop being perfect, and I’ll start seeing crazy graphs, and I’ll get disappointed, and my toes will fall off, etc. However, since I’m logging, and have had this stretch of success, I’ll hold onto hope. I now have one more awesome tool in my bag (tool bag? ... of diabetes supplies? … okay, but only if it's animal print and sparkly) to help me get through the rough times.  And to help me celebrate the good times.

*   *   *

Are you on SugarStats?  You can follow Abby, and make logging a steady part of your diabetes diet.  (I'll give it a try, but I can't make any promises.)  Oh, and one last, important note:  No one asked Abby to write about this.  SugarStats didn't ask or pay ... they're not even aware of this post until ... NOW. 

December 14, 2010

Larry Bird, No One Invited You.

My symptoms of low blood sugar used to run the gamut:  numb mouth, dizziness, sweating, crying at will, shakiness, inability to see completely clearly but a heightened sense of hearing ... fun stuff.  The symptoms of a low blood sugar can really suck.

But you know what sucks even more?  Not having any symptoms at all.

A few days ago, I was making lunch for BSparl and trying to clean up the kitchen (never a good idea at the same time), and my hands felt a little fluttery.  But nothing really worth paying attention to for more than a second.  BSparl devoured her rice cereal and mushed up bananas and then she was down for her nap. 

As I closed her bedroom door, I heard the Dexcom BEEEEEEP!ing from the kitchen counter.  There's a different sound associated with the "low" and "high" alarm, and I was surprised to hear the low alarm sounding.

"I feel fine."  I said, matter-of-factly, but not sure I meant it.  I did feel just slightly ... off.  Abby (the cat) meowed as she circled around my ankles.  But a swipe with my blood sugar meter showed me at 33 mg/dl.

Oh come on, Larry. I love you, man, but not like this.  Not as a blood sugar.  

The problem was that I didn't feel low.  At all.  I didn't have even a whisper of a hint from my body that my blood sugar was rapidly heading towards chaos.  If it hadn't been for the Dexcom, I'm not sure I would have tested.

Instead, I found myself standing in front of the fridge and sucking down grape juice straight from the bottle.  (Note:  Don't drink the juice at my house.  I've licked all the bottles.)  Auto-pilot kicked in and I treated that 33 mg/dl as though I could feel every bit of it.

Oddly, I didn't start to feel low for another five minutes or so, when my blood sugar started to come up a bit.  Such a strange thing, but when I'm coming up from a Larry low (read:  in the 30's), it doesn't throttle me until my blood sugar starts the journey back upwards.  Around the 50 mg/dl mark, I started to hit the sweats, the adrenaline panic, and that weird, white fog of precision that envelopes me when I'm low. 

This lack of symptoms has me very nervous lately.  I know that my numbers have been both pinging and ponging all over creation lately, but it's downright creepy when I'm at a blood sugar so close to chaos and I feel like I could happily climb into my car and start driving, or pick up my daughter and start dancing, or wait just a little while longer before deciding to have a snack.  My body doesn't give me the hints I need anymore, and I'm not sure why. 

Diabetes is messing with my head.

My paranoid (and hyper-sensitive) Dexcom continues to wail even after I'm back up to 70 mg/dl, but I find the noise comforting.  I know I'm back in range, and I don't have that feeling of confusion or fogginess.   

"I feel fine," I said again, only this time I meant it.  

I wish every day could look like this.  But it, um, does not.  Lots of times, I see a big letter M.

November 11, 2010

Parking Lot Lows.

Part of me would love to ride in one of these down a steep hill.  The other part of me wants to live."Brrrrr ... it's a little chilly outside today," I said to BSparl as I tucked her blanket snug around her wiggly little self in the car seat. She waved at me and showed me her sock.

"Yes, that's a nice sock, birdy.  Okay, let's get out of here and get you into the car so we can go home!"

The automatic doors parted and a brisk gust of wind came and skipped down my collar.  With the baby's car seat safely tucked into the belly of the carriage, I ventured out to find my car in the massive parking lot. 

"Ha ha, where did Mommy leave the car?"  I said out loud, walking up and down the parking lot aisles and pressing the alarm on my keys.  Nothing.  No flashing lights, no subtle little "beep" noise from my Honda.  Nothing but a sea of cars and I had no idea which one was mine.

"Am I getting old?"  I asked BSparl.

"Mmmmmm!"  she proclaimed, raising her teething toy into the air.

I walked for several minutes, combing the lot for my car.  And the wind kept whipping, only this time it felt good because it kept whisking the sweat off the nape of my neck.  I felt dizzy.  

"This car has to be here somewhere ..." I passed the the same minivan I had just seen moments ago, the one with the stickers on the back advertising the happy family that held the title.  "I just can't find it.  I can't find anything, baby.  I have no idea where this car is."

BSparl was starting to fall asleep, tucked happily into the blankets in her car seat.  And I could not find the car.  The parking lot was this sea of blue and black and red cars, none of which were mine.  My vision began to sharpen on the peripheral, leaving my main point of focus a little blurrier than usual.  The sounds of the parking lot were magnified in my head, leaving me confused and lost in my mental cotton ball.

I felt the buzzing from my purse, and then heard the unmistakable BEEEEEEEP! of the Dexcom.  Without checking to see what my blood sugar was, I reached into my purse while pushing the carriage and retrieved a jar of glucose tabs.  I chomped down on four of them at a time, the glucose dust taking off into the air.

The ground was starting to shift, like a blurry and constant tremor that only I felt.  I knew this low wasn't good - I needed to find my car and sit in a hurry.  But I had the baby with me.  So I had to make sure she was safe, too.

I saw a young kid who was corralling the shopping carts.  I motioned for him to come over, and he trotted over with a half smile.

"You okay?"  he asked.

"Not really.  I'm having a low blood sugar reaction and I cannot find my car.  I need to get my baby into the car and out of the cold, but I can't find my car.  It's not here.  I can't find it."  I hate when crying is the prominent symptom of a low.  I felt the tears coming.  And then I started to laugh, because I was picturing myself, shopping cart crammed with baby and bags, my coat sleeves covered in glucose dust, crying and roaming aimlessly around the parking lot in search of one little car.  

This poor kid must have thought I was on drugs.

Everything happened in fast forward.  This kid told me to stay where I was and he would find my car.  He took my keys and returned quickly, telling me I was just a few aisles over.  He put the baby's car seat in her car, loaded my bags into my trunk, and asked me if I was okay.  I housed a few more glucose tabs in the meantime.

"Do you need me to call someone for you?"  

"No, I'll be fine in just a few minutes.  I just couldn't find the stupid car and my blood sugar wasn't helping.  I'm so sorry.  Thank you so much for your help."

"Okay.  No problem.  If you need anything, I'll be rounding up carts.  I will be watching you, okay?"  He paused for a second, and then rubbed his hands over his attempt at a beard.  "Not like 'watching you' in a creepy way.  Just like making sure you two are okay."  

I sat in the car and waited for my blood sugar to come up while BSparl napped in the back seat.  After a few minutes, I checked to see 82 mg/dl flashing up from my meter.

"Holy biplane-building cats, Batman," I mumbled to myself.  "I must have been crazy low."

Safe in my car with my baby buckled in, I waited in the parking lot for my blood sugar to continue to rise, thankful for the kindness of strangers.

August 26, 2010

My Hat Was Kicked.

I woke up yesterday morning at a blood sugar of 158 mg/dl.  A little on the spikey side, but no worries - after I breastfeed BSparl, I usually drop about 40 points, so I figured I'd use her feeding as my "bolus."  By 8:45 am, I was down to 129 mg/dl.  And then things hit a downward slide that I couldn't control.  

Over the course of the next five hours, I tested several times and saw the numbers tumbling all over the place.  At one point, I had to leave the baby fussing in her crib because I was attending to a 38 mg/dl.  The next blood sugar I saw was 29 mg/dl.  And then 61 mg/dl.  And then 55 mg/dl.  Hours were going by, and carbs were being consumed, but they weren't making a dent on the determined low blood sugar. 

BEEEEEEEEEEEEEP!

Dexcom wailing to let me know I was, once again, under 50 mg/dl.

Shunk.

Another blood sugar test confirmed yet another low.

Hours kept ticking by but I wasn't coming up. It took until 4 pm to see a blood sugar over 100 mg/dl, and then all hell broke loose on the other side.  After over eight hours wrestling with a low blood sugar, my body decided to flip upside down and let all the hourglass sands go to the other side, sending my numbers up into the 400's.  Why on Earth was I low for so long?  And why did I rebound so hard after treating the multiple lows modestly?  

(I keep picturing the carbs, hiding out behind my lungs, waiting to actually enter my blood stream and then all screaming in at once.  "Ahhhhhhhhhhhh!!!" waging war, holding pixie sticks over their heads as they come charging in, full force, for the freaking rebound.)

Which, of course, happened in full force with a gorgeous 405 mg/dl around 9:30 pm.  Yes, I lost track of time between 6 - 9 pm, when apparently the Dexcom graph shows a sharp spike upward.  But still - low all day?  ALL day?  

You know it's been a rough diabetes day when your total dose from 7 am - 6 pm is only 8u, yet your 6 pm - midnight dose is 29u. Diabetes kicked my hat.  Kicked it right-proper.

(We're definitely installing this emergency box.  If nothing else, at least lows will be delicious.)

Yes, this is a reused image.  No, I don't have any guilt.

July 30, 2010

We. Are. KETONES!

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

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

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

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

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

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

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

We.  Are.  DIABETES WARRIORS!

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

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

July 26, 2010

Your Mom is Low.

Terrible habit, sarcasm.  Especially the "your mom" retort.  Like when my college roommates are out at the bar and someone asks for another beer.  Instantly, "Your mom wants another beer."  Immature retort?  Indeed.  But almost reflexive at this point?  Unfortunately, indeed again. 

(This intro has a point - bear with me.)

This morning, I woke up with my first bad low in a while.  For the last month or so, I haven't seen lows worse than 55 mg/dl, and my sensitivity to the symptoms seems to have increased a bit.  But while the lows of the last few weeks have felt mild, this morning's 49 mg/dl raked me over a little bit.

I woke up feeling groggy and warm, despite the air conditioning and the fact that I'd slept about seven hours straight.  (Yay for Sleeping-Through-the-Night-in-her-New-Crib BSparl!) The corners of my mouth were numb and I felt like my whole brain was encased in cotton balls.  I reached for the black meter case and brought it close to me in bed.  Fully intended to test.  But instead fell back asleep for a few minutes, with my meter snuggled against me.

Once I did wake back up, it had been another eight minutes.  And my symptoms were progressing, giving rise to shaking hands in addition to the cotton ball veil.  But it's strange, where my brain goes when I'm low.  I had a juice box right on the bedside table.  I knew I was low and didn't need to test to confirm, but I was on some kind of OCD autopilot.  I had to test.  Instead of grabbing the juice from beside me, I instead grabbed my meter from the bed, walked out into the kitchen, and set up the machine on the counter top. 

Sorry for the old photo.  (Your mom is an ... old photo?)

BEEP!

Shunk.

49 mg/dl.

"Okay,"  I said out loud, and took some glucose tabs from the cupboard.  (Chompy, chompy ... always a weird effort to get those things chewed up when I'm that low.) 

And then I heard BSparl stirring in the next room.   Not crying, but just stretching her little BSparly legs and easing into the morning routine.  I went in to stand at the side of her crib while I waited for my blood sugar to rise. 

"Hey sweetie girl.  Good morning!"

She kicked her legs and grinned at me.

"Hi!  Hang on just a few minutes, okay?  I'm having a low blood sugar and I need to wait before I get you up.  Just another minute or so.  I'm low.  Your mom is low."

And I thought of my roommates tossing the "your mom" retorts around with reckless abandon. I stood there giggling like a fool for at least a minute, the smile of irony on my face causing my daughter to bust out with an even bigger smile. 

"That's right, baby girl.  Your mom is low."  

Finally - FINALLY - the "your mom" actually makes sense.  (And with that, I've come full circle.)

July 21, 2010

Trends.

So here's a trend:  Today, I woke up to the sound of my baby cooing from her bassinet.  My hands reached over to the Dexcom receiver and I clicked on the button to light up the screen.  I saw a "74" and an arrow trending oh-so-slightly down.  So while Chris changed the baby, I went out to the kitchen to grab a swig of juice before settling in to breastfeed BSparl.  I fed her and then went into the living room to play with her.

Notice any problems here?  Anything ... oh, I don't know ... missing?  Like maybe a blood sugar check when I woke up?  Or at least one after I fed her?

Nope.  Nothing.  No test.  I went all the way from waking up to freaking NOON before busting out my meter.  This is a terrible trend.  And it's happened twice in the last four days.  I'm relying way too much on my Dexcom for guidance, instead of double-checking every hour or two with my meter.  I mean, missing a fasting blood sugar?  I've never, ever done that before.  Even in college, when I was at my diabetes worst, I still tested first thing every morning.

This is not a trend I want sticking.

I miss these little blue guys.  :)Here's another trend:  For the most part, I am BSparl's daytime friend.  During the day, Chris leaves our home office for a distraction and baby-free zone where he can focus on his writing.  So for several hours a day, BSparl is left to her mommy's devices.  (Including, but not limited to, visiting friends for lunch dates, running household errand-type things, and my own attempts to get work done.)   When I'm hanging with the baby, getting to the gym is impossible, and with the weather so hot and humid lately, I don't feel comfortable taking her for a walk in the stroller.  By the time Chris gets home, and we talk for a while, and we have dinner, etc. etc., it's suddenly so late that it's almost time for Colbert to come on.  (NATION!)  And I'm too exhausted to hit the gym.

This is not a trend I want sticking, either.  

A lot of the baby weight has come off (thank you, breastfeeding), but I am in desperate need of some muscle toning.  I need to get some workouts in as part of my schedule in a hurry, because I'm growing tired of feeling flumpy.  Before I got pregnant, I felt good about my body.  Now?  I need a little more effort to get back to fighting shape, or at least faux-fighting shape.  (Like the kind of fighting that includes throwing styrafoam peanuts.  Or something similar.)

The trends of missing blood sugar checks and workouts must end TODAY.  These habits are too damn crappy to let them continue.  I can't let these two trends wreck my goal of good health.  Small changes can make the biggest difference, so as of this moment, I'm realigned myself to test every morning and to get some exercise in at least four days a week.  (I was doing five days a week for years, so four days isn't a bad starting point.)  And it doesn't have to be a gym workout - I'll take anything from a long walk with the stroller and BSparl to an ellipmachine workout to a bike ride. 

Why am I rambling on about this?  Accountability, my friends.  By telling you, I'm setting myself up to be accountable for my actions (or lack of action).  It worked in helping me get my diabetes reigned in for pregnancy, and I hope accountability can help me get my act together to be a healthier mom.

July 07, 2010

A Big Ol' Discussion About Meter Accuracy.

Using this image again because, damnit, it's a nice one.During the course of the Roche Summit, we had a big ol' activity about meter accuracy. I've written about meter accuracy before - actually, it was way more of a spastic rant - and I have remained frustrated about the lack of accuracy that's in the meters we use every day.  So when the Roche people had us talking about meter accuracy and our perceptions and expectations, I had plenty of opinions.

We were at tables of about eight people apiece, and each table gathered together to decide how we wanted to lean.  Our choices were 5/30, 10/20, 15/15, and 15/10, meaning that we could chose between a percentage of  variability on the low end of the blood sugar range (the first number) and a percentage on the higher side of the range.

EDIT on 7/8:  I was wrong.  Thanks to Amy at DiabetesMine for clearing this up.  The numbers stand for "number of points your meter might be off on the low end, and percentage of total error on the  high end." 

As a diabetic who was diagnosed as a kid, and also as a recently-pregnant diabetic, I had a very, very tough time deciding on an accuracy pairing.  Would I rather take the hit when I'm low or high?  During the course of my pregnancy, I was aiming for a fasting blood sugar under 90 mg/dl.  With a percentage of error in the double digits, was my 80 mg/dl really an 80, or was I dipping into the 60s?  Or the 100s?  My decisions for both ends of that small spectrum are different, and the results if my meter is "off" could be really problematic.

In an ideal world - and my table picked this as our initial ratio - we'd want 0/0.  Total accuracy.  But I know that's not possible, based on the constant fluctuation of a diabetic's blood sugar and the limitations of the technology.  For me, I was leaning more towards heightened accuracy on the lower end, because the lower the number, the scarier a "mistake" could become.  Also, with my goals set at 100 mg/dl and not 300 mg/dl, my hope was that I'd be dealing with a more accurate meter because my blood sugars would be running tighter.  Also, also, I was more willing to take a sharp blood sugar tumble from a high versus from a low. Further to fall, I guess.

My vote was for 5/30.  

And then I felt this wave of frustration, because the idea of having to choose heightened accuracy at one end of the scale or the other made me pretty fired up.  If you can be more accurate on both ends, why wouldn't you be?  Oh wait, is it the cost?  Could it be that once again, affordability comes into play?  Our group talked about different strips for children (more accurate on both ends of the range) and for pregnant women, but if I were to mention that concept to my mom, she'd say, "You're still my child, and I'd want you to have the most accurate strip."  There were comments that a more accurate strip would be a more expensive strip, and insurance companies (who barely want to cover four strips for a type 1 diabetic, never mind the 15 a day that I blow through) would fight endlessly to deny coverage due to the cost.  I understand that business is business, but isn't life still ... life?

At this point, I'd just take a meter that gives me the same result twice in a row.  (Because in the last 23 years, I've seen some wicked variability that meter companies should hang their heads in shame over.)  I'd even allow it to be 5 points off in either direction.  Nothing gives me more confidence in a meter result than seeing it line up with my Dexcom.  And nothing shakes my confidence more than seeing results that vary - wildly - mere minutes from one another.  With those kinds of results, I have just as much faith in a Magic 8 ball.  (Ask again later.)

What plays into your decisions on what is "acceptable" for accuracy?  Is it once your child sleeps through a low?  Once you find out your pregnant?  Once you have a seizure?  Once you correct down a 300 mg/dl and fall into the 20s?  Would you be wiling to pay more for a more accurate strip?  Would insurance companies be willing, or would they ever see the benefit of covering preventative care now instead of treating complications later?  What is your definition of "accurate?"

And if you had to select one of those accuracy ratios, which would you choose?

June 12, 2010

Six Week Follow Up.

Yes, I have used this image before.  Yes, I am lazy.  :)For the last year of my life, it's been a monthly visit to the endocrinologist, and then once I was pregnant, the dam broke loose and I basically had a cot set up at the Beth Israel/Joslin pregnancy clinic.  Oh yeah, and then I spent a month at the hospital while waiting for BSparl. 

I have doctor burnout, big time.

So I'm done with doctor's appointments for at least a few weeks.  Mentally, at least.  (Because there is another one scheduled for August - WTF?)  But last week, I had my last appointment, for a while.  I was up at BIDMC for my "six week follow up" appointment (which took place seven weeks after the birth), and I met first with my endocrinologist. 

"How are you feeling?"

"Tired.  That's normal for a new mom, right?"

"Exhausted is more normal," she said, as she opened up my file on the computer.  We ran through my vitals, going over the medications I'm taking, the ones I'm not bothering with anymore, and how my blood sugars have been reacting to new mommyhood.  

"I've had some really good days, but the bad days are like epically bad.  Like 300's and 400's kind of bad," I said, looking at the floor.

"We want to prevent those highs, and the lows that either cause them or follow them, but you aren't the first postpartum patient I've seen who is hitting these kinds of numbers.  It's normal.  You'll even out," she said.

My basal rates seemed to be okay, but we did some tweaking to my afternoon/evening insulin:carb ratios (going from 1:12 to 1:15, which is math beyond my capacity).  Overall, I've had some nasty numbers, but my endocrinologist reassured me that my A1C wouldn't be too awful, because I wasn't letting any of those numbers ride.  (And when she called me on Monday to let me know what my lab work results were, my A1C was sitting comfortably at 7.0%.  Some people might call that too high, but I'm calling it a wicked victory for me.)

After I met with my endo, I was off for my exam with the OB/GYN.  Not to be terribly TMI, but I can't stand the pelvic exams.  They are unholy and cruel and a very strange way to spend an afternoon.  (Not only that, but I can't figure out why I'm not allowed to greet the doctor while I'm dressed.  No, they send her in only after I'm clad in the awkward paper johnny, with my regular clothes balled up on the chair near the examining table.  And it was the first time I had met with that specific OB.  "Nice to meet you, too!  This is my floppy body.") 

Thankfully, I appear to be healing well, both inside and out.  My c-section incision doesn't hurt anymore, and even though my lower abdominal muscles are currently useless and squishy, I am recovering like a "normal person."  (Read:  Not a diabetic who has seen 400's three times in the last eight weeks.  Nasty.)  There is still a little bit of light bleeding (not from the scar, silly), but my doctors told me the bleeding can last as long as nine weeks.  (Yay.)  The scar is shorter, and a light pink color as it attempts to heal.  I can't see the staple holes anymore, and when I spy the scar in the mirror, I don't want to jump out the window due to grossed-out'ed-ness.  That's progress!

So I'm cleared for "normal life," which includes being able to pick up the carseat while the baby is in it, which means I am no longer tied to my house.  THANK GOD, because I swear I was hearing the cats talk about me - in ENGLISH - which means my mind was starting to leak out.  Onward!  To normal life!

(Normal life - ha!  That's redefined with each messy diaper and baby smile.)

May 26, 2010

Oxygen Mask.

Gotta wear mine before I can help BSparl.In the airplane safety manuals, they instruct you to, in the case of an emergency, put your oxygen mask on first, before assisting others with theirs.  Makes sense.  Can't help someone if you are in need of help, yourself.

Chris and I reference the "oxygen mask" all the time, mostly when I'm low.  During the course of the pregnancy, I had some wicked lows that kept me from attending conference calls, making it to dinner meetings, and even just meeting a friend out for coffee.  "I'm going to be late, but I need a few minutes.  Oxygen mask, you know?"  And Chris would nod, knowing that I was waiting until my blood sugar was stable before I headed out. 

But as I wrote about yesterday, I'm in the middle of The Suck.  Can't wrap my head around what I need to do in order to take care of myself, because I'm too overwhelmed with what my daughter needs.  The baby learning curve is pretty steep, and both Chris and I being schooled on just a few hours of sleep.  My baby is well-cared for, but my diabetes management has seen better days.

... so I guess my baby isn't as well-cared for as she could be.  Because I'm trying to put her oxygen mask on while fumbling with my own.  

Yesterday's post had some good ideas in the comments section, and I'm going to try and implement them going forward.  Like the testing suggestion.  I'm already testing my blood sugar before I feed the baby, so now I need to find other benchmarks in my day to assign testing to.  I'm working off a mental "even numbers" schedule today, making sure that I test at all the even hours.  I'm awake around 6:15 am every morning, so that means I get a 6 am fasting, and then a test every two hours. 

Some other things I simply need to make part of the routine.  So it becomes natural(ish).  Like the Dexcom.  That tool is extremely useful to me ... when I look at it.  For the last 11 days, I had a sensor in and the Dexcom was working great, but I wasn't looking at it.  The receiver would sit on the dining room table while I worked on my laptop and I'd barely pay it any mind.  Then, one night when it was pinging because I was high, I turned off the high alarm so that it wouldn't wake up BSparl.  Being the dingbat that I am, I left the high alarm off.  For four days. WTF?  What's the point of wearing the device when I'm not using it when I need it most?  Today, a new sensor goes on and I'm determined to reset the alarms and to actually use the data.  (Otherwise, what's the point?)

And then there's what Chris and I call "life stuff." Like remembering to call in my reorder for insulin to my mail order pharmacy.  And then remembering to pick it up from the mail drop.  Or remembering to throw a bottle of glucose tabs in my purse or the baby bag, or grabbing a back-up insulin pen, or making sure I have enough test strips in my meter case to get through the day.  Maintenance.  Life stuff. 

But I can't do all this stuff at once.  Baby steps, right?  Today, I'll start with testing more frequently and rearming myself with the Dexcom.  I threw a bottle of glucose tabs both into my purse and the baby bag this morning, and I called in my insulin reorder a few minutes ago.  New bottle of test strips is floating around in my purse.  Small changes that will hopefully make a big difference in how things roll out, diabetes-wise.  Because the better care I'm taking of myself, the better care I'm taking of the little BSparl baby.

Oxygen mask, you know?

May 25, 2010

The Suck.

Bright?  Not me these days.While motherhood is going well and I'm completely in love with my daughter, I'm reminded, daily, that diabetes doesn't care if I've slept or if I have carefully counted carbs or if I've just changed my infusion set.  Diabetes doesn't give a shit about my schedule.

It's The Suck.

Like last week, when at 4:30 am, my "alarm" went off - also known as BSparl starting to fuss and wail from her bassinet in our bedroom.  Not a problem.  I woke up, tested my blood sugar, and saw that I was 176 mg/dl.  That number (albeit spiky) works just fine for feedings, so BSparl and I spent some quality time hanging out, having an early snack, and debating where exactly the sun hides behind the trees before it starts to poke out.

We both went back to bed around 5:45 and slept until the next alarm went off - the Dexcom BEEEEEEEP!ing wildly at me at 8 am.

"Do not wake up the baby, you."  I grumbled while fumbling for the receiver on the bedside table.  "LOW.  Under 55 mg/dl" was the warning it was flashing up at me.  While BEEEEEEEPing.

"Shhhhhh!!"  I unzipped my meter case and deftly stuck a strip into the top of the machine.  I wasn't sweaty, my brain was functioning fine (aside from shushing inanimate objects), and I felt physical capable.  Maybe the Dexcom was just being finicky and throwing lower numbers?

"36 mg/dl"

Well shoot.  Not a whisper of a symptom, either.  I got up from the bed and wandered out to the kitchen, where Chris was making his protein shake.

"Can you keep an ear on the baby?  I'm 36 and just want to grab some juice," I said, opening the fridge door.

"Of course."  Pause.  "What?  You're 36??"

"Yeah.  No symptoms, dude.  Not even one."  I chugged a few sips of grape juice and put the bottle back in the fridge.  "I feel fine.  The Dexcom woke me up."

A blood sugar of 36 mg/dl without a single symptom, other than a wailing Dexcom and a bit of a groggy feeling.  But, in true diabetes form, once my blood sugar started to rise, I felt the symptoms acutely. 

"I feel pretty bad right now."  Shunk.  "Fifty-six.  Why do I feel worse at 56 than I did at 36?"

There's no rhyme or reason to diabetes.  The symptoms of lows and highs change with the seasons, it seems.  And they come without warning, these numbers.  Sometimes it's a hormonal or emotional surge that sends numbers pinging.  Other times, it's a little, teeny technical glitch that sends thing spinning.

Like two nights ago, when I bolused for a snack and felt a damp spot on the side of my shirt.

"What the ..." and I probed with my fingers and felt that telltale wetness around the gauze of my infusion set.  I tugged up the side of my shirt and gave the spot a sniff - yup, that bandaid smell.  Frigging infusion set was leaking some how.  No symptoms, though.  I wasn't thirsty, I wasn't lethargic, and I was actually just about to head off to the gym.  I felt pretty okay.  Problem was, I hadn't tested in about four hours, nor had I peeked at the Dexcom.  So basically, I didn't have a clue what was going on in my body. 

I tested my blood sugar and a 423 mg/dl grinned back at me.   

(Have I mentioned Yosemite Sam yet in this post?  Suffice to say, I rocketed through a list of curse words that would have caused Yosemite Sam to give me a frick-a-frakin' high five.)

New site, quick injection with an orange capped syringe from the fridge, a ketone test (negative), and an hour and a half later, I was down to 195 mg/dl.   But I was pissed.  Because during the course of my pregnancy, I maintained an A1C between 6.0% and 6.5% and I busted my butt to keep myself controlled.  But now, with my body reacting to adjusting levels of hormones and a serious lack of concentration due to a truncated sleep schedule (read:  no sleep 'til Brooklyn, with Brooklyn being college, I think), I'm all over the map. 

I'm frustrated with my control, or lack thereof.  Trying to figure out my post-pregnancy insulin needs and taking care of my little girl have become a full-time endeavor, and I'm not getting it completely done on either front.  I have to buckle down.  These epic lows and highs are not fun, and are wrecking havoc on my healing body. 

Next week, I'm back at Joslin to see my endo.  Diabetes needs to take center stage until I can get things under better control.  It's my priority.  I need to get back to logging, to testing every hour and a half or so during the day, to actually cooking meals instead of just snacking when time allows, to changing my infusion set when it's due, not when it's convenient. 

... after diaper changes, of course.  And breastfeeding.  And BSparl laundry.  And pediatrician appointments.  And 3 am feedings.  And that occasional moment when I lock the bathroom door and look at myself in the mirror with determination and say, "Get it together, Mommy."  

May 11, 2010

Break Glass In Emergency.

BSparl and I made our first trip out today into Boston proper, so I'm wicked late on writing my post for DBlog Week.  (I apologize for my tardy, bloggy arse.)  But when I was thinking about this topic last night while I waited for the baby to decide yes, she'd like to go back to bed after her 4 am feeding, thank you very much,  I knew I couldn't wax on about the old school low blood sugar treatments I used back in the day. 

Like the white, BD glucose tabs that tasted like the Lick n' Dip sticks and came in foil-wrapped packs of three.  Or the packets of honey they'd dole out at Clara Barton Camp.  Or the bottles of grape juice that hide out in my fridge at this very moment.  Or the many flavors of glucose tabs that, despite their color or packaging, still tasted like the same flavor:  chalk. 

Because when I'm low, I don't want the recommended fifteen grams of carbs.  I don't want to wait patiently for my blood sugar to rise.  I want to grab the hammer and break the glass, as suggested in times of emergency, and house a whole bag of Reese's Pieces.

E.T. can eat his little yellow mums instead.  I'm calling dibs on these.

Those things?  Are the freaking bomb.

April 02, 2010

Day Seven in Captivity.

Little on the down side today, thanks to having just marked one week "in" and with still two to go.  What the hell is there to write about, from the mind-numbing confines of my hospital bed?

At the moment, BSparl and I are hooked up to the fetal monitoring system, and I can hear her heartbeat pumping along like a rhythmic Clydesdale and can see the movements of her little 5lb, 5oz body being tracked on the graph.  It looks almost seismic, like a BSparl earthquake.  


They haven't checked the protein levels in my urine in a day or two, but things appear to be holding steady.  Blood pressure is climbing ever-so-slightly, but monitored constantly, and there's room for titration in my Labetalol medication (read:  they can give me more of that crap).  Still rockin' the heparin injections twice a day (hate) and still not sleeping through the night thanks to the monitoring.  (Which I understand the necessity of, but it's not making for "relaxing bed rest."  Bed rest is a misnomer.  This is more like jail where the wardens grin and mean well.)

One of the hurdles I'm having a little trouble with is the diabetes management aspect of things.  The Joslin team comes by once a day to review blood sugars and make suggestions, and they are the experts in all-things diabetes.  However, I am the expert in all things specific to MY diabetes, so I've been working hard to achieve a tolerable blend there.

For example, one of the (very nice, very knowledgeable, mind you) endocrinologists had some commentary about a post-prandial blood sugar of 137 mg/dl that I had two days ago.  In my mind, 137 mg/dl an hour after eating is downright badass, and I'm very happy with it, especially considering that the pre-meal number was 84 mg/dl.  Good control, in my eyes.  

"Well, this is a little high.  We'd like to get this post down."

I don't mean to be rude.  I try to be a good patient, a "patient" patient, and to find that careful blend I had mentioned, the one of my non-medical knowledge and their medical knowledge of diabetes.  But it was 8 in the morning.  And it was the third time I had been woken up by a doctor who wanted to review my goods.  And I didn't agree that 137 mg/dl post-prandial was too high.

"Really?  Too high?  I don't see it that way.  I think that's a number to aim for, especially seeing as how I leveled out to 98 mg/dl at the two hour mark.  That's a respectable peak, don't you think?  Otherwise, I'd be treating a low at the two hour mark."

"Yes, but it should be lower than that."

And I sort of lost my cool.  

"Okay, well how about we all call the FDA and get them to tighten up their requirements for 'what's accurate' to something a little more precise than 20%, and then we can start griping about a 137.  Because for all we know, that 137 mg/dl could actually have been a 110 mg/dl, and then I'm right in the acceptable range, right?"

(I am Kerri's terrible, bedrest-fueled, pregnant rage.)

They agreed that 137 was okay.  And that revisiting my post-prandials after another day of review would be a good idea.  And then the fleet of them shuffled out the door.  I felt bad about blowing off steam, but really - I'm in no way a "perfect diabetic," but these days, I'm running really tight and carefully with my numbers.  Let's remember that the reason I'm having post-prandial peaks is because - oh yeah - I have diabetes?

It's challenging, that feeling of having people take my diabetes management control away from me.  Not that I have all the answers or have it all figured out, but I've been living with this a long time and my own instincts and experience should be as strongly considered as the vast medical knowledge of my new, trusted caregivers here.  I'm no diabetes expert, but I'm pretty well-versed when it comes to "Kerri."  ;)

Eventually, I'll find a way to balance my issues with control while "in captivity," but until then, I may need to vent here a bit.  Because I'm pretty sure they're not reading me. 

... Whoops.

February 02, 2010

BSparl: She Likes to Make Me Work.

Park City is an old mining town nestled among the Wasatch Range of the Rocky Mountains, and aside from buzzing with Sundance excitement and brimming with film-goers and celebrities, let me just say that the damn place is not flat.  Not even close to flat.  (See also:  built amongst the mountains)  The majority of the "stuff to do" is on Main Street, and I'm pretty sure that street is a 60 degree angle.

BSparl and her mommy (me), in all their frontal weight gain glory, were not amused.

Something about walking up and down (and usually up and down a few more times) that street had me more winded than if I'd tried to run a mile on the treadmill at a 6.0 incline.  I know that the air is thinner in that part of the country, being so freaking high above sea level, and I also know that having a little baby girl growing inside of me is compromising the room for my lungs to expand.  But I had not anticipated how hard it was going to be just to WALK around in Park City.  We'd take the bus from our condo down by the Yarrow Hotel and get dropped off at the city transit center, and then the huffing and puffing would begin.

We have HOW many more steps to go??

"I'm ... sorry ... for ... not ... keeping up."  I'd pant with each step as I tried to keep up with Chris.

"It's okay, baby.  We'll go slow.  We're not in any rush."

"Awe ... some.  Hang on while I lean against this lightpole for a minute ... and let my lungs ... do stuff."

(Thing was, we were late for two different dinner appointments because I couldn't catch my breath about 15 minutes into the walk.  I've never felt more awkward, or more yeti-like, than I did trying to plod up Main Street.)

Overall, little BSparl was a well-behaved fetus, doing her job of kicking and sleeping and rolling around in there.  I'm officially sporting a major baby belly, complete with visible baby movements even through my shirts.  And thankfully, my basals didn't need any adjusting while we were away.  I don't know if it was the time change or all the walking around or maybe it was just the grace of the diabetes gods, cutting me some freaking slack for the week, but my numbers ran relatively stable while we were away.  (Save for that f'ing 300 that came up as a result of overtreating two 48 mg/dl's in a row, pissing me off royally and causing me to have to skip dinner one night.)  I changed my infusion sets every three days like clockwork - mainly because I'm now using about 50u of insulin a day and that's the shelflife of one pump cartridge and also because sets left in too long are starting to get infected faster than usual - and I tested about 18 times a day.  In addition to Dexcom'ing. 

I may have left a trail of test strips on that there Main Street.

BSparl is proud of her daddy.  When I was trying to coax her into kicking at times, all it would take is a quick "Hi baby!" from Chris to get her scooting around in there.  And during the five screenings of Buried, she danced in celebration for her father's success.  I believe I may be building a "daddy's little girl" in there, and I think they're respectively smitten with one another. 

A sculpture on Main Street in Park City, Utah

Traveling at almost seven months pregnant was definitely a challenge, and I'm not sure I would have done it, were it not such a big freaking deal to go to Sundance.  Heparin before the plane ride was one thing (that shit stings going in, FYI), and not being able to lift my suitcase wasn't exactly heartbreaking, but moving around was a little awkward.  And having to pee every 30 minutes was also cumbersome.  (I know where EVERY bathroom is in Park City.  Thank you, BSparl, for making my bladder your pillow all week long.) 

But I wouldn't have missed this for the world.

January 22, 2010

Looking Back: Rage Bolus, Anyone?

Today, we're traveling to Utah for the Sundance Film Festival.  And yes, I will be photographing and videoing the hell out of the festival, because I am so excited to see how this week plays out for my husband.  But in the meantime, as I board the plane and head off to Park City, I'm looking back to this post from October 2005, where the term "rage bolus" first appeared on SUM

(It made me laugh to read this post, because this was pre-dLife, pre-Chris and I getting married, and pre-so much stuff that's in play right now that I almost forgot that I hated my job back when I lived in RI.  And how much I still want to know how many licks it takes to get to the center of a Tootsie Roll pop.)

*   *   *

October 10, 2005:  Bit of a rantish post here. And there's no reason for this other than to vent frustration.

Last night, after I came home from the U2 show in Boston (more on that later), I was a little bit high. Rang in at 212 mg/dl. Okay, no problem. Bolus it up, go to bed. Woke up this morning at 200 mg/dl. Hmmm, no drop in the blood sugar levels. Not to worry, though, because it's a Free Shower - no infusion set - Day due to the fact that it's time to change the infusion set. Primed and inserted a new set with good ol' Charlene. She purred (beeped?) happily and I set about dressing for work.

RAGE BOLUS!!

Arrived at work. Hungry. Devoured one of those sometimes-delicious-but-most-often-just-gritty Kashi Whole Grain Granola bars. Bolused two units to cover, in accordance with the 1:10 ratio. Worked at my boring job for about an hour before realizing that I had already visited the bathroom twice in that time. Hmmm. Not normal. Tested, revealing 281 mg/dl. Whaaaa... I corrected this morning. I bolused for the crappy snack. And now I'm higher than before? Frustrated Kerri. So I Rage Bolus*. I just crank the shit out the pump, knowing full well that I only need about two units to come back down. I lace in 3.5 units. Sit back, satisfied.

Not done yet. I test again, an hour and half later, clocking in at 286 mg/dl. Fan-freaking-tastic. Good thing all that insulin made me higher. Because that makes f-ing sense. So I Rage Bolus again, sending 2 more units coursing through, Frustrated Kerri not really giving a shit that the "active insulin" tally on my pump is enough to cover dinner at Olive Garden.

So it's noon. I've been high all morning. I just changed my infusion set this morning. And I'm angry. I do not want to pull this set only to find that it's perfectly fine and I've wasted yet another expensive pump supply.

I'm riding this out. It's Me against the D. Who will persevere? How high will Kerri allow herself to rise before she pulls the set and starts over? How much Rage Bolusing will eventually catch up with Herself before Kerri bottoms out at 44 mg/dl? How many licks does it indeed take to reach the center of a Tootsie Roll Tootsie Pop? If you say three, you and that f-ing owl can go screw. It at least takes 125. I'm going to find out as soon as my Rage Bolusing catches up with me and I'm Trick or Treating at people's desks here at work.

*Rage Bolusing: Taking an uncalculated amount of insulin to correct a frustrating high bloodsugar reading. Also see: Panic Eating.

January 17, 2010

BSparl Fights Back.

Last Friday, Chris and I were back up at the hospital for another round of doctor's appointments to spy on Ms. BSparl.  (This might be another long post, because I'm trying to include everything we're doing for this pregnancy, just in case someone else is looking for this info.  So thanks for bearing with me!)

Fetal Echocardiogram No. 2:  We started with a follow-up echocardiogram appointment at Children's Hospital in Boston, because last time we tried to see the structures of our little girl's heart, she was hiding out too low in her little uterine apartment to be properly found. This time, a full month later, she's over a pound and a half, and the size of an eggplant.  So hiding is a little harder.

The babies of type 1 diabetics aren't prone to every kind of complication, but are instead screened for everything under the sun, just to make sure.  The ultrasound technicians were looking for problems with BSparl's heart - ranging from a floppy valve to flow problems between the atria and ventricles, checking out the umbilical cord blood flow, too.  

"She not much of a cooperator, is she?"  the technician asked, pressing the ultrasound wand firmly against the left side of my uterus. 

"I guess not.  Bit of a shy one." 

(I love this kid already!! /sidenote)

"Well she can run, but she can't hide.  We're going to get these pictures today, whether she likes it or not."

The technician visually isolated BSparl's beating heart, looking at every chamber and pulse to make sure she was in one piece.  But as the technician worked to get the ultrasound images she needed, she was pressing pretty damn hard against me ... and against BSparl.

"Almost done.  Just one more image to capture.  You doing okay, Kerri?"

"No problem.  But I think our friend here is ... ooof!  Um, she's not very happy with you."

And when I looked down, I could see the baby kicking and fussing on my right side as the technician pressed the wand against my left.  Big kicks, clearly visible to Chris, who was sitting in a chair on my left.  BSparl was pissed - she didn't enjoy being bothered while she was trying to sleep during the day, apparently.

'Fiesty one, eh?"

I felt a little proud.

"Yes, she is."

(I guess if you poke at my kid, she fights back.  I like that.) 

The fetal echocardiogram came back without any red flags, so thankfully her little heart seems to be okay in there. 

Some orange flowers.  Not diabetes-related, but I thought they'd break up this long, boring post a bit.

OB/GYN: 
After that appointment, we had a quick visit with my OB/GYN who took some measurements of BSparl to see how big she's getting in there.

"Looks like she's about one pound, 12 oz.  She's right on track, so nothing to worry about with her size at this point."

I was relieved.  "I'm glad you're saying that, because I've had some really tough blood sugars these past 2 1/2 weeks.  I was afraid she was beefing up in there."

"No, she's in the 61st percentile, and we aren't going to worry about anything until she's in the 75th.  We're going to watch you to make sure she doesn't get too, too big in there, but at this point, she's doing just fine.  And so are you."

She printed some ultrasound photos for us (which will go into the baby scrapbook I've started but definitely need to catch up on) and then I met with my endocrinologist about my blood sugars.

Endocrinologist:  I am very, very thankful that I have a comfortable relationship with my endocrinologist, because the emotional toll of diabetes has really affected my ability enjoy being pregnant.  I've had some highs that wouldn't go away, and plenty of unexplained blood sugars that have made me feel so frustrated over the last few weeks.  I'm pretty sure my A1C will be up again this month (hopefully still under 6.5%) but I needed help fixing some of it.  And I also needed to be told that what's happening to me is normal.

"I'm high.  Like, crazy high, sometimes first thing in the morning.  And other times, I can't make my post-prandials come down under 160 mg/dl for at least two hours, no matter what I do.  Is this normal?  Is it normal for me to be experiencing such wild insulin increases at this point?  And is it normal for me to be sort of losing my mind at this part in the pregnancy, too?"

She assured me that this is the point in pregnancy when the placenta does, in fact, produce anti-insulin hormones, causing my numbers to elevates and my need for more insulin.  

"Anti-insulin hormones?  That's cruel.  Cruel irony."

She smiled as she worked to adjust my basal rates (now up to almost 20 full units of Humalog per day, in addition to bumping my insulin to carb ratio down to 1:8).  

"You're doing fine.  And you've been adjusting your own basals and going after these highs, so that's the right thing to do.  We just don't want you chasing.  I want to help prevent them in the first place."

I could have hugged her.

"Me, too.  I want to make sure she's safe in there.  I don't want to hurt her in any way, and the recent highs have me freaking out a lot."

"Don't freak out.  Just keep doing what you're doing.  Follow those numbers, stay as controlled as you can, and fax me any blood sugars that have you concerned.  I can review the changes you're making, or I can make changes for you from here.  Either way, we'll get her out just fine."

Building this baby is tough work, and these days, I feel like a full-time diabetic.  This baby, and by default, diabetes management, is my top priority and I am focused on keeping her as safe as I can.  But as my body changes and my insulin needs become less and less predictable, it's getting tougher to stay in good control.  And in solid spirits.

We're almost at the end of the second trimester.  Third trimester starts on February 8th, and after that, it's a fast track towards her arrival.  This is happening really fast.  We actually started registering for baby stuff this past weekend - holy crap.  Emotionally, I'm overwhelmed and excited and scared and trying to figure out how to just slow things down for even a day.

(More on that tomorrow, once I wrap my head around the whole concept.  For now, I need to go make some pancakes.)

January 08, 2010

BSparl: She's a Mobile Biscuit.

We're just over 23 1/2 weeks with Ms. BSparl, and she's an active little biscuit in there.  I know I mentioned it in my vlog earlier this week, but this baby is scooting around all over the place inside of me.  Last night, for the first time, Chris and I could actually SEE her kicking from the outside.  Feeling her kick is one thing, but seeing it?  Completely amazing.  When she shuttles and rolls from one side of my uterus to the other, I can see her moving.  My belly swells more on one side, and then I can feel and see the 'bulge' move over to the other side.  (I'm trying to get a video of her doing this, but usually when it happens, I'm too taken by surprised to grab the Flip!)

Baby Girl Sparling, 23 weeks along

On the diabetes front, my insulin resistance is climbing.  Daily.  Like a cat in a tree, howling from the top branch and refusing to come down.  (I need the fire department - stat!)  My basals, once at a conservative 12.4u today per day, are at an even 20u per day and I'm sure they'll need to be upped again sometime next week.  I feel like I'm chasing my tail right now with these blood sugars, but so long as I can continue to effectively stalk them, I'm confident that I'm not boiling BSparl.  This morning, after three days of waking up at 140, 155, and 203 (gah), respectively, my fasting number was 79 mg/dl and the Dexcom reflected a steady overnight, too. I'll take that, and hope it happens again tomorrow. 

But if it doesn't?  CRANK it up again!

A big hurdle I'm encountering is the exercise bit.  Honestly, I haven't had a good workout since before we went to Spain (and returned with Ms. BSparl).  In the first trimester, I was usually too exhausted to get to the gym (went three times a week instead of the five I was getting in before), and then we moved out of our apartment in Connecticut, so that whole transition sucked out my desire to work out almost entirely. 

Now, well into the second trimester, I'm trying to get to the gym but it's just so boring.  My exercise options feel so limited, and I'm not used to the whole "get on the treadmill, walk steadily for 35 minutes, END" routine.  No ab workouts, or I could smoosh BSparl.  No jumping rope, or all these new sticky-outtie parts of my body might leap off of me and my pelvic floor could be weaked.  (Kidding on the body parts leaping off but true on the pelvic floor concerns. I also can't imagine jumping rope being almost 6 months pregnant, nevermind the fact that the kid won't like it.)  And no strenuous weight lifting, thanks to compromised diabetic eyes. Those little five pound weights I have are borderline questionable, considering my retinopathy progression.  Booooooo.

So the treadmill it is, for long and awkward ambling.  (For now.)  And even though it's a whole lot of boring (I've watched that "build a six foot gingerbread house in 8 hours" challenge on the food network like seven times now), it is getting harder and harder to keep moving.  With BSparl expanding every week, my organs are getting a little smushed in there.  An expanding uterus puts pressure on my bladder, my diaphragm, and every other organ I have in there, leaving me short of breath a lot of the time and generally feeling like I'm going to tip over a little bit.  I guess these walking workouts are still exercise, even though they aren't even close to what I was doing before BSparl's creation.  

Every week is different, but I'm definitely not complaining.  Pretty damn grateful, actually.  I'm so happy to look in the mirror and see that my waistline has all but disappeared and has been replaced by this bump o' BSparl.  She's in there, she's doing well, and in just about four months, she'll be here.  

January 04, 2010

Oh, High!

I hope BSparl is going okay in there.Back at the Diabetes 2.0 conference in Florida in November, I was talking to Manny Hernandez about how evenly  my numbers were running due to the pregnancy.

"Dude, it's like a cure.  It's creeping me right out, but I am NOT complaining.  Whatever keeps this baby safest!"

Oh how I wish that was still the case.

The lows chased me all around the house for about five months, helping my A1C drop like a rock and keeping highs out of the rotation for approximately twenty weeks.  A blood sugar of 150 mg/dl felt HIGH (which was a far cry from the 250's I was sadly bonding with this time last year) and my low symptoms weren't kicking in at all (see also:  the 29 mg/dl without a whisper of a hint). 

Tomorrow I'll be in the 23rd week of my pregnancy, and the highs are back.  With a freaking vengeance. 

It started innocently enough - with some spiky numbers in the middle of the night.  Nothing chaotic, but 120's where there were 80's the day before, and they continued to climb a bit every day.  For about four days straight, I was waking up at 4:30 in the morning between 120 - 140 mg/dl, correcting back down to 100 mg/dl, and then the creeping would start again around 10 am.  It was like my body wanted to incubate BSparl at a steady blood sugar of ... 180?  NO WAY. 

After a quick chat with my endocrinologist (who told me, in no uncertain terms:  "Pregnancy is completely different.  Two days is a pattern now.  You know what you're doing - adjust your basals as often as needed."), I starting hiking up my basal rates.  Before I got pregnant, my total daily dosage was around 24u per day, thanks to a low basal rate and a lower-carbohydrate diet.  Now?  Five months and 3 weeks into my pregnancy and 17 lbs heavier?  My TDD is 45u and climbing. 

I am wearing my Dexcom and testing very regularly, but it seems like full-out stalking is necessary for the next four months.  I'm also changing my insulin pump infusion set every three days, like clockwork, to keep absorption issues from adding to the pile of variables.  What's becoming challenging is avoiding basal stacking.  As in, if I'm 140 mg/dl and I bolus it down, I need to be patient and let the insulin do its work.  I can't freak out and take another bolus 35 minutes later just because I'm nervous.  Bolus stacking (and rage bolusing, too) are totally counterproductive when they result in a nasty low blood sugar that leaves me spinning.

So what's the moral of this story?  ... honestly, I have no idea.  All I know is that blood sugar management during pregnancy just went from literal cakewalk (as in, I'd take a step and would require cake to take another step) to a struggle that has me acting like an emotional wreck.  My last A1C came in a little higher than the one the month before (went from 6.1% back up to 6.3%), and I know this is because the lows are tapering.  But I don't want to crest back up towards 7% because I'm unable to wrangle in these stupid highs.  

There's a lot of guilt when it comes to diabetes.  I knew that before.  But what I didn't realize before becoming pregnant is how much I worry about this little baby while she's growing inside of me.  Every time I test and see a number above 130 mg/dl, I feel so sad and frustrated.  My hands immediately go to my belly and I want to feel her kicking, because that at least soothes my heart, knowing she's still okay in there.

Actually, she's rolling around in there as I type this.  My blood sugar is 96 mg/dl and holding, I hope.  I have every confidence that I can do this and that she and I will be okay, but these last few days have been really emotionally tough, and I've found myself praying more now than I ever have before.

(Thank goodness for cute baby girl clip art.)

December 15, 2009

BSparl: 20 Weeks.

Dear Baby,

Daddy and I are at the halfway point in our journey to meeting you, and I'll admit - I'm a little surprised at how quickly this is happening.  I feel like I was just in Spain, hoping you were there with us, and then just at Joslin, wondering if they were going to tell us you were indeed hidden inside of me.

Baby, we know you are a little girl, and that every week, different parts of you progress in their development.  Daddy and I read through those books we bought and marvel at what's actually happening inside, when my outside just looks bulgy.  "She can hear us now!"  "She'll start kicking any day."  "Will we catch her sucking her thumb in the next ultrasound?" "Does she realize I don't know the lyrics to ANY songs, not even Christmas ones?"

Baby Girl Sparling, 20 weeks

And I've felt pretty healthy, Baby.  I am about 13 lbs heavier and wearing maternity clothes now (you'll see them when you're born - the crazy pants with the elastic waist bands that everyone was jealous of at Thanksgiving?), but a lot of the "pregnancy woes" aren't part of our lives yet.  Like heartburn.  And stretch marks (yet).  Just some back pain and I feel pretty tired a lot of the time.  Heating pads and naps work wonders these days. 

But Baby, I get very nervous about things that other people don't know about.  The stuff that isn't mentioned on the "What to Expect" websites.  We visit the doctor every two weeks, and I'm being followed very closely by my medical team, but sometimes my mind gets panicked about how capable my body is of taking the best care of you.  I can't lie - I know that diabetic women have healthy babies all the time, but Baby, when my blood sugars ring in at 200 mg/dl after a meal, no matter how carefully I've counted carbs and bolused insulin, I'm terrified that I'm hurting you.  Or this morning, when I woke up at 135 mg/dl at 7 am, I felt a pit in my stomach because I know that it's best for me to be under 100 mg/dl first thing.   I wonder, when the infusion set really stung yesterday morning upon inserting it, do you feel that pain?  Is it normal to worry about every little thing when it comes to your well-being?

Of course it is, moms and dads who have done this before will tell me.  It's completely normal for me to want the very best for you and to hope and pray for your good health and safety.  And it's also completely normal for me to worry about every little thing.  But what I worry most about are the things I am scared to talk about.  The things like blood sugars and hypertension and diabetes-related complications for you and I alike, that other people in my life think I have figured out but I just don't know how to do it right every day.  And the idea of doing it "wrong" makes my breath catch in my throat.  My numbers seem "good enough" and my A1C is lower than it's ever been, but those 200's that are creeping back in at at times terrify me.  So does the 31 mg/dl in the middle of the night.  And so does every single thing that threatens to affect you in any way.  Will I keep you safe enough? 

Diabetes is the shifting sand I'm trying to build my life on, and I can handle my being affected, but I don't want it to touch you.  Not even for a moment.

I love you endlessly, Baby.  I'm so grateful to even be this far, and I appreciate every moment I have with you, and will have with you in the future.  Don't worry, Baby.  I'm not spending every minute of our pregnancy in a panic.  It's just sometimes I feel so scared that I'm not able to provide to you everything that you deserve.  I'm very protective of you already, and I want to be a good mom to you.  When I feel you kicking around inside of me, I know you are exactly what I've always wanted.  You are a new life that your father and I created together, and I hope that I can give to you even an ounce of the joy you've already given to me in the last five months. 

I can't wait to meet you, and hold you, and know that you're okay.

Love,
Your Mommy

November 23, 2009

Diabetes Torture Devices.

Last week, on Twitter, Elizabeth Arnold posted a link to a photo that made my whole body cringe and I instinctively said, "Oh crap, THAT thing?" (I'm stealing and reposting this photo here, but the original photo credit belongs to Cardinal Health.) 

Behold - The Guillotine:

The Guillotine:  Worst Lancing Device EVER

This photo made me shudder because I remember this lancing device clearly.  It was the first one I ever used, outside of having my finger pricked by the nurses with the lancet alone, and I remember the shunk sound it made as it came careening towards my fingertip.  It wasn't the standard shunk we know now - this sucker would have to be cocked back like a rifle, and once it clicked loudly into place, you had to hit that button on the back to release the spring-loaded lancet.  And it wasn't just spring-loaded - The Guillotine had an agenda.  It would come screaming over the top of the curve and embed itself into your fingertip, and it was all my mother could do to keep my hand pressed against that little plastic circle at the bottom there. 

I hated it.  It scared the crap out of me, and even though more humane lancing devices were introduced soon after my diagnosis, The Guillotine lived in our house much longer than I'd care to admit.  Even the lancets looked like little harpoons. 

Back in 1986, diabetes technology wasn't completely archaic (I was dx'd after disposable syringes were used, and way after pumps were the size of backpacks), but it wasn't comfortable in the slightest for a second grader.  That Guillotine still makes me cringe, even 23 years later, and I'm increasingly thankful for every little advancement we've seen over the last two decades.  

Because I mean, really.  Look at that thing.  OUCH!!

November 13, 2009

Pregnancy Progress.

Tomorrow is World Diabetes Day.  While my best friend's baby shower is this weekend and I'll be busy preparing for and helping with that event, I know there are lots of events taking place to celebrate the big, blue circle (including the Big Blue Test ... more on that later).

But today is just another day in diabetes management, and it happens to be another endocrinologist appointment for me and the ol' BSparl.  BSparl is getting bigger, as evidenced here:

BSparl, 15 weeks and 2 days

I am now sporting my first baby bump, and it's becoming more and more pronounced every day.  (Pronounced baaabeee buuuhmp.)  Clothes don't fit, maternity jeans are necessary, and when I zip up my sweatshirt to head down to the gym, the zipper strains a bit over my belly. 

But is it all baby?  Or could it be some weight from treating all these lows?

One of the things I'm talking to my endocrinologist about today is low blood sugar.  Specifically, the crazy-ass low blood sugars I've been experiencing over the last four months.  The other night, I woke up to the BEEEEEEP! of the Dexcom and a pool of sweat in my clavicle.  Blood sugar was 33 mg/dl, and I wasn't even entertained by the Larry Bird reference

Instead, aside from the sweat, I was completely symptom free.  And that scares the hell out of me, because there have been several lows in the last few weeks that clocked in under 50 mg/dl without a single symptom.  Last week, it was a 29 mg/dl that just sprang up on me, and even yesterday I had a 41 mg/dl with my only symptom as thirst.

THIRST?  That is my low symptom now?  Come on, diabetes.  That doesn't even make any sense!!

In preparation for my Joslin appointment today, I have two weeks worth of blood sugars all logged and ready to roll, and as I was printing out the logbooks, I noticed that there isn't a single trend.  These lows are cropping up at 3 am, 10 am, 4 in the afternoon, while I shower, while I'm at the grocery store, during conference calls ... you name it.  No reason for these pesky lows (and also no reason why I shouldn't just buy stock in glucose tabs, seeing as how I've wrecked through a bottle in the last week alone).  Plenty of other type 1 diabetic women who have been pregnant have told me about the epic low blood sugars they've experienced, but I had no idea what they meant until the 20's and 30's started pestering me at all hours of the day.

I have high hopes that my endo can help me peel back some of these lows without sacrificing the excellent post-prandials that I've been working my butt off to achieve.  I'm willing to let my A1C creep up a bit in order to bring my machine average back up into the triple digits.  I just need some help in making these lows stop.

(I also have high hopes that I can stop sleeping with a bottle of honey next to my bed, because when I slap my hand against that instead of the alarm clock, it's all sticky.)

November 04, 2009

Dexcom and Desperation.

For a few weeks, I had a tough run with the Dexcom.  Out of the five sensors I'd used in the last three weeks, three of them had gone kaput on me.  And by "kaput," I mean that I'd put in a new sensor after Las Vegas and it instantly gave me "???" instead of blood sugar results.  I've seen the triple question marks before, but usually the sensor synchs back up and rights itself.

Dexcom tossing "???"

But this time, the question marks hung out for ages.   Like hours, and then when it would finally ask me to calibrate, it would work for about 45 minutes ("work" being a loose term here, because it had numbers that were over 180 points off from my actual blood sugar) and then the SENSOR FAILED error would come ringing up.  Stupid error. 

Dexcom sensor - FAILED!

I thought it was just the one sensor, but it happened three different times in three different weeks.  Using the Dexcom, it seems, has helped me get my A1C act together, and since becoming pregnant, the Dex has helped bail me out of many, many unpredictable low blood sugars.  (Lows plagued me during the course of the first semester, relentlessly.  50s, 40s, and 30s coming to stay for a visit without calling first.  No symptoms, no warning, and no predictable time frame.  Without the Dexcom, I wouldn’t have woken up in time for those lows, and I don’t like to think about how far I could have dropped while sleeping.  Whoops, digression.  Sorry about that!)  

So I called my contacts at Dexcom, because they are aware of my pregnancy and how paranoid I’ve become about things lately.  (Actually, I emailed them at 2 in the morning because when the third sensor in a row kicked out on me, I flaked.  I sent them one of those “Sorry I’m a lunatic, but …” emails, and thankfully they got back to me early the next day.)

After a few email threads, Dexcom decided to FedEx out new sensors and help get me back on track.  And for some reason, these worked.  I’d heard from the Twitter crew and from some comments here on SUM that there appeared to be a certain batch of sensors that just weren’t cutting it.  I don’t have the “official word” on what the deal actually was, but I do know that a certain box of sensors just weren’t working right.  And now that I’m cracked into a new box, things appear to be working okay now.  

Which is a relief, because the Dex caught a 29 mg/dl as I was getting ready to leave the house the other day.  

“Holy shit, I’m 29?”  

Chris wasn’t home at the time, so I panicked a little bit.  Not a single symptom was on board, and I was freaking out.  I tested again to make sure, as I drank grape juice straight from the carton.  Yup, 31 mg/dl.  Dexcom was blaring its head off.  

Weird things happen when you’re low and don’t realize it.  Like you find yourself sitting at the kitchen counter, eating a whole bowl of Puffins cereal in one gulp.  Chris came home as I was inhaling carbs.

“Are you okay?”  

“Yeah.  I’m 29.  No symptoms.  This sucks.  I seem fine, don’t I?”

“You do.  You seem completely fine.”  The Dexcom went off again.

“Good thing that’s working again.  Did you have juice?”

“Drank it. I’m eating the whole box of Puffins now.”  Grinned through a mouthful of carby goodness.

When it works, it works.

I’ve been wearing the Dexcom on and off for two years now, but almost 24/7 for the past six months.  And not having it on, or having its integrity compromised through technical failure, etc. makes me feel absolutely naked.  It’s not a cure, it’s not a guarantee for tighter blood sugar control, but it’s the safety net I was hoping for, and now that my basal rates, insulin:carb ratios, and blood sugar trends seem to be unpredictable during these months of pregnancy, I’m leaning on it more now than ever before.

[Dexcom disclosure]

October 29, 2009

Diabetes Can be a Five Letter Word.

... and that five letter word is "guilt." 

At the ePatient conference last week, Sue Rago was talking about diabetes and the complications that can arise.  "But the complications of well-managed diabetes?  None." 

And despite the fact that I met and enjoyed hanging out with Sue, this statement cut right through me.  Well-managed diabetes produces no complications?  So diabetes-related complications are just the result of an inattentive "host," or "slacking off?"  It's not the fault of diabetes itself?

The direct relationship between diabetes and guilt has always made me feel ... well, guilty.  I'm not familiar with what it's like to live with any other disease than type 1 diabetes, so I do feel lucky that I have never experienced something like cancer, but since my scope is limited, I know this diabetes/guilt dance all too well.  And diabetes - as a disease state including both type 1, type 2, and gestational - always seems to come with some added bonus of "You did this to yourself."  It sounds harsh, but I hear it all the time.

It makes me feel so frustrated, this assumption that diabetes only does what we tell it do to.  "The pump does it all for you, right?  So diabetes is like, simple to manage?"  Or "Just follow the rules and you'll be fine, right?  Bad stuff only happens to people who are lazy and don't take care of themselves."  I've never, ever heard someone ask a person living with a different disease - "Oh, what did you do to make this happen?" - but I've heard someone ask me about my diabetic retinopathy and respond, "Well, you must not be controlling your diabetes very well."

I work damn hard to manage my diabetes, and before I took the reigns on my disease, my parents worked hard to manage it.  I take my insulin, I test my blood sugar, and I see the doctor as often (maybe more often) than I should.  Efforts are made to best manage my health, but the fact remains that I have a disease.  I don't classify myself as "sick" and I don't view my life as compromised, but the reality is that type 1 diabetes is an autoimmune disease that causes my pancreas to stop its production of insulin.  As a result of this, the blood sugar homeostasis of my body has been forever disrupted.  And while the medical advances of the last few decades have been tremendous, giving rise to things like improved meter accuracy, insulin pumps, faster-acting insulin, and continuous glucose monitoring devices, there still isn't a cure.  My pancreas remains busted, so I will never be in "perfect diabetes control."

Yet so many people think that a pump or a medication is the answer, robbing fault from diabetes for any complications that may arise and instead making complications the result of "something I did."  I will fight that assertion tooth and nail for the rest of my life, because I care too much about my health and work too hard to let the perception of complications be that of fault. 

Back in March, I found this piece of paper wedged into an old diary of mine from middle school:

Diabetes and guilt - nasty combination.

Even then, as a kid, I was taught to feel solely responsible for my diabetes, as though diabetes itself didn't play a role in any of the outcomes.  "If I want to live:" is how that piece of paper starts off.  What a heavy burden for a child with diabetes.  High blood sugars?  My fault.  Spilling protein into my urine?  My fault.  Any threat of complication?  My fault?  Diabetes wasn't the cause - I was, apparently.  (Granted, many times highs and lows were a result of being a rebellious teenager or eating a 'forbidden food,' but were it not for the diabetes in the first place, it wouldn't be an issue.)

I don't agree with this mentality, and I refuse to subscribe to it.  Type 1 diabetes requires daily maintenance and diligence, but even if I follow "all the rules," there can still be complications.  My genetic make-up plays a role.  My family history plays a role.  And of course, my actions play a role.  This isn't a diatribe to give me a free pass to slack off and not care about my health. I need to take care of myself and work hard for my health.  I have always tried to remember my role in this relationship with diabetes, but I can't fool myself into thinking that if I just work hard enough, my body won't ever exhibit diabetes complications.  If my eyes start to bleed, it's not because I didn't care enough.  Things happen, and I need to be able to roll with whatever life dishes out.  I live with diabetes every day - I don't need the guilt.

Because at the end of the day, diabetes complications are the result of diabetes.

October 26, 2009

Ground Control (Solution) to Major Tom.

Get in control.  Cheesy photo description, no?(That’s just a cool song and I’m in the mood for a little David Bowie.  Humor me.)

I’ve learned a lot in my frequent visits to the Joslin Clinic over the last six months or so, which just goes to show that it doesn’t matter how long you’ve had diabetes – there’s always something new to learn.  As I was preparing for pregnancy, there was a lot of focus on blood sugar control, and frequent monitoring.  That, I knew.

But what I didn’t realize was how often I should have been checking my meter with control solution.  

I have to be honest:  Before Joslin told me to get my act together re: using control solution, I never used it.  Ever.  It would come in the meter kits when I first opened them and it was the first thing I removed.  I ran on the assumption that my meter was the diabetes equivalent of “the customer” – it was always right.

The Joslin CDE disagreed.

“No, you need to be checking the accuracy of your meter with the control solution at least once a week, Kerri.  That’s important to make sure everything is in range.  Think about it – you’re dosing insulin based on these results, and you’re calibrating your Dexcom, too.  Don’t you want to make sure the numbers are accurate?”

Good point.  But how naïve am I to assume that the numbers ARE accurate?  Sometimes I get a result on the meter that I know is way off, and I usually test again to see what the deal is.  But I never thought to bust out the control solution to keep tabs on the accuracy, as well.  

Since I was (and am) trying to be Captain Compliance when it comes to Joslin instructions (thanks to the ever-growing BabySparl), I dug up some bottles of control solution and started double checking my meter.  And yes, I do feel soothed when the control test comes back right on target, because it reinforces my faith in the meter.  And no, I haven’t seen any wonky control results come back yet, but at least I’m looking out for them.  

If you’re already checking your meter with the control solution, bravo!   Just wanted to pass this info on, in case you were like me and tossing the control solution into a shoebox to reside with dust bunnies under the bed.  (Or with Siah bunnies, depending on how much your cat sheds.) 

As I’ve mentioned, I’m learning so much now that I’m in constant contact with my doctors, so I want to pass on all the tips I find to you guys.  Because it’s quite obvious that while I try pretty hard, the rules of the game seem to change overnight.

September 10, 2009

A1C Payoff.

Oh hell yes.I've worked very hard over the last few weeks.  There's no denying that.  

I've logged blood sugar numbers on the Kevin spreadsheet and busted my butt to keep up with the maintenance of those logbooks.

Chris and I have counted carb after carb, making sure that I'm dosing accordingly.

I have changed some of my "bad habits" here and there in efforts to get crap under better control in pursuit of BabySparl.  (I even gave up coffee.  For anyone who knows me, THAT is a huge thing.  Huge-r than logging numbers.)

And yesterday, after spending the entire day under the weather, my phone rang.  Dr. CT was calling with my A1C results.

"Kerri?  This is Dr. CT.  I have your blood work back."

I was napping off my illness just before she called, so I had to shove the cat off my head and rub the sleep from my eyes.  "Okay.  How'd I do?"

"Wonderful.  This is just great - such progress!  You're at 6.3%.  You have done a fine job."

"No kidding?  6.3?  That's the lowest I've had in years.  Ever, maybe."

"Well I wanted to call and tell you personally.  I saw these results and said, 'Oh.  This will be a fun call!'"  

"Thanks, Dr. CT.  Thanks for calling."

And that's that. 

There's so much swirling around me right now and so much change on the horizon that I'm excited, ready, scared, and overwhelmed and all I can think is that tomorrow marks 23 years that I've been living with type 1 diabetes and I'm still learning so much every.  single.  day.

August 21, 2009

Staying Accountable.

It's been three weeks since my Joslin appointment and in that time, the accountability train, and thankfully, it hasn't derailed.  Or smashed into me. 

Yet.

But also in that time, I traveled to Spain, had plenty of wonky lows while traveling, didn't have internet access, and battled the time-space continuum, in addition to working plenty of hours at dLife before the trip and upon my return.  Stress levels?  Not at their lowest.  Also, logging opportunities?  Minimal.

But DUDE.  I'm still doing it.  

Thanks to the power of the Kevin Spreadsheet and the fact that I sit on my rear end all day long, staring into the abyss of my work Mac, and also thanks to the jazzy little Ann Taylor flashdrive I picked up at BlogHer, I actually have logbooks that mean something.  And I've actually stayed up on them for the last three weeks. 

Note:  I hate logging.  I always have.  I may always hate it, but the undeniable fact is that logging makes me accountable, too.  Seeing those numbers and the patterns they form forces me to recognize tricky trends and gives me enough perspective to make tweaks.  But I do so despise it.  It's a pain in the arse

The toughest part has been logging day-of.  Before we went to Spain, I was at work and able to keep the spreadsheet open on my desktop and update it as needed, never really breaking from work to fill in the gaps, but just keeping up with things as they happened.  And at night, I'd plug in the flash drive late at night, fill it in, and then start again the following day.  It was a tedious system, but I kept up with it.

Spain, on the other hand, was much harder.  No computer on hand during the day, difficult to track and log food (nevermind counting the stupid carbs) while we were exploring Barcelona, and even though the clock said 6 pm, my body was screaming, "Midnight, woman!!!!!"  If it hadn't been for the Dexcom, I would have completely lost control.  But since that Bad Larry was keeping me between the lines - literally - it helped me stay reasonably even.

Upon our return, it was hard to get back into the swing, but knowing my next Joslin appointment is next Friday helped get my priorities straight.  Right now, I have three neat little spreadsheets on my Flash drive, with 100% of the blood sugar results and about 70% of the insulin doses and food logs intact.  Chris is helping with my food and calculating carbs for me so that there isn't so much SWAG bolusing.  This, my faithful readers, is flipping progress for this girl. 

My 7 day machine average is down to 125 mg/dl.  My 30 day is 130 mg/dl.  This is with fewer highs and fewer lows (aside from a few episodes while traveling), which makes me feel more confident that I'm truly holding steady and not just averaging out.  I feel sickly when my blood sugar is 180 mg/dl, which means I'm becoming more sensitive to highs and also not as used to them.  (A major plus.)  My A1C came back at 7.1% last time - a .5% drop from the time prior - and I'm certain that next week will show even more improvement. 

I'm not messing around.  I can't.  I'm on a mission.  :) 

Another Stupid Note:  I'm not posting these numbers to brag.  Or to elicit criticism.  For me, these numbers are - for the most part - an improvement and I am using both Joslin and SUM as my tools for accountability.  So when you see the graphs and you see my machine average, don't think I'm inviting your commentary on my actual results.  Your diabetes may vary, and mine sure as hell does, too.  Cool?  Cool.

So next week, I'll toddle off to Joslin with four spreadsheets crammed with information and hopefully a cool head.  Chris and I will talk to them about making changes, and I'll leave feeling more in control.  Even if the numbers don't improve as fast as my attitude towards them, I still need to move forward as efficiently as possible.

Good control is RIGHT on the horizon.  I can feel it.

August 19, 2009

The Lows in Spain Stay Mainly on ... Me?

As I mentioned yesterday, the trip to Spain was lovely, but fraught with lows.  I'm not sure what caused what, but between the six hour time change, the excessively late nights and the corresponding late mornings, and spending hours walking around the city of Barcelona - my glucose levels spent a lot of time in the trenches.

Chris and I brought three big jars of glucose tabs (in grape, raspberry, and tropical flavors, of course) and four packages of Mentos candy with us for the trip, assuming this would be enough.  But I couldn't have anticipated the lows that followed us from landmark to landmark.  Aside from the initial high after the plane took off (Oh Kerri, you don't like to fly?  Hmm ... you've never mentioned that before!) and a spike after my mid-week insulin pump set change, my blood sugars were low the majority of the time we were traveling.  Nothing earth-shattering, but more a constant trend of 60 - 80 mg/dl, which sounds good in theory but when it's the result of constantly popping glucose tabs, that's a bit much.

Especially in the airport.

Leaving from JFK to head to Barcelona was fine. Our flight left NYC on time and things went smoothly, schedule-wise.  But coming home?  Completely different story.  

According to our itinerary, we had an hour and fifteen minutes between our flights from Barcelona and from London, so we thought we'd have enough time.  But when the plane left Barcelona 30 minutes late, we knew it was going to be a scramble to make our connection.  In Heathrow.  Which has to be the most confusing, unstructured airport I have ever visited in my life, more like a mall with airplanes thrown in as a bonus, instead of being a well-organized airport first.

Our plane landed in London and we had about 40 minutes to make our connection.  We stood in line to go through security again, and the Dexcom started to wail.  I dug it out of my bag and saw a blood sugar of 102 mg/dl and two double arrows pointing straight down.  (You can guess what that means.)

"Oh darn it gee wilikers, I'm going low," I said to Chris.  (Note:  This is the edited, non-Yosemite Sam version of our exchange.)

"You have glucose tabs?"

"Yup.  Chomping now."

We went through security - down to 23 minutes to catch our flight.  Raced to the board where the flights gates were being announced and searched for our flight.

"Shit, we're all the way across the airport.  We've got to book.  Keep eating, okay?"

So we start moving fast.  The Dexcom is continuing to vibrate, and I'm eating glucose tabs while dragging my suitcase behind me, my purse bouncing off my hip as we run. 

"You okay?"  Chris calls back to me as we're running while on the moving sidewalk.

"Sort of.  Are we close?"  Glucose tab dust covers my hands, leaving imprints on the railing of the sidewalk.

"Sort of." 

Time is tight.  So we start to move as quickly as we can.  We run until we get to the American Airlines gate and Chris goes to the counter to check us in.  I take my meter out of my bag with shaking hands and test, only realizing then that I've been crying.

30 mg/dl.

Oh that's lovely.

And then the panic hits with intensity.

"I'm 30.  I need something fast."  My mouth is dry and the idea of trying to consume glucose tabs with vigor makes myThank goodness for American Airlines kindness. throat close at the thought.

"Juice.  There's a machine.  Sit here, baby.  Sit and eat the tabs and I'll get juice.  You'll be fine ..."  He moves quickly to sit me in a chair, puts the bottle of glucose tabs in my hand, and runs to the Minute Maid vending machine.

Which only takes British pounds.  Not American dollars.  Or Spanish Euro.

"Gosh."  Chris said.  (See above comment re: edited version.)

I'm not sure what happened next.  My brain was in a complete fog and I'm sure I looked frightful to the unknowing outsider, surrounded by suitcases and crying and eating odd little dusty discs and looking as though I was jilted at the airport.  I know Chris ran to the check in desk and explained "medical emergency" and "needs juice from the machine" to the man in the American Airlines uniform.  I know that this stranger gave Chris all the money he had in his pocket as quickly as he could, without asking questions.  I know Chris said "thank you" as he ran back to the machine and I sat on the chair, still trying to choke down glucose tabs.  I know that a bottle of orange juice was in my hands seconds later, and I know that the plane was boarding and we were treating a really miserable low in the airport.

Twelve minutes. 

"Test, baby."

51 mg/dl. 

"You're coming up.  See?  That's already higher."

Still in a fog, but beyond pressed for time, we gathered our bags and started down the gate towards the door of the plane.  We were among the very last people to board.  I wasn't as much of a mess but I was wiped out, my whole body trying to recover. 

"Thank you," Chris said to the American Airlines employee who gave us the money for juice.  "Here, please take the money back."

The guy was behind us in line and smiled gently.  "No, it's fine.  Please.  I'm glad you're okay.  Don't worry."

I took the coins from Chris and pressed them into the employee's hand.

"Thanks very much.  But you might need this change.  You know.  For another diabetic who really needs a helping hand."

He took it.  We boarded.  And headed home.

August 04, 2009

Biking Block Island.

After the loooooooong day in Boston on Friday, I needed to work off some stress.  So Chris and I decided to 'sail away on the Block Island ferry.' (This is the theme song for the ferry, but I couldn't find a YouTube clip or anything.  If someone can find audio proof of this song, please send it to me!  Lyrics are "Sail away on the Block Island Ferry, take a trip back to carefree times.  Sail away, Block Island awaits you.  Just leave your troubles behind."  And thus ends this digression.)

Our ferry ride over was a little choppy, and we were ... green by the time the ferry docked at Payne's Dock, but we shook off our seasickness quickly after breakfast at the Mohegan Cafe.  Then we rented some dented bikes from the shop by Ballard's (I left my bike back in CT ... foolish Kerri) and got on the road.

I must admit:  July was a tough month for me, exercise-wise.  I was traveling way more than I'm used to and only made it to the hotel gyms a handful of times.  My own gym membership at home went virtually unused, save for a few ragtag workouts.  But I thought I was still in relatively decent shape, so I didn't think the bike ride would kick my ass.  I was even grinning before we attempted the hills, all hopeful. 

Oh how stupid I was. 

The first leg of the ride was all uphill.  We followed Spring Street straight up to the Southeast Lighthouse and by the time we reached the top of the bluffs, I was dying.  DYING.  My legs were wobbly and I was panting and my blood sugar was plummeting.   Thankfully, I'm a nerd and I chose the bike with the little basket on the front, and since I didn't have a small dog to stuff in there, I instead had a secure place for glucose tabs.  Which I ate.  Happily.  Next to the Southeast lighthouse. 

Exhibit A:

Tabs by the lighthouse.  Of course.

We hung out for a while at the lighthouse because my numbers just wouldn't budge, so I are a few more glucose tabs near the bluffs. 

Exhibit B:

Tabs on the bluffs, yo.

The Dexcom (also stuffed into the bike basket) finally stopped BEEEEEEEEP!ing and a quick test confirmed a number finally in the triple digits, so we ventured on our way.  Thankfully, the way down was easier on our legs, and we stopped at the Block Island airport to take a break and watch the teeny, tiny planes land.  (Note:  No.  I will never go on one of these planes.  They hold four people.  Including the pilot.  Oh hell no!)

Water Street in the background.

It was fun, though.  Chris and I had a great time - hard not to in one of my favorite places.  Even though my legs were burning and my wrist was a little aggravated from the ride, it was awesome to be out in the sunshine, taking in the sights of a beautiful place like Block Island as we whizzed by on our bikes.  (We also found the same pond three times.  Sad senses of direction, we have.) 

I already have a bike, but it's been sitting in our storage space for the last few years.  I used to ride all the time when I lived in RI because my apartment was across the street from a beautiful eight mile bike path.  Now I think I want to bust that thing out and toddle around town on my ridiculous bicycle with my equally ridiculous helmet (thank you, Nicole), maybe with Siah in a basket on the front. 

Or maybe just my meter would be more realistic. 

Either way, it was awesome to be outside, far from the glowing computer screen, pedaling away my stress on the summer streets of Block Island.

June 10, 2009

Blueberry Awesomeness.

There's stuff that's bolus-worthy.  New York style cheesecake.  Chai tea on a snowy winter day.  Wedding cake made out of red velvet with butter cream frosting.  These indulgences are worth draining my pump reservoir for, and almost worth the spike I try to, but don't always, avoid.

I've been very, very attentive to my diabetes lately.  Logging all these numbers, sporting the Dexcom, trying to manage stress levels, exercising ... whatever it takes to make me as healthy as I can be for the baby I want to have someday. But that wagon is hard to stay on all the time, and I have taken a risk or two in the last month.  Like a trip on the Connecticut Wine Trail with some friends.  And some pasta at Carmine's last weekend with my sister-in-law.  

Oh holy awesome.

And blueberry swirl cupcakes from Crumbs Bakery.

My diabetes control isn't made or broken in one bite of a fluffy, delicious cupcake.  Usually when I'm having a high sugar indulgence, I'm right on top of things, diabetes-wise.  I bolus aggressively to avoid the high and I watch that Dexcom like a hawk for any subsequent lows.  My management problems come more in the form of letting my numbers go untracked and pinging all over the place, letting highs creep up without corrections, then stacking boluses until I hit a nasty low, which I over-treat and rebound into a high ... you know the cycle.  It's not the "one thing" but more my inability to care for more than an hour or two.  The last few weeks of intensive management have been about keeping an eye on everything and not letting the cycle spin out of control. 

And it's hopefully working.  My machine averages are down, I'm seeing many hours straight of flat-lines on the CGM, and knowing my Joslin appointment is at the end of July keeps my mind on task.

Besides, it's not like I ate the whole cupcake.  I split it with Chris and I asked for the estimated carb count before I took a bite. 

But I did take the first, awkward bite. 

Whoops!  Cupcake!

And I did enjoy every other bite of it, too.  Go ahead and judge!  :)

May 29, 2009

Old School Diabetes: Meters.

A few weeks ago, when I was poking through some old photos, I found my first teaching manual from Joslin.  (The big, red book.)  And tucked inside of that book were some old advertisements for glucose meters.

Like this brick from Accu-Chek:

Old meter from the dark ages of diabetes.

This thing was huge, took two minutes to produce a result, and it was heavy enough to double as a hurricaine doorstop.  It's remarkable how much this technology has changed in the last twenty-two years.  Here's another oldie:

Another oldie.

I love the instructions - they're a freaking mile long!  Blood glucose monitoring has come a very long way since my own diagnosis - from urine testing to blood testing to the Dexcom that reads me every five minutes - but I'm not as impressed as I'd like to be.  I heard a few months back that the accuracy requirements for today's meters are the same as they were back in the late 1970's.  (Is that true?!)  Color options are great and shorter instruction manuals are also nifty, but I'd like this thing to give me results that are SPOT freaking ON. 

Like this morning.

I tested and got 77 mg/dl on my meter.

The Dexcom said I was 39 mg/dl.

I tested again and saw 101 mg/dl.

How can I respond to a number that doesn't sit still for even a second?  How is a diabetic supposed to aim for that moving target?

Most days, diabetes doesn't get into my head and scratch around.  Most of the time, I feel emotionally and mentally equipped to handle the disease management and "life" management.  It's never fun, and never simple, but it's something I feel at peace with.  But this morning, I couldn't even get a sense of what blood sugar number to react to.  And when I peeled off the Dexcom sensor to replace it, a ripe, red dot of infection had brewed up underneath.  My blood sugar, when I arrived at work, was 123 mg/dl but after I ate my snack, it crested up to 234 mg/dl for some ungodly reason.  I don't know which end is up.  And technology isn't doing anything to make type 1 diabetes any easier.

Today, I'm spent.   

May 14, 2009

I'm Sorry ... Glucose Spray?

Tuesday night's meeting did more than introduce me to some fantastic fellow type 1s ... I was also ushered into the wonderful world of glucose spray.

I know.  My face made that "Excuse me?" look, too.

One of the women at the meeting, Christina, was talking about her low blood sugar treatment methods and then she whipped out this little bottle of what looked like my dad's binaca spray

My world was once just glucose tabs.  And then they juiced 'em up and developed liquid glucose shots.  And gels.  (I love the gels, to be honest.)  But spray?  A glucose spray?  That was new to me.

So I took a picture of it, for posterity.  

The mystical, magical glucose spray.
 
(Hand model is Karen, because if I took a picture of my rotten hands, you'd force me back into my gingerbread house to wait for Hansel.  And not the other Hansel, even though he's so hot right now.)
 

According to myth, and what was written on the back of the bottle, you spray this stuff into your mouth and it absorbs into your cheeks.  The bottle says five sprays, but Christina dismissed that recommendation with a distracted wave.  "You need like 10 or 15 sprays, honestly."  

I seriously thought this was the coolest thing.  Because I'm skeptical about anything that involves "change," I'm wary of its effectiveness, but I'm so curious to see if it would work as fast as my beloved juice. I have never seen this in my local CVS, but their website lists it as available in Rite Aid, Wal-Mart, and several online distributors.  And I haven't tried it yet, but I think I'm going to have to. 

Just to satisfy my own curiosity.    

May 11, 2009

Diabetes Mor(r)on(e).

Is this thing on?I just felt off.  For like an hour.  My head was wrapped in cotton balls and my reaction time was just a half second slower than it should have been.

Internal Motivational Speaker whispered in:  Hey.  You've been a bit of a work nut lately.  How about taking a few minutes and maybe walking around?  

"No, no.  I'm good.  I have to finish this and I have the cruise the week of my anniversary, so I'll have a whole week to collapse and lay on the lido deck."

Hmmm.  So explain the dizzy?  Why are you feeling so dizzy right now?

"I don't know.  Maybe because I've been staring at this computer screen for like five hours straight without much of a reprieve.  Maybe my eyes are fried."

Could be.  Or you could have some kind of brain deformity.  

"What?  Why the hell would you say that?  I'm just a bit burnt out.  And I've had like a LOT of caffeine.  So I'm sure I'm just a little rattled."

Or suffering from some undiscovered, undiagnosed illness that starts with dizziness as a symptom.  Google it.

"No.  I am not consulting Google.  NO.  Back off and let me finish this."

Dr. Google calling.  Come on, Kerri.  You've been dizzy and sort of disoriented for over an hour now.  

"You ... stop it.  I'm not going to let you get me all frantic.  I'm fine.  I just want to finish editing this one article and then I'll take a break for a few minutes.  I promise."

Fine.  Don't say I didn't warn you.

"Warn me?"  I took quick stock of how I was feeling.  I was very irritable, short-tempered, and this weird feeling of swimmy dizziness was dominating my brain.  Granted, I'd been sitting at my desk for at least an hour and a half straight and focusing intently on my column, but maybe I should think for a second and address this nagging feeling of disorientation.  So, despite my better judgment, I Googled "causes of dizziness."

And five minutes later, I was convinced I was dying.

"Oh em gee, I'm dying.  Like today."

I told you.  You can't let something serious like dizziness go undiagnosed.  

"Wait."

And it's also important that you listen to me when I talk to you because I know what I'm talking about.  Finding out what's wrong with you, at least physically, is part of my job and ...

"Wait a second."  I took out my meter. 

Your health takes priority and you need to stay very tuned in to your body and thank goodness you have me because obviously you'd be lost with me and ... 

53 mg/dl.  I reached for some glucose tabs.

Oh.  And then there's that. 

I think it's waaaaaay past time for a vacation. 

April 30, 2009

I'm in the Zone: Cortisone.

So yesterday I went to the orthopedist for this wrist mess.Frigging sting!!

I was all, "I've been wearing the brace and I stopped lifting at the gym and have generally been taking it as light as I can, but no improvement."

And he was all, "Well, we looked at your x-rays from today and your radial and ulna bones are in perfect position, so it does appear to be a tendon issue and not a bone issue."

And I was all, "That's good, right?"

And he was all, "Yeah.  So let's talk about options.  We can move with the brace for another month, or you can do physical therapy, or you can do surgery."

And I was all, "Hmm.  Well the brace isn't helping yet.  And I don't want surgery.  Let's do a cortisone shot and follow up with physical therapy?"

And he was all, "You're an educated patient.  Okay, we'll do a very small shot today and see how that works for you."

So I sat down in a chair in his office and he moved a small table towards me for me to prop my elbow up on.  He left for a minute and then returned with a small bottle, a cotton swap and injection prep wipe, and a massive needle.

And I was all, "Whoa, that's a big needle.  Do you put the whole thing in?  That would come right out the other side of my hand!"

And he was all, "But you do needles every day, don't you?  This should be okay with you."  

And I was all, "Irony, eh?  I hate needles that I'm not controlling.  And that mega-needle?  Scares me."

And my blood in my face was all draining, so I looked white as a sheet.

He was all, "You're going a little pale on me.  Are you okay?"  He swabbed my wrist and shifted my arm around until the proper injection area was exposed.

And I was all, "I'm okay, I'm just not going to watch, okay?"

He nodded.  And the needle was all of a sudden embedded into my wrist and the pressure of the cortisone being injected made me squirm instantly.

I was all, "Ow."

He was all, "Just a few more seconds and I'll be done.  And ... you're done.  You okay?  Do you need to lie down?"

And I was all badass:  "Nah, I'm good.  I'm just going to sit here for a minute while you explain what happens next and I pretend to listen fully despite the pain."  I smiled.  But winced.  Sort of at the same time. 

And he was all, "Elevated numbers for a few days ... increase basals with your endo's help ... keep wearing the brace ... it's going to hurt where I did the shot tomorrow, but you should feel real improvement by about this time next week ... if you don't, we'll want to do that physical therapy and consider maybe another shot depending on how you feel ... you'll be okay ... hey, are you okay?"

And my color was all returning, but slowly.  We finished up, and I tested.  155 mg/dl.  Okay, a little higher than the 114 mg/dl I walked into the doctor's office at, but it must have been a stress bump.  I didn't want to fool with my basals until I was sure that the cortisone would make me high, so I waited a few hours before doing some tweaking

In the course of six hours, I went from 155 to a steady stream of 190 - 240 mg/dl numbers.  I tested for ketones and - low and behold! - the little stick went light purple on me.  Small ketones, prolonged highs, and the pain from the actual shot set in around 8:45 pm.  This morning, I woke up at 213 mg/dl and even after an aggressive bolus, I'm still cruising in that general range.  Basals have since been cranked to 150% and I'm both wearing the Dexcom and testing every hour.

The ketone thing is what's throwing me for a loop.  I hardly ever throw ketones - why now?  I drank a lot of water, ate some carbs, and still had the ketones this morning.  (Poor Chris - I asked him to test himself for ketones because I was convinced the Ketostix weren't working right.  He was all, "Um, I'm negative."  And I was all, "At least I like the color purple.  Blaaaargh.... ")

I hope this was the right decision.  I'm desperate for my wrist to heal.  The doctor said this pain and the highs could go on for 3 - 7 days.   

And I was all, "This sucks."

April 21, 2009

Precision LogBooking.

"So what is this one, the 236.  Did you correct this?  Is this after eating?  I can't really tell."

And I peered at the logbook, chock full of results.  Months of results, all neatly organized by date and time.  Only without food or insulin doses written in, so it was less like a diabetes assessment tool and more like the machine that spins the bingo balls. 

"Ah, I have no idea.  Damn, I have no clue, actually.  I'll assume I corrected it." 

There's not too much difference between writing in all the results the night before an endo appointment and printing out the numbers.

With last week's endocrinologist appointment being a little less than thrilling, I'm on a new game plan to get ready for my June follow-up.  Dr. Brown has asked me to keep a detailed logbook of my numbers.  Not necessarily a food journal, but more a list of blood sugars, insulin doses, and carb intake.  

"You don't need to list the kind of fruit you ate, but if you just put that it was 20 grams of carbs, that would be what we need.  That way we can tell what's causing what."

The wee ickle logbook.

So I bought a very small moleskine book to record everything. (I love these books. I have one in my purse at all times and I use it to jot down everything from blog post ideas to words I want to remember to look up to reminders that if I don't pay my cell phone bill, they will come for me.)  It's a wee little thing and it fits in my meter case.  Surely it will be covered in blood and have test strips stuck to it by the end of June, but so far it's been one full day and I'm still on the wagon.  (And that, my Faithful Readers, is saying a TON.)

I get burnt out with the details of diabetes.  The whole logging thing throws me off my creative stream of consciousness.  "You mean I have to write this stuff down and analyze trends?"  I'll wear the pump and the Dexcom and do my due diligence, but when it comes to the diabetes nitty-gritty, I often tumble off the wagon.  

It's a lack of patience.  Maybe a lack of desire to make a blood sugar testing moment last more than the five second countdown.  I don't like when I feel so much of my time slipping into the realm of diabetes management.  And I make plenty of excuses not to focus:  "I'm heading to Tucson."  "I'm going home to RI for the weekend."  "I'm having dinner with NBF."  "I'm too busy at work."  "I'm ... no."  

But I'm a woman on a mission.  If I don't ever buckle down and make my A1C my top priority, it may always hover around seven plus percent.  Even if it's a pain in the ass, and even if it's "hard," I owe it to myself and my future family to give it my best.

Poor Chris.  He thought Twitter ate up time?  Wait until he sees how often I have to logbook.  

April 02, 2009

Employee of the Month.

Yesterday at lunch, I was browsing at one of my favorite stores and picking through a pile of spring sweaters.  (Buy one, get one 50% off!  I'm a sucker for a good sale.)  So I find two sweaters that are pretty and springy and have that nice, soft cottony feel that you want to rub against your cheek.

Then that feeling hits.  The one where my jacket felt warm and heavy against the spring chill but suddenly made me feel like it was a fabric tanning booth - too hot, too heavy, and like the sleeves were thick with mud.

"Excuse me?  I know it's a weird question, but do you have any juice or candy in this store?"

The pregnant woman behind the counter gave me an odd look.  "I don't ... hang on ... um, I have half of a mini Milky Way bar?  Is that okay?  You just hungry, sweetie?"

"No."  My tongue was too big for my mouth, making it hard to talk.  "Can I just leave these here for a few minutes?  I'll be right back."

Walking with determined, focused steps, I went outside to where my car was parked and unlocked the door.  Leaning in the passenger side, I grabbed the bottle of glucose tabs from the center console.  

"Damn it, two?  Only two are in here?"  The bottle was almost empty, save for two lonely glucose tabs.  I poured them into my hands and ate them at the same time, the glucose tab dust coming out and snowing all over the passenger seat of my car.

"Gee whiz," I said.  (What's that?  Not kidding you on that one?  Fine.  I dropped an F bomb right there, outside of Ann Taylor.  I have no class.)  I noticed a Panera Bread next door so I slammed my car door and walked over there, listening to the Dexcom blaring from inside my purse.

There was a line for lunch.  Four cashiers were working furiously, but the low was creeping up just as fast and my legs were beginning to buckle.

"I need orange juice.  I'm diabetic and having a low blood sugar.  Can you please help me as quickly as you can?"  I stood there in my work clothes and my coat, with my grown-up purse over my arm and started to cry because I couldn't function properly and I was becoming more and more confused.  Not sobbing, not whining, not outwardly breaking down, but big tears rolled out of my eyes without permission and headed for my jawline.  

The boy behind the counter was taken aback.  "Stay here.  Stand here.  I'll be right back.  Don't move."  He ran and returned with a glass of juice.  I moved toward him like goldfish in a pond going for crumbs of bread. 

He watched as I drank the entire glass without stopping, knowing that people in line were watching me and staring and I couldn't bring myself to care.

"You good?  You seem better already, right?"  CounterBoy answered his own question.  "You're good.  You're fine." 

I fumbled with my wallet.  "How much do I owe you?"

"Miss, it's okay.  I'm happy to pay for that orange juice myself.  Please."

"No, I'm diabetic but I have a job.  And I appreciate your help."  The novocaine of the low was starting to wear off a bit, just by knowing the juice was in my system.   "I'd really like to pay."

"Okay, let's just call it a small, okay?   That's a dollar.  A dollar is fine."  He punched the keys of the register.  "$1.05" came up on the digital screen.

"A dollar five.  Okay."  I handed him a dollar and dug around in my pocket for a nickel.  "Here you go.  Exact change.  We'reHe should be employee of the month, damnit. good."

He put the money in the register and wiped his forehead with his wrist.  "You sure you're okay?  Do you want to sit for a minute?"  A guy waiting in line mumbled something about 'flirting on your own time.'  CounterBoy raised an eyebrow.  "Sir, this is a medical emergency.  I just saved her life.  Your sandwich?  Little less important at the moment, okay?"  

He turned back to me.  "You good?"

"I'm good.  Thank you for your help.  I really appreciate it.  You saved the day, man."

"I did.  I saved the day."  He squared his shoulders.  "I'm going to be employee of the month!"

March 26, 2009

True2Go Meter - It's THAT Small.

It's kind of like Review Week here at SUM, because I have a lot of diabetes-related products and goodies that I've received over the past few weeks and wanted to talk about here.

One of the items I received was this teeny True2Go meter.  Pictured heeyah:

True2Go - wicked tiny.

I am usually very good about making sure I have my on me at all times, successful mainly because I always carry a purse (even in the woods) and I am usually the group "pack mule" for any event.  Very rarely do I forget my meter, but it has happened. 

(I realize I've just tempted fate to have me leave my meter behind sometime in the near future.  Fate, please forget I said that.)

This little True2Go meter is super small, and with the meter attached to the actual bottle of strips, it's very easy to stash anywhere.  Glove compartment, desk drawer at work, mother-in-law's house, shoved into that extremely small beaded purse that your license barely fits into - teeny meter may do the job.

It seems to be reasonably accurate, and by "accurate," I mean it was just a few points off from my OneTouch UltraLink and in tune with my Dexcom graph.  For a meter the size of a silver dollar, the display is decent.  It took longer to show my result than I'm used to, but it eventually popped up on the screen after 15 seconds or so, I think.  

For true travel convenience, I could just throw a lancet into the strip bottle and be emergency-ready.  I used my OneTouch lancing device for most of my tests, though.

Having different meters is nice, for convenience, but the main drawback is that most insurance companies only cover one kind of test strip.  For me, my insurance covers my Lifescan strips, but they aren't hip to covering a second brand.  I have used a Lifescan meter for several years now, but I wonder how much of that is due to the fact that I have a stash of strips already, whereas I don't have any more of these little True2Go strips.

Points to ponder.  But this meter definitely gets high marks on size and portability, and I daresay it's a bit cute. 

For a few photos with the meter in a size comparison pose-down with my UltraLink and the ubiquitous quarter, scope out Flickr.

March 24, 2009

French Fried.

Chris has a crush on these things.Last weekend, Chris and I went out on Saturday night for his birthday.  And because he is a Francophile and borderline crème brulée addict, we revisited an excellent French bistro in Brooklyn (that we were introduced to by some wonderful friends). 

We drove in a found a parking spot right across the street from our destination (stroke of freaking good luck, that)- Moutarde in Park Slope, and we were right on time for our 8:30 reservation. 

And we ate.

Oh how we ate.

We started with slices of celery and peppers dipped into an array of spicy mustards.  There was freshly baked french bread with creamy butter.  A shared appetizer of escargot, entrees of duck confit and hanger steak with frites (read: fries) - we were beyond indulgent.  To round out our meal (and our bellies), we had not one, but TWO desserts - crème brulée and two profiteroles with ice cream and covered in warm chocolate sauce.

My blood sugars were screaming at the very notion of these noshes. 

"Nooooo!  Kerri!!!   You'll end up at 400 mg/dl, stupid!"

"Quiet, you.  I'm having a night off from your hollering."  

My husband and I cleaned our plates and topped our meals off with coffee (me) and cappuccino (Chris).   

"So how is your birthday going?"

Francophile Sparling leaned back in his chair, smiling.  "This is great.  I loved this.  I love French food!"

I reached into my purse and consulted the Dexcom, to see if my numbers were started to go berserk.  I saw a flatline - 142 mg/dl and steady.  

"Dude, I think I did this right.  After all that food, I'm barely 140."

"Nice.  Can we get another profiterole?"

I love a good night out with excellent food, excellent company, and excellent blood sugars.  A few hours later, when we were climbing into bed, I checked the Dex again and saw that I was 103 mg/dl with a little arrow pointing straight down, showing that I was falling slowly, but still falling.

Meter confirmed:  97 mg/dl.

"Bah.  I must have over-bolused.  I'm going to grab a swig of juice."

Face-planted into the bed and slowly digesting thousands of French calories, Chris murmured "Mmm hmm."

I took a drink from the grape juice bottle by the bed and settled in beside him, feeling cocky about our indulgent dinner and it's lack of effect on my numbers.

So didn't I feel like a tool when the Dex started singing at 5:30 in the morning, announcing my 271 mg/dl to the entire room?   Sweaters on teeth, that instant "Oh my God I have to pee" feeling, and my tongue weighing about 8 lbs - the whole mess. 

I never, ever remember that the fat hits my blood sugars so much later.  (And we ate a lot of fatty foods!)    Stupid overconfident Kerri.  You done been French fried.

"Kerri, we told you.  We so told you."

"Enough!  I am fixing this now and besides, it was worth it." 

"The high?"

"Nope.  The crème brulée!" 

March 11, 2009

Diabetes Back in the Day.

Last night, I found a box of old diaries.  I've been keeping a paper journal since I was seven years old and I have so many hardcover journals with cats and flowers and balloons on them, my handwriting maturing as steadily and awkwardly as my content. 

It's strange, though, to see how little focus I put on diabetes in my previous journaling.  Most of my earlier journals (eight, ten years old at the time) talk about a boy I had a crush on in fourth grade or roller skating on the weekends or battling with my brother and sister.  But there were a few entries in particular that spoke to life with diabetes.  And while I'm not quite ready to recount the long, dramatic entry about my first kiss (gah!), I wanted to share snippets of my diabetes diary from my teenage years (these entries are from when I was 14 and 15):

May 13, 1993:  Beavis and Butthead is over.  It was strange, because they were in school and in home economics.  Their assignment was to carry around a back of sugar as a "baby." But Butthead said he couldn't do it because he was "diatetic."  The teacher reprimanded him by saying, "That's DIABETIC, and yes you can do this."  I'm not exactly sure why, but that comment bothered me.  Alot.  I think it's because I'm so sensitive about being a diabetic.  It makes me wonder how handicapped people feel about 'HandyMan' on In Living Color.  If I feel offended about an off-handed comment, how would someone else feel about a recurring segment?

Was this one of the first moments of diabetes in the mainstream media that I can remember?  I honestly can recall being affected by this, and wishing Butthead had said "diabetes" correctly. 

June 27, 1994:  Today, my mother was talking with [name redacted] about diabetes camp and I couldn't help but overhear.  She said, "As soon as Kerri left, we all relaxed and lead a normal two weeks free of worries and medical stuff."  Am I a burden to my family?  Do they resent my diabetes?  Do I have a "normal" life? 

This isn't to call my mother out for saying this.  I've heard a lot of parents say the same thing about the weeks that their child is away at diabetes camp.  Diabetes requires parents to think on their feet all the time, so the reprieve of having their child away and under constant and capable medical care must have been such a nice break. 

Funny - I've always wanted a break from it, too.

July 6, 1994:  I leave for Clara Barton Camp on Sunday.  I love camp.  We are all incredibly goofy and loved.  It is such a cool feeling to have people who understand it to talk to.  Sometimes I feel alienated at home because I am the only diabetic around.  No one seems to understand the emotions I feel concerning diabetes.  I am frustrated and angry sometimes, and other times I feel bad for myself.  Sometimes I even want sympathy, and that's confusing because I say I don't want to be treated differently at the same time.  It's weird, though, because I want to be able to control every aspect of my health, so when my health emotions get all crazy, I feel like I'm going nuts.  At least at CBC I'm not the only one who feels that way.  If I tried explaining that to my friends, they'd look at me like I was nutso.

Ah, my longing for a diabetes community, even before I knew there would be one online.  :)

And this paper was shoved into my diary from 1991, written on school paper and smelling softly of pencil boxes and recess.  It speaks volumes about how much a 12 year old kid grasps about guilt and diabetes:

A 12 yr old's diabetes to-do list.

It's a lot to carry.  I felt so alone.  And as I read through these diaries late into last night, I was again grateful to know I'm not the only person out there living with this.  The power of this community is tremendous.  I also realized how everything has changed, but at the same time, nothing has changed.

(And some embarrassing diary snapshots coming soon ... once I get the guts!)

March 06, 2009

Kerri's Diabetes Technology FAIL.

I've had about three solid weeks of good blood sugar control, with just one or two lows and not many excessive highs.  I celebrated regularly, because this kind of even keel isn't common for me.  And because I'm in hot pursuit of a lower A1C.

So you can imagine my frustration when I had a 400+ blood sugar with no detectable cause - until I realized the pump tubing hadn't clicked into place properly after my shower.  (Something about the sweaters on my teeth and the fact that I was falling asleep face-first into my laptop didn't tip me off, apparently.   I had to wait until the realization of "Hey, haven't you peed three times in an hour?" hit me in full.)

Kerri + Diabetes Technology = FAIL.

(And also, be on the lookout for "fox paws." You'll see what I mean.)

February 19, 2009

Length Matters.

Since I started pumping back in 2004, I've been using the Minimed Paradigm Quick-Sets with 23" tubing and a 6 mm cannula.  (For folks who aren't pumping or who have no idea what I'm talking about, the tubing is the part of the pump that connects the physical pump to the infusion set on my body.  The cannula is the tiny plastic tube that goes into my skin.)

I'm a creature of habit and I'm pretty resistant to change.  But insulin absorption has been crummy on my thighs lately and I've been trying to use my lower back "real estate" more often.  

Thing is, the shorter pump tubing doesn't reach from my back to my sock - no sock trick on those days.  And while I liked the reliable absorption of a new site, I still prefer to keep my pump on the downlow - literally.

So I sucked it up and made a change to my last order of pump supplies: 

A little tubing goes a long way.

Cannula is the same length, but the tubing is 20 " longer.  Now I can wear the pump on my back and still snake the tubing down my leg and into my sock

This tubing is looooooong.  It took over 13 units to prime (versus the 6 1/2 units for the 23 " tube).

The stuff is long enough for the pump to not only hit the floor if it happens to drop from my hand while changing, but even has enough slack for the tubing to coil around like a snake.  It's also long enough to become completely tangled in while changing into my gym clothes after work.  Long enough to take over a full minute to check for air bubbles. 

It's long enough to wrap around my waist and tie into a jaunty bow. Long enough that I can leave my pump on my desk at work and make it home without missing a unit. Long enough that I could knit up a freaking scarf with this tubing and still have enough left over to go fly fishing.

This new tubing gig is just about 2/3 the length of my whole darn body!  I feel like I'm part spider, weaving this weird insulin-filled web.  But this new length option is letting me explore different infusion site real estate while keeping with my fashion preferences

It's all about hitting a blood sugar stride ... and not having my pump fall into the toilet in the process.* 

(*Kerri: 40,800, Pump: Almost 3.)

February 18, 2009

Blood Sucking Meter.

Normal blood sugar test:  Unzip meter, put s strip in it, wait until it gives me the "Hey, apply blood now" signal, and apply a droplet of blood.

This has been the routine for years now.  

So imagine my surprise when I put in a new strip, got the go ahead, and applied a blood sample only to have the meter continue to grin at me.

This meter is so confused it must be related to the cat.

"Apply blood!"

Okay.

Blink, blink.

"Apply blood!"

Um, we tried this already.

"Hey, um ... apply blood!"

"Meter, I already did this.  Count down already, would you?"

Blink.

"You have enough blood on there.  It's good to go.  Give me a result!"

"I like ... your shoes?  Apply blood!"

"Stop.  Being.  Miserable!  Give me the number, you bastard!"

"Hey look over there - is that Rocco?  Apply blood!"

It took three different strips before one actually gave me a result.  This has never, ever happened to me before.  Mind you, on Monday night, I wasn't able to get a result from six different strips from this bottle - kept throwing "Error 5" type-messages and absolutely refused to let me in on the result. 

I switched bottles (with 14 strips left), and all I could picture was tossing actual cash into the garbage can.  Those test strips are expensive!

Can a whole bottle go rogue on you? 

February 05, 2009

Vlogging While Low.

A funny thing happened to me on the way to the Internet last week.  I wanted to record a vlog post on my lunch break, but my blood sugar took a bit of a dip. 

Moron that I am, I still recorded and talked my face off.  

The point I made at the end of the video is one that I've thought about a lot - diabetes is an invisible disease, especially for those of us who are younger.  Even though we are dealing with diabetes every day, it's not a disease that is visible to people on the outside.  There's a certain blessing to people not knowing we're "sick," but does it make it seem like we don't need our cure?

Oh hell yes we need our cure.

February 03, 2009

Frustrated.

I am absolutely furious.

Last night (after a very nice dinner with Karen and J), I went to bed at a blood sugar of 101 mg/dl.  My Dexcom showed a flat line throughout the night, and I woke up at 89 mg/dl.

Nice.

So I showered and got ready for work.  Dexcom has climbed to 130 mg/dl, but I took .5 u after getting out of the shower (to cover when I was disconnected), so I expected things to be cool.   Commuted to work (10 minutes) and settled in at my desk. 

But I'm already starting to climb.   

Cup of coffee - drained.   I decided not to correct the climb because I had already taken that 0.5 u and besides, I didn't want to completely compromise my new basal settings.  I needed to give this at least a week or two to see how it really worked.

Started answering emails at work.  Checked Twitter.  Sent off a few columns.  

BEEEEEEEEP!  Still climbing.

I tested and saw 189 mg/dl.  Fine, I'll correct this now.  Laced in a few units to correct and to cover my morning snack, and went back to work, headphones in a music blaring.  About an hour went by.

Then I noticed that everything seemed "off."  My eyes felt sticky in my head, like every part of my body was dehydrated.  My mouth was dry, my skin felt too tight, and I was exhausted.  The words were swimming around on the computer screen, and the papers on my desk were a blur of type fonts. 

So I tested.  And motherfucker (sorry):  364 mg/dl.

Taken with my KerriBerry - and it shows the ridiculous climb.

If I had not been at work, I would have thrown something.  Instead, I ripped the headphones out of my ear and grabbed an insulin pen from my emergency kit at work.  I dialed up a correction dose and injected into my stomach.  I wanted relief from this high - I felt like absolute garbage.

While my overnights are completely fine and stable, my mornings have turned into a chaotic tumble of terrible numbers.  I don't know how to fix this, so I am consulting my logbooks, my battered copy of Smart Pumping, and drafting a "HELP!" email to my endocrinologist.  My A1C goal of under 7% will not be achieved while these mornings are mucking up the works. 

But besides all that, I'm pissed.  These highs feel very frustrating and they aren't little, peaky "180s" but instead whopping "360s."  My ability work feels compromised, and I can't chew enough gum to get these sweaters off my teeth fast enough.   I'm drinking water by the liter and skin is so dry and so cracked that my hands started bleeding while I was typing.  I feel "sick."  That makes me mad, because for the most part, I don't feel very sick. I usually feel capable enough to move past whatever is chewing on my nerves.

Today?  I want to crawl back into bed and ride out this high under the covers, hiding from the reality of life with diabetes. 

Except that Siah is most likely face-planted into the bed.  So no hiding for me.

My only option is to relax, try to get some work done, and wait for my blood sugar to come back down.  No need to add more stress to an already-stressful moment.  But when I get home from work tonight, I need to figure out what needs to be done.  This can't go on.  Not for even one more day.  I have a birthday to celebrate this weekend (mine!), and I'm sure as hell not going to do it at 360 mg/dl.  ;)

Frustrated.

I am absolutely furious.

Last night (after a very nice dinner with Karen and J), I went to bed at a blood sugar of 101 mg/dl.  My Dexcom showed a flat line throughout the night, and I woke up at 89 mg/dl.

Nice.

So I showered and got ready for work.  Dexcom has climbed to 130 mg/dl, but I took .5 u after getting out of the shower (to cover when I was disconnected), so I expected things to be cool.   Commuted to work (10 minutes) and settled in at my desk. 

But I'm already starting to climb.   

Cup of coffee - drained.   I decided not to correct the climb because I had already taken that 0.5 u and besides, I didn't want to completely compromise my new basal settings.  I needed to give this at least a week or two to see how it really worked.

Started answering emails at work.  Checked Twitter.  Sent off a few columns.  

BEEEEEEEEP!  Still climbing.

I tested and saw 189 mg/dl.  Fine, I'll correct this now.  Laced in a few units to correct and to cover my morning snack, and went back to work, headphones in a music blaring.  About an hour went by.

Then I noticed that everything seemed "off."  My eyes felt sticky in my head, like every part of my body was dehydrated.  My mouth was dry, my skin felt too tight, and I was exhausted.  The words were swimming around on the computer screen, and the papers on my desk were a blur of type fonts. 

So I tested.  And motherfucker (sorry):  364 mg/dl.

Taken with my KerriBerry - and it shows the ridiculous climb.

If I had not been at work, I would have thrown something.  Instead, I ripped the headphones out of my ear and grabbed an insulin pen from my emergency kit at work.  I dialed up a correction dose and injected into my stomach.  I wanted relief from this high - I felt like absolute garbage.

While my overnights are completely fine and stable, my mornings have turned into a chaotic tumble of terrible numbers.  I don't know how to fix this, so I am consulting my logbooks, my battered copy of Smart Pumping, and drafting a "HELP!" email to my endocrinologist.  My A1C goal of under 7% will not be achieved while these mornings are mucking up the works. 

But besides all that, I'm pissed.  These highs feel very frustrating and they aren't little, peaky "180s" but instead whopping "360s."  My ability work feels compromised, and I can't chew enough gum to get these sweaters off my teeth fast enough.   I'm drinking water by the liter and skin is so dry and so cracked that my hands started bleeding while I was typing.  I feel "sick."  That makes me mad, because for the most part, I don't feel very sick. I usually feel capable enough to move past whatever is chewing on my nerves.

Today?  I want to crawl back into bed and ride out this high under the covers, hiding from the reality of life with diabetes. 

Except that Siah is most likely face-planted into the bed.  So no hiding for me.

My only option is to relax, try to get some work done, and wait for my blood sugar to come back down.  No need to add more stress to an already-stressful moment.  But when I get home from work tonight, I need to figure out what needs to be done.  This can't go on.  Not for even one more day.  I have a birthday to celebrate this weekend (mine!), and I'm sure as hell not going to do it at 360 mg/dl.  ;)

January 29, 2009

Abby and Dex.

(This is embarrassing.  But true.)

At night, when I go to sleep, I tuck myself in underneath the down comforter and the blankets, I snuggle up against my husband, and I fall asleep, usually with my head about halfway on the pillow.  And Chris and I sleep.  For about twenty minutes.

Until the cats come calling.

Somehow, all 16 lbs of Abby the Fat Cat manages to launch onto my side of the bed.  (I swear the bed lists to one side.)  And instead of curling up at the foot of the bed, like a normal animal, she takes up residence on my pillow. She tries to stick her paws in my ears, she snores, and she completely disregards the fact that the pillow is meant for MY head, not her whole fuzzy body.  (Usually, I end up sleeping on about 1/8 of the pillow.)

Unfortunately for Abby, things have changed in the Sparling household.  Not only is there a Chris and a Kerri in the bed, but there's also a Dexcom.  The Dexcom hangs from a headband that I have wound around the headboard of our bed.  That way, if it buzzes, Chris and I both are certain to hear it.

And two nights ago, the alarm on that sucker sounded at 3 in the morning.  Just as the sun was stirring, the Dexcom BEEEEEEEP!ed and I vaulted up from the bed.  Unfortunately for Abby again, the receiver was sitting on her back, and she also freaked out.

BEEEEEEEEEEEP!

"Meow!!!"  Her claws come out and sink into my head.

"Ahhhhhhhh!" 

BEEEEEEEEEEEP!

Unzip meter.  Shunk.

35 mg/dl.

"Chris.  I need juice."

'Mmmm hmmm."  Juicebox with orange juice in it appears out of nowhere.  

Slurp.

"Meow!"

BEEEEEEEEEEEP!

"You okay?"

"I will be in a minute."

I'm sweaty, shaky, mouth sticky with orange juice and sleep.  It's three in the morning and I want to go back to sleep.  But I know I should wait a few minutes, so while I do, I take picture of what a 3 am low looks like:

You do realize there is very little room for my head here...

 At least she keeps my head warm.

January 22, 2009

BEEEEEEEEEP!s and Basals.

Damn diabetes juggling act.It's January 22, and I've been sticking with my New Year's resolution of keeping a Log Book.  (Said Log Book is currently in my home, all current and three-hole punched and was almost eaten once by Abby but then I put it in the bookcase so now it's safe.)  And after taking note of all the highs I've had in the morning hours, and the weird drops I'm experiencing just before going to the gym at night, I decided to do a little basal tweaking.

Here's the disclaimer:  Talk to your doctor before tweaking your basals.  Kerri is not a licensed CDE or a medical professional of any kind, and quite frankly, if you follow her advice, you may end up tucked inside of a banana for all eternity.  [See also:  Siah.] 

I don't take a lot of basal insulin throughout the day, but I do use many basal flucutations.  It's not one steady dose for me.  I range from .45 u of Humalog in the afternoon hours to about .75 u in the early morning hours. For a while, this worked out pretty well.  But maybe it's the lack of birth control pill hormones, or the absence of wedding-related stress, or maybe the new mousepad I have at home is shifting the tides ... in any event, I needed to make some adjustments.  I could see the trends happening by watching the Dexcom screen, so I knew this was more than just a fluke thing.  (The Log Book confirmed my suspicions.  Who'd have thought that logging could be useful!)  The Dexcom was hollering at me in the morning - BEEEEEEEEEP!ing to the point where my coworkers noticed.  

"You okay?"

"Yeah.  Frigging beeping.  I have diabetes."

Laughter.  "Oh yeah."

So on Monday morning, after another frustrating BEEEEEEEP! confirmed by a meter check showing me at 267 mg/dl (thank you, glucose goblins), I tinkered around with the patterns in my pump.  I dialed up another .2 u for my mornings, hoping to stave off the highs. 

It worked.

Yesterday morning, I woke up at 6 am with bricks hanging from any firing synapses in my brain.  The Dexcom was BEEEEEEP!ing from the headboard of the bed (where it stays during the night so Chris can see it and hear it, too) and I woke slowly.  Moving without thinking, I unzipped the meter case and went through the motions.  41 mg/dl.  Fantastic.  Seeing the number cut a few bricks loose, and I was able to shuffle off into the kitchen for juice.  (Yes, there were reaction treaters in my bedside table.  No, I didn't use them.  Instead, I found myself in the kitchen with a huge knife, cutting a slice of a brownie from the container in the fridge.  Sharp knife + Kerri when she's low + wee hours of the morning could = disaster, but thankfully no fingers were severed during the course of my low.)

Reaction treated, I went back to bed, crumbs still on my shirt.  I rested my head against the pillow and the Dexcom howled at me once more, showing me the slow bell curve towards a low that had been happening for over an hour.

"No, I heard you.  It's cool now.  Leave me alone."

Chris stirred.  "You're going off.  You're beeping.  Did you hear the beeping?  You're low."  Talking in his sleep, the poor guy.  He's on autopilot, too.

"I treated. It's okay now." 

It's a little research, a little trial-and-error, and a whopping dose of blind faith required for mucking with basals. Hopefully over the next few weeks, I can make slow adjustments to this basal crap and eliminate some of those frustrating highs.  Even though I'm sleepless some nights due to the Dexcom, I'm grateful to be able to see those graphs and lines and make adjustments to my insulin doses accordingly. 

If only it could keep me from juggling knives while I'm low.  I think I need a whole separate alarm for that. 

[Dexcom disclosure

January 14, 2009

A1C - Sigh.

I had my A1C drawn on Monday.  Late.  I haven't had one since like June and that's waaaaay too long between results.  The last one, taken a few weeks after we returned from our honeymoon, was extremely high (or at least extremely high for a woman who is trying to gain better control as she plans for pregnancy ... in third person) and I was very reluctant to have another one done.

I hate negative reinforcement.  I don't like that feeling of "Hey, you worked hard.  You really put a lot of effort into managing this disease.  Here's your shitty A1C."  And that feeling of "ARGHHHHH!" is what I'm vlogging about this week.   

(Also, guest appearances by Siah, the Dexcom, and some bed dinosaurs.)   

January 12, 2009

Diabetes Rebellion.

The first rule is ... test!When the Dexcom sensor goes kaput, I usually take a day or two off before slapping a new one on.  Sometimes I want to let the site heal a bit and reuse the same location, and other times I just want a quick break before committing to it again for another six days or so.

Most often, these "days off" fall on the weekends.  I usually put a new sensor in on Sunday nights or Monday mornings before work and wear it straight through to Saturday morning. At work, at the gym, and throughout the night, that sucker BEEEEEEEP!s when I'm high or when I'm trending low, and I react accordingly.  I don't test as often on these days - maybe five times a day versus my pre-Dexcom 11-15 times - but I feel like I have a good handle on things, for the most part.

So why is it that, on weekends, my blood sugars fall to pieces?

I can't figure it out. 

And then again, I sort of can.  Over the last month or so, I've become like a diabetes rebel on weekends.  I go to bed at two or three in the morning.  I sleep until 11 am.  I eat French Toast (with sugar-free syrup, but still - holy carbs) on Saturdays and my intake of coffee is as constant as insulin.  I skip the gym and watch tv and generally become a lazy bum.

And, of course, this all goes down when I'm sensor-free.

This particular weekend, I had a glorious 374 mg/dl and a sneaky 38 mg/dl.  We went to the movies on Sunday afternoon to see Valkyrie and I hadn't tested recently before heading into the movie.  During the course of the film, I felt extremely sleepy and felt my eyelids becoming heavy at times.  After we drove home, I tested and saw a grim 374 mg/dl staring back at me.

Fantastic.  "I felt this one, yet I still didn't test.  What the hell is wrong with me?  I'm pissed - it's like I start sliding down that slope and it all goes amuck."

"Did you bolus?"  Chris asked.

"Yeah, I just did.  I just feel stupid."

"You'll come down.  It's okay."

A few hours later, after hanging out at the house, I tested arbitrarily.  I felt completely fine - no headache, no sweaty forehead, no shakiness.  I wasn't pale, my eyes weren't heavy-lidded, and I didn't feel lightheaded at all.  Yet a 38 mg/dl was the result that greeted me this round, and I didn't feel even a glimpse of a symptom.

Tested again and confirmed:  34 mg/dl.  Definitely low.

I drank juice, I sat on the couch, and I waited patiently (or at least patiently for me, which meant I didn't throw anything).  And as I waited for my blood sugar to start coming up, the symptoms came slamming into me.  I was dizzy, to the point where I felt unable to stand up.  Chris came to talk to me and I couldn't string a sentence together, only able to communicate in short bursts.  "Low.  Yes, drank juice.  Waiting.  Love you, too."

From 374 to 38 - a drop of over 330 points.  This doesn't feel good and it isn't healthy for my body, yet it happens sometimes.  Even when I'm paying attention and "following the rules," there's still something I've missed.  I didn't test often enough.  I neglected to account for some of the food I ate.  I took the weekend off from the Dexcom.  I'm battling myself.  It's a diabetes Fight Club.  (The first rule is to not blog about fight club, but I've already blown it.)

I'm feeling frustrated these days and I'm not sure where to go from here.   But at least with this kind of rut, I can flip things towards "change" at any moment.  All ... I ... need ... to ... do ... is hit the switch.

January 08, 2009

The Year of the Log.

My mom and I used to fill in my log book the night before Joslin appointments, clicking through the glucose meter's memory and writing results into a steno notepad.  

"Use a different pen, Mom," I'd encourage her.  "That way it will look like we did this on different days."

"Kerri, grab that coffee cup and smudge a bit riiiiiiight ... here."  

My logbooks looked like treasure maps from centuries past, complete with fire-singed edges and wrinkled, tea-stained corners.  And my then-endocrinologist at Joslin was no idiot. 

"Your log book is very ... weathered," she'd say with a smirk.  "Has it seen far-away and exotic countries?" 

Blush. 

I've been diabetic for over 22 years, and keeping track of my numbers has been a challenge for me and my management team since Day 1.  I need to turn this trend around and actually keep track of these numbers because they mean so much on their own, but they mean so much more when they're viewed as a big picture.  Logging is the one big resolution I have for 2009, and I said I was going to try.  So I'm trying.

I needed to get myself all incentivized to log my blood sugars.  Logging, as I've mention a million times before, is THE hardest thing for me to reign in.  I test regularly, eat well, and exercise, but I have a mental block about logging numbers.  One that I need to get over.

So I did a very grown-up thing.

I bought stickers.

Stickers work for adults too, right?

 And made myself laugh with a pun.
 
My not-so-clever pun about my diabetes log book.  I'm trying, though!

This is going to be my Log Book, and my last week's blood sugars are printed out, three-hole punched, and all nice-nice in there.  I had the chance to look at my glucose average (173 mg/dl, thanks to a 404 mg/dl after a pump site change), my glucose numbers within target (62%) and the number of hypos I've had (5).  Rough week.  I'm determined to look at better results next week and say, "Ah, there it is- I've hit my stride."  Or at least, "Hey, there weren't any numbers over 240 mg/dl and you only had one low."   

I'm hoping I can stick with printing out my blood sugars every week, and if I can stick with the program, I will slap a star on my calendar.  Stupid?  Maybe, but it's tangible proof that I DID IT.  And hopefully by DOING IT, I can hold myself accountable for my management and make some improvements.  I won't know unless I TRY.  In all caps.  That's how I roll.

So, armed with stickers and silly puns, I'm making 2009 "The Year of the Log."   And I think that I'm telling you guys in efforts to make me stick with it.  Knowing that YOU know makes ME feel like following through isn't so tough.  IN ALL CAPS.  ;)

December 22, 2008

Dexcom Pros and Cons.

As with everything diabetes-related (or maybe just life-related), there are pros and cons to this whole continuous glucose monitoring thing.  For those of you who are still thinking about whether you want to make this CGM leap, here are my pros and cons of CGMing to shed some light on the subject.

CGM CONS:

The sensor is bulky.  The sensor isn't tiny (about the size of an iPod shuffle), but it's held securely down by the adhesive gauze, so once it's in place, I can't feel it.  This is a big deal for me, since the Minimed CGM was painful for me.  However, it's visible underneath the sleeve of my shirts when I wear it on my arm and it's slightly uncomfortable to sleep on when it's on my back.

Can be "too much information."  Having blood sugar updates every five minutes is awesome, until you find yourself checking it every five minutes and obsessing over each result.  I needed to be psychologically ready for a CGM, and I need to be able to keep it from ruling my life. 

Receiver is enormous.  The Dexcom receiver is pretty big - bigger than my Blackberry - and it's cumbersome to wear.  I usually keep it on my desk, in my purse, or in my coat pocket when I'm out.  At night, I strap it to the headboard of the bed using a headband.  Not a big deal, but it's hard to miss.  Especially when it ...

Beeeeeeeeeeeps! The beeps are LOUD.  Mega loud.  Loud enough to wake me up during the night if I'm low (thankfully), but during the quieter parts of the workday, it's loud enough to distract my coworkers.  I recognize that the beeping is important, but it's not always convenient.

Adhesive sort of sucks.   This is my biggest compliant about Dexcom sensors.  The things do NOT want to stay stuck for more than five or six days.  I shower twice a day (before work and after the gym) and I wear clothes that rub up against the sensor, no matter where I place it.  Even with SkinTac, the edges of the sensor start to peel up at about the five day mark, and it's loose and ready to fall at the 7 - 8 day mark.  (And sometimes, the SkinTac and the Dexcom adhesive and a not-so-helpful bandaid create a huge and ugly problem:  frigging ouch.  See the photo on Flickr for a full rundown.) 

Ouchy Dexcom

I do not like when a $60 sensor starts to peel away.  This is highly annoying.

Insurance coverage battles. While others have had their requests approved without batting much of an eye, my insurance coverage for the CGM had to be fought for.  I battled my insurance company for over eight months before receiving my approval letter.  The insurance hurdles are a definite con, and might make some people reluctant to fight for their right for a CGM.  (Cheerleader note:  But don't let it stop you!  Go for it!)

Doesn't feel "sexy."  (Yes, I know this "shouldn't matter," but these are my personal pros and cons, so roll with me, okay?)  With the pump infusion set stuck into one part of me and the CGM sensor in another, wearing two devices doesn't exactly feel like I'm ready to model for Victoria's Secret.  There have been plenty of times when a moment has been interrupted by the CGM beeping or the sensor getting stuck on my clothes and whatnot. 

CGM PROS:

Low blood sugar safety net.  This was a huge part of why I wanted to use a CGM in the first place:  hypoglycemia unawareness.  I was exhausted and frightened of the lows at 3 am, so having the added safety net of the CGM has been a huge improvement.  The CGM does its job and protects me from plummeting blood sugars.  When Chris is away on business, he prefers that I wear the CGM to keep an eye on those lows.  It makes me feel safe, and I value that "pro" above all others.

Helps me avoid staying high.  My body reacts to blood sugars that are over 260 mg/dl or so, but those 160's and 180's often go unnoticed.  The Dexcom helps me wrangle in these "minor" highs and tighten up my blood sugar standard deviation overall.  Staving off both the lows and the highs will be particularly helpful during my future pregnancy.

Excellent for exercise.  I go to the gym at least five days a week, and my workouts range from walking/jogging on the treadmill to cardio circuit training.  The CGM has been AWESOME at detecting fluctuations in my numbers while I work out, helping me avoid those crash-and-burn lows at the gym and also the highs that sometimes crop up after a hard workout.  (And it was great on our hikes when we went to Acadia - excellent tool!)

Driving safety.  I spend a lot of time in the car driving back and forth to RI, and the drive time is anywhere from 2 1/2 hours to 4 hours (depending on traffic - I hate CT highways).  Having the Dexcom in the center console next to me while I travel is another big bonus.  With hypoglycemia unawareness and blood sugars that seem to be affected as much by my moods as by what I'm eating, having an extra eye on those numbers is crucial to keep be safe behind the wheel.

Integration-free works for me.  I trialed both the Minimed CGM and the Dexcom and for me, the Dexcom being a seperate device worked best for me.  With the Minimed CGM, I couldn't hear the pump alarming in the night because it was buried underneath the blankets.  Having the Dex receiver separate from the pump is convenient for the nighttime alarms and also if I want to avoid having to deal with the CGM for a little bit.  I can shove it into my purse, bury it in a desk drawer, or even walk away from it for a little while if I want.  I like the freedom from being beeped at sometimes.  It sounds counterproductive, but in the longrun, this is a bonus for me.

Trending and tracking.  Here's the point of CGMs - to track the trends of my blood sugars.  The Dex doesn't replace my meter, but instead works with it.  I test on my meter and see a result of 100 mg/dl, but with the Dex, I know I'm "100 going down," "100 going up," or "100 holding steady."  This makes it easy to go into long meetings at work without fearing a crash, and also lets me go to bed at a blood sugar of 90 mg/dl with confidence.

Pretty darn accurate.  I don't expect this thing to be right all the time.  I already have my head programmed to accept that a CGM doesn't replace finger sticks, so when things don't match up all nice-nice, I don't flip out.  Overall, though, I've found that the CGM rides pretty close to my meter.  Dex works better when I'm running a bit steadier, so it's actually a weird sort of incentive to maintain better control to retain the integrity of the sensor.  Don't ask me to mentally make sense of that - I need to take whatever motivation I can and run with it.  ;)

But it does feel sexy.  And this is the flip side to that "con" coin.  The Dexcom is sexy.  It's stuck to me to gain better control of my diabetes.  Good control helps everything from my weight to my hair to my internal organs to my smile.  Being healthy is sexy as hell.  And being confident enough to wear this machine, despite its cons and because of its pros, makes me feel stronger all the way around.  For me, after weighing all these pros and cons, the CGM is definitely worth it.

Conquering diabetes, damnit.

Readers Beware!!:  These are MY pros and cons.  I chronicle my personal experiences with diabetes here on SUM and I'm not a doctor or a CDE or a medical professional of any kind.  I have decided to use the Dexcom CGM after trialing both the Minimed and the Dexcom, but I know plenty of people who are using the Minimed CGM without issue.  For me, the Dexcom was a more comfortable fit into my life, literally and figuratively.  It's all about personal preferences, and these are mine. 

If you're thinking about trying out a CGM, I recommend trialing as many kinds as you can before making an informed decision.  Your mileage on these devices will vary, so it's important to find out what works best for YOU.  Contact your CDE and see if you can schedule a week trial session with different devices. 

If you want to share your perspectives, feel free!  I love that the online diabetes community has become a real source of information for diabetics everywhere who are looking for real information - we are the true mavens of patient experience!

December 12, 2008

Low Blood Sugar Woes. (And Whoas)

Next week will be better.

Because this week has sort of sucked, on the diabetes front.  

On Wednesday afternoon, I stopped home for lunch to make a quick sandwich and grab my laptop. It was a warmer day, so I felt a little sticky as I brushed my teeth in the bathroom.  I was delaying putting on my coat.  My forehead was damp.  And the sounds of cars going by outside and the radio in the living room were tumbling around in my ears like socks in the dryer.  My brain knew I was low.  My body was slower to acknowledge this.  I went to the fridge to get the juice, my legs operating much slower than usual.

And I stood there with the fridge door open for several minutes, just staring into it and trying to remember what I was doing.  I kept looking at the juice, my brain poking at me frantically - "Um, some sugar would be nice.  Why don't you get that?" - but I wasn't moving and instead stood there a few minutes longer, letting the cold wash over me as I found myself sitting on the floor.

I've been diabetic for a long time.  Even I should know better than to let my lows eat my brain like this. (Zombie lows?  Whoops, digression.)  Finally, I fully tuned into the fact that I was low and I drank juice until it ran down my jawline. 

I tested.  45 mg/dl.  Stupid lows.

Low blood sugar:  45 mg/dl.  Damnit.

I can rebound physically from a low that happens in the middle of the night or the wee hours of the morning, but the aftermath of a low during the day sucks the life out of me.  I felt exhausted and shaky for several hours afterward.  These moments make me angry at diabetes, because there is so much out of my control.

Last night, at our holiday party, it happened again.  I was talking with my husband and some coworkers and drinking a diet soda (avoiding the alcohol because ... well, then I may have been inclined to sing karaoke and that would have been a crisis), but then the headache came on.  Again with the damp forehead.  Again with the dizzy feeling and the swimmy sounds in the room.

"Excuse me, I'll be right back," I said to Chris and our friends, walking over to the open bar.

"Orange juice, please?"  I used the bar to prop myself up a bit, hoping no one was noticing how rattled I looked but hoping someone would notice if I needed them to.

"And vodka?"  The bartender put some ice in my glass.

"No thanks.  Just orange juice, please."  He gave me a big glass and I downed it as quickly and discreetly as I could. 

Everyone knows I have diabetes.  It's not discussed and it's not avoided, but it's common knowledge.  Yet I didn't want anyone to see me in that vulnerable state.  The waves of nausea and light headedness were washing over me, but I did what I could to appear "normal."  It doesn't make sense - these people know and like me and I have nothing to be ashamed of, yet I still felt warm with both hypoglycemia and embarrassment.

It passed.  It always passes.  And the night went on without issue.  (And we had fun.)

But these lows.  I can track my blood sugars and attempt to plot the trends. I can wear the CGM and test often.  I can carry fast acting glucose and be all "responsible."  But they still come.  Prevention is a good effort, but it doesn't completely eliminate these nasty lows.   

it's been a crappy week.  I have felt "off" all week long and my the fallout has been visible in my numbers, my mood, and my motivation.  I hope an easy weekend will realign me. 

Next week will be better.    Next week I will be better.

December 11, 2008

Irony: The Thrice Edition.

(No, I'm not sure if that title makes sense either.)

After my last few days of completely screwing up, I tried to do at least one thing to improve my diabetes - I finally created a real emergency kit for work.  

This little gem has everything I need for a diabetes moment on the job:  I have a backup infusion set, some lancets, several boxes of test strips, a Humalog insulin pen, a spare One Touch UltraMini, and even a SkinTac wipe for any CGM sensors or pump sites that go rogue.

Neat and tidy and prepared.  Hang on .. let me adjust my Boy Scout badge.  It's the one for diabetes preparedness. 

But what's missing from this kit?  Fast-acting sugar?  Nope - my office has a handy stash of candy for low blood sugar reactions and sweet teeth (sweet tooths?) alike.  How about the Quick-Serter for the infusion set?  Nah, I live five minutes from my office, so if the site isn't working out, I can pop home and fix it right quick.  Battery for the pump or a just-in-case syringe?  Both are safely tucked into the meter case.  This little box appears to have everything I'd need for a short-term fix ... what could be missing?

Oh, I know!  Irony!

Godiva!  You saved me!

Irony once again:  keeping backup diabetes supplies in a Godiva chocolate box. 

November 25, 2008

Dexcom Sensor Video - Sort Of.

I've had several emails about how to apply the Dexcom sensor (watch the video), how big is it (like two quarters side-by-side), does it hurt (not usually), does it automatically give insulin (no - that would mean it's a pancreas), does it need to be fed or watered (no), can it fly (yes - when I throw it), do I like it (yes).

I wanted to do an akward little instructional about how to apply a new Dexcom sensor to my lower back, and with Chris's help, I think we captured most of it.  It gets a little shaky in there when we're clipping in the transmitter to the sensor housing, but you get the gist.  Hopefully.  :)

As far as placement goes, I've worn it on the back of my arm, on my abdomen, and on my lower back.  My main issue is keeping that sucker STUCK to me for the full duration.  For those of you wearing a Dexcom, where are you sticking your sensors?  Any tips on new places?  

(Please forgive me for talking so damn fast on that video.  I forget that not everyone communicates at the same foolish warp speed as me.  I need to take a breath!) 

November 19, 2008

Need Some Adjustments.

The last few days have been nothing short of annoying - and I have the blood sugar logs to prove it.  In this past week alone, I've had six low blood sugar episodes ringing in under 50 mg/dl.  The lows are intense, sneaky, and have me fumbling with my meter, my hands, my words. 

Hypoglycemic unawareness is very, very scary to me.  It's this weird mix of being proud that I can still function at a blood sugar of 31 mg/dl, but also frightening because I'm not feeling the symptoms of a low until my body has almost crashed.  Last night, as I was getting dressed to go to Chris's film event in the city, I felt the teeniest twinge of a headache, but nothing that stopped me from doing my hair or brushing my teeth.  It wasn't until Chris asked me, nicely, if I was able to pull up HopStop on my Blackberry from the train.

My snippy response:  "Yeah.  I can, okay?"  Pause, realizing I was being enormously bitchy.  "I'm going to test.  I think I'm low."

A few seconds later, I'm looking at that officially scary number of 31 mg/dl staring back at me.  Still, no real symptoms.  I drank some juice, finished getting ready, and put on my coat and scarf.  It wasn't until I was all buttoned up and ready to go that my legs gave out and my brain went on hiatus.  It took about 30 minutes to fully recover.

Later on, during the screening, I tested at random and saw a blood sugar of 48 mg/dl.  More juice.  More nervousness, because that one came without any warning whatsoever.

I'm not sure what's been going on these past few days, but the lows have been unpredictable, yet daily.  I can't explain them with an "Oh, I over-bolused," or "I did a more intense workout than usual," or "Whoops, I forgot to eat!"  I even (TMI) took a pregnancy test to rule out any possible biscuit building.  Negative - no biscuit.  So now what?

Thank goodness for Dexcom.

My Dexcom sensors arrived via FedEx yesterday and I put one on this morning (after charging the receiver - I always forget to do that in advance).  Actually, Chris put it on for me because the sensor is on the back of my right arm today.

"I'm glad this is back on," he said, expertly pulling out the needle and attaching the black sensor to the housing on my arm.  Since I wear my sensors mostly on my arm or my lower back, Chris is the one who knows how to put them on best.  His hands move quickly and surely, talking to me as he attaches this device to my body.

"Me, too.  Yesterday sort of sucked.  The gym on Monday sucked, too."  The sensor clicked into place and he kissed me on the cheek.

"All set."

Now that I can watch the numbers trend and burn, I'm going to run a basal test for the next few afternoons, so I can see what the hell is going on with my body.  Am I suddenly more sensitive in the afternoons?  Is there something going on in the morning that is affecting my afternoon numbers?  Are the glucose gremlins on vacation?  I'm counting on my meter, the Dexcom, and a little old-fashioned freaking vigilance to help me find the source of these lows.

Either way, I'm still on this diabetes trapeze.  But at least I have a bit of a safety net now.

November 18, 2008

No More Larry Bird.

Dexcom - I need  you back!They left me alone for several months, but now the lows have returned, and they brought friends. Last night, before we left the house to go to the gym, I tested at 137 mg/dl. Knowing I'd be doing at least 30 minutes of cardio and some weights, I figured I should eat something. Grabbed a bar from the cupboard and chomped on it.

"Will that do it?"  Chris asked as he mixed up his protein shake.

"Yeah.  It has like 18 grams of carbs.  If I disconnect and eat this, I should be good."

Munch, munch.  Feeling good.  We drive off to the gym and go our separate ways - Chris to the weight room downstairs and me to the women's cardio section.  I hit the treadmill and dial up a 30 minute workout.

Music is loud - a little Muse.  My legs feel strong and my sneakers pound against the treadmill.  Strong, healthy, strong, healthy ... the words jostle around in my brain with each step.

But I start feeling a little funny at the 20 minute mark.  The music is too loud.  My headphones feel tight against my ears and my hands are numb at the very edges.  I scan the far wall of the room and the walls look a little wobbly.  My legs are a little wobbly. 

With the treadmill still running, I jump off quickly to the side and grab my meter from my gym bag.  Jump back on to the treadmill with the meter in hand, slowing down the pace so I can unzip the bag and lance my finger.

33 mg/dl.

"That sucks."  I press "Stop" on the treadmill interface and open my bottle of juice, taking eight long slugs from the plastic bottle.   My legs, which just a few minutes ago were holding me up just fine, feel like they're made of yarn.  Leaning against the railing of the treadmill, I finish the bottle.

This low feels particularly rotten.  Waves of nausea and a feeling of extreme light-headedness are coming up from my knees and cresting over my eyes.  I know I need to get downstairs and find Chris, just in case.  My legs work on autopilot, bringing me downstairs and into the weight room, where Chris is working out.

One look is all he needs.

"How low?"

"Thirty-three."

"Hmm.  Larry Bird."   He guides me by the elbow over to where I can sit down.  "Did you drink juice?"

"Yeah. I'm frustrated.  I only got 20 minutes into my workout.  And I feel like I'm all ..." Words aren't processing properly in my head.  "Mushy.  I feel mushy."

"You just need a few minutes.  You'll be okay.  Right?"

"Right."  The affirmation makes sense.  "Baby, I'm sort of tired of Larry Bird."

He smiled and we waited for the numbers to climb.

I don't know where these lows are coming from, but they are sneaky, intense little suckers that buckle me at the knees and steal the words from my mouth.  I'm waiting on my next order of Dexcom sensors to be shipped, but last night was one of those moments where I missed the Dex.  I would have at least seen the low creeping up on me a little bit.

But the wildest part is how strong I feel when I'm in that range, that 90 mg/dl range.  It's my magic number.  I feel strong, capable, almost borderline athletic.  (For those of you who know me in real life, you know how remarkable that statement really is!)  It's crazy how much just a little fluctuation in these numbers can really change how our bodies respond. 

Dex, I need you back, buddy. 

November 06, 2008

Petal By Petal.

I'm picking my priorities, petal by petal.

I'm choosing to wear this Dexcom and adhere another site to my body.  I'm choosing to have the beeps ring out and scrape against the walls of my office, letting everyone know I'm out of range somehow.  Sometimes the site doesn't bother me, sometimes it itches a little bit.  Depending on where it is resting, either on my arm or on my lower back, I sometimes see it in the mirror and am reminded of what I'm trying to accomplish.

I'm choosing to test my blood sugars and log the results regularly these days, even though keeping a log book goes against what appears to be my internal wiring.  I've always been challenged by keeping track of blood sugar numbers, even though just looking at a few days' worth of numbers really does help me isolate patterns.  I'm building a binder, and it's a pain in the arse, but I'm hopeful that tighter numbers will be the result.

I'm choosing to laugh at the things that hurt me.  When the infusion set hits a nerve as it goes in or when my CGM site bangs against the doorjam, I try to embrace my inner Yosemite Sam instead of letting the pain get to me.  Making this choice makes me hop around like a rabid bunny sometimes, and eventually gets me giggling, but it's better than feeling angry.

I'm choosing to go to the gym after work every weeknight.  I do not like the impact this has on my free time, and I don't always like the actual sweating part (oh how I hate to sweat), but I need to keep my heart healthy and my body strong ... and it helps clear my head a little bit, too.  So even though this hour and a half is something I want back at times, I know this choice is worth it.

I've chosen to limit my commitments these days, because over-extending myself leads to stress patterns that make my brain melt.  I'm stoked to do NaBloPoMo, but I've ducked out of doing NaNoWriMo this year.  I'm working at dLife and freelancing, but I'm being careful not to plan to be in fourteen different places at once.  I've decided to stay home in CT some weekends instead of making the long drive back to Rhode Island.  Peace of mind goes a very long way for me, and I'm making the choice to stay a bit more stable. 

Life gets busier and busier every time I blink, and I know it's not just me.  Everyone seems to have a side business they're cultivating, or organizations they're volunteering for, or events they're coordinating.  Life is blasting forward at a breakneck pace and we, as members of this community, have that added bonus of diabetes to manage in conjunction with everything else.  I'm trying hard not to get sucked into the stressful chaos of accomplishing everything, and instead giving a go at managing life petal by petal. 

Diabetes management, petal by petal.

November 05, 2008

More Sweet Irony.

Last Friday, we had a little Halloween party at dLife, complete with costume competition.  And there were treats - oh holy sugar rush, there were brownies and candy bars and cupcakes and other delicious, carb-laden tasty bits.

But somehow, willpower had settled into my brain on the overnight and took up residence there, keeping my hands steady when the sugary treats were passed around.  And while other moments of willpower are hard for me to maintain, this one was easy.  I've felt a little "off the wagon" lately with my eating, so I'm trying to revert back to pre-wedding mentality, with a focus on lower carbohydrate consumption and ramping up my workouts a little bit.

"No thanks, I'm all set," as the candy dish is passed around.
"I'm cool," while the brownies are being cut and served.
"I'll have coffee," when offered a delicious cupcake.

And it wasn't difficult.  I actually felt unaffected by this mysterious willpower.  It was kind of nice to just coast without feeling any pangs of "Man, I wish I wanted to take the leap and eat that ..."

So why, dear diabetes, did you decide to take a mini-hiatus for the afternoon?  My "good behavior" was rewarded by a series of low blood sugars that righteously kicked my ass.  As soon as I got to work, I started taking pictures of my co-workers' costumes and enjoying the festivities.  But after a few minutes, I realized there was a hollow tin to the way everything sounded, and my lightweight Red Riding Hood cape felt like it was about 33 (Larry Bird) lbs of fabric.  

I tested, and sure enough:  34 mg/dl.

Fantastic.  I had to borrow change from a coworker and grab a juice from the kitchen, chugging it in almost one gulp.  Thankfully, my body recovered fast and by the time my friend asked, "Hey, are you okay?", I already was.

Forty-five minutes goes by.  And I'm sitting at my desk, typing away in an email and realizing I've typed the word "diabetus" instead of "diabetes."  I hit the backspace and tried to retype it, but my fingertips skidded off the keyboard clumsily.  The headache behind my ears was a pounding one, and beads of sweat were on my forehead.  Oh for crying out loud - another one?  I reached back and grabbed my bottle of glucose tabs, popping two in my mouth at once as I fumbled with my meter.  

Well lookie here:  48 mg/dl.  How did that happen?!  I haven't eaten anything that required a big, potentially miscalculated bolus, so what gives?  Whatever - treated it and tried to move on.  (But I giggled again at "diabetus," and promptly had Liberty Medical commercials stuck in my head for the next three hours.  Digression?  Don't mind if I do!)

We had our Halloween costume contest, gave out the prizes, and work resumed again.  I was talking with my coworker when I felt the old, familiar symptoms creeping back up on me.  Her voice was too loud, the heating vents were too loud, the buzzing from the computer screen was creeping into my brain and gnawing on my nerves.  I felt testy.  Overly sensitive.  I wanted to tell her I felt low but the words coming out of my mouth weren't ones that had checked in with me, first.  

"I wanted to ... you know, I'm sorry.  I think I'm low again.  I need to test."  Shunk.  55 mg/dl.  I didn't know what to say.  Why won't this low just back off!?  Does it want brownies that badly?  I moved my chair back and reached for the glucose tabs again, my coworker pausing to look at my quizzically.  "Apparently, I'm cured," I said with a shrug.

I do not understand what causes these lows that hang around for hoooooours.  I didn't change my basals.  I didn't do anything bizarre, like run five miles before work or start doing crunches at my desk.  I hadn't eaten anything out of the ordinary, and I was eating snacks at very regular intervals.  But for some reason, this low blood sugar was hanging with me - we were buddies.

Dear diabetes, if you wanted a brownie, you could have just said so.  Seriously. 

Diabetes wanted a brownie.
  

October 20, 2008

Crumbs Sparling. (Different from Crumbs Morrone)

The weekend weather was so excellent that we had to take advantage of it.  On Saturday, we took the quick train ride into NYC with a Chris-driven agenda:  hop on a row boat in Central Park and then devour cupcakes at Crumbs Bakery on Amsterdam.  (He saw the idea written up in InFlight magazine last week, and tore out the page.  We're easily persuaded, as a couple.  The mere mention of cupcakes is enough to send us on a cross country adventure.)

Kerri at the Bethesda Fountain in NYC

We stopped by the Bethesda Fountain (near the Boathouse), which I recognized from photos I've seen online but hadn't ever scoped out in person.  The park was busy, thanks to the beautiful weather, but we managed to grab a few photos.

View from the boat

I did not know you could rent rowboats in Central Park and tool around the Pond.  Chris rowed, rowed, rowed our boat and I did my best not to tip the boat over.  And after all that work rowing (and trying not to fall in), we had worked up quite an appetite.  It was time to bring on the cupcakes!  Trying to guesstimate the carbohydrate content in this sucker was an adventure in and of itself.  

Holy cupcake

"Maybe sixty?"

"Dude, a bagel has eighty-five.  I'm going to guess at least sixty-five."  I cranked up the pump to six and a half units, knowing that the frosting alone was more than my daily carb allowance.  (But it was DELICIOUS.  Easily the tastiest cupcake I've ever had, and almost worth the $4.00 price tag.) 

Dosing for high carb, high sugar dessert treats is always tricky, and I usually over compensate in efforts to avoid the spike.  I bolused and also requested that we walk back to Grand Central (I hate the subway, and I avoid it at every opportunity), which had me chomping on glucose tabs around 56th.

"Thwarted by that cupcake.  I guess I'll have to have another one sometime and see if I can fine tune the bolus."  I'll do my part, even if it means consuming another cupcake or two.  It's for science.

(Crumbs bakery + Kerri Sparling = Crumbs Sparling.  Very different from Crumbs Morrone.)

October 03, 2008

Whine.

Wine, whine?I woke up high this morning, thanks to a late-night snack of quinoa that didn't get into my system fully until well after I'd gone to bed.  Pre-bedtime test was 94 mg/dl, but I woke up at 7:30 am with a full bladder, sweaters on the ol' teeth, a backache, small ketones, and a blood sugar of 298 mg/dl.  I cranked in a correction bolus and went about getting ready for work.

I don't usually fall fast after highs.  It takes me about two hours to really settle back into a steadier range, and sometimes longer to even start the blood sugar tumble.  So I showered, reconnected the pump, got dressed in a hurry, and shuffled my almost-always-late ass out the door.   Mind you, only 38 minutes had passed from the time I bolused.

Got to work, turned on my computer, and started picking through my work emails.  But I had that feeling of foggy distraction - the sound of a coworker tapping her fingers against the keys were resonating in my brain too loudly.  And I clicked on "new" about three times before realizing that I was trying to "reply" to an email instead.  Brain was malfunctioning.  So I tested, knowing something was up.

Or down, since the result was 53 mg/dl and falling fast.  

I reached into my small, compact work bag (lie: the bag is enormous and I'll end up deformed from carrying around so much unnecessary crap) and pulled out a bottle of juice I'd had stashed for a few weeks.  It was a bottle I used at the gym once before and just refilled for an emergency.  I twisted off the cap and heard a distinct hiss, like I woke up an angry grape juice rattle snake.

Juice doesn't normally hiss, does it? 

I gave the contents a quick sniff and realized that the grape juice had fermented and was now spoiled and closer to "wine" than "reaction treater."  Thankfully, I had a can of juice in the fridge at work, so a quick pull helped elevate my blood sugar.

Kerri, take note (from yourself in third person):  Juice becomes wine when you have it go from hot to cold a million times.  No juice when you're low becomes whine.  Though the pun is delightful, stick with glucose tabs, okay?  They're less apt to spoil.

September 26, 2008

It's Friday. That Means ...

The Friday Six:  September 26, 2008 edition... The Friday Six.  It's time for a week-end wrap-up, and to share some of the latest bits with you.  I hope you're all having a good week.  I am so ready for the weekend (and the debates tonight)!!!  I'm going to just jump right in with number ONE ...

1.  Last week, I posted a photo on D365 of Tickles the Tapeworm, and just a few days after posting it, a package of Parasite Pals stickers was delivered to my office, courtesy of my Flickr friend, Stinky_Harriet (aka Liz).  THANK YOU, LIZ!!!  You totally made my day, and I shared these stickers with my editorial team.  (We thought they were digustingly awesome.)  If you're following the Diabetes365 crew over on Flickr, you may have seen some of the wonderful photos from Liz.  Click through and check out the photos, and give some love to Sara, who is on the cusp of finishing her 365 days!! 

2.  In CGM news, there's a chat with Aaron Kowalski on Monday, September 29th, in the DiabetesTalkFest chatroom.  Dr. Kowalski will be answering your questions about the JDRF CGM trial that was in the New England Journal of Medicine last week, so check it out if CGMs are on your wishlist.  (It's on mine!)

3.  (Full disclosure:  This next bit has it's fair share of we in New England call "wicked bias.")  My husband has teamed up with some of his old buddies from the fitness world to create a cool and informative health and fitness site called I Look Like Fit.  There's a ton of useful information on the site, including workouts, diet ideas, weight loss tips, and even a social networking page called - wait for it - FitHeads.  So, if you're looking to tone up or trim down, this new site and its social networking sidekick could be a good fit for you.

4.  This Sunday, Fairfield County is playing host to the JDRF Walk For A Cure, and the dLife team will be there.  (I'm hoping it doesn't rain all over our heads during the walk, but we're badass enough to take the risk.  Diabetics don't melt!)  Are there any SUM readers who will be walking on Sunday?  If you're there and you see a cloud of white dLife t-shirts, come by and say hello!  :) 

5.  In cake-related news (this may be my favorite segue ever), the popular site CakeWrecks has its first comment controversy going on, all about a cake shaped like an insulin pen.  Personally, I find this cake to be amusing.  The comments on this post, however, are less entertaining.  Plenty of diabetic-bashing going on in there, from laying down guilt on people with type 2 diabetes to the stereotype that diabetics on the whole can't eat anything but carrot sticks and ... dreams, I guess.  If you want to weigh in on this mess, feel free.  Stop the ignorance, if you can.

6.  And finally, I vlogged.  I vlogged from my stupid car, because time is limited this week but I've felt delinquent as a vlogger (and I've been enjoying the ones from SuperG and Sara and Windy, and Landi even joined the fray!) and I needed to catch up.  If you skip on over to my YouTube channel, you can find my latest attempt at vlogging.  And, like George mentioned in his post today, I'm open to any questions because, quite frankly, sometimes I have no clue what to say.  :)

The weekend should be rainy here in New England, but it's still the weekend, and that makes it awesome.  Have a good one, and I'll catch you on Monday!

September 23, 2008

Irony.

I cooked last night.  (Contain your shock, please.)  I made chicken and vegetable soup, whipped up some delicious sugar-free pudding, and baked a chocolate cake for my co-worker's birthday.  Nothing caught on fire, nothing turned to sawdust, and consuming aforementioned tasties did not kill anyone.

Damn you, chocolate cake!

However, the cake baking was a little bit of a thorn in my side, because I was soooo tempted to lick the mixer beaters (no, not while they were spinning) and to stick my finger in that thick, chocolate frosting.   

But HA!  I did not succumb to temptation!  I baked that cake, frosted it, and put it in the fridge, all without even a taste.  HA HA!!!  Take that, diabetes! 

After the cake was all done, I sat down on the floor with my laptop to go through my emails.  But the screen was too bright.  The colors were all ... off.  And my hearing was fading in and out, like someone was shaking a blanket out to spread over the bed.  My head was in a complete fog, and Abby was weaving between my elbows, meowing frantically.

So I tested.  

And after all that baking, after avoiding that delicious treat and trying to "stick to the plan" and "be a good little diabetic," I saw "35 mg/dl" winking back at me from my meter.  Eight gulps of juice later, I was laying on the living room floor, telling Chris, "I didn't feel that one coming at all," and "If I lay still enough, I sort of feel like I'm on a record player, spinning."

Damn you, irony!

September 22, 2008

Diabetes ... Period.

Diabetes and birth control ... WTF?About once a month, there's a certain spike to blood sugar patterns that is both predictable and completely chaotic - welcome to this morning's TMI post about diabetes and the menstrual cycle. 

Two months ago, when the gene for the Factor V Leiden mutation was detected in my blood, my endocrinologist and my gynecologist decided to remove me from my birth control pill and switch me to something with less of a clotting risk.  Since I decided to go on the pill when I was a freshman in college, I have always been on the standard estrogen/progesterone pill (I was on the ortho-tricyclen, then tri-sprintec, if you want a good ol' dose of TMI).  When it came to diabetes and this kind of pill, there was plenty of information out there, so I had a good idea of what to expect.

But this new one?  The progesterone only?  It's a bit of a wildcard.  I'm currently taking the Errin pill (28 days of hormones, no "placebo" pills) and these first two months have been pretty damn tricky.  I'm not sure if it's my age, the ticking of my biological clock, or just the changes in my body as I age, but this pill made my emotions run wildly.   And the information I've received on this pill has varied.  The internet (oh Internet!) informs me that the brand name version of this pill comes with a diabetes-specific warning:  "Diabetes patients - Ortho Micronor may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine."

Oh for crying out loud ... another variable?  

I was on the old pill for almost ten years, in total, and I was used to the effects it had on my body.  I was accustomed to the 28 day cycle, the guaranteed four day period, and the pre-period spikes weren't dramatic.  I actually noticed a drop in my insulin needs while I was on the placebo week, and I had a decade to really adjust to the whole process.  This new bit, with a whole new hormone regimen, has thrown my body into the spin cycle.  I can't anticipate the highs because I'm not sure if/when the actual period is coming.  (Part of the trick with progesterone-only pills is that you may not always have a period, which makes my brain melt.) 

Aside from these unpredictable start times, this seems to be the first pill that affects my emotional state closer to the end of the 28 day cycle ... for example, I came across this video of a singing little six year old and promptly burst into tears.  I had a few days of feeling amped up, over-emotional, and anxious, and these emotions had their own little tea party with my blood sugars.

I want stability.  My whole reason for being on birth control at this point is to protect my body from pregnancy, because my A1C is spikey.  So I take the pill to protect body-from-baby/baby-from-body, yet the pill itself could be contributing to an elevated A1C.  It's frustrating because pill options are limited (thank you, Factor V), pregnancy is not encouraged at this A1C, and I'm a young, newly-wedded woman with a healthy libido.  (Kerri!  Your mother reads this blog!  And so does HIS mother!  Ahhhhhh!  Go delete that!  I'll wait.)

Nope.  Can't delete it.  This is real life with diabetes, awkward bits and all.  Anyone out there on a mini-pill and seeing some numbers (and emotional) fluctuations?  I'm trying to learn everything and anything I can, with the end goal being Nice Healthy Baby Range.  Talk to me - I need some advice!

September 15, 2008

The Temptation of Cookies.

But are they bolus-worthy?!"I'll just stand here and keep you company."  He crossed his arms over his chest and kept his eyes on the red bowl I was stirring.

"Chris, you aren't keeping me company.  You're lurking."  The butter and the sugar were starting to mix up in the bowl, giving off that sweet aroma of cookies-to-be.

He smiled.  

"I love cookie dough!"

I'm not much of a cook, but I can definitely bake.  Flourless chocolate cake.  Banana bread that's made with extra bananas so it's all moist and decadent.  I can make chocolate crinkle cookies and Hershey kiss cookies, chocolate chip with oatmeal, peanut butter cookies ... you name it.  And last night, at the begging of my husband, I made chocolate chip cookies with extra chocolate chips.

It's almost Murphy's Law, my cooking talents unable to be used for "good."  I can't cook up a turkey dinner, or make a delicious dinner, but I can create the most sinful desserts without effort.  And the irony of standing there with my insulin pump clipped to my hip as I mixed up a bowl of brown sugar, chocolate chips, white flour, and butter was enough to make me laugh.

I've become decent with the willpower bit, able to say "no thanks" to indulgences if I have my head on straight, but sometimes I completely buckle and make stupid decisions.  I caved to the temptation of cookies last night.  They were fresh from the oven and sitting on the cooling rack, making the whole house smell ... simply: awesome. 

And Chris and I settled in to watch Vantage Point (mini-review: decent enough of a movie, but I could have done with the rewind device every fifteen minutes or so), I grabbed three cookies for Chris.  And then I grabbed three for myself.  My willpower went pfffft.  And the cookies tasted delicious.

Indulgences, for me, make me fear the highs.  I'm not as concerned with the calories or the effects on my weight (maybe I should be), but I try and ward off any post-indulgence highs anyway that I can.  Usually, I bolus aggressively, and sometimes hit the mark perfectly.  Other times I end up chasing a low, making the indulgence go from "reasonable" to downright gluttonous.   Last night I managed to do both.  Those three (delicious) cookies sent me up to 204 mg/dl, then I hit 54 mg/dl about an hour later.  

But was it worth it?  

I hadn't had cookies fresh from the oven in years.  Can't even remember the last time.  And these cookies were moist, hot, freshly baked, delicious, just the right amount of chocolate chips, and delicious.  So yeah, I'd say that little blip in my willpower radar was okay.  One cookie won't kill me.  Neither will three.

But Chris, eating spoonful after spoonful of raw cookie dough?  I think that may be more of a problem.  ;) 

August 27, 2008

You Gotta Fight ... For Your Site.

I am pretty crap with site rotations.  This is a fact, evidenced by the same pad of callous on my fingertips from testing and the smudge of dots on my thighs from infusion sets.  Back when I was taking injections, I favored my arms for a few years, then my stomach, then my legs, building up layers of scartissue and absorption issues with every prick.

I know site rotation is important, but it's never been my strong point.  Until I'm forced to do it.  Change is something I'm reluctant to make sometimes, especially when it comes to managing pain.  I have to be honest - most of the time I prefer using the same site locations because they sting less.  I test on the tips of my fingers because those nerves aren't as responsive and the lancet doesn't sting, for the most part.  Same for my thighs - the infusion sets don't sting as much when they are nested in an already-broken in area.  

But those wild highs forced me to change my stubborn ways.  (Yes, wicked stubborn.  Ask Chris.  Or my mom.  Or ... anyone, I guess.)  And now, after over two weeks of using expanded body real estate, my numbers are faring a bit better.  I'm seeing much better absorption using lower back sites and even though the infusion sets sting like hell for a few minutes after going in, my postprandials are more in range.  I feel like a bit of a stooge for being so stubborn and letting a little sting or a smidge of fear keep me from taking control of this crap. 

This has nothing to do with being stubborn, but I liked the photo.

Ruts - I get in them.  I'll do the same thing, every day, expecting something to change.  And I get all moody when it doesn't.  I frustrate myself because I let complacency or comfort or sometimes fear keep me from making even the tiniest of changes.  I'm now accustomed to having my infusion set on my lower back and I feel comfortable using it.  And my body seems to be enjoying the change, too, because my thighs are starting to heal up and the speckled red dots of old sets are disappearing (helped along by some high octane moisturizers, exfoliation, and some good old fashioned neosporin). 

It's not all awesome, though.  With this new site location on my lower back, the tubing is a bit more exposed and I've found myself forgetting to tuck it back into the waist of my skirt.  It's also less-than-cozy on the first site night, because I sleep on my back and I can feel the infusion set.  But these discomforts are worth it when I'm seeing my blood sugar at 147 mg/dl an hour and a half after lunch.  I'll freaking take that. 

Stubborn Kerri ... she needs to shake things up now and again!  (Only in first person, not in third person.  Third person is not as effective.)

August 25, 2008

Just Say No.

Holy delicious.Saturday afternoon, we were at Diane's birthday party (Happy Birthday, Chris's mom!), and there was a decadent chocolate cake to celebrate.  Sunday played host to my friend Kate's wedding shower, where there was an open bar, cookies, and a delicious butter cream cake.  Yet I didn't taste any of these items.

And I have no clue where this willpower came from.

After a startlingly high A1c result last month and a string of elevated blood sugars, I feel like I'm starting to get things back under control these days.  I'm giving my thighs a rest and trying out new infusion set sites, and the absorption has undoubtedly improved.  I'm also doing my best to keep a closer eye on numbers and be a bit more proactive instead of reactive with corrections (i.e. counting carbs more precisely and giving my insulin time to get in before eating in efforts to avoid a spike), which seems to be working.  My meter average has gone from 160 mg/dl two weeks ago to 143 mg/dl - and I'll take it.

Granted, I'm not all good behavior.  I had an awesome peach martini on Saturday night with my husband.  And I have been indulging in too much tasty iced coffee on those long drives home to Rhode Island. Some stuff is bolus-worthy!  But with such a focus on diabetes management, I'm becoming stingier with indulgences.  I wanted to taste that chocolate cake, but the fabulous smell of chocolate was wiped out by the thought of a big bolus, the potential for a post-prandial spike, and then the low that may result from the correction.  My blood sugar at the time was 89 mg/dl, and I wanted to keep the steady number more than the cake.  Same for the wedding shower treats - it was easier to say no than to handle the potential highs and lows.  (Even though the cookies at the shower looked so exquisite I almost buckled.)  But I keep thinking about a baby someday.  And a lower A1c.  And feeling better.  It made it easier to just say no.

While I was at the shower, my friend's mother (a type 2) remarked while the cookies were being passed around, "You have such great willpower!" 

I laughed.  "Today.  Who knows what tomorrow will bring!" 

Diabetes has become like chess - I'm looking a few moves ahead and basing my decisions on the future rather than the present.  I don't plan on letting diabetes checkmate me ... instead, I'll steal its horse and run off.  For now, I hope I can make the willpower last!

August 18, 2008

Diabetes Real Estate.

Control is tough to come by these days - and it seems like the more I fret about it, the more tangled my numbers become.  I'm trying a more relaxed approach (yes, I am as high-strung as I seem, why do you ask?!) to diabetes management.  Like this past weekend:  instead of shlepping myself home to RI and spending more time in the car than with friends and family, I decided to stay home in CT and relax.  I watched movies.  I worked on some writing I was trying to finish.  I made iced tea and cleaned my house.  (And I also tried on my wedding dress for no reason, but that's neither here nor there.)

Overall, I tried to freaking relax.  And it helped - my numbers didn't act out.  Apparently the absence of cortisol helps blood sugar stability - who knew? 

In addition to decompressing a bit, I also tried out a few new site locations last week.  I'm wondering if my thighs are a bit overused and if absorption is suffering as a result of the scartissue.  To give my legs a rest, I made good use of an arm site and a back site.

Infusion set on the back of my arm.

The arm site I've done before.  I can insert it myself (on my left arm, since I'm right-handed), it is pretty pain-free, and is away from my abdomen, which I prefer.  The mechanics of an arm site are a bit tricky, though.  If I aim the tubing towards my shoulder (see the photo), the tube goes up my shoulder, through the sleeve of my shirt, down the side of my body and then comes to a rest at my waist, where the pump is clipped.  It's a little complicated, because the tubing sometimes pinches where it's snaked underneath the side of my bra and it tickles a smidge, too.  Also, I almost ripped the site off a few times when putting on/taking off a sports bra, but overall, I just need to remember where the hell the site is and I don't screw it up.

Using my lower back as a site for an infusion set scared the crap out of me, but I knew it was possible because I saw Sara stick her CGM trial sensor there at the CWD conference.  It just made me feel squeamish thinking about the needle being inserted into my back ... actually, just writing that is making me feel all eeeew.  But, after psyching myself up and reminding myself that if it hurt, I could just rip it right out, I used the ol' Quick-Serter to stick a set into my lower back, towards the side.

Infusion set on back.  Thought it would hurt.  Was wrong, thankfully!
 

This site didn't sting much going in (totally unused real estate here), but the first bolus was a bitch and a half.  It stung like crazy!  Thankfully, it only took a few boluses to really get the site settled in and by the end of the first day, I didn't feel it at all.  I've worn it to the gym, to the movies, and in clothing with varying waist bands with no problem.  The only difference between this and wearing it on my thigh is that it's higher and the tubing doesn't naturally tuck down my leg, so snagged tubing is a risk.  Overall, I'm digging it, and grateful for the option.

New real estate options for my pump?  Check. Chillin' out, maxing, relaxing all cool?  (Name that sitcom!)  Check.  Have any of you guys tried these sites?  Any options for new places? 

And how was your weekend?  :)

August 12, 2008

Free Test Strips? Do Tell!

Diabetes is expensive.  With test strips clocking in around a buck apiece, it's no wonder that every time I open the bottle I hear "ca-ching!"

So when I hear that there are free test strips being given out, my interest piques like crazy.  And I had to share with you guys.  :)

Thanks to Kelly Close and the crew at diaTribe, there is a year's worth of One Touch test strips up for grabs. According to the diaTribe site, "You have a chance of winning a grand prize of one year's worth of OneTouch Ultra test strips (based on about 5 strips per day). That's 18 boxes each containing 100 OneTouch test strips. There are also 18 runner up prizes, each consisting of a box of 100 OneTouch Ultra test strips, and you will have a chance to win any of these 19 prizes. That's a lot of strips!" 

Now here's where I disclose the fact that I write a column for diaTribe, so I'm not exactly unbiased in urging you to sign up.  I am, however, a fan of accurate information about diabetes being passed around, so I'd be pro-diaTribe regardless of my professional association.  

The point is, if you sign on up, you can receive not only good diabetes-related information, but you can also score a year's worth of test strips.  That's a deal if I ever heard one!!  Sign up between August 3rd and August 31st to enter! 

August 08, 2008

My Glucose Meter Talks To Me.

I spoke with my meter about whether or not he's comfortable talking on camera.  After some cajoling, Meter decided he was ready for his close-up.  He wasn't happy about the nose, and he was a little frustrated that cars kept driving by as we were taping, but overall he was pleased to share his perspectives with the diabetes community.

My Glucose Meter Talks To Me.

Coffee?  Yes, it's making me do strange things.  Why do you ask?

July 31, 2008

CWD: Lancet Devices.

At the CWD conference, there was a big ol' expo going on while the focus groups were taking place.  Every company from Omnipod to Dex4 to my friends at diaTribe were interacting with the CWD Friends for Life attendees. 

Before the expo, I was talking with Sara about lancing devices.  (My life is a thrill a minute, no?)  She swears by the Muliticlix, while I had never used one before.

"You NEVER have?  We need to fix that."   

So when the expo opened that morning, we went off to find the folks at Accu-Chek, so I could try out one of their Multiclixes.  (Multiclixes?  Multiclixi?  How do you make that one plural?)  After a demonstration, some questions, and wrangling them to hand over a demo device, I also checked out the Renew booth and convinced them to hand over a sample, too.

So now that the dust has settled from CWD, I finally had a minute to try out these devices.  

First, the Renew.  I'll admit it:  It looked like a spaceship, so I was intrigued.  I liked the color choices (mine is the old lime green one they first marketed, but they have a whole new selection of colors now) and it's reasonably small.  However, I needed to read the manual before I could get the cartridge in there.  I'm not sure if it was the lack of coffee in my system or my overblown KerriBerry technojoy, but I couldn't figure out how to unhinge the thing to get the lancing cartridge in there.

Kerri and the Renew

The manual was clear, thankfully, so within a few seconds, I had the cartridge loaded up and ready to roll.  Thanks to decades of diabetes and an unquenchable desire to prick the center of my fingers instead of the sides, I have some serious calluses to work through.  I used the "3" setting at first, but that barely made a dent and produced the teeniest drop of blood ever.  Cranking it up to the "4" setting procured a good drop. 

The device is less painful (admittedly) than the One Touch lancing device I used every day, but here's the big drawback:  every new test uses a new lancet.  Yes, this is best for finger health and to avoid infection, but it's also a big, fat waste of a lancet if you aren't able to draw blood with the first prick.  Testing my blood sugar once used two lancets, and there are only 20 in the cartridge.  I'm hoping that a future generation of this product allows lancet reuse (for us old-timers who only change lancets with our clocks). And I'm also hoping that the future generation is a little smaller because while I was intrigued by the round design, it doesn't fit neatly into any of my factory meter cases.

Kerri tried out the Multiclix, too.

I also tried out the Muliticlix and Sara is right:  this thing is pretty pain-free.  The woman at the Accu-Chek booth was telling us about the patented technology they have for their devices, keeping the lancet on a track so it doesn't spiral into your finger and rip up your skin any more than necessary.  I've used it a few times already in the last day or two and the results have been pretty good.  Once I figured out how to insert the drum (I'm fumbly-clumsy these days, and it took me a few seconds to load this one, too), it was all systems go.  The shape of this device is the familiar cylindrical one, and it fits into my meter case.

Pros for this device are that you can reuse the same lancet as many times as you'd like.  Economical, in my eyes, because I'm not wasting lancets.  It also, as I said before, fits in my meter case, which makes it easier to integrate into my current routine.  The cons on the Multiclix are that the depth settings just aren't deep enough for a veteran tester like me.  On one of my least-calloused fingers, I'm using the "4" setting.  Maybe with continued use, the calluses would ease up a bit, but from my perspective now, it would be good if the settings went up another notch.  Or two.  ;)

Have you guys used any of these devices?  What was your experience - good or bad?  

(And I'm also waiting for my Pelikan Sun device to be mailed to me - more on that once it arrives!)


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July 21, 2008

Blue Bird of Happiness.

We drive.  Friday night, after taking in the new Batman movie, we hopped in the car late at night and drove home to RI.  (Late-night driving means less sleep but also means less traffic, and we'll take the latter, thanks.)  Saturday morning had me at the beach with a few of my college roommates, then dinner out with family on Saturday night, then breakfast with Batman (my friend, not Christian Bale), then a cookout at my mother's house on Sunday afternoon.

It sounds like a lot of driving because it IS a lot.  Chris and I try to connect with as many of our friends and family as possible when we come home on the weekends because we don't have the opportunity to see them for several weeks on end.  Connecticut, though filled with career opportunities for us both, doesn't have much in the way of family.  And lately, family and friends are something I've been missing tremendously.

I've hit a very rough patch, diabetes-management wise.  My A1c came back the highest it's been in five and a half years, and I didn't take the increase with any grace at all.  Even though I can attribute the rise to wedding chaos and honeymoon laziness, I still felt so disappointed.  In addition to an elevated A1c, I've also been diagnosed with a disorder called Factor V Leiden, which can cause blood clots and has forced me to change some of my routine (read: birth control pills are now a no-no).  Despite the fact that this disorder is unlikely to cause problems, it's still a new blip on my health radar and contributed to my feeling of "eh" last week.  I was feeling overwhelmed with health concerns, frustrated with insurance issues for the Dexcom, and pretty damn grumpy.  Crumbs Morrone ... er, Sparling.  Crumbs Sparling.

I needed some time with friends and family this weekend, to help take the edge off a roughish week.  And it worked.  Yesterday afternoon, I was hanging out in my mother's yard, taking pictures of her garden.  My mom is very whimsical and a little silly, and her yard is crammed with flowers and these strange little garden critters that she finds from the Christmas Tree Shop:  small ceramic ducks, little turtles, and garden gnomes.  It sounds like her lawn is littered with trash, but these creatures aren't just flung about haphazardly.  They're carefully placed, hidden between hydrangea bushes and underneath rhododendrons.  You have to look for them to find them.

Bluebird of Good Health 

I came across a big, fat, ceramic bluebird yesterday.  It was in her front lawn and guarding an azalea bush.  

"Bluebird of happiness!"  My mother came by, checking out what I was photographing.

"I see that."

"Well?  Doesn't it make you happy?"

I thought for a minute.  I felt revitalized after being socially reconnected with my friend and family.  I felt ready to make the medical changes necessary to accommodate the new condition and to take change of my diabetes management once more.  I felt loved.  Supported.  Happy.

"It does, Mom.  That fat bird totally makes me happy."  She grinned at me. 

Onward, right?  All I can do is get over the bad news and move forward towards something better.  Good health is one day at a time.

July 17, 2008

Give Me The Sample!

Antisocial little droplet
Hiding in my fingertip.
I called for you - you did not answer!
Forcing me to now reprick.

I lanced again, into the tissue,
Calloused hard from all these thuds,
I squeezed my finger with the purpose
Of procuring bright red blood.

But no!  My body stayed so stubborn,
Not giving me a proper sample.
"I'll change the lancet - then I'll finally
Get results."  My smile was ample.

Knowing that it wasn't time
To change the clocks or check detectors,
I still swapped out my old lancet
For a fresh, sharp blood collector.

I pressed the button, heard the shunk
And felt the sting of proper lancing,
Squeezed my finger, saw the blood
And did a jig of happy dancing.

I'd forgotten how convenient
It could be to just prick once -
Leaving me, the lancet horder,
Feeling like a mild dunce.

I suggest, my Faithful Readers
That you heed my sage advice.
Don't forget to change the lancet -
Prick your finger once, not twice!

Three little blood droplets, all in a row...

July 11, 2008

A1C You Soon.

Image courtesy of the BloodBankOnWebThe paperwork has been on my desk, but I kept staring at it for a long time.  And by "long time," I mean three full months.  I kept finding reasons to put it off - my wedding was coming, I was busy at work, my shirt sleeves were too long - but the real reason was because I knew the number would be kind of crap.  A1Cs are never fun, and they serve as a sort of diabetes report card.  With my stress levels being a little out of control during the wedding ramp-up, my numbers followed suit.  And I didn't want to know what my A1C was, out of fear and stubbornness. 

But on Tuesday, I turned my brain off for a bit.  I grabbed the paperwork, left my office, and drove directly to the blood work lab.  I refused to psyche myself out (and I tried really hard not to think about the pinchy needle easing into that tender part of my arm ... not a fan). 

"Hi, I'm Kerri.  I need to have an A1C drawn."

"Okay, write your name on the sheet here and have a seat."  

I wrote my name, thus making it official.  I was there, for my A1C, and there was no turning back.

I'm not sure why I shy away from this test so much.  I think it's because I have spent over twenty years putting so much of my self-worth into this percentage.  When it comes back under 7%, I feel like these moments of diabetes difficulty are worth the effort.  I feel strong and confident, like I'm really making strides in achieving good health.

But the bummer numbers.  The ones that are over 7% and cause the endocrinologist to check the "uncontrolled type 1 diabetes" box.  My Internal Motivational Speaker screams in protest at this box checking.  "Hey!  Uncontrolled?  Dude, she's paying attention and really putting forth a huge effort to manage this disease!"  I get overwhelmed by the possibility of complications and maybe not having a healthy pregnancy.  The parts of this disease that I try not to think about, try not to focus on, creep into my thoughts and whisper in my ear.

The phlebotomist put the rubber thing around my bicep, asking me to make a fist.  "To bring out your vein," she said, preparing the needle.

"Oooh, I'm not a fan of needles," I admitted.  

"But you take needles all the time, right?  With the diabetes?"  She tapped my arm a few times with her finger.

"Sort of.  I have a pump.  And a CGM," I gestured to the Dexcom sensor on the back of my arm.  "This takes blood sugar results for me so I don't have to prick my finger so much."

"Aye!  The finger prick!  I do not like that so much at all.  I am a diabetic type 2.  The finger pricking makes me all ... " she made a face to let me know how much the finger pricks stung.  "I do not enjoy it."

"Well I don't enjoy having blood taken.  That's why I am nervous."

She laughed at me softly.  "And that's why you are staring at the wall instead of looking at your arm, right?"

"Damn straight."   

Now I wait.  I should have my results in a few days, and I'm really hoping that this A1C result doesn't reflect the weeks of stress and honeymoon and worky bits.  I hope it shows the hours at the gym, the healthy eating, and the constant monitoring.  Either way, knowing this number is important.  Some would say it's half the battle.  But I wouldn't end this post with a silly reference to GI Joe ... would I?

June 25, 2008

Nice Happy Baby Range.

First comes love, then comes marriage, then something goes in this baby carriage thing.Oh no, not yet.  Definitely not this year, and maybe not even next year.  We're not quite there yet, but now that we're married and happy, starting a family is on our collective Sparling radar. 

I know that pregnancy is a wild ride, diabetic or not.  But from what I've heard, being a diabetic woman and being pregnant can be a challenge.  I've heard both horror stories and problem-free successes, so it seems like those nine months vary from person to person.

For me, I'm going to make getting healthy my goal for the next year.  While I was engaged, I was very focused on getting fit for the wedding, keeping that white dress in mind (and oh, all those pictures that I'm still waiting for and it may take another five weeks and Kerri is not happy about waiting so long but wow, run-on sentence much?).  But that mindset was very superficial.  This whole "getting ready for baby" thing is a mindset I've never experienced before.

I found myself making phone calls last month to set up doctor's appointments, as I mentioned.  I scheduled an appointment with my primary care physcian.  I make my yearly gynecological appointment.  And I also made an appointment to start the pregnancy clinic at Joslin later this summer.  In the past, these appointments were more routine maintenance events.  Now, I'm intent upon optomizing my health in hopes of carrying a child in the next year or two.  It's not too early to be thinking about this - it's actually the best time.

Last week I had my yearly appointment and after my doctor congratulated me on my recent nuptials, she got right down to the discussion about children.

"You're young and you're healthy, so we are not going to worry.  What I want to do is get your A1C down to that nice happy baby range.  When are you planning on coming off birth control?"

"Not at least until March or so of next year."

"Good.  Okay, so from now until March, we work on those blood sugars.  Under 7% is a good goal, but you are already there.  We want a nice happy baby range.  We want as close to 6% as we can get.  How does that sound to you?"

"Good to me.  I'm actually working on getting a continuous glucose monitor insured as part of my pre-pregnancy plan, so that will help."

"I like the sounds of that.  And once you are in that range ..."

I couldn't help but interrupt.  "The Nice Happy Baby Range?"

She laughed.  "Yes, the NHB range.  We get there, we talk with your husband about when you want to start trying, stop the birth control methods, and then you two go let nature take it's course.  But that A1C is important.  You're ready to make that commitment to your diabetes, right?"

I thought about that maternal instinct that has bloomed in me over the past decade and that feeling of a soft, sleeping baby tucked underneath my chin.  I pictured my husband as a father.  I saw myself as someone's mother.  This may not be easy, but I think it may be the most rewarding experience of my life.

"I am ready to do that.  I can't think of a more important reason to make these changes now."

My doctor gave me a smile and leaned across her desk, motioning for me to come closer. 

"Baby or not, Mrs. Sparling, it's worth making these changes just for your own health." 

June 11, 2008

Unreliable.

Meter accuracy - that's the target!We're back in the swing of things at home:  working, writing, laughing at the stupid cats, going to the gym, exploring our surroundings.  Stress levels are lower, thanks to the wedding being behind us, and our routine is a bit more predictable. 

BUT - before the wedding, everything was running amuck.  My schedule was erratic, work was insane, and I was stressed to the point where I couldn't wrap my head around anything.  For the six weeks or so before the wedding, I tweaked my basal rates and bolus ratios several times.  On our honeymoon, I had to tweak again due to a completely relaxed schedule.  And now that we're back, I need to re-tweak once more.

As a result of this readjustment to normal life, my blood sugars have been sort of scattered.  An occasional morning high of 197 mg/dl (which never, ever happens - my overnights are the only thing I have nailed down), some tricky lows at work, and a sticky high after lunch one day.  I'm in the process of working towards Dexcom insurance coverage, but in the meantime, I'm out of sensors and going on my meter results alone.

Last night, after we returned from the gym, I tested.  165 mg/dl post-workout.  No problem - I reconnected, took a correction bolus, and then jumped in the shower.  About five minutes into the shower, my head started to fog up as quickly as the mirror.  My brain was only half-focused on the lather-rinse-repeat routine and instead was starting to wander down that "should I test?" road.

"Nah."  I said to myself.  "I was 165 like ten minutes ago.  Insulin doesn't bullet in that fast."

I yelled out into the hallway.  

"Chris?  I feel kind of low.  I just wanted to let you know.  I'm getting out soon."

"Why don't you just get out now and test?  Do you want me to bring you juice?"  I could tell by his Doppler-voice that he was walking down the hallway towards me.

"No.  I'm fine.  I'll get out when I'm ready, okay?" 

Internal Motivation Speaker yawned in my ear, still not adjusted to being back from vacation.  "Kerri, why the highly bitchy response?  He's right, you know.  Just get out and test."

"I just tested."  I muttered to myself.  

Internal Motivational Speaker sighed.  "Just test.  God, you can be so freaking difficult."

"Fine."  Miserable.  What was with this headache, and why aren't my hands responding to my requests?  I fumbled awkwardly with the towel as I wrapped it around myself, my skin bristling at my own touch.  I grabbed my meter and dried my hands off.  Shunk.  102 mg/dl.

"102.  Maybe I'm sick or something.  I feel like shit."  I sat on the floor for a minute.  Chris stood above me, concerned.

The sound of the air conditioning unit was becoming louder with each second.  Abby came waddling up, urging her head underneath my hand so I would pet her.  Minutes passed, but they felt like hours.  What the heck was wrong with me?  I felt miserable.

I unzipped my meter again.   "I just feel so bad.  I'm going to double check."

Shunk.  35 mg/dl.

"Ah ha!  I knew it!"  I yelled.

"I knew it, too." 

"Okay, let's get some juice."  I drained the bottle in eight quick gulps, leaned back against the side of the bed, and waited for my blood sugar to rise.

It's a strange battle in my body at times.  I knew I was low.  I felt low and should have trusted my instincts.  But sometimes my instincts are unreliable, like when I feel low but am just hungry, or when I feel completely fine and am instead 345 mg/dl.  Maybe I should have trusted a CGM.  But CGMs are best for trending, not spot-checking.  So I should trust my meter.  But sometimes my meter gives me botched results that aren't the fault of hand lotion.  Arghhhh ... who can I trust?

All of these new products being buzzed about.  All of these bells and whistles and colored screens and fancy upgrades and ambitious developments.  I am so thankful for the advances, but all of these companies need to remember that we use this technology to keep us alive.  These bells or whistles aren't substitutes for old-fashioned accuracy.

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