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November 02, 2012

Dexcom Rash: Swinging for the Fences.

The Dexcom rash wasn't fixed by Opsite Flexifix tape underneath it as a barrier between the sensor and my skin.  Alcohol wipes after showing/before applying the sensor didn't work, either.  Neither did using a hydrocortisone cream, or Skin Tac, or Cetaphil soap.  Dexcom, regardless of what I threw at the sensor, continued to act rashly.

And this is where a reader came in with a suggestion that saved my skin.  She wrote, "You need to spray steroid asthma inhaler on the site after the alcohol or iv prep and before you insert."  She also attached a photo of a rash she received from a CGM and it looked just like mine.

Oh Internet ... I love you big time.  

It took some research, and several phone calls/visits/consultations with my PCP, dermatologist, and endocrinologist, in addition to phone calls to the Dexcom hotline o' bearded service (shout-out to The Hammer) to lock down a prescription for a steroid inhaler (the conversations about this off-label application were long and intense), and this morning marks the 36 hour mark with a sensor. 

Without a rash.  

"And there goes the ball ... right over the fence ... home run!!!" 

*Crowd goes wild.  Or at least Birdy claps her hands and the cats don't throw up, for once.*

Just as the fabulous reader (my hero) had suggested and after discussing the option at length with my endocrinologist, I showered and dried off, and then sprayed the inhaler spray against my clean, dry skin.  (It surprised me when it came out as a kind of powdery substance and not a mist.)  I sprayed it about three times to cover the anticipated surface area of the sensor adhesive.  After about 30 seconds, when my skin seemed dry, I placed the sensor on like normal and deployed the needle.  The adhesive patch felt a little stiffer and cracklier than normal, but the following morning, it was smooth and pliable against my skin, like it usually is.

But the best part is that after 24 hours, I wasn't itchy.  And this morning, at the 36 hour mark, the adhesive edge wasn't ringed with the red, puffy, reactive skin I've become used to since the end of August.  I'm not sure where this adhesive allergy came from in the first place (and for those who asked, no, I'm not pregnant), and I'm not sure why the inhaler steroid is battling it, but it is.  And honestly, after so many weeks without a proper Dexcom safety net, I don't care why it's working.  I'm just thankful that it is, and that my medical team is on board to try some different things in efforts to keep me safe.

Mystery rash cured, hopefully!

Note:  This is not medical advice.  Please don't try this without consulting with and getting clearance from your medical team.  I'm just sharing anecdotal information about something that worked in my personal diabetes life.  Nothing I ever say should be taken as medical advice because if I was really useful, I'd have an A1C of 5.7% and I'd burp rainbows.

(Second Note, for Monica, who may be reading this post today and who I know hates sports analogies.  "Swinging for the fences" means "attempts at doing difficult or near-impossible things," or at least according to Urban Dictionary.  You're welcome.  Oh, and this is also for you.)

August 10, 2012

Wrong Diabetes Diagnosis.

On Monday, the Wall Street Journal (look at me, linking to a real publication instead of a Strongbad email) had an article about doctors misdiagnosing type 1 diabetes in adults.  I posted a link to the article, called "Wrong Call:  The Trouble Diagnosing Diabetes," on my Facebook page and received several comments from people who went through a similar misdiagnosis.  They have offered to share some of their story here, and I'm hopeful that their words will help someone else in a similar situation.

The Initial Symptoms.
Jessica, diagnosed at age 26, was already familiar with type 1 diabetes.  "My diagnosis story actually begins with my husband, diagnosed with type 1 on his 21st birthday.  Fortunately he was diagnosed correctly and quickly, and we were able to get him all of the help he needed."  She described hitting a wall of thirst and exhaustion that set in when her son was nine months old.  "These symptoms continued for about a week, and mostly only bothered me at night.  During the day, although I was tired, I wasn't going to the bathroom constantly or super thirsty."

Lindsay had a similar experience, just before she turned 27.  "I was just a few weeks sPinging and ponging between proper diagnoses.  hy of my 27th birthday.  I had been sick a long time with weight loss, hair loss, you name it.  I ended up with intense upper GI pain that couldn't be ignored, so my mom took me to the ER where the symptoms were investigated with an ultrasound, blood work, etc.  The doctor came back to report that I had 'viral gastritis, likely due to your increased blood glucose level, which is 277.  Now, because of your age, you'll be considered a type 2.'  Love that one, eh?? My mom and I sat stunned; my dad had JUST been diagnosed with type 2 three weeks before."

Sarah also sang the same symptoms tune:  "The morning of February 22, 2007 I woke up and with diabetes without a doubt in my mind. I had nearly every symptom there was - constant thirst, frequent urination, fatigue. I had the works and I knew it.  I had a yearly physical coming up about three weeks after this and decided to wait until then to bring it up with the doctor. I realize now that this was foolish of me and that I really should have gone in right away!"

The Wrong Diagnosis.
Sarah was heading off to Europe the day after her initial type 2 diagnosis, armed with a bottle of metformin and instructions to see a doctor immediately if she felt at all ill.  "When I returned from Europe and for nearly five months, I had appointments every other week to monitor the progress of my BG readings and to adjust medications that ranged from Metformin to Glypizide to Byetta. By the time my last appointment in July had come around, I'd lost 45 pounds, the Byetta had caused my boss to think I was going to vomit every time I ate (even though he knew the side effects only included nausea, not actual throwing up) and for me to feel even worse than I had the 3 months before I began taking it. I was done. If I had to be a T2 Diabetic on insulin, I would be. But I was done feeling sick; being sick. My doctor offered to write me a referral, in which I quickly took him up on - even providing him with the name of an endocrinologist during that very appointment.  He gave me a prescription for insulin and a low dosage to start me off until I could get in to see the new doctor."

"We were given the name of an endocrinologist, a prescription for Amaryl and a prescription for a blood glucose meter," said Lindsay, recalling her initial diagnosis and treatment.  "We were told that once my blood sugars were under control, the gastric pain would go away.  I remember so clearly the nurse making sure I knew that as a diabetic my 'days wearing open toed shoes were no longer.'  No real information on what diabetes was, no instruction on how to use the meter, no information at all.  We left and I felt totally and completely lost. I was still so sick from the upper GI pain that I was relatively accepting of my fate because I was under the impression it would get better fast."

Jessica, however, had her husband's type 1 tools at home to make a quick check:  "One day, we went to my moms for dinner ... a night I now refer to as my "Last Supper."  It was my favorite meal - pot roast, mashed potatoes, loads of gravy, corn, bread, and Pepsi.  Immediately after dinner, I was going to the bathroom every 15 minutes.  I laughed about it, was a little concerned, but rationalized that I had drank a lot of water and Pepsi that day.  My mom looked at me and said sarcastically, "You should check your blood sugar!"  And it hit me.  My husband wasn't with us that night, but my sister drove me home, and we pulled out the meter:  HI.  'Bullshit,' I thought.  Check again:  HI."  She was off the the ER and sent home with a prescription of metformin, after minimal lab work.

Tipping Point, and Resolution.
That endocrinologist appointment was a true tipping point for Sarah.  "I remember my first [insulin] injection like it was yesterday. It wasn't much, but I remember feeling better within the hour. It was the best I'd felt in months - not only physically but emotionally, too. My fatigue and over all demeanor caused a lot of emotional angst that summer.  About a week later, during our first appointment with the endocrinologist, we [my parents and I] learned that I was a type 1 diabetic. She taught us about insulin to carb ratios, how to calculate them, when to take my injections for food and when to correct a high blood glucose reading, and what the difference was between Lantus and Humolog. She told me what was happening to my body and for the first time in months I understood. I was grateful for that day."

Lindsay also found quick, but bittersweet resolution at the endo's office.  "One week after visiting the ER, I met with my new endocrinologist who would be the first to tell me 'Um, no.  The doctors at the ER were shockingly and sadly mistaken.  Your A1c was 15.3 and you are, by every definition a classic case of a type 1, soon-to-be insulin dependent diabetic.  Your lab results are more than clear in that.'  I started SOBBING.  I had just accepted my fate as a type 2 who would have to watch my diet, maybe exercise some more and take medication.  I could handle that.  But shots???  UGH - no freaking way.  Looking back on it now, I'm baffled at how it was SO important to make sure I knew I shouldn't ever get pedicures or wear sandals again, but the meter?  The safe blood glucose ranges?  Ways to treat highs & lows?  Nah.  That wasn't important, I guess."

"I went to an endocrinologist.  I was begging for answers, telling her my story and asked if she thought I would ever be able to stop taking insulin," said Jessica, talking about her first visit to an endo. "She said, 'You know that you have Type 1, right?'  I cried, but more from relief that I finally had an answer.  My latest results had also revealed a hyperthyroid problem and she began to treat me for both.  I understand that I was extremely overweight and that's a red flag for a T2 diagnosis.  But it is terrifying to think about what would have happened to me had my husband not had a stockpile of insulin, test strips and needles for me to use.  We trust our doctors - and when we are diagnosed we do what they tell us to because we are scared, they know more than us at that point, and we want to feel better."

I only know what I know:  diagnosed as a kid with type 1 diabetes, never going through the pain and heartache of a misdiagnosis.  But after reading the WSJ article, and the stories from these women here, it breaks my heart to think of someone dealing with diabetes, but not finding answers, or relief.  All three women were misdiagnosed with type 2 diabetes and given oral medication, when they actually had type 1 diabetes, and needed insulin.

Jessica sums it up for me with this:  "I knew of only one girl with T1 when I was growing up.  I've met a few more as an adult.  What scares the hell out of me is the number of adult T1's I've met who are diagnosed in adulthood.  It's obviously a real and growing problem, and while our healthcare professionals are trained to see the signs in childhood, they aren't seeing it in adults."

December 07, 2010

Guest Post: Facebook Isn't Just About Tending Your Crops.

Manny Hernandez isn't just a "friend" on Facebook; he's my friend in "real life," too.  I've always admired his dedication to improving the lives of people with diabetes, and how he uses social media to bridge the gaps between diabetic communities.  Which is why I'm very happy to have him guest posting here today about his Facebook diabetes management game, HealthSeeker.

*   *   *
 
Manny Hernandez and his hatOn Facebook, You Can Also Play to Manage Your Diabetes!
Let’s face it: Facebook is a giant. More than 550 million people in the world use it for keeping up with friends and family, to stay informed, and to be entertained.

At the end of 2009, seeing this trend and realizing how many people on Facebook were playing so-called social games (FarmVille is just one example of these), at the Diabetes Hands Foundation (DHF) we thought we should develop a game on Facebook to help with diabetes management.

With the sponsorship of Boehringer Ingelheim Pharmaceuticals and in collaboration with Boston-based Joslin Diabetes Center, we began to shape  a new game called HealthSeeker. The game saw the light of day in June 2010, when it was launched in English at www.healthSeekerGame.org. The game was launched in Spanish during the month of November (si quieres jugar HealthSeeker en Español visita www.ExplorandoTuSalud.org).

HealthSeeker offers players suggestions to help them improve their lifestyle and nutrition, to better manage diabetes. As a player, you can invite your Facebook friends (actually, it is more fun to play alongside them): they can become sources of inspiration and motivation as you move through levels.

The game tackles two of the risk factors associated with the incidence of type 2 diabetes (though people with type 1 diabetes and all people who simply want to live a healthier life can benefit from it too): the lack of physical activity and the not-so-healthy eating habits we sometimes exhibit.

How does HealthSeeker work?
The game motivates players to take on simple daily challenges, such as switching from wheat to white bread or walking around the block after lunch, in order to help them reach their lifestyle goals.

The lifestyle goals include healthier eating, reaching an optimal weight, improve your diabetes management and reducing the risks of heart problems. HealthSeeker, the diabetes management Facebook game!

The game contains missions and actions that the participants choose. These need to be completed in order to progress. The vast majority of the actions are completed in real life, not in front of the computer. This makes sense considering that we don’t really burn too many calories when we’re not moving anything but our fingers on the keyboard. :)

As players complete actions and return to the game to inform about their progress, they receive awards and points for their achievements and their Facebook friends can give them kudos. Players can also share their accomplishments on their Facebook wall, through Twitter or challenge their friends complete the same missions and actions. This is part of the viral character of the game and is what makes it that much more fun to play alongside your Facebook friends.

As of today, more than 5,000 people are playing HealthSeeker and we look forward to receiving more players. The game is available free of charge, in English at www.HealthSeekerGame.org (en español a través de www.ExplorandoTuSalud.org)

I look forward to seeing you and your Facbeook friends playing soon to take simple steps to get healthier together!

*   *   *

Manny Hernandez (@askmanny) is a nonprofit executive, social media author, and consultant and a diabetes advocate. He is the President of the Diabetes Hands Foundation (DHF) and the founder of www.TuDiabetes.org (in English) and www.EsTuDiabetes.org (in Spanish).


September 09, 2010

Running with Diabetes.

I don't run.  Not well, anyway.  Running isn't my activity of choice because my body doesn't do well at high speeds.  But when I go walking or any other exercise that's outside and brings me far away from my car, I grapple with that whole "what the hell do I do with my diabetes supplies" issue.

For the most part, I usually carry a small bag.  Sometimes I bust out the meter from it's protective black case and throw it into a SpiBelt, adding in a tube of glucose tabs and my keys and cell phone and ... suddenly, I'm a pack mule, careening up the mountainside. 

I am not a "travel light" diabetic.  I'm a messy, throw-it-all-in-a-bag-and-hope-you-don't-lose-the-bag diabetic.  But some PWDs have figured out a terrific way to keep tabs on their diabetes while exercising.  Like my friend Melissa (a fellow Clara Barton Camp alum), who MacGyver'd her meter into her running shoes.  Here's a shot of her kicks, that she's graciously allowed me to share with you guys:

Melissa "Rebel" Kauffman and her diabetes running shoes.
Photo credit to Melissa K.  She also has a series of glucose stashes on her run route, in case of a low.  Clever girl!  (But no, I have no idea where she keeps the actual test strips.  You'll have to ask her.)

I think this is brilliant!  How do you keep your supplies at the ready when you're on the run - literally?  Are you like me, with an awkward bag of everything, or are you as streamlined as the pictured PWD?

August 25, 2010

WEGO ChronicBabe Rebel-Rousing.

(The subject line makes sense ... sort of.)  This morning I have a few bits and pieces from the ol' inbox to share, so it's sort of like a Friday Six. Only it's on a Wednesday.  And I only have three.

ONE! If it's for Barton, I'm all over it.  Over the summer, I visited Clara Barton Camp and met Melissa "Rebel" Kauffman.  She's awesome.  She's also running the NYC Marathon to raise money for Barton, and she's looking for support from anyone who has a little to give.  Here's the deal, in her words:

"Five people with diabetes representing The Barton Center for Diabetes Education are running in the NYC Marathon this November as a fund raiser for Barton day camps.  I am a 3rd generation type 1 diabetic myself and run XC and Track for Oregon State University.  This past summer, I worked on the health care team for The Barton Center's Camp Clara Barton and Camp Joslin. I believe that this charity event is a great way to show the over 2,00 children with diabetes who participate in The Barton Center programs every year that you can do anything if you have diabetes - even run a marathon!

My goal is to raise $3200.00 by November 7th the money raised will go to the Barton Day Camps that reach out to hundreds of kids in the northeast every year.  Please help by donating to:

Melissa "Rebel" Kauffman NYC Marathon
The Barton Center For Diabetes Education
30 Enis Rd.
Oxford Ma. 01537
or by calling 508-987-2056"

If you can lend a hand to this rebel-rouser, please do!  

Dos.Secondly on this truncated Six is some information from the team at WEGO Health.  Their Community Director passed on some information about a type 2-centric focus group that they're putting together, so I wanted to spread the word to you guys.  Here WEGO with the info:

"Join WEGO Health’s new Online Panel for Diabetes Health Activists
In their ongoing work to empower Health Activists, WEGO Health is hosting an Online Panel of Diabetes Health Activists.  The panel will “meet” monthly (meetings are held virtually – on the phone and online) to share their feedback and experiences with Type 2 Diabetes communities online.  Panelists will get a $25 Amazon.com gift certificate for each meeting they’re able to attend, and WEGO Health will also make a $200 donation on behalf of each panelist to the diabetes non-profit of their choice.  Please note that this panel is being held on behalf of one of WEGO Health’s sponsors.
 
Interested in joining the Online Panel of Diabetes Health Activists?
  Get started by taking the Diabetes Community Insight Survey from WEGO Health: http://www.surveymonkey.com/s/FT5NM93
 
Questions about the Panel? Contact WEGO Health at: community@wegohealth.com"

Tres!And last but not least:  my conference wife Jenni Prokopy (editrix of ChronicBabe) needs our help getting her panel chosen for SXSW 2011.  She sent out some details on how to vote, if you're looking to help, so here are the details from Jenni herself:

"Just a couple more days remain to vote for my SXSW interactive panel. Health Communities: Superheroes Who Need a Justice League will aim to help people build better sites that truly help each other - and this is the FIRST year sxsw has held a health track, so it's extra important to be included. i can't get there without your help! please take just one minute today to register and vote up my panel, and please spread the word." 

Click here to vote for Jenni's panel!

So there you have it.  Some link love well worth the click.  Thanks for helping out any and all of these people who are making a difference!

July 13, 2010

Clara Barton Camp.

I love Clara Barton Camp.  I love the way it smells, the way it looks, and the way it makes you feel as soon as you step foot on the grounds.  Driving in to North Oxford, MA last weekend to speak to the staff, I was hit with a wave of excitement at the idea of visiting my old stomping grounds.

And even though the cabins are new (no more rotten old Pixie Place) and they have bathrooms and showers IN THEM (no more waking up a buddy in the middle of the night to take a trek to the lab - which was across the camp - because you had to pee), and even though I was a camper there over fifteen years ago, NOTHING has really changed.  Almost all of the campers and staff have type 1 diabetes, making the few people who didn't have to test their blood sugar first thing in the morning the odd ones out (for once).

When I arrived, the dining hall was literally throbbing with the sounds of campers and staff singing camp songs at the top of their lungs.  "Sounds exactly the same as when I was camper here," I said to Abby, who was giving me a quick tour of the new cabins at CBC.  Admittedly, I felt a little old when she was walking me through the cabins, because I kept remarking at the fact that the structures had both running water and electricity.  

"I feel like one of those old people who constantly tells you about how, when they went to school, they had to walk uphill BOTH WAYS, clutching potatoes in their hands to keep them warm.  But seriously, cabins having bathrooms is amazing.  My mind is blown."

Once we made it up to the dining hall, I had the absolute honor of meeting with the staff and LITs (Leaders in Training) at CBC that had diabetes.  I was invited up to talk about growing up with diabetes what it's like to transition from being a child with diabetes to an "official" grown up with diabetes, and these girls were the best audience I have ever had.  And the audience with the highest percentage of diabetes!  According to the camp director, there are only about 14 people on the grounds who aren't living with diabetes - that's a LOT of insulin being piped in on a daily basis! 

The awesome staff members at Clara Barton Camp.

We all hung out in the dining hall and just chatted.  It felt like a big slumber party, only I wasn't sporting pajamas (and I planned to sleep at home).  They had a lot of questions about managing things like college, dating, and of course, the whole baby thing.  I tried to be as honest as I could be, toeing the line between "one of them" and "an adult."  Like when they asked me about drinking.  "I know I'm supposed to be responsible and tell you that drinking with diabetes can be really dangerous, and can lead to some very serious diabetes-related consequences, which is all true.  But I can't lie and say that I didn't drink in college.  So here's what my experiences were like ..."

It was an incredible night.  These girls are a group for the entire diabetes community to be proud of.  Their energy, their endless smiles, their excitement for everything.  They took pictures (some goofy) and burst into song at the mere mention of the word "song."  (Video of a song about ketones coming at you ... now:)

Clara Barton Camp has this way of making you feel like you're being hugged the entire time you're there.  It sounds cheesy, but it's true.  CBC is like a second home to so many girls with diabetes, and for some, it's the first place they've ever felt like everything was going to be okay.  I asked some of the staff members to tell me what camp means to them.  Their responses were varied, but all hitting on the same general theme:

"Camp helps make me who I am."
"It feels good to be able to text someone in the 'off season' [when camp isn't in session] and vent about a high blood sugar."
"When I'm here, I sometimes feel homesick, but when I'm home, I definitely feel campsick."
"Here, diabetes is cool.  The people who don't have it are 'wannabetics.'"
"When I am here, I feel like a whole person."
"I thought it would be about teaching the kids, but I'm learning so much myself here."
"This place is literally my second home."
"These are friends that I'll have for the rest of my life."
"Camp is my security."
"I'm glad I'm staff this year because I get to give back to something that gives so much to me."

But my favorite was when one staff member raised her hand and said, "It's the happy bubble.  This whole place makes me feel like I'm in a happy bubble."

Clara Barton Camp is definitely one, big happy bubble.  And it was such an honor to revisit a place that played a huge role in shaping how I view my diabetes today.  Huge thanks to Abby, who coordinated the event, and to each and every member of the CBC staff for their warm and inspiring reception - and for the kick-ass t-shirt.  (And props to Savannah for rocking those mismatched galoshes!)

July 02, 2010

Reaching the Summit.

On Monday afternoon, BSparl, Chris, and I boarded a plane bound for Orlando, Florida.  (It was our first trip with the baby - more on that later, because I'm still processing all the stuff required to travel with an infant.)  My trip was dual-purposed:  to attend the Roche Social Media Summit and then co-lead a focus group on Wednesday morning at Friends for Life. 

Like everyone else, I have a disclosure with this:  Roche paid for my plane tickets to and from Florida, and they also covered my hotel room for Monday and Tuesday night.  But they didn't hold me over a shark tank to gain input from me, and I am also still using my brain on my own, so basically they can only claim travel, food during the conference, and lodging.  They also didn't ask us to blog about the event (even though they knew we would).

But like I said last year, Roche is smart because they know by bringing together a pile of bloggers, Roche will be discussed on a pile of blogs.  And also in step with last year, Roche treated us respectfully and worked hard to make sure we were happy, as a group.  But I can't lie:  I was excited to attend this event because it would put me in "real life" touch with my extended diabetes family.  The invitation coming from Roche makes it a "Roche" event, and I can't hide my bias when it comes to being grateful to them for having the opportunity to socialize with my social media friends.  So that's the full disclosure. 

The event took place as a bookend to the CWD "Friends for Life" conference, which seemed to dictate the timing and location.  I think there was a total of thirty-seven bloggers, representing the type 1 community heavily, but with voices from the type 2 and caregiver crew as well, and we were hanging out in a conference ballroom at the Orlando Marriott all day on Tuesday.  

The Roche representatives were very cool to us, and didn't seem to have an agenda of expectations - just an agenda of events.  They had us engaged in discussions about meter accuracy and they also invited in representatives from the American Diabetes Association and the American Association of Diabetes Educators to talk with us.  I felt a little quiet during these discussions (thanks to the utter lack of sleep the night before, with BSparl not adjusting to the travel schedule and deciding to stay up until about 4 am), but I kept an eye on the RocheWANTED! reps during the chats, because I wanted to see what they were reacting to. (That, and there was this long table set up at the back of the room, where a few of the Roche team members sat, watching us.  So I went over to them and let them know I was watching THEM.  Now the student has become the teacher, grasshopper.  /Confucius rant)

Overall, discussions were interesting.  Meter accuracy has been a hot topic for a while now, with the FDA meetings and an explosion in the blogosphere, and it was a topic of utmost importance for me during the course of my pregnancy.  It amazes me still that meters are "allowed" to be 20% off, and that we almost have to choose accuracy over cost when it comes to test strips.  (More on that later.)  And while the ADA panel of guests answered questions, I still couldn't help but wonder how the ADA spoke for me, as a person with type 1 diabetes.  (More on that later, too.)  

But the Summit itself wasn't about the discussions or the agenda of our host Pharma company.  (Even though, and I'm being completely honest here - I'm impressed that Roche wants to sit in the same room with a bunch of bloggers.  We aren't known for being quiet or demure, that's for damn sure, and we don't have a penchant for butt-kissing.  So they get us and our opinions, raw and unadulterated.  Yet, this is the second year they've invited us to meet with them.  I remain impressed.)  The Summit is about bloggers getting to know one another offline, and whether or not Roche understands that aspect wins out over any Pharma agenda, it doesn't matter.  People power wins over scheduled discussions.

So thanks to the Pharma company that dared to play host to bloggers for the second year in a row.  And thanks to the diabetes blogging community, which plays a huge part in improving my emotional diabetes health. 

(Oh, and thanks to the Photobooth, which let Scott and I pretend to be lions in the first shot and let us see up George's nose in the last one.)

June 22, 2010

Pregnant With Pre-Existing Diabetes?

For anyone who has been reading my blog since my engagement three years ago, you know that motherhood has been on my radar for a long time.  Longer than marriage.  That quest for a decent A1C, that desire for a "normal" pregnancy, and that hope for a happy and healthy baby.

Buy this book!Part of the reason I wanted to write about my pregnancy here on SUM is because there wasn't a lot of information out there about pre-existing diabetes and pregnancy.  There was a LOT of information on gestational diabetes (obviously), and type 2 diabetes got some good press, but type 1 was sort of swept under the rug.  Thankfully, there were a few diabetes bloggers who had chronicled their journeys, and I wanted to add my voice to that hopeful chorus.   

But also thankfully, Cheryl Alkon had taken the topic to her publisher, and she penned the first book on managing pre-existing diabetes and pregnancy.  And I'm very honored to have been both featured in her book (as a women preparing for pregnancy) and to have her contributing here on SUM:

Doom and gloom. That was the message I got several years ago when I first thought about trying to have a baby while also dealing with my type 1 diabetes. Whether at the doctor's office, going online, or reading the very few books about the subject, trying to get and be pregnant while managing blood sugars, taking insulin, closely counting carbs (and avoiding a lot of low-carb proteins that were good for blood sugars, but bad for babies-to-be) all sounded like a nearly impossible task. One fraught with higher risks of birth defects, overweight babies, worsened diabetes complications, and more.

But I also saw type 1 friends who had healthy babies and sensed what could be possible. This spurred me to research, craft a book proposal, and eventually devote myself to publishing an insider's guide to pregnancy with type 1 or type 2 diabetes. I'm thrilled to say that, five years later, "Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby" was published by Demos Health this spring, and has been enthusiastically welcomed by others who, like me, craved the inside story about how to have a healthy pregnancy and baby while managing diabetes.

I had the pleasure of receiving an advance copy of Cheryl's book just before my baby was born, and even though I was in my third trimester and just weeks away from delivering my daughter, it was so reassuring to read about all the things that could go right.  A diabetic pregnancy is a high-risk one, and the challenges can lead to some tough emotional roller coasters and some scary medical experiences (see also:  stuck in the hospital for a month) - but these pregnancies can also lead to a healthy, happy baby.  (See also:  BSparl)  Touching on everything from pre-conception to managing the months of the pregnancy to post-delivery recovery and how to wrangle in diabetes control once again, this book was exactly what I needed to read while pregnant with my daughter.  I only wish it had gone to press before I had conceived!

If you are a woman with diabetes and you're thinking about becoming pregnant, this book is a good resource for you.  If you are the partner of a WWD (woman with diabetes) and you want the full story on how pregnancy and diabetes can mix, this book is a good resource for you, too.  And if you are the parent of a woman with diabetes and you want to know that your child can have the same chances of a healthy pregnancy as any other woman, this book is a good resource for you as well.  

Cheryl will actually be speaking in Boston in the coming weeks (the first event being THIS WEDNESDAY - sign up!), so if you'd like to hear more from Cheryl in person (and meet my endocrinologist, who consulted on the book with Cheryl), you can attend a discussion this Wednesday.  For more details on upcoming events, check out Cheryl's post on her blog.

Thank you, Cheryl, for giving new moms and moms-to-be with diabetes a sense of peace.  And congratulations on your BIG ANNOUNCEMENT on your blog today!

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?

April 13, 2010

Diabetes During the C-Section: Here's the Plan.

Preparing for the diabetes part of BSparl's birthI've received a lot of emails about the how diabetes will be handled during the actual "birth" of Ms. Bsparl, and while I won't have all the details until it's all over with, I do have a few answers for now.  I talked with my OB (who will be performing the c-section) and my team at Joslin about some of the details.  This might be a detailed, kind of boring post, but I wanted to make sure I'm answering all the questions possible! 

Here's what I know so far:

On Wednesday night, an IV will be "installed" in preparation for the insulin drip.  I'll still have my insulin pump on, though.  As of midnight on Wednesday, I won't be able to eat anything from that point until post-surgery, so the IV will be at the ready in case I go low during the course of the night.  In the event of a low blood sugar, my team will do one of the following:  suspend my insulin pump, administer glucose through the IV, or potentially allow me to drink apple juice, depending on the circumstances. 

The c-section will be first thing in the morning (8 am), so the night before will be spent checking my blood sugar with the glucose meter every 30 - 45 minutes to ensure the tightest, steadiest control possible.  In my circumstances, I plan to keep the Dexcom connected throughout the night, too, to help with that goal.

The morning of the c-section, I'll get up wicked (pissah) early (5:30 am, I think) and I'll rip out my insulin pump and remove the Dexcom sensor.  The nurses will hook me up to the insulin drip and my blood sugar will be monitored - wait, strike that.  Stalked.  :)  I'll be hooked up with the drip, etc by 6:30 am and up to the delivery room.

We'll move into the operating room and my blood sugar will be monitored stalked by the Joslin team while the OB/GYN team prepares to deliver my baby girl.  Chris will be in the waiting room while they administer a spinal epidural (Do not Google this, because it will make you cringe.  I made the mistake once of Googling it.  Never again.  It made me want to give birth orally.) and then they will ensure that my lower half is numb and ready for surgery.  Chris will scrub in and be brought in to the room, where he'll be situated up near my head and the surgery will begin.  My team said that Chris is welcomed to hold my meter and test my blood sugar at our discretion, and the Joslin team will be doing the same using their meter or mine, depending on our preference.  But if I feel nervous about going low, etc, I am able to keep tabs on my own numbers. 

During the course of the surgery, I'll have a regular IV in for fluids, etc, and then the insulin drip will be combined with a glucose drip, the contents of which can be adjusted based on my blood sugar needs.  So if I start to spike, they can increase the insulin titration.  If I start to drop, the glucose can be turned up.  All of this is handled by the Joslin team, so my OB team can concentrate on BSparl's escape.

According to my doctors, the whole c-section will take about an hour, from start to finish.  Bsparl should be in Chris's arms by 8:30, and I should have all my pieces back together again by 9:00 am.  I'll be brought to the recovery room and Chris and BSparl will join me soon thereafter, barring any issues.  The insulin/glucose drip will remain in until I'm able to eat something, at which time the pump will be reconnected (by me), and after an approximate 30 minute overlap, the insulin drip will be removed. 

The Joslin crew told me that my postpartum insulin settings on the pump will be a whisper of what they were during the pregnancy, and about a third of what they were pre-pregnancy.  At this stage, they're assuming that I'll jump down to a midnight to midnight basal rate of 0.3u, an insulin-to-carb ratio of 1:20, and a sensitivity factor of 1:80.  (My pre-pregnancy basals were more around the 0.4 - 0.6u range, an I:C of 1:10, and a sensitivity factor of 1:55.)   And once I'm breastfeeding, all bets are off as to how that activity could affect my blood sugars.  Only time will tell. 

So that's the low-down on how the diabetes, at least, will be handled during delivery.  I don't want to think too much about the surgery itself, because it freaks me out.  But handing over all of my diabetes control also has me a little tweaked.  After over 20 years of doing it myself, it's hard to grasp the concept of "let someone else handle it entirely."  But I know I'm in capable hands with Joslin, and I know that my focus needs to be on the baby. 

She's worth every hurdle that we, as a family, have overcome to make it to this point.

Because at some time during the whole ordeal, her little teeny cry will cut through all the noise, and in that moment, I'll become a mom. 

February 26, 2010

Diabetes 365: Diabetes is Every Day.

There's been a handful of photographers who have tackled the Diabetes 365 project for this year, and I'm proud to be in their company.  It's a very inspiring experience, to see how diabetes is reflected in the lives of the members of D365, and how it is captured through their camera lenses.

An update on Diabetes 365

Some of us are using our DSLR cameras, some of us our point-and-shoots, some documenting with our iPhones or our Blackberries, but every last one of us is showing our lives with diabetes, every day.  I know I've talked about this project before, but watching the photos stack up in the Diabetes 365 Flickr group and seeing how, and what, people with diabetes are choosing to document their lives with this disease is incredible.

You didn't need to join the group in January - it's a rotating door of participants.  If you want to join the Diabetes 365 group, you can jump in anytime and start.  Every day can be Day 1.  

February 19, 2010

It's All Rainbows and Unicorns.

I love BSparl.  I love her little feet and her pouty lips and that feeling I get when she rolls around inside of me.  I love knowing that my daughter is just a few weeks away from becoming a part of our Sparling family, and I know that every moment of this pregnancy is completely worth every iota of effort and worry.

That being said ...Rainbow not included.

I'm starting to lose my mind a little bit.

I've blogged about the details of the doctor's appointments, and the ultrasound scans, and the way that diabetes has impacted my pregnancy, and vice versa.  But by the end of my posts, I feel better having purged the feelings and worry.  And I want to reassure women who have type 1 diabetes that a pregnancy is possible, and enjoyable, and like they all say - so, so worth it.

But, like I said, I'm starting to crack a bit.  On Tuesday, I'll be at 30 weeks, seven and a half months pregnant with just under nine weeks left to go.  And these last few weeks have been ... well, not exactly rainbows and unicorns.

  • Like last week, when a string of 200's had me bump my basal so high, on the heels of amped up nerves, that I overdid it and ended up with two 50 mg/dl's in the middle of the night.
  • Or on Monday, when a carefully measured breakfast and a carefully calculated bolus, delivered 45 minutes before the meal, sent my blood sugars rocketing up to 248 mg/dl and held there for two hours.  
  • Or the other day, when i realized that pregnancy is actually ten months long, not nine.  Damn lunar months, and why the hell didn't someone give me a head's up about that?
  • Or that yesterday, Joslin gave me the run down on the rest of my appointments that are scheduled.  There are 20 of them.  I don't understand how people manage a high risk pregnancy and keep their jobs. 
  • Or that next week, I'm having the eye dilation that will determine BSparl's method of arrival, and I'm really nervous about it.  I'm nervous about vaginal birth or c-section.  Doesn't matter.  Just "giving birth" has my stomach twisty.
  • Or the fact that I'm craving carbs (nasty carbs, like cheeseburgers and chicken nuggets and pastries) and am having a very hard time not caving to these cravings.  I can't have anything even close to a sleeve of Ritz crackers in the house or they will disappear within a day's time.  I'm ravenous for these rotten carbs, and I've crocheted three scarves in efforts to curb the cravings.
  • Or that every time my numbers are out of range, I want to hold her little hands and tell her I'm sorry.
  • Or yesterday, when a perfect Dexcom flatline overnight was shaken by a cheese stick and a cup of decaf tea, leaving me with a blood sugar of 350 mg/dl and on the cusp of a panic attack.  What does this do to my baby?  Is she okay when I'm spending an hour over 300 mg/dl, without much food at all in my system?  Does she hurt when I am chugging water and stressing out but trying to control my emotions because I want her little womb to be serene and calm, not the spin cycle of diabetes chaos that I am so good at tossing her into lately?

Diabetics have healthy babies all the time.  I know this.  I've read this, others have proven this, and I hope to write those words myself in a few weeks.  But honestly, the mental part of pregnancy is more than I was prepared to deal with.  The guilt of every blood sugar and every miscalculation makes my heart ache, and I have found myself praying more in the last seven months than I ever have the thirty years before. 

I want to paint that "rainbows and unicorns" picture for you guys.  I want to make pregnancy seem like it's the most beautiful thing on the planet and even a person with type 1 diabetes can see the nine (ten?!) months through safely.  But as my delivery date draws closer, I'm not sure.  And I'm scared.  And I feel stupid because I have zero control over my emotions these days, leaving plenty of tears in my wake. (I've become a mega-wuss.)

Ugh, downer of a post.  I really can't wait to have the baby, but I know that part of why I want her out is because I believe she'll be safer once she's in the world and outside of me.  I know that Chris and I can take care of her, as parents, and keep her as safe as any other couple who loves their child.  It's the whole "now" process that has me in knots, wondering if I'm taking good care of her now.  I want the absolute best for my daughter, and I feel so guilty because I know that my body creates a challenge in some ways.

Just a few more weeks.  Every test, every infusion set change, every moment of blood work, every doctor's appointment, every time I pay the co-pay or the parking garage fee, every refilled prescription, every new CGM sensor, every curbed craving ... everything.  Everything is worth it if I can get to the end of this and have her out, safely. 

And then she and I will get matching mommy and daughter tattoos - hers a rainbow, and mine a unicorn.

(Note to people who may think I've completely lost my mind:  Kidding about the tattoos.  But I might buy her a t-shirt.)

January 25, 2010

What's Sexier Than Compression Stockings?

Thanks to the happy combination of Factor V Leiden and being pregnant, I'm rocking a higher chance than average for a blood clot while traveling.  Back in October, when I was just a few months along, a lot of my travel was on the Acela, cruising back and forth between Boston and Philly, in addition to some flights.  So I needed to take these clotting risks into account.

"You're telling me I should pick up some compression stockings, then?"  I asked my obstetrician, after we had discussed my upcoming travel plans.

Compression stockings are cool ... right?  :p

"Yes ma'am.  And wear them.  Not just for traveling, but as often as you can."

"Will do.  So I'll be potbellied and wearing compression stockings.  Hot!"

My feeble attempts at joking aside, these stockings are important.  Even though I'm working hard to get to the gym several times a week, I'm more definitively working hard on making money, so there's a bit too much time spent at the computer these days.  Heeding the advice of my doctors, I'm careful to keep my legs elevated as much as possible, and I'm sure to pop up and walk around every hour or so, in addition to staying hydrated.  (Note:  Staying hydrated makes getting up every hour easier, especially when BSparl is gnawing on my bladder.)  

And I'm also sporting these socks, purchased for $4.99 at my local CVS.  (Another note:  CVS takes too much of my money on a regular basis, from their clever selection of lip glosses - love me some Bonnie Bell - to their strategic arrangement of Hallmark greeting cards to their convenient pharmacy that's open 24 hours.  I have an intense love/hate relationship with CVS, as evidenced by their constant contact with my debit card.)  The socks aren't uncomfortable, they appear to be working well (no varicose veins yet), and they are black, so thankfully they go with my go-to flats of choice these days.  I'm safe, BSparl is safe, and CVS is safe because they will continue to get my money.

So what's sexier than compression stockings?

Nothing.

Because without these blasted old lady leg warmers, I'd be risking a blood clot and varicose veins, thank you very much.

January 13, 2010

JDRF, Animas, and Dexcom Walk Into a Bar: Not a Diabetes Joke - An Artificial Pancreas.

Okay, so it's not a joke.  And it's not a bar.  But the JDRF, Animas, and DexCom have walked into a momumental agreement in efforts to create an artificial pancreas.

According to the press release, "The Juvenile Diabetes Research Foundation today announced an innovative partnership with Animas Corporation to develop an automated system to help people with type 1 diabetes better control their disease – the first step on the path to what would be among the most revolutionary advancements in treating type 1 diabetes: the development of an artificial pancreas, a fully automated system to dispense insulin to patients based on real-time changes in blood sugar levels."  

Alan Lewis, PhD, President and Chief Executive Officer of JDRF, is quoted in the release as saying, "JDRF will provide $8 million in funding over the next three years for this project, with a target of having a first-generation system ready for regulatory review within the next four or so years.” 

So what exactly would it mean to have an artificial pancreas?  More from the release:  “If successful, the development of this first-generation system would begin the process of automating how people with diabetes manage their blood sugar,” said Alan Lewis, PhD, President and Chief Executive Officer of JDRF.  'Ultimately, an artificial pancreas will deliver insulin as needed, minute-by-minute, throughout the day to maintain blood sugars within a target range.  But even this early system could bring dramatic changes in the quality of life for the 3 million people in the U.S. with type 1 diabetes, beginning to free kids and adults from testing, calculating and treating themselves throughout the day.'”  

Also, "DexCom, Inc., a leading manufacturer of CGM devices, will supply the CGM technology for the system to be developed by JDRF and Animas." 

I think this is a huge step forward for a new way of treating type 1 diabetes.  I've clocked over 204,360 hours with type 1 diabetes since my diagnosis over two decades ago, I've seen so many tremendous technological steps forward in treatment options for type 1.  Home glucose testing machines were "all the rage" when I was diagnosed, and there were only two or three insulin options for injection therapy.  Now, home meters are the norm, there are more insulin options and more insulin delivery options now than ever before, and continuous glucose monitors are part of my regular routine (versus before, if you had mentioned them to me as a kid, I would have thought you were from the moon). 

And now we're talking about an artificial pancreas?  A real one?  One that actually could be used in my lifetime, before I'm too old to care or too sick to benefit from it?  I believe this can happen, and I am so hopeful that these organizations and companies can make this a reality.

A cure is something I don't think much about.  It's something my heart has protectively hardened me against hoping for.  I know that reversing my body's inclination to attack its own islet cells could be a long time in coming.  What I do know is that I've been living with type 1 diabetes for almost my entire life, and I've battled hard to keep my body healthy and strong.  And now, I'm expecting a baby and have even more incentive to stay healthy for my child, so that I can be part of her life for a long, long time.  

If an artificial pancreas can help me minimize highs and lows in my blood sugars, that could help to protect my body from diabetes-related complications.  I could be safer.  My body could feel more "normal."  And my baby has a better chance of having me see her children born some day.

This press release has given me a reason to grin today.  And I'm excited to see how far these organizations can bring us all towards a better life with type 1 diabetes.

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.  

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]

November 03, 2009

Lovenox, Heparin, and WTF.

What the hell am I supposed to take?During my endocrinologist appointment last week, I brought up that itchy, scratchy Lovenox rash to my OB/GYN, Dr. T.  And she wasn’t comfortable with how my body reacted.  

“That rash is from two weeks ago?  How does it feel now?”

“Less itchy, that’s for sure.  But it got all hivey and wouldn’t relax, not for about a week.  It itched like mad.”

“I don’t like that.  I don’t want you to continue to take Lovenox, especially if it gave you that reaction.  Who knows how bad the reaction could be the next time?  I want to switch you to something else.”  She started to write on my chart.  “Heparin could be another alternative for you.”

“Okay, what’s the difference?”

She told me that both Lovenox and Heparin are large-molecule drugs that don’t pass into the placenta, so Bsparl is safe, and also that they both serve the same purpose:  to protect me and my baby from blood clots (the risk of which increases with both Factor V and pregnancy).  

But you guys know how I am by now.  I feel weird taking extra drugs, and I’m very conservative about adding more and more Rxs to my daily routine.  Also, consulting with Dr. Google brings me all this scary information about how Heparin is a category C drug, meaning it could have effects on the baby.  I don't know what's what, but I do know that I need to trust my doctor and her years of experience over a Google search.  (Right now, I'm wondering if I can bypass these drugs altogether and just work out in the airplane bathroom for the whole flight.  Kidding.  Sort of.)

Yet I still find myeslf feeling uneasy, and looking to see if any of you have had personal experience with Heparin.  I'm very WTF about this and confused as can be.  Right now, I’m only on insulin, pre-natal vitamins, and blood pressure meds (don’t worry – safe for baby), but according to Dr. T, I’ll be taking something to help protect me from clots for six weeks after BSparl is born.  (Great.)  So now is a good time to figure out what works best for me.

Once again, I’m clueless about what to expect.  I’m sorry to keep pestering you guys with all these questions, but when it comes to anything other than insulin, I’m lost.  When I wrote about Lovenox before, you guys were invaluable and I learned a ton (even brought some of it up to my doctor).  Now I’m asking once more – has anyone ever taken Heparin?  Any weird, itchy side effects?  Any burning at the injection site?  Any … anything?  

(And BSparl says hi.  He just sent a messenger pigeon to me from the womb.  He is baking cookies in there.  Busy little peanut.)

October 22, 2009

Diabetes, Lovenox, and Bathroom Jane Fonda.

The flight to Las Vegas from Boston is a long one – six hours on the way there and five on the way back.  I talked with my doctors before taking the flight, and being pregnant, I’m dealing with an increased threat of deep vein thrombosis.  The Factor V Leiden gene in my body is also a red flag, so these longs flights caused some concern for my medical team.

“We’re not worried so much as we have some rules for when you’re flying. The first is that you need to get up and move around about once every hour to keep your circulation steady and your legs moving.  And the second thing is that we’d like you to take Lovenox on the days that you’re flying.  That will help combat the Factor V risk.”

Take a shot?  No problem.  At least that’s one thing I can commit to without fear.

So about an hour and a half before my flights took off, I snuck into the airport bathroom and pulled out the pre-filled syringe of Lovenox.  Lovenox is an anti-coagulant drug that helps to prevent blood clots.  I don’t know much about it, other that it’s safe for pregnant women to take and it was one of the conditions set forth by Joslin, so I pretty much do what they say these days.  I’ve never taken anything like it before, so Wednesday evening was my first time.

Fellow diabetics, I just need to say that we have it good with our teeny, ultra-fine needles.  This Lovenox needle was clumsy, long, and thick.  “Inject it right into your abdomen, where you’d normally take an insulin injection,” the doctors recommended, so I did just that.  But it sucked a little bit.  One of the side effects of the injection is bruising and soreness, and they’re not kidding.  Within 15 minutes of taking the injection, a deep red thumbprint popped up on my abdomen, tender to the touch.  

But that seems to be the only side-effect I’ve experienced.  Except for a little bit of paranoia.  And now, a few days after the trip, I have the itchiest, red rash at my injection sites. 

Once a doctor tells me that I could be at risk for something, I do what I can to help mitigate that risk.  For these flights to Las Vegas, I took the Lovenox injections and made sure I was up and about once an hour, but I also did something else.

Every time I went into the airplane bathroom, I did some weird kind of calisthenics.  Thanks to BabySparl, the need to pee is hourly (making me test my blood sugar all the time, wondering, “Is this because of Baby or am I high?), so I’d use the ladies’ room and then face the mirror.  And then do this bizarre mix of high knee raises, running in place, and stretching.  Thankfully, being barely 5’4” gives me enough room to move around in there, but I felt like a tool.

“And stretch!  And stretch!”  I heard Jane Fonda in my head as I faux-exercised in the airplane bathroom.   

I prayed that the stewardesses couldn’t hear me thrashing around in there.  How the hell would I explain that?  “I don’t want a blood clot so I’m doing a little dance here in the bathroom.  That's legal, right?”

The itchy frigging rash from the Lovenox injections.
 
The flights were fine.  (If you don’t count the flight from Boston to Las Vegas, which included an extra hour on the trip due to a strong headwind, expired food, not enough meals for passengers, no movie, and no working radios.  US Airways, you sucked it up on that one.)  Lovenox was a success.  And now I feel like I’ve managed to fit in a workout, even at 35,000 feet.  But I’m curious to know if anyone else has ever taken Lovenox, or another kind of anti-coagulant.  And if anyone has ANY tips at all on dealing with this frigging itchy rash.  It's starting to go away, and I know it's just part of the side-effect fun, but it's making me scratchy-crazy. 

It’s all new to me, and I’d appreciate any feedback from someone who’s been there.  (And if you have airplane exercise tips, share those, too.  I’m heading to Florida in two weeks and am wondering how I’m going to embarrass myself on that plane, too!)

September 29, 2009

Inspired by the Parents.

Parents of kids with diabetes - it's a full time job.Last night I had a chance to sit with some parents here in Norwalk and talk about our collective experiences with diabetes.  These parents were taking care of children with diabetes, ranging from the newly diagnosed three year old to the newly diagnosed 13 year old, and everywhere in between.  High school angst, the issues of disclosure, the pursuit of "perfection," and all those other issues that parents of kids with diabetes, and the kids themselves, are dealing with.

"I was invited here to talk about how to raise a child with diabetes without losing your mind.  But I'm not really qualified to talk about that sort of thing, to be honest.  I'm not the parent of a diabetic child.  I am the diabetic child."

The parents at this group were wonderful, all actively engaged in their child's health, just trying to make sense of what diabetes doles out every day.  We were a small group - about 12 of us in total - so the conversation flowed pretty smoothly and comfortably.  And we hit upon some very intimate issues.

Like menstrual cycles and their impact on blood sugars.  (Remind me again why I'm talking about puberty and my female hormones with strangers?)  Or the dodgy things I did as a kid to lash out at my diabetes or my parents or at life in general.

I admitted to hitting the old school glucose meters with a touch of rubbing alcohol so that the result would come up lower.  I also admitted to knowing that my mother hid ice cream sandwiches in the frozen vegetable boxes, but I ate them despite her efforts. 

"I wasn't the best kid, and definitely not the best kid with diabetes, but I made it through okay.  And my parents and I?  We still talk.  And we still like each other."

They laughed.  

"What advice do you have for parents who are dealing with teenagers?  What's on the 'don't ever say that,' list?"

And the only thing I could think of was the epic "We."  

"It's just that one pronoun.  The 'we.'  We need to test our blood sugar.  We need to take our injection.  We have diabetes.  This always drove me nuts because unless my mother was testing her blood sugar or my father was taking an injection, they weren't diabetic.  They didn't know what the lows and the highs felt like, only what it felt like to watch the highs and lows and to feel those moments externally and emotionally."

The group nodded, understanding.

"But it wasn't until I was older that I realized the 'we' concept did apply.  It wasn't just me.  It was all of us, as a family, living with this disease.  And even though I was the one who had diabetes, my parents were dealing with something, too.  Diabetes has a lot of different sides to it, and it doesn't just affect the person who actually has it.  So it is a 'we' thing.  We live with diabetes, as a family.  And it took me a long time to realize that."

One of the parents piped up.  "How long?"

"Like ... yesterday morning?  Maybe Friday, at the earliest." 

She laughed.  Another parent asked, "When will my kid figure that part out?" 

"I don't know, honestly.  Everyone's experiences vary.  For me, diabetes wa a dragon that we, as a family, fought together.  We didn't fight one another, but it was us against IT.  And now, I'm a married woman with a husband who goes to the doctor with my instead of my mom and dad going, and my mother has no idea how this insulin pump works or how the CGM works or what the hell 'basal insulin' is, but she still has the same protective instincts, and still works hard to take care of me."

"Even just this past Friday, at my Joslin appointment, I saw this CDE I'd never met before.  This lady was critical of every number, every moment of my management, and yelled at me for doing too much while she yelled at me for not doing enough.  I was feeling pretty emotional after 45 minutes of this, so I went to take a break to calm down, leaving the CDE and my mother alone in the room together."

"And I guess while I was gathering my wits in the bathroom, my mother, who had been sitting there quietly and watching the fireworks, leaned towards this CDE and said, 'It's been a long, emotional day.  And you are supposed to support her, not rip her apart.  I think you should tone it down a bit, don't you?'"

"I guess you don't ever age out of being the parent of a kid with diabetes."

Diabetes is a journey, and for some of these parents, they've been on it for many, many years.  For others, they are just beginning to take those first steps.  And for me, with more than two decades with type 1, it was beyond amazing to see them gathered together around the table to find answers, find support, and find inspiration.

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 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.

August 03, 2009

A Diabetes To-Do List.

I stood there with my best friend as she rubbed her pregnant belly.  The whole waiting room was filled with these lovely women and their round beachball bellies of varying sizes.

And I felt oddly self-conscious with my lack of roundness.

Last Friday was my first official appointment at the Joslin pregnancy clinic.  It's located at Beth Israel in Boston and is a beautiful hospital, different from the Joslin Clinic across the street that feels like home at this point.  I'm not pregnant, and we aren't trying to become pregnant YET, but this appointment puts things into full swing to bring me to a safe level of pre-pregnancy health. 

Sigh.  This all sounds redundant, even to me.  I've talked the Big Talk before.  "Oooh, look at me!  I'm going to really wrangle in my numbers and have an A1C you can bounce a quarter off!"  And I'm all gung-ho for a week or two, armed with my little log book and my good intentions, but within a few days, Other Things start to creep in.  Like work.  And stress.  And getting to the gym.  And social stuff, like hanging out with my friends and going to RI on weekends.  Eventually my good intentions end up in the spin cycle, and my log book starts to gather dust.  My workload piles up.  And my stress levels skyrocket.

I'm so frustrated because I want to have a career.  And I want to have a baby.  (I'd also love some tight control of my diabetes, too.)  These things would be excellent, but it feels like tightly managing type 1 diabetes is a full time job unto itself.  Slacking off is easy, and frustrating, and not healthy for me or any baby I'd like to have.   

But I also realize this is one of my biggest hurdles when it comes to pregancy planning - the whole "sticking with the pre-program."  This becomes more and more obvious to me when I go back and re-read old blog posts where I'm so excited to get back into better control, only to be derailed by those Other Things.  So during the course of my appointments on Friday with the endocrinologist, the registered dietician, and the certified diabetes educator, I admitted my faults freely.

"I need help being held accountable."  

They didn't quite hear me at first.  "We can do some tweaking, and in a month or two, we can revisit your A1C and see if it's lower and then we can give you the green light for pregnancy."

I knew I needed more than that.  I had to be completely honest. 

"Guys, I really need to be held accountable.  I know this sounds crazy and I seem very compliant, but I have trouble following through.  I'm great out of the gate, but I lose steam after a few weeks and I'm at the point where it isn't good enough anymore.  I'm out of excuses.  And I'd really like to join the ranks of those pretty pregnant ladies out there.  Please help me?"

And they listened.  We spent the rest of the day working out a plan for me.  One that will actually make a difference.  One that will get me there.

I'll be in Boston every three weeks until I'm pregnant.  This is a huge commitment but I need to make diabetes a priority without fail.  I want this.  I want to succeed at this more than anything else.  I'll have my blood sugars logged for those three weeks and we (my husband and my diabetes team and I) will all review them together.  Chris is in charge of my meals, in that he'll be helping me plan my day, food-wise, and he'll be counting carbs and measuring things for me. I'll be eating relatively similar items every day so I can manage the trends and control them.  I'll continue to test all the live long day and wear the pump and the CGM, but I'll actually use these devices to their fullest potential, instead of just going through the motions. 

With these appointments spaced just a few weeks from one another, I hope I can stay tuned in to intense diabetes management for three week stints.  Being sent out for three or four months is too much for me.  Obviously, because I burn out well before my follow-up appointments.  I just plain can't pay rapt attention for that long.  But three weeks?  Can I do that?

I have to do that. 

I will do that. 

It's a long way down from here.

July 28, 2009

Charlie and the Twitter Factory.

I have a lot to catch up on, including a post about Lee Ann and I braving the Indiana highways and then the BlogHer conference, but let me just say this first:  I like Charlie Kimball.  I like him as a person, as a fellow diabetes advocate, and as a race car driver because, really, that is just damn cool.  So there's my big disclaimer:  I like Charlie.  (I even have a post ready to write about meeting up with him at Friends for Life a few weeks ago.)

So I do not like to see Charlie, the guy, under such attack for the @racewithinsulin Twitter account.  Plenty of bloggers are up in arms about the Novo/Kimball union and its steps into social media, like John Mack from the Pharma Marketing Blog.  I felt a little protective of my fellow PWD, which prompted me to do a little investigating.  I wanted to know how Novo, the company, feels about this whole Twitter/marketing/Pharma thing.

So I asked them.

Charlie Kimball and Kerri Sparling.  Dressed almost identically.  Weird.

Ambre Morley, Associate Director of Product Communications at Novo Nordisk and I met at the Friends for Life conference, and I told her that I was concerned about the backlash towards Charlie and the branded Twitter account.  "I have a ton of questions, and I know some of the PR people who are questioning the account might do well to hear the answers.  Like why the account doesn't follow anyone.  And what's the deal with those blatantly branded Tweets?"

She agreed to answer my questions.  And since Novo is the first I can think of to jump in with a pharma-branded Twitter account with a "real face," I wanted to hear the answers.  (Note:  All links to pages within the answers were added by me.)

Kerri:   Charlie is a valued member of the diabetes community, so I can understand why you guys chose to partner with him. But what made you decide to start a Twitter acct?  

Novo:  When we decided to partner with Charlie, we explored a number of different opportunities. He was already "tweeting" personally, however, when he asked about tweeting about our partnership, which includes the insulin he takes everyday, Levemir and NovoLog, we knew had to figure out a way to do it right. We didn't think it was right to ask him to put the prescribing information on his page and monitor every time he tweeted about diabetes. So we created a new account that we could ensure met all regulatory guidelines. Why Twitter? He was already doing it, so we wanted to create something that would easily fit into Charlie's lifestyle.
 
Kerri:  Why are Charlie's personal Tweets and his Levemir Tweets exactly the same?  
 
Novo:  It's important to understand that Charlie does all of the tweeting, both on his personal page and on the Novo Nordisk Race with Insulin page. It's up to him. They aren't always exactly the same, but where convenient and appropriate, he uses the same tweets, as it's probably easier to copy and paste. There are times when the tweets are different.
 
Kerri:  Does Charlie write the Levemir Tweets or is there an editorial vetting proces? Can you explain the thoughts behind the "branded" Tweets?  
 
Novo:  Charlie writes all of the tweets, including the Levemir and NovoLog branded tweets.  We provided him with instruction for how to tweet about the brands and comply with pharmaceutical regulations. So, anytime he tweets the words Levemir or NovoLog, a link to the product prescribing information has to be included.
 
The reason? Take a look at the page from your computer. You see the patient safety information on the left, along with a link to novonordiskcare.com on the right, which contains all of the prescribing and other important information. The challenge is, because the majority of Twitter users read and update their accounts from mobile devices, we knew most people would not see that information if Charlie wrote a tweet. That's why the prescribing information is there. It's required. It's similar to when a company does any stand-alone promotion of a product, that information has to be there.
 
More importantly, it's important to understand that the branded tweets aren't random. Charlie takes Levemir and NovoLog, so when he decides to tweet that he just took his insulin, he really just did. We don't believe a pharmaceutical company has tried to do branded tweets before, much less with a spokesperson who takes the insulin. But we're still learning and trying to figure it out. It's been a fun and definitely interesting time.  
 
Kerri:  Why doesn't the @racewithinsulin Twitter acct follow or reply to anyone? What kind of regulations must be in place for a Twitter acct of this kind?  
 
Novo:  While Charlie is the face of Race with Insulin, it is a corporate account for Novo Nordisk.  At this time, we aren't able to follow anyone, as pharmaceutical usage of social media is very regulated and we want to ensure we do it right. This is just the first phase and as we grow and learn, hopefully we will be able to follow people in the future. We are also open to suggestion.

After speaking to you, we took your advice and set up an e-mail address for the page. (Editor's Note:  I suggested that the account would seem a bit more accessible if they, at the very least, had some contact information.)  You should see an image update in the next week with the new address. But as I know you know, social media moves in real time and we haven't quite caught up to that speed in pharma. We're making baby steps but we're trying to stay in the race.
 
Kerri:  We know you guys are breaking new ground with this Twitter account, so what should we expect as part of your growing pains?  
 
Novo:  We're still learning. We want to do a lot, but we also understand that the pharmaceutical industry is the most heavily regulated in this country. We won't be able to do things as easily as say computer or food companies, but you have our commitment that we do plan to try to engage. Stay tuned.  
 
Kerri:  How has Novo felt about the blog backlash to @racewithinsulin, and how has Novo moved to protect themselves and Charlie?  
 
Novo:  If no one talks about what you do, you probably haven't made much of an impact. That said, it would be nice if the talk was all positive and more importantly, true. We encourage people to ask questions and give us an opportunity answer. We're pretty transparent about our challenges and open to discussion about any ideas to make it better. There were some false assumptions gaining traction, but that's also the nature of this business. You can never please everyone, but you can only hope that social media will adopt some of the principals [sic] of traditional journalism and report the facts, before making assumptions. We're working to move quicker to respond but also encouraging anyone to just ask. As for Charlie, he has been great. He's in a profession where he already has a lot of attention on him and is working with us to help make the page a success.

Kerri:  What do you want the Twitter community to understand about the aims of @racewithinsulin?
 
Novo:  We are very happy to be working with Charlie and wanted to reach as many people as possible. Twitter was an application that Charlie was already using and we wanted to find a way where he could continue to do so and incorporate our relationship.

It's still new and we're just getting started, but we hope to continue to find new, innovative ways to continue to reach everyone with his powerful message that diabetes does NOT slow him down!

*   *   *

I'm glad Novo went out on a limb and dove into the social media space, and I'm also glad that they agreed to answer my questions.  Thanks, Ambre!  What are your thoughts about Pharma in the social networking space?  Don't just say "Hey, they're doing it wrong!"  If you think it's so wrong, what would make it right? 

July 27, 2009

Roche Diabetes Summit: SUM Edition.

You have already read some great wrap-ups of the Roche Diabetes Blogger Summit from some of my fellow bloggers - Amy, Manny, David, Gina, Christopher, Bennet (Note: Mr. YDMV's updates are fictional.  Well, mostly.), and Sandra.  I just wanted to chime in with my thoughts and add my photos to the collection.  :)

We met up in Indianapolis on Wednesday afternoon, after I had flown from LaGuardia to Detroit and then to Indianapolis.  (Yes, I took two flights so that I could avoid taking the itsy bitsy plane that Roche originally had scheduled me on.  The travel people at Roche were very patient and understanding regarding my travel issues, and I really appreciate their compassion.)

But apparently my fear of flying wasn't kept within the travel coordinator circle, as several people from Roche mentioned at the dinner that "Some of us even traveled despite our fear of flying," and heads slowly turned towards me, to which my only xanax-laced response was "I walked."  

Good thing I don't mind being laughed at.  Or with.  More on that later.  

I'm no fool - part of what Roche wanted was to be talked about in the blogs.  Hence why they asked many of the diabetes bloggers to visit their headquarters and brainstorm about social networking and Pharma involvement.  But Roche did this right - they paid for our travel, they paid for our hotel, they made us feel as though we were valued guests, and they listened when we offered our opinions.  We didn't travel on our own dime and feel taken advantage of, but instead appreciated.  That's a good start, in my book. 

It was really a groundbreaking sort of event, with Roche having the balls (go ahead and quote me on that, Rodger the Social Media Warlord) to invite a pack of opinionated bloggers into their house to talk frankly about social media and Pharma - specifically, THEIR Pharma.  We talked about ways that Pharma can appropriately enter the social media space without being received by a mob with torches and pitchforks.

In my opinion, Pharma needs to simply embrace the fact that transparency, honesty, and being open to feedback can make a huge difference in how they are perceived by their patient base.  For Roche to sign on to a social networking site by creating a fake profile or pretending to actually live with diabetes, well that's just plain stupid because we'll sniff them out in a second and destroy them.  However, if Roche, or any other Pharma crew, is willing to put a face to their company and leap into social media by saying, "We aren't living with diabetes, but we want to help improve the lives of people living with diabetes - that's why we are here and that's why we want to be engaged" ... that kind of disclosure and transparency will go a very long way.

I gave the example of Albert Chen, a member of the Agamatrix team who, with grace, honesty, and class, joined the diabetes blogosphere with his blog "What Is Diabetes?"  He said, right in his bio, that he didn't have diabetes, but wanted to better understand the community he was working to serve.  That, Pharma companies who are reading this, is the way to work with the diabetes online community.  Get to know us.  See that we are more than just the sum of our co-pays.  Remind us that Pharma has a face, and more importantly, that you remember we are people, too.  

The Roche team didn't always directly answer the questions, but I can understand that "Why aren't strips cheaper" isn't a question that they can answer without sounding like a business.  However, they need to understand, and always remember, that their business is our life.  So while that chasm remains wide, I think this was an important step in beginning to bridge that gap.

The gap - we're making efforts to bridge it.

July 08, 2009

Diabetes ... is a Game?

The idea of creating a game about diabetes both intrigues me and creeps me out a little bit.  Diabetes is a game? I guess after an evening of "WHY 200?  WHY?!!" I'm not feeling so light and fluffy about diabetes.  But I see the potential for kids to learn about diabetes and its management through the use of games, so I'm all so for whatever gets good information out there.  And over the last few days, I've come across two particularly interesting games, thanks to reader alerts, aimed at kids who either have diabetes or have friends with diabetes.

The first game is on the Nobel Prize educational games site and it's cleverly called The Diabetic Dog game.  (Wee bit short on imagination once they got to the naming part, I suppose.)  I will admit - I played this game for at least 15 minutes and I appreciated the cuteness of the doggy. 

The Diabetic Dog Game

As a "caretaker," I was instructed to keep my diabetic doggy (named, in my profile, "DoggyPants") happy (by petting him), well-fed (by purchasing food for him), getting him to exercise (by walking him), and keeping his blood sugar in check by giving him insulin injections.  Keeping an eye on the bar at the bottom left of my screen let me know what DoggyPants's blood sugar was, and I could feed and dose him accordingly.

(Sidenote:  Having that bar gauge with his blood sugar in it sure helped me figure out what I was doing, and I wondered if the developers of this Diabetic Dog Game realized how they're helping further the case for continuous glucose monitors.) 

Overall, I liked how this game showed the importance of insulin, food choices, and exercise as the cornerstones for good diabetes management, and it didn't tout insulin as "a cure."  Basically, all you do is chase this little puppy around and feed him or dose him or walk him.  Constant cycle of redundancy, only the results aren't predictable.  Kind of like real life.  :)  

The other game I have been receiving reader alerts on is the Didget from Bayer.  I haven't seen this game in person, but according to the word on the street (read: their website), "The Didget blood glucose meter from Bayer is the only meter that plugs into a Nintendo DS or Nintendo DS Lite gaming system to reward children for consistent testing."  

The DIDGET.  IN ALL CAPS!

So it's an actual meter that snaps into the Nintendo system.  (It appears to be, or be completely identical to, the former "GlucoBoy" from a bit ago.)  Honestly, that is pretty darn cool, and I wish that kind of "fun" was available when I was testing my blood sugar as a kid.  Hell, I'd like to have that kind of positive reinforcement NOW, thank you very much.  

"This unique meter helps encourage consistent testing with reward points that children can use to buy items within the game and unlock new game levels. And, since the DIDGET meter is based on Bayer’s trusted CONTOUR™ system, you know you’re getting a meter that’s reliable." They are also building a community for kids to "hang out in" virtually, comparing notes.  Of course, since it's Bayer, they need to slide in their personal product endorsement, but they have the right idea.  Test often, get rewarded for keeping tabs on your numbers, and maybe Nick Jonas will show up at your house and give you a hug.

That last part?  A lie.  But Bayer is working its way into the hearts of kids with diabetes, and as a former kid with diabetes myself, I would have appreciated that kind of innovation as part of my childhood with this disease.  From what I can tell so far, this meter is being marketed towards diabetics in the UK, but hopefully there will be a United States counterpart.  With mg/dl readings.  Because doing conversions when low?  Not so easy.

So there you have it. We've come a long way from that game with the elephants or the other one about the Escape from Diab, and hopefully more efforts will be made to engage kids - and adults! - with diabetes.  Positive reinforcement is hard to come by in this whole diabetes mess, so every little bit helps.

July 02, 2009

One Lump or Two?

Like I wrote a few weeks ago, "Even though I do not like the disease, there are some diabetes-related simple pleasures that make me smile." 

But on the flip side of that, there are some diabetes-related things that make me grimace.  (Not Grimace, but grimace.)  And when I'm feeling down about the hard parts of managing this disease, I often turn to humor to lift me back up.  (For me, a little gallows humor goes a long way in keeping me from really falling into a depressive state.  It seems like a counterproductive idea, but it really helps me.)

This is where Haidee Soule Merritt's book comes in:  One Lump or Two?  Her book more than resonated for a 20+ year diabetes veteran like myself.  It's taken me a long time to build up this much amusement at a disease that's trying its hardest to take me out, but now I'm in the thick of the smirking-despite-the-chaos.  

As I read through her book, I laughed.  I laughed and nodded my head in agreement, thinking, "Oh hell yes, I hate those geyser fingerpricks."

How many times has this happened to you??
Who hasn't this happened to?  (Image credit:  Haidee Soule Merritt)
 
I snicked despite trying to be classy when I saw the one about low blood sugars after sex.  (Trust me, not fun.  And also, awkward as hell.)  

Low blood sugar after sex.  Oy.
Been there.  Done that. (Image credit:  Haidee Soule Merritt)

Diabetes isn't easy.  Neither is laughing at it.  But laughter, finding something that alleviates some of the anxiety and fear that comes with a chronic illness, can make such a huge difference in health.

If you want to order your own copy of Haidee's book, visit her website (and enjoy the duck sounds on the buttons, because they quacked me up).  As you thumb through your copy of One Lump or Two?, you'll find yourself smirking with understanding, too.    

June 24, 2009

Why I Wanted a CGM.

On my soapbox again.  Hello!I'm often asked about why I chose the Dexcom CGM over the Minimed, and I have plenty of posts here on SUM that talk about my experiences with the two devices:

And then fighting for insurance:

And after I had won insurance approval, Dexcom and I joined forces:

Phew!  But part of even starting this process was wanting to go on a CGM to begin with.  I'm often asked about the different continuos glucose devices and pros and cons of each, I get just as many questions as simple as this:  "What made you ready to go on a CGM in the first place?" 

I know that for going from injections to pump therapy, I was frustrated with the lows that were happening three times a week, and how my ex-boyfriend was constantly finding me motionless in the bed at 4 am, covered with sweat.  After 17 years of injections and after two years of an A1C that wouldn't budge, I made the decision to use an insulin pump.

After deciding to wear one medical device, it was easier to try another one.  A few years of pumping made me feel comfortable with the 24/7 attachment of a diabetes device, so when the continuous glucose monitors became more prevalent on the scene, my interest was piqued.  At the time, I was in a serious relationship, thinking about having children in the future, and realizing how my blood sugars still weren't running better, despite my increased education and effort.  It was time to try something a bit different.

With a CGM of any kind, there's a certain security that comes with it.  I feel more confident speaking at events when I can look at the graph on my CGM and see that I'm holding steady.  Same for getting in the car for long drives, or on a plane for a few hours.  After twenty plus years of only having snapshots of what my numbers were like, I now have access to the streaming video, so to speak, of continuous monitoring.

Yes, there's also the "Hey, you're a robot" component to this.  I can't lie.  When I look at my body and I see all these things stuck to me, in addition to the red dots of diabetes devices past, I feel a little overwhelmed.  But it's part of living with this disease. (Most of the time, I'm able to shake off the robot feeling and just let Chris call me Rosie.  Whoops - there's the digression.)  I actually feel okay with wearing two medical devices.  It's sometimes cumbersome and inconvenient, but for me, the pros outweight any cons.  I hear a lot of bad news about diabetes, about how this many years with type 1 can really cause a landslide of issues, about how life can be compromised.  And I don't want that. 

Regardless of what happens in my future, I want to make every effort to be as healthy as I can, both mentally and physically.  And I'm ready to keep trying.  That's why I blog.  That's why I raise awareness.  That's why I pump. 

And that's why I wanted a CGM.

June 15, 2009

Old School Diabetes: Diagnosis.

I saw my niece over the weekend.  She just turned seven.  She had a bit of a fever and wasn't feeling very well, so when I saw her snuggled up on the couch under a blanket, she looked every bit the little kid she is.  Poor little peanut, hiding out until she felt better.

I remembered that I was about her age when I was diagnosed.

I found an old school photo from second grade, with me sitting next to my friend Bobby (who I still talk to, which is a very surreal experience, hanging out with someone I've known longer than I've known insulin injections).  I was diagnosed in September, right as second grade started.

Second grade, 1986.
I'm in the blue dress, second row from the bottom, third from the left.
Swinging my feet.  Not much for sitting still, even in second grade.

Over the last few days, I've been reading some emails from the CWD parents as they gear up for the Friends for Life conference in Orlando in a few weeks.  These emails are sent out to a whole mailing list of attendees, and somehow I ended up on the list with all the parents.  (Or maybe the list just happens to be mostly parents and I just happen to be an adult "kid" with diabetes.)  These parents are comparing notes and reaching out to one another, looking forward to other parents who understand what they're going through every day as they care for their kid with diabetes.

And I wish that my mother had this kind of support when she was dealing with my diagnosis over twenty years ago.  My mom had a lackluster team of doctors at the Rhode Island Hospital (where I went for a few months before going to Joslin) and Eleanor (the only other mother of a diabetic kid that we knew of in our town and the woman who just happens to be my local Dexcom rep), leaving her with little to manage the enormous learning curve.

This weekend, I went on a bike ride with my sister-in-law, my father-in-law, and my husband.  I had to remember to test beforehand, bring my meter, stash some glucose sources on several people, and monitor as re rode.  A lot of thought for maybe an hour long bike ride.  And it made me wonder what kind of preparation and worry my mother went through when she sent me out to play for a whole Saturday afternoon.  Lot of work on my mom's part just to keep things normal. 

I forget this sometimes, how many people are really involved in keeping me healthy. 

I need to call my mom. 

(Granted, my diabetes diagnosis hasn't kept me from doing much at all.  And it definitely didn't keep me from being ... um, a bit of a goofball.)

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 26, 2009

Sotomayor and Diabetes Get All Media'd Out.

I can't pretend to have all the information on Judge Sotomayor and her Supreme Court appointment.  But I do know that my first day back here at work has been one email after the other about Sonia Sotomayor and the effects of her type 1 diabetes on her potential new gig. 

Total media deluge.  Here are some of the highlights:

  • Time Magazine provided an article that made me wonder if I'll make it to 40 years old, never mind to tomorrow, complete with heroin-esque photo to represent an "insulin injection."  They unfortunately paint diabetes as a disease that will rot you in a month's timeframe and leave nothing but your shoes.  (Hey Time, why don't you visit the Diabetes365 project to get a feel for what real diabetes photos look like?  Sorry for that digression but mainstream media needs to get their hands on some better, more accurate stock photography!)

  • The Wall Street Journal asks the question, "Should Sotomayor's diabetes be considered in the nominiation process?", citing the ADA's press release applauding Obama's selection.  Apparently, Sotomayor's weight is under attack as well as her diabetes status.  Are only the uber-healthy capable of just rulings?  The news, she is going berserk.

  • The Newsweek "Human Condition" blog comes right out and says not to worry about Sotomayor's diabetes, stating, "And while Sotomayor's condition may lead to complications that force her to retire after twenty years of hard work on the court, there's also the chance that if appointed, she could be hit by a bus on her second day and be forced to retire then."  (Morbid, but good point.)

  • The Huffington Post is in on the action, too, calling out a few Twitterers for running their 140 characters:  "Glenn Beck's Twitter - wondered if Obama, the 'messiah,' has healed Sotomayor's diabetes yet. Michelle Malkin proved that Twitter's 140 character cap isn't too strict to include both a vague sexist and racist remark."  And the Wonkette takes sarcasm and snark to a new level with their "Sotomayor has diabetes - good or bad?" column.

  • Yet this article from the New York Times doesn't even mention her diabetes at all.

  • Of course, this topic hasn't escaped us, the diabetes community, either.  Amy wrote about Judge Sotomayor last week, David posted on Diabetes Daily, the dLife Today blog has a piece, and TuDiabetes members are sharing their perspectives, too, like Jenny's post and Ann's discussion.  The JDRF also issued a statement regarding Sotomayor.  And I'm sure there are others who weigh in.

Holy media overload.  The Internet is exploding, it seems. 

I admittedly do not know much about Judge Sotomayor or her background other than what I've read over the last week or two about her potential appointment.  But I do know quite a bit about type 1 diabetes after 22 years with it.  And in my opinion, her diabetes shouldn't play a role in this consideration process - at all.

A "defective pancreas" does not mean a defective mind. 

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.    

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 10, 2009

Color Comparision Chart.

As I mentioned yesterday, I stumbled upon some diabetes relics at my dad's house the other day.  Now I'm totally in memory lane mode.  :)  I found this staple of my early diabetes management:

The Red Diabetes Book

The "Red Bible."  This book was given to my parents by the Joslin Clinic when I was diagnosed, and it held the supposed answers to any diabetes questions.  (You can see on the cover there where I was practicing spelling "restaurant" many years ago.)  I thumbed through the book and found plenty of recipes and snack ideas, all using the old food exchange philosophy.  Pages and pages of things I couldn't eat, and small sections of what my lunch options were. Half a cup of spinach, one sugar-free popsicle, rice cakes with peanut butter, those peanut butter nab things ... places to buy food scales and measuring cups ... countless pages focusing on food.  I always hated that assumption that a healthy diabetes life was achieved solely through my dinner plate.

There were three pages on handling diabetes in school settings.  No mention of 504 plans or testing in the classroom or anything about how my fellow students would react.  A short description of the symptoms of low blood sugar and how to treat it, but that was about it.

The pages on blood sugar monitoring and management brought me back to my diagnosis days.  When I first started testing my blood sugar back in 1986, we used a machine that took 120 seconds to produce a result and the strips were color-comparison ones that had to be wiped with a cotton ball and then plugged into the meter.  The color comparison chart seems so remedial compared to the UltraLink on my desk or the Dexcom on my hip.   Here's a screenshot of what we'd compare the color pads to:

Chemstrip color comparison chart

Not much to go on.  (And the numbers were too easy to manipulate.  I remember wiping the color pads on the strip with rubbing alcohol to make the results seem lower.  I wasn't the most responsible kid.)

The thing that kills me is the lack of focus on the emotions of diabetes.  There were only TWO pages on "living with diabetes."  How stress can affect blood sugar management.  How important the impact of a support network is for acceptance and dedication.  I want to rewrite this Red Bible and flesh out more of the parts that count.  Support groups, diabetes blogs, communities ... this is the future of diabetes management.  Meters have improved a little, insulin has improved a smidge, but our methods of support have leapt by such enormous margins that my future health is already brighter.  

My Joslin appointment is next week.  And believe me, I'll be talking about you guys there.

March 27, 2009

Diabetes Carnage.

I know my daily diabetes stuff produces a lot of waste, like the test strip I use every time I prick my finger and all the packaging that comes along with each disposable insulin pump infusion set. 

But it wasn't until I changed my pump and my Dexcom sensor at once that I realized how much carnage I leave in my management wake.  

Exhibit C (for crap, holy):

So.  Much.  Stuff!

If you scoot over to Flickr, you can see each item flagged in the photo, but the basic gist is that two small bits of technology attached to my body creates a lot of waste.  (The Blackberry is in the photo purely because I forgot to move it.  It isn't related to diabetes management.  Then again, with the number of emails I'm sending from that thing on an hourly basis on the climb, maybe it is.  Digression?  Yup.)

Other PWDs and parents of PWDs (POPWD?) have talked about the insane amount of diabetes-related garbage before, but this one night really showed me how so little goes such a long way - and not in a great way.  And with Earth Day coming up at the end of April, I'm extra-aware of the mess I make sometimes.  Do you guys put your stuff in a sharps container, or do you throw these things out?  I used to be so good about clipping syringe tips and filling those coffee cans and taping them shut with electrical tape, but the last few years have produced medical waste that doesn't look as "druggy" as the orange-capped syringes of my past diabetes life.  ;)

Once, in college, we had a party and threw out a lot of beer cans.  (There were seven of us in one house, okay?)  During the night, animals got into our garbage and we woke up to beer cans and - oh crap - syringes all over the front lawn.  I.  Was.  Mortified and have been paranoid ever since.  How do you guys dispose of your diabetes carnage?  I need some tips, because I'm getting sloppy.

(Also also, SUM may have some downtime this weekend, as I'm moving some web bits around.  So if you stop by over the weekend and hit a 404 or 500 error, please be patient.  I should be back up by Monday morning.  Thanks, and have a good weekend!)

March 25, 2009

Smiths Medical Pulls Out from Diabetes Market.

Farewell, Cozmo.Wow - this surprised me. 

The company that makes the Deltec Cozmo pump issued a statement today, saying that they are stopping the sale of their insulin pump.  According to the press release

“The continued health of the thousands of people who use the Deltec Cozmo® insulin pump is our primary concern, and they should be reassured that their pump remains an excellent choice to help them manage their diabetes,” said Srini Seshadri, president of Smiths Medical. “Our customers also should be reassured that Smiths Medical will meet all of its warranty obligations; provide customer and clinical support for the lifetime of the warranty of all pumps; ensure that Deltec Cozmo® insulin pump cartridges and Cleo® and Comfort® infusion sets are available; and make any necessary transitions as simple as possible.”

Why did they pull out? Looks like the pump "biggies" - Medtronic and Johnson & Johnson - have cornered the market share.  More from the release:

"In addition, as its only direct-to-consumer enterprise, the Diabetes business has little synergy with the rest of Smiths Medical’s businesses. For this reason, Diabetes requires its own extensive sales, marketing, reimbursement, insurance and clinical support infrastructure in the United States, which has resulted in it becoming uneconomical as sales and profits for the business have decreased. Without a strong, profitable Diabetes business in the United States, the world's largest medical market, it would also be impossible to sustain the business internationally.

Looks like the full transition out will take about four years, which corresponds to the warranty on new insulin pumps.  Cozmo pumpers, at that time, will need to chat up their medical team to get information on switching to a new insulin pump.  They have a whole website dedicated to answering questions, so if you need more information, check out the site.

Personally, I'm sad to see this happening.  I think having more pump manufacturers contributes to more innovation, offering diversity to insulin pumpers.  I'm a Medtronic pumper, but I considered the Cozmo back when I was shopping for a pump.  I hate seeing options removed from us.

Sorry to see you go, Cozmo.   

March 20, 2009

Dexcom Seven Plus: First Impressions.

So far, so good.

Last night, I installed my first Dexcom Seven Plus sensor.  "First" might be a bit of a misnomer, because the sensors that actually go into my body are still the same as the ones I used previous.  I have a new transmitter (the little plastic part that clips into the sensor housing) and a new receiver (the external device), which are the pieces that have been upgraded.  

Dexcom has a good overview of the new system and its features, including a video that walks you through the upgrades.  They can give you all the technical jargony stuff.  :)

For me, I've put this new sensor on my left thigh and after the initial pinch, I was good to go.  The hardware on the Seven Plus works almost exactly like the old system, with a two hour calibration period, same sensor insertion devices, and the same general gist.  What's new is the software inside the receiver.

When I tried out the Minimed system last year, I liked the fact that the MiniLink had rate of change arrows on the CGM.  So when I looked at my pump, I could see my blood sugar graph and could also see if I was plummeting or rising quickly.  I was sorry that Dexcom didn't have this option before - but now they do.  The new Seven Plus has those rate of change arrows, and you can also set an alarm to BEEEEEEEEEP (if you want) when you're rising or falling too quickly. 

Oh so dexy ... I mean, sexy!

And regarding BEEEEEEEP!s, there are more beeping options on this thing, too.  You can set an alarm for a high, low, rise rate, fall rate, and sensor out of range (i.e. when the cat takes off with it in the middle of the night and you don't realize it until you wake up without it).  There are snooze alarms for the high and low levels, so I have mine set to BEEEEEEEP! at a low and then give me 30 minutes to correct and climb, instead of beeping its head off every five minutes for hours.  (Nice.) 

Another feature that's been added is the ability to add "events," like exercise, food, insulin doses, and health info - much like the One Touch Ultra meters.  I've been consistent so far with entering this info (read: it's only been 12 hours with this thing attached, so I'm in a bit of "new device euphoria" and I have no clue if I'll stick with being so tuned in), and if I can keep up, it will make the records from the Dex pretty comprehensive.

Dexcom 2 Software screenshot.  Sorry this caption wasn't that interesting.

The software is pretty good this round, able to download information from past sensors, instead of just the most previous one.  I took some screenshots of the software and gave my notes on Flickr, because honestly, I'm not terribly techy and writing on and on and on and on ... zzzzzzz ... and on about software upgrades could make me yawn my face off.  Overall, the software is good and tracks what I need it to track and if I was able to make my patient profile avatar into a picture of Siah's head, I would.  You know it.

Overall, I like the upgrades.  And the upgrade is universally available to all Dexcom users (EDIT:  It's available immediately to all new customers.  Existing ones can get it in May.  I'm not sure why that is, but if anyone from Dexcom is reading and wants to leave a comment, please do!), but I don't know the details of insurance coverage and cost.  I am glad that Dexcom is willing to push out new options as they become available, instead of waiting for a full device overhaul.  I'm hopeful that the next round of developments will help reduce the size of the sensor and the receiver. 

I'll let you know next week how a few days worth of experience with this system feels, but in the meantime, feel free to check out my Flickr photos of the Dexcom Seven Plus.  If you have questions, I'll do my best to help.  (Keep in mind:  I'm slightly clueless.)

Now I'm heading to work in this snow squall (WTF?) - what is that about?  I thought today was supposed to be the first day of spring??  More later!

[Dexcom disclosure]

March 13, 2009

My Mom Says Hi.

I love my mom.It's no secret that my mom is a huge part of my success as an adult with diabetes.  Her support, even when I rebelled against it with all my might, has made me confident in dealing with whatever diabetes has to throw at me. 

My mom has guest posted here a few times in the past (here are her archived entries), and she's offered to share her perspective again.  Reading her posts makes me think about how much the parents of kids with diabetes work so hard to maintain our "normal." 

From My Mom: 

Hello ... Kerri’s mom here! From time to time, Kerri will ask me to do a guest post.  What prompted me to post at this time is her recent blog regarding her old childhood journals. (Yes, she could write like a champ way back when. It’s always been a gift she has possessed.)

The fact that Kerri went to Clara Barton Camp from the time she was diagnosed until she was too old was a blessing in that I was able to hand over the responsibility of her medical care to a very capable and trusted staff at the camp. I don’t think I ever thought of it as “ok, now we can be normal for two weeks.” Maybe her siblings thought there would now be more sugary, tasty treats available during those two weeks that were not hidden in frozen bean boxes.

Parents are responsible for the well being of their children from birth to when they  are able to live on their own. (Not that it stops us from worrying.)  Throw diabetes into the mix and it can be overwhelming at times. We love our children and would do anything to keep them safe and protected. It is our “job.” I looked at sending Kerri to camp as a benefit to everyone in our family. She could bond with children who deal with the same issues she did on a daily basis. They can complain about how over protective their parents are and that we don’t understand what it’s like. No, we don’t, but as a parent these children don’t understand the fear that is ever present in our minds. Will we handle their diabetes care well enough to ensure that they don’t have serious lows or highs? Have we done enough to protect their future health from diabetes complications. It’s a scary ride we parents are on. I guess until they have children of their own … they can’t know how we feel just like we can’t know what it’s truly like for them.

Kerri used to get upset with me when I would say things like “we have to do a better job at…” She said it wasn’t a “we” disease, it was she who had diabetes. I beg to differ! When you are trying to protect your child from the consequences of diabetes or any disease it does become “our” disease as well. How can we let anything bad happen to them? You become the Lioness protecting her cub! I thought I was the only one that knew how to take care of her and I didn’t insist that others help out. If I could go back in time, I would certainly rethink that one! Everyone needs a support network. In a way, Clara Barton camp was that for me.

I needed that two week camp time to regroup. To take a mental health vacation. While she was at camp, I would often wonder how she was doing. How were her blood sugars running? Was she having fun?  But I can say that I wasn’t worried. She was in good hands. We both felt refreshed when camp was over. Kerri would come home having forged some long lasting friendships. She was more confident and determined. Camp allowed her to share feelings with other kids who understood what it was like to live with diabetes. No worries about acting weird when low…they all had been there and done that!

I lost my job as “Protector of the Kerri” a long time ago. She is very capable of handling her life and health. Will I always worry about her? Yes, like I do with all my children. That’s normal. But she is very fortunate in that she is married to Chris. My mind is at ease ... he is my Clara Barton camp!

Thanks, Mom.  For everything. 

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 09, 2009

Diabetes + Stem Cell Research = Hope.

Go Bama!  Go Bama!Chris and I were talking the other day about something completely random, when he turns to me and says, "Oh, wait.  Did you hear that Obama is signing that bill to reverse the ban on stem cell research?"

"I did."  

"So?  Are you excited?"

And I thought about the last two decades.  How the veiled promise of "five more years and then ..." and still nothing. 

"I'm hopeful.  You know me, baby.  I'm almost always hopeful, but until it's actually real ..."

He gave me a grin.  "We just keep you healthy and hoping, right?  Well, this is a huge leap forward."

And today, we leapt as President Obama reversed the ban.

We'll keep hoping.  With the JDRF actively leading (and Tweeting!) the charge, and with diabetes on the national stage, progress could actually be made.  Not just a product redesign or another clever device, not just another type of insulin or another pill - real progress.   

I'd love to go from "type 1" to "type: cured." 

(I've been itching to use the past tense for a long time now.)

February 26, 2009

24 Hours with Diabetes.

This clock is obviously wrong.  Should say 7 am.7:00 am:  The alarm goes off for the first time.  I stumble from bed, find out where my pump has landed during the course of the night, wander off to the alarm clock, bang my hand against it, and then shuffle back to bed to claim another 9 minutes of sleep.

7:09 am:  Alarm goes off again.  Snooze one more time, grab my meter from the bedside table, and hope to test when it goes off again.

7:16 am:  Okay, this is it.  No more snooze, test blood sugar. Whatever the result, it kind of sets the tone for my day.  I’ll correct it, treat it, or celebrate it, depending on the number.  Calibrate the CGM, disconnect the pump, and head off to the shower.

7:20 am:  Connect CGM to my bathrobe on the bathroom door so it’s close enough to pick up a signal while I shower.  Shower quickly so I’m not disconnected from the pump too long.  Carefully dry off to keep CGM sensor and pump site from becoming loose.

7:30 – 8:15 am:  While getting ready for work, put at least underpants on to have something to hook the pump to.  Dress in clothes that make me feel comfortable, fashionable, and able to wrangle in any diabetes technology I’m trying to wear. 

8:20 am:  Grab enough snacks to get me through the day, but make sure the food is d-friendly enough to keep my numbers in line.

8:30 am:  Drive to work.  Check the CGM to ensure I’m not sailing out of range.  For the record, my car has glucose tabs in the glove compartment, in case I go low.

8:45 am:  Time to buckle down.  I’ve got my coffee, my computer, and my meter at the ready.  During the course of my morning at work, I’m testing my blood sugar every hour or so to make sure I’m in range.  Sometimes the blasted dawn phenomenon grabs me and I end up fighting a high for hours.  Other times, a tricky little low sneaks up on me and I have to down some juice and then muddle through the aftermath.  And lots of times, my body behaves and numbers hold steady.  But I still have to check and confirm this, so I’m still actively maintaining diabetes stuff.  And I usually have a snack in the morning at some point. 

Noon-Thirty: 
Lunch time.  I test beforehand, I react to this number, and I try to anticipate what I’ll be eating for lunch.  Most often, I eat carbs at lunch, either in the form of a sandwich or soup or something like that, but food is always consumed at this time.  (I get hungry!)  

1:30 – 5:30 pm: 
Work afternoon.  Looks a lot like the morning, only for me it tends to be a little more even with blood sugars and a little less even with stress levels.  (Something about the afternoons at work tend to bring on the meetings, wacky emails, etc.  Either that, or maybe in the morning I’m too sleep to mind the difference.)  Lots of testing blood sugar and/or scoping out the CGM line during this period.

6:00 pm:  Homeward bound.  But it’s not over, yet.  From here, I have about 30 minutes to change up to head out to the gym, and make sure my blood sugars are high enough to take on an hour of exercise.  (This is one of the only moments in my day when I’m intentionally a bit higher.)  Aiming to be at around 180 mg/dl, I head off to the gym toting my bag crammed with my meter, music, water bottle, CGM receiver, and a fast-acting glucose stash. 

7:00 pm:  (We’re here already?  Man, this day goes by fast.)  Gym is ovah.  Time to test before heading home to see if I need to act on a number, make sure I’m good to disconnect and take a shower. (Yes, two showers.  I hate to stink.)  A shower is followed by dinner.  Dinner is followed by testing.  Testing is hopefully followed by sugar-free pudding with cool whip or something.  ;)

From Dinner to Bedtime:  Evenings are sort of status quo, with lots of options.  Heading out for a movie?  Going into NYC for the night?  Grabbing a drink downtown?  Staying home and working on computer crap?  Perhaps some [hey, something shiny!]  Or grocery shopping, changing out the CGM sensor, cooking (ha!) ...  Whatever the hours of my evening are filled with, I’m still keeping close to my meter and maintaining an eye on my body.

Before Bed:  Go through the whole before bed routine (washing face, flossing, brushing teeth, fighting to keep the cat out from underneath the bathroom sink), and then head into bed.  One of the last things I do every night is test my blood sugar and check my pump reservoir and battery life to ensure I'm good for the night.  After that, I try to fall asleep, with all hell usually breaking loose when the cats run races at the foot of the bed around two in the morning.

Sleep:  Awesome.  Hopefully, there aren't any hypoglycemic episodes throughout the night.  If there are, the Dexcom usually BEEEEEEEEP!s until I wake up.  (No snooze button on that thing, that's for sure.)

7:00 am:  Lather, rinse, and repeat. 

A team of students contacted me and asked me to tick through a day in my life with diabetes.  I tried to do a standard day - one without a wicked low or high - but it's hard.  Variables come raining in from everywhere, and it's nearly impossible to account for all of them.

I've written those kinds of "day in the life" posts about diabetes before, but they never really capture what can and does happen.  I even attempted to do a video, but it didn't cut it, either.  It's hard to show how much instinctive management comes into play, like those moments when we don't realize we're managing diabetes (but we are). 

How would you describe a day in your diabetes life?  Or, when you try, do you get tangled in the same set of variables?  How do we describe something so random and far-reaching?

February 25, 2009

Diabetes Snake Oil.

Snake oil - he haz it.There is no way I’m going to name the person who contacted me, nor would I even think about linking out to their ridiculous product.  But I received an email over the weekend from a tool who I will call Peddler.

Peddler started their email to me by saying, “Hello Kerri.  You can cure diabetes.”  Then there was a link to a YouTube video.  (With instructions on how to cure me, I assumed.)  I clicked through and watched their video and did the whole “rolled eyes” routine.

I am a relatively well-educated patient.  I am by no means a doctor, but I could pretend to be one for at least 8 minutes (until someone asks me to recommend treatment options or draw blood, and then I pass out and they find out I’m a lowly editor).  False claims of a “cure” don’t sit well with me, so I decided to email Peddler back and see what kind of web he would weave.

“Dear Peddler.  I have type 1 diabetes.  I have been diabetic for over 22 years.  Are you telling me I missed a cure?  Best, Kerri.”

His response:  “Yes, it must be possible.  Although it’s not easy.  Did you watch the video?  You can try [product name] and [other product name] to cure diabetes type 1?  The [product 2] keeps my blood sugar between 5 – 6 (European measure).  When normally it will go like a roller coaster.  It are the most advanced products ever made.  I use them myself.  You can find them here.  [Link]. “

My goodness. 

My response:  “You can cure my type 1 diabetes when no doctors at the Joslin Clinic, no researchers, etc. have that ability?  Can I stop taking insulin when taking your recommended product?  My body doesn’t have active islet cells – you can reverse this?  How much does your product cost and what is your personal involvement?”

Peddler’s response:  “No sure, you can’t stop taking insulin.  But if you take the product it might reverse it over time.  I have absolutely no involvement into this.  I just use it myself.  Have been looking for years to try and find a cure myself.  But you must read the information and watch the video.  But there are a lot of products and research outside of the conventional research.”

Then Peddler loses it a little bit, emailing again:  “[Another guy’s name], the health ranger, healed himself of type 2 diabetes through dieet and supplements.  You can read a lot of information on [website].  Do you know anything about farmaceutical companies and their research?  They only want to make money.  They cannot use natural vitamins and minerals because they cannot pattent them.  It’s a big money industry.  I was a shareholder, been very active on the stock market.  I know a lot about these companies.  It’s just like the oil industry.”

The snake oil industry that wants in on my “dieet” and “pattents” and “farmaceuticals?”  And what the hell is a "health ranger?"

I emailed him back:  “It will reverse my need for insulin?  Type 1 diabetes means my insulin-producing cells were attacked by my own immune system.  This product can reverse my own auto immunity?  I am shocked.  Are you involved with this supplement company, because I have to be honest - I doubt the integrity of your intentions.”

Radio silence.  Maybe he had to call back the Mother Ship for guidance. 

Then Peddler comes back out at me.

"Ok, no I'm really not. I'm 27 years old, working in a pipe factory here in Holland. I really am not involved into this company,  I'm a person just like you."

Then he sent me YouTube clips of different people talking about the supplement, and others of people showing how a certain diet plan "cured" their diabetes.  How if I just authorized some payments from my PayPal account, I'd be right ready for a life without diabetes.  (Come on, Mr. Pipe Layer from Holland.)  After clicking around for a while, I had a good sense of how much snake oil is being peddled to people with diabetes. 

And the thought made my stomach spin.

I can't help it.  This shit makes me crazy!  Don't market your false cures to me.  Nothing I eat is going to cure me.  No amount of raw vegetables or coffee or protein powder or amino acids or special high-fiber, low carb, strapless, backless nutrition bars.  Unless you have a way to keep my immune system from taking out my body's own insulin-producing cells, do not email me.  Stop preying on people with diabetes.

And for crying out loud, use spell check, would you?  

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 11, 2009

Wrist and Shout.

It's like the metal arm that Beyonce wears in "Single Ladies," sort of.  Or not.About two weeks ago, I had this little, nagging pain in my right wrist.  Not so much at the bendy part, but on the outside of it, right on the bone.  It was sore to the touch, aggravated by movement, and hurt when I woke up in the morning.  It seemed to get worse every day.

So, because I'm a very bright girl, I didn't do anything about it.  Instead, I went to the gym, continued to work feverishly in efforts to meet some writing deadlines, and even finished a scarf I was working on.  (Crochet.  Yes, I am a Grammie-in-Training, it seems.)

Thanks to all of this injury aggravation, I finally had to get myself to the doctor's office yesterday.  The phone call to the nurse/receptionist, as always, was awkward.

"Hi.  It's Kerri Sparling.  I think I have carpal tunnel or some nonsense."

The nurse laughed.

"Hi, Kerri.  Sure, can you come in this morning at 11:45?  So we can check out your nonsense?"

(They are so patient with me.)

"Thanks, see you at 11:45!"

When I arrived, my wrist was throbbing after a morning's worth of mouse-clicking and typing at work.   After being weighed (five pounds since the wedding - more on that later.) and having my blood pressure checked (120 over 72 - good to go), I waited for Dr. CT to visit me.

"Carpal tunnel?"  She said, walking into the room with a concerned look on her face.  "And hi, Kerri.  Carpal tunnel in diabetes is common, but let's make sure that's what you have going on."

"It hurts here," I said, pointing to the outer right hand side of my ... well, my right hand.  "And when I lift it in a pulling motion, it doesn't hurt.  But a pushing motion and a lifting motion kills."

She took my hand and pressed on the sides, asking me to flex the tendons.  "Here is the worst?"  

"Yes.  Yup, right there."  

"Well, the good news is that it isn't carpal tunnel.  It is tendinitis, though.  I'm sorry because I can tell this is making you very uncomfortable.  What I want to do is start you taking Advil three times a day, wearing a wrist brace while you sleep, and layng off the mouse as much as you can.  We need to let this rest so it can heal properly, okay?"

I'm like an addict.  My Internet-itchy fingers started to quiver.  

"Ah, staying off the mouse will be tough because I work all day on computers and I have a tendency to write a lot when I get home at night."   

She shot me a look.  

"Okay, okay, Dr. CT.  I will be mouse-free as often as possible."  Possibly a lie, but I'll try, anyway.

Tendinitis.   Another side dish that seems to come with diabetes.  Fantastico.  Anyone else have any experience with this one?  I'm looking for fast recovery and yet the ability to remain bloggy.

Edit:  Great idea from George and some folks on Twitter - might need to Bedazzle that shit! Now I just have to order one.  ;)

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.  ;)

January 17, 2009

A Pancreas Transplant Story.

Denise Martinez used to have type 1 diabetes.  She had it for 24 years.  She also used to have cancer.  But now, Denise is diabetes and cancer free.  Her story is amazing, and she has offered to share it with us.  Here it is, in her own words:

"On April 9th, 2008 my life changed forever.

I was diagnosed with type 1 diabetes when I was 7 years old. I was diagnosed at a time when type 1 diabetes was commonly mistaken with type 2. So of course, everyone had all kinds of ignorant advice such as "Don't eat anything with sugar in it or they'll cut off your legs". It was a very scary time. Fortunately, I had a great support system. My friends were all interested in what was happening to me and they would all try to help me feel as normal as possible. They learned to give shots just as all my family members did. And my mom would make all kinds of sugar-free goodies for me. They tasted horrible because Equal and Splenda did not exist back then...LOL. I lived with diabetes and was able to control it well for many years. As a young adult, I dealt with the same things everyone else does- school, boyfriends, and independence. Living with diabetes taught me a lot of things. Controlling your diabetes is a huge responsibility. No one can do it for you. I learned discipline, patience, tolerance, and most of all that if you don't love yourself, you cannot love anyone else.
 
The great thing about diabetes (if there is one), is that you can control it. When I was 15 years old I was diagnosed with Non-Hodgkin's Lymphoma. It is a rare form of Cancer that attacks your lymph nodes. You have lymph nodes all over your body so it is very hard to treat it. I struggled with this type of cancer for many years. I had 7 different tumors. Five of which were malignant and required chemotherapy and/or radiation. Through all of this diabetes was always the main issue. I didn't want to lose control of my blood sugars because I was terrified of the complications. With so many meds and so many changes in my body, my A1C reached 8.5 at one point. I have been in remission for 3 years now. Cancer is just a memory now, but it left it's mark on me.

During my last treatments of radiation my creatinine levels skyrocketed and I went into kidney failure. Both of my kidneys were working at less than 10%. In February of 2007 I began dialysis. It is a terrible, terrible treatment that is necessary for you to live when your kidneys are no longer able to function on their own. I had a surgery to implant a surgical graft in my arm so that they could insert the two needles in my arm every session. I went to dialysis every other day for four hours for a year and two months. I decided against live donorship because I am not comfortable with someone making that type of sacrifice for me. You can live with one kidney but I still wouldn't want someone to go through the surgery and recovery. It is a huge operation. My transplant surgeon also informed me that because I had type 1 diabetes it would not make sense to transplant the kidney only. Eventually, diabetes would ruin my new kidney. It wouldn't last very long. So I got on a list to get a kidney/pancreas transplant. Just 8 days later, they called me. They had found a donor for me. I had no idea how my life was about to change.

Continue reading "A Pancreas Transplant Story." »

January 16, 2009

Appointment'd Out.

The Friday Six:  January 16, 2009 editionWhat a freaking long week, with a doctor's appointment every day and way too much medical analysis.  This week is a very personal Friday Six, and here it is:

1.  On Monday, I had my A1C drawn.  I've been to this specific lab before, and the same woman has drawn my blood before, so I didn't have a lot of anticipatory nerves.  But when the lab technician said, "Okay, you have lost all of your color - put your head down, Mrs. Sparling," I knew I wasn't as badass as I wished to be.  (And I also winced when I pulled off the cotton ball she had taped to my inner arm ... I'm such a wuss.)  But thankfully, the results were a full point lower than my last A1c, leaving me with a 7.5% and a reachable goal of <7% for April. 

2.  And Tuesday, I had a dentist appointment.  Those of you who have been reading SUM for a few years know that I have an unholy fear of the dentist, but it is warranted.  My teeth are so sensitive and require barrels of novocain to make them numb, so fearing the wielder of pointy metal hooks in my mouth is a rational fear.  However, my new dentist is FANTASTIC and brings me no pain.  I had my teeth cleaned (first time in ... ages, unfortunately), no cavities, and I have already scheduled another cleaning for April.  I'm considering the dentist hurdle cleared for the time being.

3.  Wednesday has me sitting at the dermatologist's office to have a new freckle on my breast examined.  (Whoa, Kerri.  TMI?)  Yes, that is way too much information, but since when did I start censoring myself?  (Since ... today?  Maybe I should start.)  Always in a constant state of medical over analysis, I decided it was best to have it checked out.  So I spent Wednesday morning having a kind, eccentric, little bald doctor look at my breast with a magnifying glass.  Definitely a "first."  This little issue ended up being nothing to worry about, but now I can check "awkward sharing moment with the Internet" off my list for the week. 

4.  Thursday had me with dilated pupils at the retinologist's office.  Of all the appointments this week, this eye one was the least ... awesome.   

"Look up ... okay, now look a little to the left ... Kerri, up again ..."  Dr. Retina kept shining the light in my left eye and making a "hmmmm" sound under his breath.  My face was cupped by the eye examination machine.

"You can't fool me.  I know you found something.  Spit it out."  My eye doctor and I have a very good relationship, and we talk like we're about to go grab a beer together.

"Small little something.  Hemorrhages in there that I want to keep an eye on."

"Pun intended?"  Without moving my face from the chin rest, I reached over and grabbed a Kleenex because I immediately started to cry.  But I was oddly okay with the news.  Maybe I've already had that bubble busted.

"It's okay.  But with you and your husband talking about maybe getting pregnant in the coming year, I want to keep close tabs on your eyes.  You've had diabetes for what, a million years?"

"Twenty-two years."  I smiled.

"Twenty-two years.  And your eyes look beautiful - barely a problem at all.  But I want to keep them that way.  Let's schedule an appointment to do a fluorescein dye exam before you and Chris are pregnant, just so we know exactly what we're dealing with."

"What is that?"

"We'll inject a dye into your arm, then do a dilation on your eyes.  The dye lets me really see what's going on in there with complete precision.  And with you, I do not want to take any chances."

"Okay.  So do I need to worry about this?  I'm worried.   You know I worry."

"You worry?  You do?"  The gentle ribbing was okay with me.  Soothed my anxiety a bit.  "You do what you're doing.  Work to keep your blood sugars controlled.  And think about taking some time off from all that work you do.  Maybe take a vacation?"

Fine.  So now I need to schedule a vacation.  Doctor's orders, you see.  ;)

5.  Now that these appointments are all behind me, I'm moving forward towards the next steps.  I am doing the pre-pregnancy clinic at Joslin in March, and Chris and I are working to get everything in order so that we can make our family-starting decisions based on factors other than diabetes ones.  It's an exciting time, and one I've been looking forward to my whole life.

6.  And in my only news-related bit of the day, this weekend is the end of the MedGadget awards, and thanks to all of your help and support, SUM is in the lead for Best Patient Blog.  I would be honored to win this award on behalf of every last one of us, so please keep spreading the word and voting!  :)  Thanks for everything, and hopefully on Sunday I can report that WE DID IT! 

I'm planning to spend the weekend hanging with my girl friends (finally seeing the Batman after a long absence!) and doing some recreational writing.  I hope you guys have a great weekend, and stay WARM!!

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.  ;)

January 07, 2009

FDA Petition For Diabetes.

A little patient perspective goes an awfully long way.

And this time, the diabetes community is rallying to make a lot of patient perspective go as far as it can - straight to the Food and Drug Administration (FDA) to urge them towards creating a Diabetes Advisory Council.

Members of the diabetes community, myself included, are co-sponsoring a petition to achieve this advisory council goal.  Here is the core goal of the petition, as written on the website:

"Due to the very nature of the severity and prevalence of diabetes, the following leaders within the diabetes community, who have signed this petition, implore the FDA for the immediate creation of a Diabetes Advisory Council, whose goal would be to improve options for patients. This council would include practicing endocrinologists, diabetes educators and others communicating directly with patients. Our experience, focus, and keen awareness of the needs of the diabetes community would be an invaluable resource to the FDA as it faces the arduous process of evaluating new diabetes treatments.  Our aim is to improve options for patients.

We urge the new FDA leadership to recognize the urgent need for more safe and effective treatment options for diabetes and to reduce barriers to innovation. More treatment options will benefit patients. The disease is progressive. Delays in the availability of new treatments will only result in tremendous cost to public health and the economy.  Our recommendation can benefit patients without sacrificing their safety."

- Ask FDA to Better Serve Diabetes Patients

This petition isn't about passing unsafe drugs and paving the way for companies to market crappy products to our community.  It's not about turning a blind eye to drug-induced cardiovascular issues.  What this petition does is give people with diabetes, and the people who care for them, a clear voice in these government processes.  As the petition states, our "experience, focus, and keen awareness" of the needs of the diabetes community would be an invaluable resource to the FDA. 

We want safe and effective treatment options.  Diabetes is a disease that affects my life every single day, and I work hard to stay as healthy as possible.  I believe that the perspective of patients like us and those who love us can collectively raise our voices and bring newer, safer diabetes treatment options into our lives sooner rather than later.

I want a cure.

But for now, I'll settle for progress.

If you want to see a Diabetes Advisory Council created, sign the petition and pass it on.  And for more information on the programs the FDA already has in place for patient advocates, check out this link.  Help spread the word on how the diabetes community can make our collective voices heard.

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 18, 2008

Minimed Trick I Didn't Know About.

I have had this Minimed 522 for over a year now, and just yesterday I discovered an option I hadn't previously known about:  Daily Totals Screen.

My old pump had daily totals.  I would hit the utilities option, scroll down to daily totals, and I'd see a running tally of how much insulin I took in total on the previous two or three weeks.  This was a cool option I clicked on every few days so I could keep track of my total daily dosage (and it also helped me isolate the days when I was running higher, because those TDDs were higher).   

Purely by accident (because I do not read the manuals that come with any technological device - technoJOY!), I realized that my new Minimed 522 not only gives my total daily dosage, but it also gives me averages of my blood sugars.  This is AWESOME because, thanks to the One Touch UltraLink that shoots my results over to the pump and thanks to the CGM sensor lodged in my arm, I have a really good sense of how crap my blood sugars have been for the last week and a half.  

Minimed pump features I had no clue about.

(Oh how I kid.)  Actually and unfortunately, I'm not kidding at all.  Last week was a veritable ping-pong match in my body and there is concrete evidence of this terrible run in both my Dexcom receiver and my pump.  My daily insulin totals have leapt from 22 units of Humalog a day to a whopping 35 units.  (And before you start thinking, "Hey, that's not a lot of insulin," remember:  your diabetes may vary.  It's a lot for me.)  Seeing my blood sugar averages and the number of correction boluses I'm taking during the course of a week shocks my brain into lurching into action.  "Average of 189 mg/dl?  Must ... improve ... control ..."

I think this Minimed bolus/TDD/blood sugar tracking feature is very handy, and a great tool for anyone who wants to see their diabetes in a customizable snapshot.  Like I said, I now know that my numbers truly have sucked for the past week, but I'm hoping that when I take a peek at my 14 day averages next week, I'll see some improvement. 

I wonder what other secrets this pump holds. Maybe if I press a few buttons in unison and hop on one foot while wearing bunny slippers, I can unlock this cryptex to find where Siah's been hiding my wallet ...

EDIT:  Just realized I didn't specify how to find the feature, if you haven't already.  Go to Utilities, then Daily Totals, then Daily Averages. Set the number of days you want, and hit ACT. Viola! 

December 16, 2008

Diabetes Fashion Trends.

Hiding my pump behind the scarfBig sunglasses?  Tucking my pants into a pair of thigh high boots?  Ridiculous white plastic 80's earrings? 

No, no, and NOPE.

But if there's one fashion trend I'm embracing whole-heartedly, it's the scarf thing.  Scarves, pashminas ... whatever you're calling them, I love them.  Every time we're in NYC, I spend way too much time perusing the pashmina color selections offered up by the street vendors. 

Five bucks for one scarf?  Don't mind if I do! 

These handy little numbers come in a whole rainbow of colors - I have everything from midnight blue to pink to purple.  They add a splash of color to an otherwise drab ensemble, and the fabric itself is soft and flowy.  I'm frigging smitten with the things. 

And in addition to being fun and fashionable, these scarves are also my new weapon in diabetes device discretion.  One scarf, draped casually in any way that falls past my hip, can cover the bulge of the insulin pump or the Dexcom receiver.  Since I've been rotating my sites more frequently and making use of the real estate on my lower back, the tubing doesn't always reach far enough to hide the pump in my sock.  In these instances, I clip the pump to my pocket or waistline.  And the lovely scarves are awesome for keeping my devices incognito.

Even though the cold weather is chapping the hell out of my hands and making me shiver as my car warms up in the morning, I'm thankful that this chilly weather offers up plenty of opportunities to be fashionably healthy.  (And they're sort of snuggly, too, these scarves.  Almost forgot that part.)

How do you make your insulin pump or other diabetes device part of your ensemble?

December 15, 2008

Drug-Free Monday.

No more The Pill.Today's post is brought to you by the letters "T," "M," and "I."  And also "Y," for "why the heck am I telling you this?"

Because it may not be just me.  So I'm inclined to both share and draw on the genius of the blogosphere.

My period came when I was 13 years old - textbook "time to become a woman" sort of thing.  And it came for the first time at church.  During Sunday school.  Fantastic.  I knew what was going on (health class + MomTalks = educated Kerri), but the timing was a bit entertaining.

For the first few years, my cycle was more seasonal than monthly.  I only had my period once a season, skipping months at a time, but because I wasn't sexually active, it didn't raise any concerns.  My doctors and my parents decided I was going to take a few years to acclimate to a monthly cycle, and since I was only 16 at the time, it wasn't a raised concern.  I was under the medical microscope at that time anyway, being in my teens, having trouble controlling my blood sugars and/or hormones, and enjoying yeast infections, urinary tract infections, and other high blood sugar added bonuses. 

Once I became sexually active at the age of [hey look, something shiny!], I talked with my doctor about starting on a birth control pill.  Being the paranoid peanut that I am, I talked extensively with my endocrinologist and my gynecologist before deciding on a pill, and kept in close contact when them for the next few years.

But then there were some hiccups in the system that made me rethink the regular pill regimen.  First, I entered my late twenties and realized I had been on hormones for over ten years.  Second, I got engaged, which made me think BABIES and made me want to confirm that my reproductive system was in fine working order.  And thirdly, there was the diagnosis of the Factor V gene, which made regular birth control pills a risky choice and forcing me to try the minipill.

So, with all of these factors (literally and figuratively) in play, I've decided to come off the pill.  Effective last night. 

I've come off the pill once before, in college.  At that time, I was between serious boyfriends and wasn't sexually active.  So, under the advice of my doctor, I stopped taking the pill for eight months.  And during the course of those eight months, I did not get my period even once.  I decided to go back on the pill to re-regulate my cycle and it was only after taking a medication to induce my period did I get one.  Once I was back on the pill, my cycle came predictably and without issue.  But this "gap" concerned me, and I want to make sure I'm okay.

With my marriage behind me, my thirtieth birthday ahead of me, and my desire to start a family becoming more of a "now" than a "later," it's time to make sure my body is ready.  And not just from a diabetes perspective.  From all perspectives.

But - FOR THE RECORD - I am not pregnant.  I am not trying to get pregnant.  And I'm not ready to get pregnant.  When I'm there, I'll definitely share that news proudly!  But for now, I'm going to enjoy being a newlywed for a bit longer.  :)

So ... who out there was on the pill for years and came off it?  I am not sure what to physically expect (Will I cycle right away?  Will my body become sore or more sensitive?  Will I be an emotional wreck?  Will my face fall off?) and I could use some guidance.  Or advice.  Or maybe some coffee would suffice. 

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 10, 2008

Stupid Diabetes Move.

Glucose meter, home aloneMy brain hasn't been attached this week.  I overslept one morning and was late to work.  I left my wallet at home another day.  I completely blanked out on a meeting I had at work.

And yesterday, I left my meter at home by accident. 

You would think that working in a diabetes media company, with another diabetic, would have me existing in a constant state of able-to-be-bailed-out.  But no!  I went foraging for my meter around 9:30 in the morning and couldn't find it.  I dumped out the contents of my work back on the floor (making a clattering sound against the concrete, but my coworkers have since learned that I'm a disaster and they anticipate the random noise), but couldn't find that blasted black zippered case.  

"Where are you?"  I said out loud.  (Coworkers are also used to me talking to myself.  Poor coworkers.)  My meter didn't answer.  Apparently it did not hear me because it was rested quite happily on top of the basket of folded laundry in my bedroom at home.

"Hey, Howard?  Do you have an extra meter hanging around?"  Nothing like paupering for diabetes supplies to the CEO.  While he didn't have an extra meter, he did have a strip I could use in my back up Freestyle meter. 

"Do you need more than one?"  

"Nah.  I'll go home at lunch and find my meter.  No problem - thanks!"

It was a weird feeling of relief to finally test.  Not having the option of knowing my numbers made me feel uneasy.  And it was an even weirder feeling of unpreparedness.  I felt like the diabetes anti-Boy Scout.

And then Real Life took hold.  A meeting that ran late prevented me from going home for lunch, and I had to instead pop out quickly to grab a bite from the deli down the street.  Howard (and his diabetes supply stash) had to leave the office for a meeting for the rest of the afternoon.  Diabetes took a big time backseat to the rest of the day, and all of a sudden, I realized it was 3:00 in the afternoon and I hadn't tested since 9:30 in the morning.

And the Dexcom sensor fell off on Monday evening and I've yet to stick the next one back on.

I felt like I was driving blindly - nervous about eating anything with more than few carbs because I didn't want to chance the spike, reluctant to bolus because I feared not feeling the low.  Yes, I should have gone home to get my meter.  Yes, I should have been more prepared.  Yes, yes, yes, I did the self-nagging and the guilt-tripping.  But NO, I wasn't prepared.  I wasn't even remotely ready.  It was the diabetes equivalent of that dream where you are naked in you 10th grade classroom.

I've talked about this before, but there's a LOT of packing that goes along with diabetes.  A weekend home in RI is never just a bag with clothes and my toothbrush - I bring a whole backup medical kit to account for everything from pump failures to yeast infections (thank you, stash of probiotics!).  And my work desk is more than dLife papers and columns - there's a rotation of meters, infusion sets, and other diabetes supplies kicking around.  I'm always preaching about being prepared, and for the most part, I am. 

Those moments of being caught with my meter down prove why being well-stocked is the best option.  But blah blah, it's not always that easy to get it right every time.  Yesterday sucked, and I felt like a fool, and I was rewarded with a blood sugar of 300 mg/dl when I came home.

I'm off my game this week.  I think it's because I forgot to call Larry on his birthday.

December 01, 2008

Dexcom Discard.

Holy December - I can't believe it's the end of the year already!  Holiday chaos reigns supreme, starting with this past weekend's Thanksgiving holiday and stemming straight into New Year's.  Since I've been wearing the Dexcom pretty regularly (approximately five or six days in a row, then a day or two off), I realized how awesome it is to have that little thing attached during holidays like Thanksgiving. 

I slapped on the new sensor last week and it stayed pretty solid until last night, when the adhesive was peeling too much for me to handle.  (It gets itchy once it starts to peel, and that makes me craaaazy.)  

Dexcom sensor before I pulled it off.  All tattered.

This is the sensor after six days of changing clothes, working out, spending hours in the car, wool sweaters, multiple showers, and the general wear and tear that I put my body through in the course of a week.  The sensor is still attached, but the gauze around it isn't in good shape.  So I decided to pull the site and reapply it this afternoon.  Dexcom discard.  I'm freewheeling without the Dexcom at the moment.

The graphic on the Dexcom receiver that indicates ending a sensor run makes me laugh every time.  The little guy tosses off his sensor with reckless abandon into the garbage can.  Then it asks me, "Okay?"  Okay, let's throw the whole thing out.  (Note:  You don't throw the whole thing out.  You remove the EXPENSIVE transmitter first, then throw out the sensor housing.)

Bye bye, Dexcom sensor!

This past sensor was a bit of a needy one - it didn't want me to shower, apparently, because it kept throwing the "???" at me (meaning it's "confused" and needs a few minutes to catch up) every time I was in the shower.  It also wasn't as tolerant as usual when it came to distance, so instead of keeping it on my bedside table or on the back of the headboard, I had to tuck it under my pillow.   Maybe wearing the site on my lower back instead of my arm caused the difference in transmission - I'll have to see if it happens next time.

Watching my numbers closely for the holiday really helped out a lot.  I saw that a glass of white wine on an empty stomach actually made my blood sugar spike almost instantly.  I also saw that lemon meringue pie (de-li-cious) didn't do much after 15 minutes, but the 40 minute mark showed a real intense spike.  Insulin?  Yeah, it takes at least 35 minutes to impact my blood sugars, but knowing that made me more precise in when I bolused.  The result?  Elevated blood sugars during Thanksgiving (avg. about 195 mg/dl) but I didn't hit the wicked highs, and once I was high, I wasn't stuck there for hours.

Thanksgiving has come and gone, but I'm thankful to have another effective tool in dealing with diabetes.  Now it's time to get to the damn gym and work off that pie. 

November 24, 2008

Old School Insulin Storage.

Diabetes supplies used to be pretty damn tough.  And insulin storage was downright badass.

When I was in college, I was on injection therapy, taking Regular insulin and UltraLente.  Instead of my current insulin pump, I used orange capped syringes and old school insulin pens.  The insulin pens were awesome and made out of metal, making them almost bulletproof.  One afternoon, I was heading out with one of my roommates to go to class and I back up the car along the gravel driveway.  To feel a little bit of a buckle and a crunch.

"Oh for crying out loud," I muttered, wondering what I just ran over.  I opened thThe blue case.  e door, popped my head out, and rolled the car forward to reveal my insulin pen, crushed underneath the back wheel.

"Shit!  I killed the pen!"  I unbuckled and retrieved the pen from the driveway, expecting to pick up shards.

But the thing was perfectly intact, only a few scratches on from the gravel.  I was impressed.

Then there was "the blue case."  From the time I was a kid, I stored my insulin in this blue cool pack that was virtually indestructable.  It was a blue zipper case with a heavy cool pack in the middle that I'd store in the freezer at night and then stick in the bag for the duration of the following day.  This pack was dragged everywhere from the beach to school to sleep overs to the car for long road trips to airplanes to my first apartment.  And it withstood the test of time, refusing to succumb heat, cold, jostling, and being slammed in the trunk door by accident.  (I am an abusive insulin keeper, it seems.) 

Even though I've switched from injections to insulin pumping, I still have these diabetes relics from ancient times.  The blue case is under the bed somewhere, and that metal insulin pen is in the pen cup on my desk at home.  Saving these bits of diabetes memorabilia isn't just unique to my dLife - apparently, Jim Turner does it, too.

When he came to visit the office a few weeks back, he brought in this little pellet of a thing that stored his insulin vial.  "Protects it from being cracked if it falls or something." It was worn from several decades of use, but it still did its job.

Jim Turner's "insulin bullet" 

I thought it was awesome.  It was like a beer cozy for insulin.  (Cozy?  Koozi?  Kangaroo?  I have no idea.)  I have only broken a bottle of insulin once, but of course it was the last one in my stash, thus creating chaos.  Anything that protects supplies, I am a fan of.

What kinds of tools from years gone by are you still hanging on to?    

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 17, 2008

World Diabetes Day in NYC.

Last Friday, on World Diabetes Day, I had the pleasure of spending the day with Fran Carpentier at the Young Voices event in NYC.   Discovery Health showcased the video submissions from people with diabetes and they had a talented panel of guest speakers and ambassadors, including Lee Fine from FiveHumans, the adorable Charlie Kimball of racing fame, and Miss Black USA Kalilah Allen-Harris

I had some great interviews with these folks that I'll be posting over the next few weeks, but in meantime, I wanted to share some photos from the event.

World Diabetes Day in NYC 

Former Mets player Todd Zeile, Fran Carpentier, Kerri Sparling, ESPN report Brian Kenny, and country star Steve Wariner 

Fran, Kerri, and Kalilah. 

Fran, me, and Kalilah Harris

Charlie Kimball and Kerri Sparling 

Charlie Kimball and me.  :) 

A big part of what was discussed at this event was the DAWN Youth Initiative, which is dedicated to improving the level and conditions of psychological support for kids and young adults with diabetes.  The DAWN Youth WebTalk survey was conducted in partnership with Novo Nordisk, the International Diabetes Federation (IDF) and the International Society for Pediatric and Adolescent Diabetes (ISPAD).  I had a chance to speak with Dr. Barbara Anderson, DAWN Youth Advisor (and a former part of my own personal diabetes care team at Joslin!) about diabetes, depression, and how we deal with diabetes.  "It's important to be in touch with other young people with diabetes," she said, and I thought of all of us here in the diabetes blogosphere.  Our interactions with one another are crucial to our diabetes management.  We keep one another sane!

World Diabetes Day was recognized across the world and the outpouring of support was tremendous.  Over 1,000 landmarks were lit in blue.  Those of us in the blogosphere wrote about our diabetes lives, created videos, and even expressed ourselves in song.  But there is still a lot of work to be done (check out the comments on my YouTube video for examples of miseducation and ignorance).  And every day, we all help to raise awareness in our own ways.

How did you celebrate World Diabetes Day?  Feel free to post your link in the comments section.  And with almost two weeks left in Diabetes Awareness Month, how will you close it out?  (Should I dye Siah blue?  Somehow, I think she'd find a way to thwart me.) 

(And, for the record, I wore a bright blue scarf on Friday to show my support.  But it was muggy as hell in the city, so the scarf ended up crumpled up in my purse instead of around my neck.  I tried, I swear!)

(One more post script:  Today is my brother's birthday, so wish him a happy one!) 

November 09, 2008

SUM Diabetes Blogging.

Today is the fourth D-Blog Day, and I'm proudly raising my voice with you guys, the diabetes community.  Three years ago, I wrote about why my blog is called "Six Until Me."  Two years ago, I wrote about my heroes.  And last year, I wrote about what matters.

This year, I wanted to thank you guys for being such a crucial part of my health.  You are all heroes, and I appreciate every one of you.

November 07, 2008

Listen to the diaBeat.

The Friday Six:  November 7, 2008 editionWell that title gets the prize for Worst Pun on the Planet.  It's Friday, I was up way too late last night trying to find a stupid purse, and I woke up this morning with Siah trying to faceplant into my collar bone.  Foolish Sausage ... but at least there's a Friday Six.

1.  ReliOn has issued a recall on some of their insulin syringes.  (Thanks to all of the readers who sent me a head's up on this one.)  According to the press release, ReliOn is "recalling one lot of ReliOn sterile, single-use, disposable, hypodermic syringes with permanently affixed hypodermic needles due to possible mislabeling. The use of these syringes may lead to patients receiving an overdose of as much as 2.5 times the intended dose, which may lead to hypoglycemia, serious health consequences, and even death."  Check the release to see if this development affects you.

2.  Last week, I wrote about the Hannah Montana and diabetes episode that the parents at CWD, and other folks as well, were fighting to have pulled by Disney.  And holy power of the diabetes community - it was pulled off the air!  Parents are pleased, some fans are disgruntled, and Miley Cyrus is now encouraging people to ... Drink Water, Not Sugar?  Not sure where she's going with this, but I'm curious to see.

3.  And because I haven't had a chance to mention it yet, I wanted to thank everyone who came out for the JDRF walk in RI on October 26th.  The day was absolutely gorgeous, and there were about 6,000 people at this year's walk in Roger Williams Park.  My mom, stepfather, brother, nephew, niece, sister- and brother-in-law, Chris's best friend, and my ever-supportive husband walked as part of Team Six Until Me.  I had a chance to meet a few RI readers, chat up some parents, and enjoy a nice lunch out joined by Chris's mother and grandmother.  Diabetes awareness has become a family affair, and I'm so honored and proud to have their support.

4.  This Sunday, November 9, marks the fourth annual D-Blogger Day.  The details are on Gina's Talkfest blog, but the general gist is this:  If you are a diabetes blogger, November 9th is the day we collectively come together and post about diabetes.  Sure, there are other things going on in our lives, and who wants to blog on a Sunday?  But D-Blogger day has been a tradition in this here blogosphere and I've been a proud participant for three years, so be sure to raise your voice on Sunday.

5.  And next Friday is World Diabetes Day - are you ready to mark the occasion?  There are events taking place all over the blogosphere and in the "real world," as well.  Will you dress in blue to show your spirit?  Will you blog about diabetes and educate others?  Are you helping to light a building in blue?  I'll be in NYC marking the day - where will you be?  Do you love questions?  Does it sound like I have upspeak?

6.  Wow, five very diabetes-centric things.  I think I need a little levity.  So I'll consult Le Sausweege.  I went to grab my work bag this morning and it turns out that Siah wanted to visit dLife.  She was sitting patiently in my bag, her little paws pressing the buttons on my cell phone.

Bring Siah to Work Day

Thanks, Sausage.  You aren't annoying at all.

Have a great weekend, and since it's NaBloPoMo all month long (ahhhhh!), I'll see you tomorrow.  And Sunday.  And all next week.  :)

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.
  

November 03, 2008

Diabetes Crush.

I have to admit it:  I have a diabetes crush.  He is funny, upbeat, realistic, and is easy to identify with.  I've watched all his dLife segments and I think I speak for the entire dLife editorial team when i say, "Jim Turner ... sigh ... he's the best!"

And he came into the office on Friday, just in time to see us all decked out in our Halloween finest.  (Note:  I managed to ditch the red riding hood cape for the picture, but others weren't as quickly uncostumed.  The coworker on my left doesn't usually have this fluffy hairdo, for example.) 

Jim Turner and the dLife Editorial Crew
Swoon. 

Jim Turner has been living with type 1 diabetes for several decades now, but you wouldn't know by looking at him.  He looks healthy, seems happy, and has a wicked sense of humor that makes you giggle at things you didn't even realize were potentially funny.  If laughter is the best medicine, then Jim might be the ultimate endocrinologist. 

And of course he comes in on a day when we're all dressed up like goof balls.  

Thanks for entertaining us for the afternoon, Jim.  We remain your loyal fans!!  

Swoon again. 

November 02, 2008

Patients and the Web.

(Sounds sort of like a children's book title, no?  "Once upon a time, there was the Internet...")

My friend Berci at ScienceRoll asked me to create a video to show his Medicine 2.0 class how the web can impact chronic disease management.  My take on the whole concept is that it's amazing how the web can bring a world of people together to share their common experiences, which for me makes diabetes less isolating.  I used to be one of the only diabetics I knew - now I know hundreds! 

Thanks, Berci, for letting me virtually address your class.  I hope they didn''t think I talked too fast.

October 29, 2008

Hannah Montana Does Diabetes?

Old school TigerBeat.  Ahhh!  Luke Perry!Here I am again, stepping waaaay outside of my comfort zone and admitting that I've seen that ridiculous TV show "Hannah Montana."  My niece M (formerly "Chris's niece M," but now that he and I are married, she's my niece, too!) has made me watch Hannah Montana many times, and it makes her giggle, so I tolerate it.

Now we all know that Hanna Montana is played by Miley Cirus.  Miley Cirus used to date Nick Jonas.  (Gag - I can't believe I'm writing this, but there's a point.  Bear with me being all TigerBeat.)  Nick Jonas was diagnosed with diabetes in November 2005.  And in an episode airing on November 2nd, diabetes makes an appearance on Disney's Hannah Montana show.

I've come full circle.  Finally.  ;)

This upcoming Hannah Montana show was brought to my attention by one of the wonderful CWD parents (full disclosure:  I love the CWD parents.  They remind me of my own mom and dad, and they rock!), and she wanted to know if I could help get the word out about this upcoming episode.  I watched the bootlegged show on YouTube several times, and I can see why the parents are up in arms about this.

Parents are protectors.  That is their job, and the parents of kids with diabetes are the ultimate protectors, acting as external pancreases while maintaining a normal life for their child.  So when a show that kids are rabid for, like Hannah Montana, highlights diabetes, there's this sense of hope.   Like, "Hey, Disney is involved with Nick Jonas.  They are tuned into kids.  They won't screw this up."

But did they?

If you watch the episode, you'll see plenty of references to diabetes, some accurate and some completely eye-rolling.  Calling the character with diabetes "sugar boy"?  Pointless.  (I'm not the most PC person you'll ever meet, and if someone called me "sugar girl," I wouldn't care.  But if it were my kid receiving that moniker, I'd rip heads off.  Yet I've digressed.)

However, the thing that struck me as completely off-base was the constant theme that Oliver couldn't have any sugar.  He spends most of the episode drooling after sweets, fantasizing about cotton candy, and even diving into a trash can to retrieve a tossed out candy bar.   The other kids in the show kept talking about how they need to keep sugar away from Oliver, at all costs.  This is what made me think, "Uh oh."  I get that the show is trying to talk about diabetes in ways that kids can understand, but this theme was dangerous. 

So what if Oliver gets low at school?  And needs sugar?  Is the lesson here that diabetics can't ever have sugar?  Holy food police training video.  This message sets a dangerous precedent, one that could leave a low diabetic child being denied sugar, if all their peers have to base their knowledge on is Hannah Montana.  And yes, I know that education comes in more forms than Hannah Montana, but lots of kid watch this foolish show, and I don't want their impressionable heads filled with misinformation.

I'm not blowing the whistle on this episode, not entirely.  I'm glad that diabetes is making its way into mainstream media, and I'm also glad that the end of this show had Hannah Montana and her friends reassuring Oliver that he was still the same guy and still their friend.   That's pretty damn important.  I just want to see this positive message of acceptance accompanied by accuracy. 

Watch the video (there are three parts) and let me know what you think.  Do you feel like this episode presented factual diabetes information?  Were there parts you liked?  Didn't like?  Wanted changed?  Are you of the mindset that all exposure is good exposure?  That intentions were good with this episode?  Or do you expect more from Disney?  Are you inclined to write a letter?  Plain don't care?  Are you sick of my questions?  Who the hell is Hannah Montana, anyway? 

Phew!  I'm off to read the newest issue of TigerBeat.

October 23, 2008

Halloweenin' Diabetes.

Folks who commented on the last vlog post gave me some stuff to talk about, and this round I've tackled diabetes management and Halloween.  I was diagnosed in 1986 and have spent almost all of my Halloweens as a diabetic, so I've been trick-or-treating around the block for decades now.  (Hmmm ... that sounds a bit ... odd.  Yet I've digressed again.)

If you have any tips on managing diabetes during trick-or-treat season, feel free to toss 'em in the comments section! And share what your costume idea is for this Halloween! Chris and I are dressing up as ... well, you'll hear at the end of the video. ;)

October 22, 2008

Diabetes Goodie Bag.

Le Goodie Bag.  Le French.  Fronch?  Fronch fries.Over the past few weeks, I've received some terrific diabetes-related products and information from people out there who are aiming to make a difference.  Ranging from support groups to bracelets, it's time to help spread the word.  (Note:  I received all of these products as samples and have not paid for these items, nor have I been paid to talk about these items.)

This is a green dot.First off, some bracelets from Lauren's Hope came in the mail.  I had a bit of an addiction to beaded medical alert bracelets a few years ago, and this care package seems to have reignited my love for something diabetes-related and delicate.  The beaded samples were beautiful (pictures coming on Flickr later today) and there was also a very cool waterproof/adjustable/washable bracelet that would be great for active little kids ... or active grown ups.  :)  If you are looking for some medical alert jewelry options that are a little different and fun, check out Lauren's Hope.

This is a green dot.I also received a sample from Stephanie Cion at WellAlarm, and she was kind enough to answer a few questions about their unique service (interview will be posted later next week).  The charm itself is sleek and classy looking, and has a sophisticated look, considering it's intended for medical use.  There is a PIN on the back of the charm that, if someone called the number and punched in the code, they'd have access to my medical information. I think this is a unique service and has some potentially life-saving benefits, but I have to admit - the idea that dropping this charm on the ground leaves my information potentially vulnerable.   (Important note:  "regular medical information" can also be engraved on the charm, so it's not just a PIN code.)  WellAlarm has received some good press this morning already, being featured in this morning's HARO newsletter.  I'm curious to see where this product lines goes.

This is a green dot.Bob Hawkins sent me a copy of his terrific book, The Joy Of Diabetes.  I'm a huge fan of anything that helps to raise awareness for diabetes in a way that's easy for people to understand and identify with.  Bob writes about his 45+ years with type 1 diabetes in a way that isn't intimidating.  His little cartoon avatar explores everything from alcohol to exercise to aiming for the joy in life.  I definitely recommend his book, and you can order a copy from his website.

This is a green dot.And I heard from Katie, one of my readers in NYC, that she's starting a support group which is meeting fro the first time on November 18th at the Friendman Diabetes Institute.  According to the flyer, "This group is open to members of the public who are young women living with diabetes. There is no cost for participation. The group will be self-led however there will always be a staff member from Friedman Diabetes Institute available during the meetings. We are creating a place to talk with others about living with diabetes, particularly as young adult women. If you think this group is for you, it probably is. Please get in touch and let us know that you are interested and if you can make it to the first meeting."  For more details, check out this flyer and email Katie at DiabetesNYC [at] gmail [dot] com.

This is a green dot.One other thing, for all your vloggers out there: The JDRF, Discovery Health, and Novo Nordisk are calling for video submissions for their Young Voices: Life With Diabetes program. Videos are being accepted until November 1st, so get cracking!  The videos should be "highlighting your attitudes, wishes, and needs for how the next U.S. president can help defeat this disease."  Okay, easy enough.  The website states:  "For video submissions, Novo Nordisk will donate $10 to the Juvenile Diabetes Research Foundation to help fund research leading to a cure for type 1 diabetes. For teams, group entries, or multiple videos submitted by an individual, a single donation of $10 will be made. Novo Nordisk will make a total donation of up to $25,000."  For more information, visit the Young Voices website and raise your voice!  :)

That's all for the goodie bag today, aside from piles of tissue paper that Siah is already dancing around in.  

Oh, one last thing:  I bet I'm the last person on the whole damn internet to see this video clip, but have you caught the drunken Orsen Wells commercial?  The moment at 0:51 made me laugh so hard that I watched it several times over.  "MmWaaaHaaa ... the Frensh!"

October 17, 2008

Insomnia.

In need of a cat nap.Back in high school, I used to have wicked insomnia.  I would lay there in bed for hours, unable to fall asleep.  Then I'd get stressed out because I couldn't fall asleep, which kept me awake longer.  Reading a book didn't help.  Watching tv didn't help.  Warm milk is gross, so I didn't even try that.  And some mornings, I would fall asleep during anatomy.

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

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

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

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

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

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

Being sleepy = being absentminded.

Being absentminded = dodgy diabetes control for the day.

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

October 14, 2008

Fran's Diabetes Parade.

A cup of coffee with a fellow diabetic.  :)There's that instant connection between people who have diabetes, because we really know.  We know what it's like to test blood sugars, count carbs, wrangle in pump tubing, battle numbers, fear complications, and live life with this disease every single day.  We get it, physically and emotionally.

And then there are the people with diabetes who you connect with, regardless of the disease bond.  When I heard Fran Carpentier take the microphone at the Women's Empowerment, Diabetes, and Development event (sponsored by Novo Nordisk, World Diabetes Foundation, the MDG3 Global Call to Action, and the Global Alliance for Women's Health), I knew this lady was on my wavelength.

"I didn't cry when I was diagnosed because my mother was too busy fainting," she said with a loud laugh, filling the room with her warmth and charismatic spirit.  Type 1 for over 39 years and a Senior Editor at Parade.com, Fran looks healthy, sounds healthy, and has a seemingly unbreakable spirit.  And she's passionate about diabetes.  Diagnosed in 1969 and "Patient No. 2" of the landmark DCCT trial, Fran stated confidently, "You not only survive, but you also prevail!"

After the speakers finished their presentations, I made my way over to Fran to introduce myself.  Instant connection - we started comparing diagnosis dates, insulin pumps (we're both Medtronic users these days), questions about CGMs, and talking about those moments that only another diabetic woman can understand. 

"So my pump is here," she reached into her shirt and pulled out her insulin pump.  

I laughed.  "Mine, too.  In the bra is the best place to hide it in a dress!"  

We sat at one of the tables in the conference room and chatted without effort.  Life as a diabetic, life as an editor, growing up in RI versus growing up in NYC, insurance battles (at that time, I was mid-stream in my war with Oxford for the CGM), and diabetes blogs.

"I've been a diabetes blogger since May 2005.  It's a fantastic way to connect with other diabetics, and to help me feel like I'm not the only one out there who is dealing with this."  I grinned at her.  "It's what connected me to dLife in the first place." 

"I know!  I've read your stuff!  I'm starting my own diabetes blog next month at Parade.com."

The conference ended, yet we found ourselves at a diner down the street, sharing stories over many cups of coffee (don't worry - we switched to decaf to prevent off-the-wallishness).  Diabetes brought us together and gave us "war stories" to share, and we spent several hours chatting each other up.  It was like connecting with an old friend, even though we'd never met before.  

I sat across from Fran, a powerful career woman with a laugh that caused heads to turn at the diner and with her pump casually hanging out of the front of her dress, and I saw what I hoped would be my future.  Thank you, Fran, for being someone I can relate to, respect, and hope to be just like.

Editor's Note (read:  more from Kerri):  Fran's blog is live!  Check out Diabetes, Day-By-Day over at Parade.com!

October 10, 2008

Vroooom!

The Friday Six:  October 10, 2008 editionToday has been condensed into just a few little hours of productivity.  But I had a few things I wanted to share.  (Six things, to be precise.)

1.  Is anyone out there going to the BlogHer Reach Out conference in Boston tomorrow?  I will be there, proudly attending my first BlogHer event and helping raise the visibility of patient bloggers.  If you're in Boston for the conference, please email me and let me know - I'd love to say hello in person.

2.  Speaking of blogger ladies, my friend Dr. Val (formerly of Revolution Health) has launched her new site:  Getting Better with Dr. Val.  The site has an accessible tone, a great look, and is definitely going to be one of my regular Internet stops.  Val also offers up some seriously funny medical-themed cartoons, which I'm so happy to see because I feel that humor is a HUGE part of disease management.  A little laughter goes a long way.  Be sure to check out Dr. Val's new site!

3.  Dates and times for another Fairfield County Dinner are being tossed around - any new takers?  Looking to do something in the first or second week of November.  Meet-ups are happening more and more around the blogosphere (check out Scott's Second Annual one!) and it's a great way to put a face and a voice with the blogger's we're reading.  Email me if you are available, and interested!

4.  Just a reminder:  Have you signed your name to the Google Doodle petition?  As of this morning, we have 3,097 signatures.  Let's see if we can crack 4,000 by the end of the day!  So coworkers, friends, family members, random people reading this blog, and cats across the world (use those paws and claws for good), sign it and raise your voice!

5.  In completely unrelated-to-diabetes stuff, this link (found on Twitter - imagine my shock) made me giggle.  Actually, it made me laugh out loud, so loud that I think I startled co-workers.  Nothing like the relationship battles between what appear to be overgrown Dots candies

6.  And in just a few hours, I'll be making the worst financial decision of the year and heading off to RI to pick up my new car.  (THANK GOD - the Jetta and I have not even been speaking for the last month.)  I'm excited and terrified, all at once.  And I know I'm going to be a lunatic about keeping it pristine because, well, it's part of my OCD charm.

Have a good weekend!!! 

October 07, 2008

Doodle For Google.

A Doodle For Diabetes!You know those cool little drawings on the Google homepage?  The moaning man on Edvard Munch's birthday?  Or the one of the turkeys sitting around the dining room table to mark last year's Thanksgiving holiday?  (That one was pleasantly ironic.)  These doodles are done up by the Google crew to raise awareness for specific events and holidays.

And this year, the diabetes community is aiming to have a diabetes doodle for World Diabetes Day on November 14th.  

"How can I help?  I can't even draw a straight line!"

Yes, there is something you can do.  The advocacy crews at Diabetes Daily and TuDiabetes have teamed up to get Google's attention by providing a petition with 20,000 signatures by November 1st.  That means we only have the month of October (which is whizzing by) to get names added to the petition. 

Sign the petition by clicking here.  Add your name, then share it with your coworkers.  Send it to friends.  Family members.  Buddies from Facebook.  Your Twitter pals.  Ask your brother (Hey Darrell) or your sister (Hi Court) or husband (Hi Chris!) or your mom or dad to sign.  Maybe even send it to the nice man at the Honda dealership who is working to get you a new car at a reasonable finance rate.  (Hi, Bill!)  Either way, 20,000 signatures isn't going to be easy, but if there's any community that can pull it off, it's us.

I think it would be pretty damn cool to have our own Google doodle.  Let's make it happen!!

October 03, 2008

Approved!!!

I have been approved!!!!!!!

YAY!!!!!!

They're covering my sensors.  I cannot believe it.  And from what I've been told, I'm one of the first on Connecticut's Oxford Health Plans to be approved for CGM use. 

Also from what I've been told, it takes an external appeal to make it happen.  So if you are fighting for CGM coverage, DO NOT GIVE UP.  Keep fighting!  Appeal every denial.  Make sure you don't miss any appeal deadlines!  It seems like insurance companies deny everything at first and only approve once you battle back.  So keep fighting, and do not give up!  (And use exclamation points!  Ahhh!  I'm so excited!!)

The tools to live well with diabetes should not just be for the people who can afford them.  Fight for your right for coverage.

October 02, 2008

A Unified Front.

United by diabetesTmana wrote a post on TuDiabetes today that hit home and hit hard. An excerpt:

"I am concerned that these different outlooks and interests could, rather than unite us in the common cause of improved quality of life and life expectancy for people with diabetes, cause public conflicts that could rob all of our communities of the resources needed to assist diabetics, both within our online communities and outside of them."

I agree with this whole-heartedly.  While I'm an in-house editor at dLife, a member of several online communities like TuDiabetes, Diabetes Daily, a diabetes blogger here at SUM, and an active supporter of organizations like the JDRF, ADA, CWD, and DRI, these things all come second to why I'm doing this in the first place:  I am a person with diabetes, a diabetic, a type 1, pancreatically-challenged ... whatever you want to call me, I have diabetes, first and foremost.

What I care about is improving my life, and our collective lives, as we live with diabetes.  I want to see support communities do just that - SUPPORT.  The very concept of different online groups pitting against one another is ridiculous.  Aren't we all working towards the same common goal?  To live long, healthy, and well-supported lives with diabetes?  To see technological improvements?  To see a cure, maybe in our lifetimes? 

Everyone has different agendas and different goals - I understand that.  But I also understand that diabetes is not a business to me.  It's my life - our lives.  And anything that can improve that life should be supported and encouraged, despite whether or not I'm a member or if I participate in a fundraising walk. 

And while I understand the business aspect of different companies and organizations, I don't like the idea of division.  I don't like the idea that three different places are working their tails off to cure this disease, but not sharing the data.  I am not sure who crosses what communication lines, but I want to know that the JDRF, DRI, and other research hubs are sharing their theories on curing this disease.  That is happening, right?  We're all working together to cure this, right?  There are so many different diabetes organizations, but where is our unified front? 

In her post, tmana said that she didn't want different communities to assimilate in efforts to "merely to present a united front to the high-priced resources and partners," and I agree with that completely.  This disease is unique to each diabetic and their loved ones, and the various communities and organizations reflect that.  But I want the diabetes communities to mature and embrace one another instead of ostracizing and battling.  It sounds altruistic, but we're not talking about t-shirts here.  This is about a disease, a serious one, that we live with every day.  And while we rally behind all these different organizations, we need to remember - never, ever forget this - that we are really rallying behind one another as a community of diabetics, regardless of whose newsletter we receive or whose network we have a username in.

The "industry" of diabetes continues to grow, especially as more and more people are diagnosed every day.  But we can't lose sight of the most important aspect of these communities and organizations:  Support.   And I value the support I get from you guys here on the blog, outside in your blogs, in-person at dinners and events, and all over the internet and the Real World as a whole.

We are all living with diabetes.  Standing together does far more than walking alone. 

September 29, 2008

Walking The Walk.

Sunday morning, bright and much earlier than I was ready for, I found myself at Cranbury Park in Fairfield County for Connecticut's JDRF Walk to Cure Diabetes.  Despite the rain and the extremely muggy conditions, Team dLife represented and made me proud to be a part of the crew.

The walk, for some reason, wasn't along a track but instead was along a mild hiking trail.  This was fine for people who were able to traverse the rocky terrain, but for some parents piloting strollers, it was tricky indeed. (Note to CT JDRF:  Maybe you should have called it the JDRF Hike for a Cure?)

I had the pleasure of being escorted by my co-worker's daughter, who is four years old but wise well beyond her years.

"Let's go in the wood!  We can camp in the woods.  I saw a movie about bears.  And snakes.  I saw a snakes movie.   Hey, there's a path - let's go that way and we can camp in the woods overnight!"

"No way!  Your mom would be mad if we went camping without telling her.  And why do you have so much energy?  Did you drink a whole pot of coffee this morning?"

"I drank ten pots of coffee." She turned to be and gave me a 1,000 watt grin.

I believed her. 

Team dLife 2008!

Working at dLife, as a person with diabetes myself, is a unique experience because I walk the walk and talk the talk.  But at the JDRF event on Sunday, it was nice to see everyone walking the walk, right alongside me.

Thanks to everyone who came out to the walk, and onward to the RI JDRF walk on October 26th!

September 25, 2008

When At First You Aren't Approved - Appeal, Appeal, Appeal.

There's a lot of buzz in the blogosphere today about insurance denials and appeals, starting with an article in the Wall Street Journal about "Pushing Back When Insurers Deny Coverage For Treatment."  Scott Strumello brought this article to my attention this morning via his comprehensive blog post about it, and Bernard sent me there again with his perspective.  And after reading everyone's take, in addition to having experienced three denials for CGM coverage from my insurance company (Oxford Health), I realize that I have gone at this problem the wrong way.

Insurance companies don't care about my future baby.  They don't care about my A1c.  Unfortunately, insurance companies are watching dollars and cents, not good sense.  A passionate letter from a patient doesn't even come close to moving an insurance company to provide coverage or overturn an appeal.  They seem to respond to "the facts" only, and I should have attacked them with facts to begin with.  Instead, I took the personal approach, which left me denied three times.  And it's partially my fault because I expect them to care, even when I know they won't.  My approach was arrogant, thinking they'd respond to actual emotion.

But this time?  No emotion at all.  This appeal was just the facts, ma'am.

I sent the Connecticut Department of Insurance a packet of information this morning, in hopes of having my Dexcom CGM system denial overturned.   I included the following:

  • Request for External Appeal form (my insurance information, healthcare provider information, detailed description of disagreement with healthcare plan)
  • The denial letter from Oxford Health Plans, stating that their decision is final
  • Proof that the service in question is a covered benefit (this was in the form of my insurance policy benefit handbook)
  • Executed medical release form
  • Photocopy of my insurance card
  • Documentation supporting my appeal, including a letter from me, my endocrinologist, and Dexcom
  • Oh, and a check for $25.  They specify that this is non-refundable. 
Insurance appeal packet - heavy.

Under the guidance of the Region Managed Care Director at Dexcom, the supporting documentation I included was very factual and devoid of almost any emotion.  My personal letter, which was written with the help of the Dexcom rep and is so stoic and so dry that it doesn't even sound close to anything I would say is supposedly an example of what "will work."  The letter from my endocrinologist cited my elevated A1c, the ADA A1c standard for pregnancy, the Factor V issue, 22 years of IDDM, and various complications I've experienced (including the cotton wool spot, high blood pressure, etc).

Dexcom also provided a packet, which included the recent NEJM study results and other studies supporting the use of CGM technology to better control diabetes.  The letter from my Dexcom rep included a demonstration of the proven benefits of CGM technology on health outcomes, and also outlined the appeal-denied-appeal-denied cycle that I've been in for the last few months.

So it's in the FedEx box now and waiting to be sent off to the Connecticut Department of Insurance.  Each item is tabbed and in the order requested by the appeal form.  It's on time, comprehensive, and fact-filled.  I hope this appeal gets my CGM approved.

The only frustrating part of this process was that I couldn't really lash out.  I couldn't tell these insurance companies what I was really thinking, which was along the lines of "WHAT THE FUCK IS WRONG WITH YOU?  CAN'T YOU SEE THAT THIS TECHNOLOGY WORKS AND I WANT A HEALTHY PREGNANCY AND WHO ARE YOU TO TELL ME I'M NOT APPROVED?!!"  (Ahem.  Sorry.)  It's infuriating to play by their rules, but I'll do whatever it takes to obtain approval.  It makes me absolutely crazy that this technology exists and it has worked for me and it's still not covered.  Don't insurance companies want people to remain healthy?  Isn't there a cost-benefit to them for acting proactively instead of reactively? What is wrong with this healthcare system?!

I'll wait patiently.  I'll hope that this fact-driven approach gets me somewhere.  And I'm very thankful for the assistance and support I've received from Dexcom, dLife, and my friends and family.

But I had to get my digs in somewhere - the memo line of the check is "ridiculous fee for appeal."  Jerkface insurance company.  They're messing with the wrong girl.

(I hope.) 

September 24, 2008

Kiss Diabetes Goodbye!

Us Barton girls stick together - it's a proven fact.  And when a Barton girl emails me about her efforts to raise funds for diabetes research, I have to do what I can to help her raise awareness.  Meet Valerie Riordan, both a fellow Bartonian and a type 1 diabetic, and her campaign to Kiss Diabetes Goodbye!

Kerri:  What is your diabetes story?

Valerie:  I, like you, was diagnosed with type 1 diabetes in August 1986.  Twenty two years ago this week.  It was one week before my 11th birthday.  That was one birthday I'll never forget!  I remember seeing the doctor the day after I was diagnosed.  He told me I couldn't have cake and ice cream at my birthday party.  I was devastated.  What's a birthday party without cake and ice cream?!  And so a life with diabetes began.

It hasn't always been an easy road.  I am very thankful that early on I found many friends and a very large support group in Clara Barton Camp.  At home I was the only one in school who had diabetes.  At camp I was one of many.  I loved being in a place where everyone understood.  I wish those camp years could have lasted forever.

However, my camp days did come to an end, and when they did I suffered a little diabetes rebellion.  I didn't want diabetes, so I was going to pretend I didn't have it.  I cut so far back on my insulin that I pretty much wasn't taking any.  The same was true for food.  That was pretty much nonexistent as well.  Of course I wasn't seeing my endo at this point either.  I got very, very skinny, but in my mind I was in control.  Even though my diabetes wasn't.

Fortunately for me, there was a new endo at the office I went to.  She really helped rescue me.  She got me and my diabetes back on the right track.  She was very encouraging and didn't lecture me.  With her rooting me on, I worked really hard to pull things together.  But there were still a lot of ups and downs.

Then in August 2000 I got married.  A year later, my husband and I were ready to start a family.  Then before I could even come up with a plan with my endo, I found out I was pregnant.  I, very quickly, whipped myself into shape with a lot of help from my endo.  When I was 4 months pregnant my endo started me on my first insulin pump.  Suddenly I was in the best control I had ever been in.  My A1C went from 8 to 4.8!  I amazed even myself.  My very healthy baby boy was born in May 2002.  Then I was blessed again with a beautiful little girl in August 2005.

Now at ages 6 and almost 3, they are seasoned veterans of diabetes.  They watch me do my blood tests everyday.  In fact I had to give my daughter one of my old machines to play with.  She kept swiping mine because she wanted to do a blood test like mommy.  They know mommy's pump is not a toy, but occasionally they get to help mommy by pushing the blue button.  My daughter loves to help me out by putting my pump in my pocket for me.  They know that when mommy's blood sugar is low I need sugar fast and they know exactly which soda to get out of the refrigerator for me.  And my son amazed me when he had to get blood taken one day.  They put the needle in and he didn't even flinch.  He said he knew it wouldn't hurt because he watches mommy get it done all the time.  

They don't know my life without diabetes.  They only know their mommy has diabetes.  For all they know I've always had it.  That's okay for now, but I hope someday that will change.

For now I just do my best to take care of myself, not only for myself, but for them.  So I may enjoy watching them grow for as long as I can.

Kerri:  What is the inspiration behind 'Kiss Diabetes Goodbye'?

Valerie:  A friend of mine, who's son has diabetes, told me about Dr. Faustman and the research she was doing. (Editor's Note:  YAY Dr. Faustman!)  She was very enthusiastic about wanting to do something to raise money for this project and she wanted me to be involved in it. She had an idea of what she wanted to do, but couldn't quite seem to make it happen.
 
Also, the mom's group that my friend and I belong to was getting involved in doing community service projects.  They were looking for fund raising ideas and charities to give to. So, I began thinking of some ideas.

While I was trying to come up with something, I came across this idea on the Arbonne yahoo group that I belong to.  It seemed like perfect timing!
 
Kerri:  What makes your fundraiser different from all the other diabetes fundraisers?

Valerie:  Having a son in elementary school, I've seen many fundraisers come through my house.  I feel this fundraiser is unique because it's different than anything I've ever seen, it's affordable and it's something I would use.

Continue reading "Kiss Diabetes Goodbye!" »

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 19, 2008

Arghhhh, Me Hearties.

The Friday Six:  September 19, 2008 edition

Holy late post, but better late than never, right, me hearties?  (Oh, this pirate crap will be the very death of me.)  Jumping right into this week's Friday Six!

1.  Yes, it's Talk Like a Pirate Day.  In celebration of this silliness, I offer you the Pirate Translator, some pirate jokes, and a Twitter avatar, courtesy of my extremely silly brother:  Kerri the pirate.

2.  The JDRF is still taking applications for the 2009 Children's Congress - but not for long!  The deadline for application is October 6, 2008, so if you and your child are interested in applying and representing the diabetes community before Congress, now is the time to apply.  Visit the JDRF website for more information.

3.  Another D-related event is the First Annual Diabetes Rockstar Cruise, brought to you by the folks at Diabetic Rockstar.  According to Sara, a SUM reader and a member of the Diabetic Rockstar crew, "The most exciting part about the cruise is that Carnival has a program called Cruising for Charity, where we will be receiving a portion of the proceeds for Fight It! our charity arm at Diabetic Rockstar.  Our funding goes to uninsured, in-need and newly diagnosed diabetics who need supplies and additional help."  Unfortunately, I won't be attending this event, but if you're interested in learning more about this cruise, taking place next May, visit the Diabetic Rockstar website

4.  And in my own personal diabetes news, I've been embroiled in the battle with Oxford Health of Connecticut for CGM coverage.  Fun.  (Sarcasm.)  I have a solid insurance representative at Dexcom who is helping me get all the paperwork together for my external appeal - yes, this is the one I have to send them a CHECK for, greedy bastards - and I'm working with my endocrinologist on a letter highlighting pre-pregnancy planning and the need for tighter diabetes control.  This is a paperwork nightmare, and now I understand why lots of people never get to this stage of the appeal, because it's so damn complicated.  BUT I am moving forward and will file this external appeal by the end of next week.  Hopefully this will overturn my previous three denials.  In any event, I'm almost positive they won't refund the $25 filing fee.  Pricks.  ;) 

5.  On the Children With Diabetes site, there's a short video about Friends For Life 2008, and you'll find a smattering of diabetes bloggers in there, including Sara, Heidi, Bennet, and me!  (And I look seeeeerious, since they caught me in the pregnancy seminar and I was all panicked ears.)  Check out the video!

6.  And I'm still woefully behind on vlogging, but I'm hoping to get a clip up here by Monday or Tuesday.  Next week is pretty nuts - I have plans for dinner in the city, I'll be at a seminar at the UN midweek, and I'm gearing up the dLife crew for our JDRF walk next weekend - but I need a little face-time.  I'm sort of short on vlog topics - any ideas from you guys?  For now, all I have is this sort of crummy quality clip from The Swell Season show on Wednesday.  I have another one, of one of their new songs, that I can post this weekend after I pull it from my KerriBerry

For now, I'm off to RI for yet ANOTHER wedding this weekend (btw, Chris and I have been married for four months as of yesterday - holy cow!) and to spend time with the family.  You guys have a great weekend!!!

September 12, 2008

Le Friday Six.

(That title's for you, CALPumper!) 

The Friday Six:  September 12, 2008 editionI need a break.  :)  Here's The Friday Six, because if I had to string more than three sentences together, my brain would turn to ice cream cake.

1.  I'm looking forward to the fourth (had to edit - there have been three already and my brain went to mush on this fact) Fairfield County dinner on Monday, September 15th.  So far, there are about seven people coming and I'm excited to meet everyone.  If you live in the Fairfield County area and I missed your email, drop me a line at kerri (at) sixuntilme (dot) com and I can send you the specifics.

2.  Also, the first winners of the TuDiabetes "Word In Your Hand" project are up, and they are remarkable.  (My personal favorite is the "secret" one ... very cool photo.)  If you want to get involved and submit your photo, check out the details on TuDiabetes, and say hi to Manny and Landileigh!

3.  And I'm proud to say that Blogabetes turns one year old this month.  I've had the pleasure of working with Carey, Nicole, Julia, Lindsey, SuperG, Rebecca, Michelle, Kim, Andy, and Scott over the last twelve months, and I am always impressed and inspired by their writing.  If you haven't visited dLife to spin through their posts, you're really missing out. 

4.  In news I'm confused about, I've received several emails from companies asking to make me "part of their blogging team" by adding my posts to their RSS feed.  I don't mean to sound daft, but is that a good thing?  I know plenty of other bloggers have been approached by these kinds of companies and I'm still on the fence about whether or not that's a good thing, since I've also heard that Google penalizes you if you reproduce blog content across the wilds of the Internet.  For my fellow bloggers - how are you guys handling these requests?  Do you let them add your feed?  I am unsure how to handle these requests and I don't know enough about Google to guess if this is a good idea or not.  Help!  I need brain power from the blogosphere. 

5.  dLife has been subjecting me to cute overload this week, starting first with some of dLife's finest teeny dogs and culminating with a crate full of newborn baby chicks.  My co-worker has chicken business (I know) and he brought in a dozen baby chicks for the morning, so we could all coo and chuckle over them.  They are so damn cute.  I stumbled upon my co-worker, diligently answering emails with a baby chick in his pocket.  I love my office.  It's productive, yet eccentric.  I dig that.

6.  And thanks for your uplifting messages yesterday.  You guys, with a little help from Fudgy the Whale, made a bit of a dreary day much brighter for me, and I really appreciate it.  I know I've said it before, but this community is one of the best things to happen to diabetics since ... well, insulin, and you all make this journey a little easier.  So thank you.  And go get an ice cream cake, because damn that makes everything better. 

Unfortunately, no time to vlog this week.  But next week, I will definitely think of something worth waxing on about and will fill your computer speakers with nonsense once again.  Until then, have a great weekend and I'll bother you on Monday.  :)  

September 10, 2008

Diabetes For The Day: Third Edition.

I've said it before, but I must say it again:  my co-workers are a rare breed.  They are funny, brilliant, and they actually care about making a difference in the lives of people with diabetes.  Another co-worker took the Diabetes For The Day challenge, and wrote about what it was like to test all day and wear the newest version of the "faux pump."  (This one was a definite upgrade from the Kool-aid box of yester-post.  We used a Freestyle flash meter as "the pump" and taped an infusion set, sans needle, to the back of it.)  Here's her take on a day with diabetes.

Meter, with infusion set attached, serves as a pump for our experiment.

Kerri:  You wore a “pump” and tested your blood sugar throughout your day with diabetes.  How did you feel about these devices?

Co-Worker:  At first I thought it was kind of fun to know what my blood sugar was, but after maybe the second prick, the novelty wore off. It hurt and seeing my numbers go up and down freaked me out. The pump was a huge pain. At work it wasn’t embarrassing but outside of the office, I felt like everyone saw it and wondered about me.

Kerri:  You wore the pump all day and overnight.  Was it comfortable?  How was sleeping with something attached?  Showering?  Was it difficult to dress for?  Did you almost drop it into the toilet at any point?  ;)  

CW:  It was relatively comfortable, comfortable enough that I would forget about it until I caught the tube on something and felt the yank on my “infusion point”. I was nervous about sleeping with it since I don’t own pajama bottoms with pockets but I was able to tuck it under my pillow. I slept fine but woke up with the pump halfway across the bed. I wore pants with pockets the day I had my pump so I didn’t have to worry about where I would stick it. However, I wear a lot of dresses and I could see that being a big pain. I didn’t drop it in the toilet but only because I was paranoid that I would.

The infusion set, without the needle inserted.
My co-workers put up with a lot from me, and they even wear fake pumps to help them understand.

Kerri:  Did physical evidence of diabetes (i.e. wearing the pump) make you feel self-conscious?

CW:  At work, I felt normal, even proud of what I was doing. However, the second I left, I felt awkward, especially when a friend nearly pulled it out and I had to explain what it was and what I was doing. 

Kerri:  How did testing your blood sugar affect the way you thought about food?

CW:  It made me aware of how many carbs I eat and that it is probably contributing to the fact that my blood sugar was all over the place. It also made me less likely to snack because I wanted to avoid testing.  I remember thinking, "A piece of candy is already in my mouth before I think about testing. Did I just mess up? Man, this is annoying. Diabetes sucks."

Kerri:  Did you find the blood sugar testing to be painful?  How comfortable were you with the process?

CW:  After the first or second time, I started to really wince every time I had to test. The sharp pain only lasts a moment but it made my fingers sensitive and bruised. I felt pretty comfortable with the process because I’ve tested before and I’m not afraid of blood or needles.

Kerri:  How did the blood glucose numbers make you feel? Did any of your results make you raise an eyebrow?


CW:  My blood glucose numbers made me feel anxious. I was like a roller coaster, relatively high and then a few hours later, relatively low. If I hadn’t had Kerri around to reassure me, I would have freaked out.  After a bagel with cream cheese and an iced coffee with Splenda, two hours later I was at 141. I panicked. 141, that’s bad! (Right, except you have a pancreas, give it a second woman). Kerri assured me that I was fine. 

(Editor's note:  Her blood sugars hit highs of 140 mg/dl after a high carb lunch.  So "high" by her standards was a little different than my highs.)

Kerri:  Do you feel as though you have a better idea of what life with diabetes is like?  What else would you want to know?  What are you grateful for not knowing?

CW:  I still don’t think I have a clue what it must be like. I did it for one day. I didn’t change my diet, I didn’t have to take action when my numbers went out of their normal range. I can’t imagine having to test every day. Given that experience, I would rather not know any more.

Kerri:  Did this experiment make you appreciate your health any more?  Less?


CW:  It made me appreciate my health tremendously. That my body functions and regulates things on its own is a blessing most people don’t take notice of.

Kerri:  Do you think other people who are close to diabetes, but aren’t diabetic themselves, should spend a day as a diabetic?


CW:  I think everyone should.

Kerri:  Anything else you want to add?


CW:  Kerri is pretty awesome. (Editor's note:  YAY!)  And diabetes sucks.  (Editor again:  Word.)

September 09, 2008

Lunch Hour Education.

Not in the mood to educateDuring my lunch break yesterday, I dropped by the local Ann Taylor store to poke around in their sale rack.  An older woman, maybe about 55 years old, approached me and asked if I needed a dressing room started.

"No, I'm all set, thanks.  I'm on lunch, so this is just a quick visit."  

"Oh!  You work in the area?  I've seen you in here before."

"Yes, I work at dLife."

She pursed her lips.  "dLife?  What's that?"

"It's a diabetes media company.  We have a website?  And a show on CNBC about diabetes management."  I ran my fingertips down the seam of a black dressy top that I loved.

"Diabetes.  Oh, the sugar!  I have that.  I have diabetes and my doctor told me to try and lose weight."

"That's good!  You're taking the right steps."  I moved away a little bit, perusing another sale rack.  She followed me.

"You know, I see all these fat little kids at the high school when I drop my daughter off.  I see them and I can't help but think that they are all going to get diabetes.  Like me.  They'll end up taking shots and losing their eyesight, you know.  Diabetes is a very serious disease."

I smiled at her.  "Diabetes is a very serious disease.  But diabetes isn't always caused by being overweight.  There are different types of diabetes."

"I know.  The kind I have?  It's because of being overweight.  My ex-husband told me that."  She adjusted her glasses.  "But I want to lose the weight so I don't end up taking shots.  Did you know that some people have to wear a machine all day long that gives them their shot?  My goodness.  Those people must be sick as can be.  No ma'am, I don't want that to be me.  I take my pills.  I'm not going to end up like those people."

I was on my lunch break.  I didn't want to get into a big diabetes discussion while I was shopping.  But I couldn't let this lady ramble on, thinking diabetes was her fault and also thinking that pump wearers are on their death bed.

"Well, diabetes isn't your fault.  It's a disease, not a guilt trip.  But it's good that you're taking your pills and trying to lose weight.  That's a step in the right direction.  I also have diabetes - type 1 - and I wear one of those machines that gives me insulin all day long."  I smiled again, trying to show her that I wasn't dying.

"Oh my.  How long do you have?"

"Excuse me?"

"How many years?"

(Is she seriously asking me this?) 

"Left?  Ma'am, I'm not dying.  This machine doesn't mean I'm dying.  It's just another method of insulin delivery.  So instead of shots, I wear this pump.  It's okay.  I'm in good health.  I've been diabetic almost 22 years.  It's complicated, but it's not my fault.  Diabetes brings enough to the table - we don't need guilt, too."

"Well, I don't want to wear that thing."  She gestured quickly towards my pocket, where my pump was clipped.  "I'll just keep taking my pills.  I don't want my diabetes turning into what you have.  No offense, sweetie.   You look very healthy, and I never expected you to have it, too.  And I never expected yours to be that bad."  She smiled sweetly, making her remarks sound even more ignorant.

I'm all about educating people and raising awareness.  But sometimes I'm not up for the challenge.  I wanted to buy a pretty shirt, go to the bank, and then go back to work.  I didn't have the patience to be tolerant that afternoon.

"That's great, ma'am.  I wish you and your health all the best.  And just so you know, I don't want to wear this pump, either.  But it keeps me healthy.  And I want to be healthy.  Have a good one."

Turned on my heel.  She was still talking, something about "We're having a sale on suits, did you know that ..."

Lady, if I have just one day left or a million years in my future, I don't want to spend another minute of it talking with you.

September 08, 2008

CGM Study Shows This Stuff Works!!!

My insurance company still says NO to my request for approval of a continuous glucose monitoring system.  But - a ha! - a study conducted by the JDRF has given me something to print out and mail along with my third appeal.  Thanks to several dozen emails this morning directing me to the study and special thanks to Cynthia Rice, Director of New Technology Access in Washington, DC, I now have the inside scoop on why insurance companies should listen up and listen good:

Kerri:  This study quantifies the value of a continuous glucose monitoring device for people with type 1 diabetes, in particular, for adults aged 25 and over.  How did individuals over the age of 25 fare using this device?

Cynthia:  The study found patients with type 1 diabetes who used continuous glucose monitoring (CGM) devices to help manage their disease experienced significant improvements in blood sugar control. Overall, adults 25 and over lowered their A1c by .53%; were more likely to lower their A1c by 10%; and were more likely to reach target below 7.0.

Kerri:  In regards to the younger group, the kids under 15, how were their results similar or different?

Cynthia:  Children under age 15 using CGM were more likely to lower their HbA1c by at least 10% and achieve HbA1c levels below 7% compared with non-CGM users.  At the same time, the average decrease in HbA1c was not significantly different in the CGM and non-CGM groups.  Although the study was not specifically designed to assess the effect of frequency of CGM use on A1c, an initial analysis of the data suggests that patients under 15 who used CGM at least six days a week or more lowered their A1cs just as much as adults.  On average, only 50% of children under 15 who used CGM used it six days a week or more.

Kerri:  What is the assumption about the 15 - 24 age group?  Why didn't the use of a CGM make a bigger impact on their A1c values?

Cynthia: 
Fifteen to twenty-four-year-old CGM users as a group did not experience significant improvements in glucose control compared with the control group.  Although it’s clear from a preliminary analysis of the data that teenagers were the least likely group to wear the CGM near daily (30%), the study was not geared to answer this question -- however, many families with teenagers will not be terribly surprised with the result.

Kerri:  At a session at CWD in Orlando this year, Bruce Buckingham discussed how CGMs work best for people who wear them at least six days a week.  Your study appeared to confirm this statement, at least for the 25 and older group.  How does duration of use affect results?

Cynthia:  In the study, CGM use varied with age, averaging at least six days a week over the course of the trial in 83% of the patients 25 years and older, but dropping off to 30% of the 15 to 24 year olds and 50% of the 8 to 14 year olds. Although the study was not specifically designed to assess the effect of frequency of CGM use on HbA1c, an analysis presented this week at a scientific conference suggested that patients within all three age groups, including teens and young adults, who used the device at least six days a week had substantially lower HbA1c levels after six months compared with patients who used CGM less than six days a week.

Kerri:  Many people with diabetes are fighting with their insurance companies to get their CGM systems approved.  How can this study help move patients towards approval?

Cynthia:  By showing that CGM use improves glucose control, this study, published in the prestigious, peer-reviewed New England Journal of Medicine, gives justification for expanded health plan coverage of CGM.  JDRF will be briefing health plans on these results and encouraging people with type 1 diabetes and their loved ones advocate to their own health plans to cover CGM.  You can help secure coverage for CGM by clicking here.

Kerri:  And lastly, how can we, as the diabetes community, get more involved and help move research forward?

Cynthia:  When you click on this link, you can not only help secure coverage for CGM, but sign up to receive emails from JDRF on how you can advocate for federal research funding and get involved in your local community to help move research forward.  

I am Kerri and I approve this CGM.  I wish you would, too!

Thanks for your time, Cynthia!  And for more information on CGM insurance coverage, you can visit the JDRF website, sign the CGM Anti-Denial Petition, and check for more CGM updates here on SUM.

Code Word - "Shoot Up."

Code word:  Shoot up!We know we have a special language - it's been confirmed in several editions of dTOES - and almost all of us in this community recognize the different terms.

But sometimes, those terms drop from the mouths of our friends, and the sound always amazes me.

Like yesterday morning, I was having a marathon phone conversation with Batman, and she mentioned that she told one of her co-workers about me having diabetes.  "I was like, yeah, Kerri is a type 1 and she wears an insulin pump ..." and she kept talking but the phrase "a type 1" stuck in my head.  Batman and I don't talk about diabetes much, but she's one of my closest friends and this language has become part of her vernacular almost by osmosis. 

It's my diabetes and my disease to manage, but my closest friends and family members are so tuned in to it that they don't even notice anymore.  Needles in my purse are par for the course.  Looking at me and casually mentioning, "Ker, your wire is out," happens all the time.  "Whoa, that'll empty out a pump," after seeing a huge dessert delivered to a table.  Smooshed granola bars and stashes of juice boxes have found their way into everyone's glove compartments, and I'm not even sure they realize it.  Numbers like 98 and 112 become amusing - "Hey, that's like a perfect blood sugar!" - and people's mentions of "juvenile diabetes" are quickly corrected as "Yeah, they used to call it that but now it's type 1 diabetes." 

"Oh my gosh, that looks delicious  You think like 40 grams of carbs?"
"Dude, let's go in the water.  Throw your pump in the cooler!"
"We've got everything we need for the hike:  water bottle, sunscreen, and sunscreen." 

They "get it," but the best part is that they don't realize how much they've "gotten it."  Their level of understanding is so intrinsic and instinctive that they barely notice. 

I rely on these people so much.   My meter gives me blood sugar results and my pump delivers life-sustaining insulin, but my emotional health is nurtured and cared for by my outstanding support team.  It blows my mind to think about how many people are really needed to keep me healthy.  My endocrinolgist and my primary care physician monitior my physiological progress and keep me steeped in information.  My ob/gyn keeps tabs on my reproductive system and helps me prepare my body for baby.  My retinologist watches out for those pesky eye issues.

But there's so much more than just the doctors with initials after their names.  There's my mom and dad remind me that regardless of how old I become, I'm still their daughter and still their worry.  My brother and sister, who know how to support without smothering.  My close friends, who make sure my life is as free as theirs, but just in case, they keep juice at the ready.  And my husband, who loves me in sickness and in health, not letting diabetes define our relationship - or us.

"Oh, the food's here.  Time to shoot up."  

That's a phrase only a diabetic, or a person who cares for a diabetic, would understand.

August 29, 2008

I Love The Dirt.

The Friday Six:  August 29, 2008 editionIt's been almost a month since my last Friday Six, so I thought I'd dust off the photoshop file and revive it for this fine Labor Day weekend.  You know why?  Because I'll be in the woods this weekend.  Camping in the wilds of Maine.

Stop laughing. 

So yes, Chris and I are making the long trek to Maine this weekend to spend our holiday in a tree.  I mean in the wood, camping.  And before you collapse into laughter, I have camped before.  Back in high school, my friends and I used to go camping in the summer all the time.  I love hiking, and there's something so serene about being in a place where there's no television blaring, computer whirring, or people connected to any kind of network.  We're camping out in Acadia National Park one night, then staying at a bed and breakfast in Bar Harbor the next.  I'm very excited to disconnect from EVERYTHING for the weekend.  And it's my first camping trip with the pump, so I'm hopeful that I can keep it clean and safe from the freaking bears. 

In the spirit of camping, long car rides, and packing (oh my!), I've realized that a simple walk in the woods requires some serious backpack stocking-up.  We hit the grocery store last night and I bought several protein bars, high-carb power bars, and a few sports bottles of juice.  At home, I took quick stock of the supplies I need to bring "just in case," like insulin and syringes in case my pump craps out in the woods (i.e. stops working, not craps out in the woods ... you know what I mean), extra infusion sets, test strips, and a cooler to store all the cool-temperature supplies in.  Diabetes means hoping for the best and planning for the worst, and for me, that translates into not packing light.  (We did pack marshmallows, a chocolate bar, and graham crackers, of course.  We are going camping, after all, and what's a night around the campfire without s'mores and insulin?!)

In quasi-political news, a certain flash file made me laugh out loud.  Something about the iced coffee and the grinning faces made my day.  And Biden doing the Cabbage Patch in the back seat.  See for yourself and blame my brother for sending me the weirdest things on the internet.

Team Six Until Me is walking again at the Rhode Island JDRF Walk on October 26th!  If you are in the RI area and you'll be at the walk, please come by and say hello!  Just look for the rag-tag crew of silly people, anchored by my grinning head and the grinning heads of my friends and family. 

Last week, Chris and I visited NYC and went to the Top of the Rock.  Yes, it's a big ol' tourist draw and I can't pretend to be anything more than a tourist.  (I'm from Rhode Island - we hardly ever leave the borders of our own damn state! Living in CT is like breaking all the rules.)  Anyway, going to the top of Rockefeller Center was very cool.  The view, as you can imagine, is remarkable.  Of course we took a pile of pictures.  We haven't had much time to get into the city lately, but I'm always impressed with what it has to offer every time I go.

And unfortunately, I haven't had a chance to do a vlog this week, but I'll do one early next week.  And I think I may need to finally respond to the gauntlet laid down by Mr. Bennet himself - for the Whack-A-Meter challenge.  I have plenty of old school meters in my home that don't work and I don't think there are even strips being made for them anymore.  It may be time to take out my aggressions on those symbols of diabetes.  Anybody with me?   It may actually feel good.

Have a good three-day weekend, and I'll see you on Tuesday!  (After I pick the spiders out of my hair.  Oh good Lord.)

August 28, 2008

Everybody Exercises.

There are days when I feel like I'm draaaaaging myself to the gym.  Literally, like scooping my legs off the floor, forcing them into my workout clothes, and dawdling over to the door.  The weeks after the wedding and through the beginning of August were particularly hard, because my numbers were on the level of "sucking royally" and my body was infected with a general feeling of "vlah." 

Thank goodness that Chris is usually ready to roll.  It helps to have someone who is also dedicated to being healthy, because it makes it easier for me to keep from slacking off due to my own laziness or vlah-ishness.  Especially when work gets busy and freelance is hopping - getting my sorry butt to the gym becomes a real challenge.  Chris and his equal quest for good health and a long life serve as more motivation to get moving.

It also helps that the Sausage does her part.  

By trying on my running shoes. 

The cat wears sneakers.  Enough said.

Wrong foot, Siah.  The other one.

There you go, Siah.

There you go, piggy.  That's the correct foot.

Diabetes requires support on all fronts.  Even from the cat. 

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 26, 2008

Corn On The Carb.

Elizabeth Joy Arnold(Editor's note:  Sometimes I like the title of a post so much it makes me smirky.  Man, I love a good pun.) 

Today's post is from my friend Elizabeth Arnold.   Elizabeth is the bestselling author of two novels, with a third due out next summer.  She’s been diabetic for over thirty years, and is the "proud, doting owner of two cats, a husband and an OmniPod, all of whom she considers her best friend forever."  I've had the pleasure of chatting with Elizabeth a few times and she's sharp, funny, and definitely on the level.  She offered to write a guest post for SUM, and I'm honored to have her contribution!

*   *   * 

I woke up the other morning, and my sugar was 287.  And my first thought?  Well my first thought was a word that can’t be printed on a “family” blog, but my second thought?  That I’m an idiot.  I’d eaten corn on the cob the night before (sweet New Jersey corn which has approximately a bazillion carbs), and I could only guess at the correct bolus as one cannot use Calorie King for this corn; it’s THAT sweet.  And I must’ve come up about 20 carbs short.  I know I shouldn’t really eat this corn because I rarely get it right, but you know, it is truly one of the world’s greatest foods.  I do happy dances in July when I see the cornstalks rising on local farms, and when the ears start to grow I fall on my knees in rapture, so giving it up is Just Not An Option.  So I eat and inevitably my sugar’s high, and then of course I beat myself up.   

I also despise myself for those nights my husband’s had to give me glucagon, knowing how freaked out it makes him to see me unresponsive.  (Although for some reason I never feel guilty when I catch a low myself, just think, Yay!  I get to pig out! eat 15 grams, test again and if necessary eat another 15 grams!)

But you’ve all been there, haven’t you?  You test and your number’s not where you want it to be, so you start blaming yourself for not being perfect.  I’d assume it’s twice as bad if you’re the parent of a diabetic, and–since you’re not superhuman–can’t keep your child in perfect control.  And even worse for many type 2’s who probably blame themselves for the disease itself.  The problems we face aren’t the fault of the diabetes, they’re because we’re just not working hard enough.

It can be the same with complications.  I felt guilty about my retinopathy, even though my A1C was in the high 5’s at the time I was diagnosed with it.  I blamed the teenage-Elizabeth for not being more careful, all the afternoons (and yeah, there were a lot of them) when I’d gone out with friends and not taken a shot to cover pizza or fries, NEVER testing in public because, when you’re 14 years old, exposing your blood to the world seems excruciatingly embarrassing.  Even when I was five or six, before the days of blood testing, whenever my urine tests read 4+ I’d be ashamed, and sometimes fudge the numbers so my parents wouldn’t see.

Does this make sense?  Well of course logically, it doesn’t.  We feel guilty because we do have so much control over this disease, but we all know diabetes can be a stubborn and temperamental (insert curse word of choice), trying to prove it’s stronger than all the time and energy we put into controlling it.  There are site issues and infections and stress and hormones, and just days our bodies decide to go wacky for no conceivable reason.

So what’s the answer?  Who knows?  I think it’s our tendency to want to place blame on things we're not happy about, and who can we blame for this other than ourselves?  I guess you could look at diabetes as a separate entity, pin a photo of a broken pancreas on the wall and throw darts at it, or something.  But that doesn’t work for me–I’ve been diabetic for virtually all my life, so it’s an integral part of who I am, which means hating it would be like hating my own right arm.

There probably is no real answer, except to remind yourself that you’re human, and humanness + diabetes = inevitable fallibility.  So I’ve been telling myself that I’m going to just relax when I feel like beating myself (or my meter) upside the head.  If my sugar’s high, I’ll make myself a cup of tea (or rather, take a correction dose, test for ketones and THEN make the tea.)  Put up my feet and go easy on myself until I feel okay.  The “bad” sugars aren’t bad, they’re just information I can use to make things better, and why should I feel ashamed of information?  Ashamed if I don’t test to get that information, yes, but not if I don’t like the results of that test.

So…here we go.  The truth is my sugar wasn’t 287 on the after-corn morning, it was actually 302.  (Eek!  That sounds so much worse, doesn’t it?  Even though it’s only 15 points higher?  Even writing it down was kinda painful.)  But I’m going to remind myself it wasn’t really my fault, just a mistake, and that making mistakes once in awhile is no big deal.

And dammit, I don’t care, I’m having corn again tonight.

*   *   * 

For more from Elizabeth Arnold, including information about her writing, visit her website at www.ElizabethJoyArnold.com

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 15, 2008

The Diabetes Police.

The diabetes police are usually well-meaning, usually nice, but most often think they are the resident experts on all things diabetes. Frustrating for sure. Dealing with the diabetes police usually means supressing a sigh, carefully explaining the situation, and hoping it sinks in.  But when the person policing you is someone you love, it can be tricky.

My video post this week is a short cartoon about being hunted by the diabetes police and how Siah, a little iced coffee, and the support of some friends can make a difference. 

Stick people have it easy. They don't even have faces. And cookies fall from the sky.

August 14, 2008

CGM Denial - Yes, Another One.

Battling for CGM coverage.Dear Liana Masone, Grievance Associate at Oxford Health,

What can I do to help you understand why my request for a continuous glucose monitor should be approved?   I've received your third and final letter, and according to your team:

"We have thoroughly considered all of the available information submitted in support of your appeal.  Based upon review of that information and the terms of your plan, a medical director with a specialty in General Surgery, continues to uphold the denial of coverage for the Dexcom sensors.  This type of continuous glucose monitoring has not been shown to provide superior health outcomes.  Therefore, an Oxford medical diretor has determined that coverage for the Dexcom sensors is Not Medically Necessary, as the term is defined in your Certificate of Coverage."

You know what's great?  The part of your website that talks about the 2008 Healthy Bonus Offers, claiming the following:  "We recognize there are ways we can help members reduce out-of-pocket health are costs.  We believe in the power of prevention: that is  by taking a little extra time to eat better, exercise and reduce stress, individuals can do a better job of staying on the path of wellness."

Is that so?  By seeking approval for the Dexcom continuous glucose monitoring device, I am trying to stop as many of the fluctuations in my blood sugar control as I can.  I am also trying to safeguard my body against hypoglycemic unawareness, because my body does not recognize the symptoms of low blood sugar with any reliability.  I am also preparing for pregnancy and making these CGM efforts for my baby and my husband.  Proactive approach, no?  You would do well to be more proactive in preventing complications, instead of being reactive and paying for them later.

According to the paperwork you sent me, I have been advised that I have exhausted my internal appeals and may now file an external appeal for CGM coverage.  You have also told me that I need to enclose a check in the amount of $25.00 made out to the Treasurer, State of Connecticut.  This check is the first item on your appeal application checklist, showing me how committed you are to making this appeal process as difficult as possible.  

I have been a type 1 diabetic for almost 22 years.  The paramedics have visited my home due to morning hypoglycemia.  My A1c is currently above 7.5% and not within the range for pre-conception, as advised by my endocrinologist at Joslin.  I do not want to experience diabetes-related complications, and I am trying to stay as healthy as I can. I will continue to fight for approval of a CGM.

In the next week, your team will receive a letter from my endocrinologist, stating her recommendation for CGM coverage.  You will also receive my current blood work results, a copy of my certificate of coverage, and yes, my check for $25.00.

I look forward to your response.  

Best,

Kerri Morrone Sparling

August 11, 2008

Beach Blanket ... Pumping.

Growing up in southern Rhode Island means having access to some of the most beautiful beaches in the country.   The sound of the ocean waves, and of the seagulls flying overhead.  The smell of clam chowder (chowdah), fritters, and onion rings from the beach stand.  The ancient woman who sold popcorn from the kiosk in Watch Hill.  The hot sand and the hot sun.  I love it all.

My best friend and I hit the beach in RI this past Saturday, drinking iced coffees, swimming around in the August ocean, and gossiping our heads off.  I'm very pro-pump when it comes to doing my diabetes thaang, so I do what I need to do in order to make it part of every day.  Wearing it at work or out to dinner doesn't present many issues, but the beach is tricky indeed.  Here are a few tips I use to keep the pump from interfering at the beach:    

Pumping can be a day at the beach.  Holla.

Top Five Beach Pumping Tips:

1.  Bring a bottle of water.  If you're like me and you love to swim around like an awkward little dolphin, you'll find that the infusion set can get covered in salt and sticky sand.  Sometimes I have trouble reconnecting my pump due to the slty build-up.  Using a water bottle to rinse off the site helps remove the stick and get me reattached without any trouble.

2.  Bring an extra towel.  If you are like me and you stay attached to your pump while you lay on the blanket, make sure you keep it covered.  An extra towel or t-shirt is handy to wrap up the pump in, keeping it cooler and away from the heat of the sun.  

3.  Have back-up insulin.  Whether it's the salt caked up on your site that's keeping you from reconnecting or if there's a malfunction with you pump, it's important to keep an insulin pen in your beach stash.  I have one of those Frio things that works great to keep the pen cool and collected. 

4.  Sunscreen it  up.  If you're an Irish girl who burns with the best of them, sunscreen is your friend.  This past weekend, I blew it a little and didn't wear enough sunscreen, and now my body is slightly crispy.  Pushing a new pump site into sunburnt skin is not very comfortable.  Also, wearing enough SPF keeps me from getting wild infusion set tan lines. 

5.  Be confident!  People are going to stare at the pump.  This is a fact - they can't help it!  It's probably not something they see every day, and it's hard to hide in a bathing suit.  Just remember that we're wearing this device to manage diabetes, and it's nothing to be ashamed of.  Let 'em stare.  ;)

What do you do with your pump in the hot, hot heat?  Any tricks you want to share?  (And any good recipes for chowdah?  I think I'm ready to try and make some at home!) 

August 01, 2008

Flaking Out Friday Six.

The Friday Six:  August 1, 2008 editionWhirlwind doesn't even begin to describe the last two weeks, but I'm trying to recap bit by teeny bit.  From adventures with web-camming (There you go, Google. Just for you.) to Manny Ramirez being traded, it's time for The Friday Six.

1.  A few months ago, I mentioned a Fairfield County D-Dinner meet-up, and several people emailed.  Then, because I am hopelessly disorganized and was in the middle of planning my wedding, I lost track of planning that event.  I'm very sorry, and still hopelessly disorganized.  :)  But I'm trying to set it up again, and am looking at having the dinner sometime in late August or early September.  If you are still interested, would you please drop me (another) line at kerri at sixuntilme dot com?  If it's okay with the potential attendees, I can create an email list so we can figure out the details via email.  Thanks!

2.  Also, adding a little Canadian flair to the diabetes-theme, have you heard of Team Diabetes?  Skip off to Orlando this coming January and join Buzz Bishop and the 95 Crave Team Diabetes Crew to raise funds and awareness for the Canadian Diabetes Association.  For more information, check out the Canadian Diabetes Association and throw some support to our neighbors to the north.

3.  I'm very eh about this:  Manny Rameriz?  To the Dodgers?  Granted, he's one of the best ballplayers on paper, but boy is he a "wicked pissah" (thanks, Julia).  For the real-deal details, without even a smidge of bias, check out Boston Dirt Dogs.  (And keeping with the Boston news, do you want to see what your site looks like written in the ol' Boston accent?  Here's how SUM readsDo yours!  Valley Girl may make you laugh out loud for real.)

4.  Total side note:  On my way to lunch, I heard "Crazy In Love" on the radio.  As I was leaving lunch, I heard "Ring The Alarm."  I love Beyonce.  She is my musical guilty pleasure.  Please share yours, so I'm not forced to have my face burning in shame all alone.  I also like Yanni.  Help!!!

5.  In some TuDiabetes news, there's a new video about seeing diabetes through the eyes of children.  As a former child with diabetes (now a pseudo-adult with diabetes), this video helps me remember how I saw diabetes, and how I saw myself as a result, when I was small.  Click here to watch the video on YouTube, and click here to get involved with the inititative

6.  Lastly, because I bought a webcam and have nothing but time on my hands (What? Lies, Kerri - lies!), I'm debating starting to vlog (video blog) here on SUM.  Only - here's the problem - I have no CLUE what to talk about.  I'm much more the wordsmithy-type than the talk-to-the-camera type.  But I love meeting other diabetics and am always so surprised when I hear their voices or see their faces.  Words are just one dimension to our personalities - the way someone sounds or the way they laugh really tells you alot.  I'm curious to hear what you guys would be interested in (or should I just give the camera to Siah and let her do her thing?).  In any event, forgive me for talking too fast, moving too much, and using lions for my own personal gain.  (The password is "sixuntilme")

Chris and I are excited to host Batman and her boyfriend this weekend - yay for friends who will drive all the way out here! - so have a good weekend and I'll see you Monday!  :)
 

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July 29, 2008

CWD Meets CGM.

"The problems are that they aren't accurate all the time and they don't replace fingersticks."  She adjusted her shirt collar.  "It's tough for insurance companies to get on board with that."

It's no surprise that I attended every CGM focus group offered at CWD.  From discussions about government viewpoints with Arleen Pinkus of the FDA to debates about accuracy with Dr. Bruce Buckingham, I was tuned in and looking for ammo against my insurance company's repeated denials.  (Acknowledgment of my second appeal arrived in the mail while I was away.) 

When the group (which included Manny, Sara, and the man himself - Bennet) asked about insurance coverage, the FDA lady told us that there just wasn't enough data from the Medicare crowd.  

"So you're telling us that we just need to slap a few sensors on some 65 plus diabetics and that will help turn the tide?" I asked.

She actually said, "Yes.  That would do it."

Fight for your right to monitor!

Fortunately, the CGM session with Bruce Buckingham was far more informative and armed me with enough information for my third appeal letter.  He was a warm and soft-spoken man who lead a 90 minute session about CGMs and how they can benefit the life of someone with diabetes. 

"When I worked at the diabetes camps, they called me a pancreas, because my pancreas worked," he quipped to us, talking about the history of diabetes and explaining how physicians used to taste the urine of their patients to make a diagnosis.  "The first pump was in 1978.  The first common place meter was in 1980.  I know - the pump was before the meter!"  

Dr. Buckingham talked about how CGMs don't measure blood glucose, but instead measure the interstitial fluid.  He told us that it takes about six minutes for the blood glucose to affect the interstitial fluid measurements, which helps explain how CGMs and glucose meters don't always match up with precision.  He cited that the delay is more realistically a full eight minutes.

There was a lot of discussion about accuracy.  From my almost 22 years of experience with type 1 diabetes, I'm convinced that every mg/dl result is a concrete one.  It's been a tough mental hurdle, leaping from snapshots to trending.  But Dr. Buckingham confirmed yet again that a CGM is a trending, and not a treatment, device.  Any CGM result should be confirmed on a glucose meter before treating with food or insulin. 

Another point he touched upon was that of sensor calibration.  I test upwards of 15 times per day, so I was inclined to calibrate my sensor whenever I tested my blood sugar.  "Calibrating when unsteady can cause the sensor to be biased," Dr. Buckingham said.  If I test and my numbers are rapidly rising, I'm calibrating my sensor on the climb.  That's going to throw off the accuracy for sure.  Calibrating when steady (or at least steady-ish ... diabetes is never completely precise) helps retain the integrity of the sensor.  But there is always a lag time with subcutaneous sensors, i.e. recovery from a low blood sugar may not be apparent on a sensor in a timely fashion.

All these technical details were well and good, but I wanted information on what made someone a good candidate for a CGM (particularly in the eyes of insurance companies).  Dr. Buckingham provided a list of possible candidates:

  • patients at a high A1c
  • patients with a fear of hypoglycemia
  • hypoglycemic unawareness
  • pregnancy/preconception
  • gastroparesis
  • athletes
  • patients on medications like pramlintide (Symlin) and exenatide
  • patients who may wear the sensor intermittently to better understand their own diabetes

I saw myself on that list several times.  Dr. Buckingham told the group about how a CGM can provide fantastic feedback that can really affect diabetes management decisions.  He said that the immediacy of the feedback helps identify causality, meaning that we could see how different foods affect blood glucose levels, and that the data can be use to prevent or detect earlier extremes in glucose levels. 

He did have some warnings, though.  He warned about over-calibrating (as discussed before).  He also warned against insulin stacking (taking small bolus after small bolus in efforts to correct highs). He also acknowledged that some of the alarms weren't effective, and that many PWDs slept through them.  One tip he offered was to keep the CGM receiver in a glass on the bedside table, so that when it vibrates, the rattle in the glass helps wake you up.

"It doesn't work unless you wear it," he offered, adding that the sensor is a behavior modification tool and if you aren't ready to accept diabetes, you may not be ready to wear an extra device.  According to Dr. Buckingham, a CGM can make someone feel vulnerable and defensive, with every number out there on display.   

But then he said this:  "A CGM can help you achieve a better A1C without increasing hypoglycemia."  I thought about the lack of lows I've had in the past few months, and I was happy to not be crashing and burning in the middle of the night.  But an elevated A1C also came along without those lows to tip the curve.  I'm so hopeful that a CGM will help me gain better control of my diabetes without tossing my numbers down the well every few days.  

I thought about how Chris said he feels safer when I wear it.  My mom said the same thing.  And I agree.

Come on, Insurance Companies.  Get on board!!

Editor's Note:  Do you want to join the fight for CGM coverage?  Sign the CGM Denial Petition and Raise Your Voice!! Also, Dr. Bruce Buckingham is leading a chat about Continuous Glucose Monitors on DiabetesTalkFest tonight.  Log in at 9 pm EST!

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July 28, 2008

CWD: My First Time.

My diabetes greeting card.Up until last week, I had never been to a CWD event before.  I had heard about them through the diabetes community, and I knew that many of the parents who were reading my blog were members of the CWD forums.

Now I know why people are so into CWD.  It's like coming home.

These people get it.  I've said that before about my best friends, who do their best to understand the subtleties of diabetes, and about my wonderful co-workers, who go to great lengths to know what a real "dLife" might be like. But the parents and children at the CWD conference are the ones on the front line, the folks who are living with this disease every single day, either as the diabetic themself or the caregiver of a PWD.

The CWD Friends for Life conference in Orlando is filled with parents who care.  With kids who boop beep boop and shunk and who know the carb content in their favorite breakfast cereal.  With grandparents who can proudly program a pump, or siblings who know how to treat their brother or sister's low blood sugar.

It's also filled with some of the diabetes medical community's finest, with Fran Kaufman, Bruce  Buckingham, Richard Rubin, and Barbara Anderson among the faculty.  I attended several focus groups about diabetes and pre-pregnancy planning, CGM use, and the artificial pancreas.  (The groups deserve their own posts, so more on those later in the week.)  I also had a chance to meet with some of d-blogging's most friendly faces, like Manny from TuDiabetes and Sara from Moments of Wonderful

The first focus group I attended was about Diabetes and the Web, which has people talking about websites they frequent for their diabetes care.  A little girl sitting in front of me, about 8 years old and with an insulin pump clipped to her shorts, said "I visit dLife to find recipes I can eat."  My heart swelled with pride. 

They asked us to envision cards we'd receive from our endocrinologists or CDEs.  "What kind of card would you want to receive from your doctor?"  Even though the group was dominated by children, there were several adults (myself and Manny included) who grabbed for the crayons with vigor.  

The front of my card read:  "Do you have diabetes?"

Inside:  "You are still YOU."

After sharing our cards with the group, the leader asked when we'd want to receive these cards.  On our diagnosis anniversary?  After we have an A1c done?  When we're feeling frustrated?

"I'd take these cards anytime.  Randomly, monthly ... daily."  I said. 

A father in the group laughed.  "Me, too." 

I've said it before and I'm sticking with it:  Diabetes doesn't define me, but it helps explain me.  And attending this conference drove that point home.  I was one of many, united by a common medical bond, but I was still me.  A pump in my pocket, a meter in my bag, and two decades of diabetes under my belt - but I was still me.  And I wasn't alone.

Thanks for the warm welcome, CWD. 

(I have a Flickr set of the conference online now - feel free to poke through if you have time.  More on the conference to come!)

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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 16, 2008

Body Image.

What fits.Beauty benchmarks seem to be measured in what size pants you fit into and what designer hand bag you have draped over your rail-thin arm. 

This is the biggest bunch of crap I have ever heard.  In my life.

There's a lot of body image problems in our society.  Women are shown almost-unattainable media images and are encouraged - expected? - to achieve that look.  As a girl with diabetes and part of a family of curvier people, whittling my body down to that socially mandated size isn't easy ... and wasn't accomplished.  Life with diabetes puts a huge emphasis on food, making me unable to eat just a raisin for lunch.  Instead, I ate in accordance with the then-peaking of my insulin and tried to keep my weight, and my diabetes, under control.  This was difficult at times.

I was never a "thin" adult.  I've always had more of an athletic build than that of a runway model.  As a kid, I was scrawny, but once puberty hit, my body took on womanly curves and held fast to them.  I never felt shapely or feminine - instead, I felt fat. In college, I lived with six other girls (six until me?) and they were all teeny little things.  They had thin arms and thin legs and they shared clothes with one another, but I couldn't get in on that scene because I was about two sizes bigger than all of them.  If they were wearing size 4 pants, I was in an 8.  I always felt a bit bigger, a bit more awkward, and very shy about my body. Despite whether or not I looked as overweight as I felt, my mind was entrenched in thoughts that were self-conscious.  I was very unfair to myself, just like many other women are.  It sucks to feel bad about yourself.

Diabetes challenges my health, but it sometimes offers up a healthy perspective.  It took me several years to really come to terms with the fact that my body needs to have different priorities.  Going to the gym has become less about slimming down my stomach and more about improving my cardiovascular health, lowering my A1C, and reducing body fat so that I can make better use of my injected insulin.  It couldn't be about fitting into a smaller dress size because it needed to be about being healthier every day.

I'm not going to be teeny.  I will not be the girl who appears to be challenged by every breeze that blows through.  My body will be strong and curvy and ornamented by various medical devices, like a diabetic Christmas tree.  It's taken me a long time to achieve a level of confidence in how I look and how I feel about myself.  But I see myself now and realize that I don't look much different than I did in high school or in college.   I just feel different.  I feel like the numbers that matter aren't the ones on the scale or sewn into the tag on my skirt, but instead the ones stored in my meter. 

I feel happy, and that looks better on me than any stitch of clothing I own.

July 15, 2008

Bolus-Worthy?

Last night, I was in the city with my co-workers for Ricky Gervais (guy from the original Office) and we left straight from work.  Gervais, though he played for only about an hour, was terribly crass and clever and peppered his jokes with British witticisms and some aptly placed f-words ... which means I laughed my ass off at every inappropriate bit.  (Granted, he's not as funny as Eddie Izzard, but there aren't many who are.)

Ricky Gervais in NYC

Before the show, the group of us stopped at a restaurant near the WaMu Center and grabbed a bite to eat.  I decided to go "off the carb wagon" and order up a cheeseburger.  Then my co-worker got a slice of red velvet cake which made me crave my wedding cake.  So I snaked a few forkfuls of that, too.

Needless to say, this meal took about seven units to cover it.

For me, there are plenty of foods that are worth garnering the "Whoa, you're eating that?" response.  Red velvet cake with cream cheese frosting would be one of them.  Cheesecake from the Cheesecake Factory in Providence is another.  Oh, and fresh baked Italian bread dipped in extra-virgin olive oil with sea salt and garlic chips.  That may be the most bolus-worthy carb influx of all time.  And a few years ago, a chai tea latte was totally worth the insulin (but now I can't justify drinking calories - I'd rather actually eat them).  My bolus-worthy choices change with the tides, but there's always those few items that I'm willing to crank up my pump for.  Black raspberry ice cream from St. Claire's Annex.  A bowl of linguine with alfredo sauce.  Strawberry shortcake in the summer.  Yum, yum, yum.

Food is one of those things that walks a fine line in my life.  I'm usually very consistent with my dietary choices, sticking closer to green beans and chicken than pasta and meatballs.  But I'm not one to assign "good" and "bad" attributes to different foods.  That's always struck me as a tricky attitude.  An ice cream cone isn't "bad" - it's just meant for a certain time, place, insulin dose, and blood sugar level.  Denying myself some culinary treats doesn't help me maintain a healthy food-i-tude, but instead can make me want to go hide behind the dresser and eat a pint of ice cream in secret.  (And believe me, I binge-ate in secret as a teenager due to complicated emotions about food and diabetes.  Was not fun.)  I want to enjoy what I'm eating.  Having access to technology like an insulin pump, fast-acting insulin, and a CGM opens up eating options that weren't easily made part of the equation when I was diagnosed over 20 years ago.  While a lower-carbohydrate diet keeps my numbers steadiest, I can indulge in the occasional delicious treat without sacrificing blood sugar control.

Holy crap, that last sentence sounded like an advertisement.  How 'bout this:  Cake or death?  Um, cake please.  Side of insulin, thanks.

What are your bolus-worthy foods?  (And here's a short Ricky Gervais clip about Humpty Dumpty, which made me laugh so hard I cried.)

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?

July 09, 2008

CGM: Denied Once Again.

Please approve my CGM!Dear Insurance Company,

I got your letter yesterday.  I opened it up and saw your second denial.

"Our Medical Director has decided to uphold the initial adverse determination because this monitoring system has not been proven to be any more effective in the management of diabetes mellitus than the standard monitoring."

I disagree.

I test my blood sugar 15 times per day.  I test when I wake up, before I eat, after I eat, before I exercise, while I exercise, before I sleep, and sometimes in the middle of the night.  I also test when I feel "off."  I try to catch the fluctuations as often as I can and I respond accordingly.  Unfortunately, I am only seeing snapshots with this "standard monitoring," instead of the streaming video I get from a CGM.  Maintaining tight control is difficult with only snapshots of information.

I got married two months ago and my husband and I are planning to start a family in the next year or so.  As a type 1 diabetic for over 21 years, preparing my body for baby is a bit of a daunting task.  My endocrinologist has told me to bring my A1C as close to 6% as possible.  I am starting the Pregnancy Clinic at Joslin at the end of the summer and am working hard to run my numbers tight.  Unfortunately, running at a tighter clip results in more low blood sugars. 

Sometimes I don't feel my low blood sugars.  I've felt perfectly fine and then tested to see a result of 38 mg/dl or 41 mg/dl or 45 mg/dl.  These are not safe numbers.  As a result of my efforts to lower my A1C, it takes longer for me to feel the lows.  I have hypoglycemic unawareness.  A CGM would keep me safer from these undetected lows.  And when I'm pregnant, it would protect me and my baby - at no extra cost to your company. 

And in January 2003, my then-boyfriend woke up to find me unresponsive and sweaty.  He tried to get me to drink juice but I fought him off.  The paramedics were called and it took three of them to hold me down and administer glucose.  After a tube of glucose gel, my blood sugar was 44 mg/dl.  Had my ex not woken up, discovered I was low, and called the paramedics, I may have died.  Let's just think about that for a minute, okay?  Dead, thanks to a low blood sugar that I did not wake up for.  A CGM would have warned me about my falling glucose with a loud and relentless BEEEEEEEP.  I would have woken up, tested, and most likely caught this low at 60 mg/dl instead of whatever low I achieved that morning.

While I believe that your company should respond to these issues on an empathetic and proactive level, you may only care about the financial aspects of this issue.  I offer the following:

The Dexcom unit I am using was given to me by the company.  You would not need to purchase the receiver unit or the transmitter at this time.  This is a savings of $1000.00.  What I am looking to cover is the cost of Dexcom sensors, which are $240 for four sensors.  Over the course of a year, these sensors would cost $2,880.

To offset this cost, I would be testing less frequently.  I would go from testing 15 times a day to approximately 7 times, saving $5.00 a day.  Over the course of a year, I would be using 2,920 less test strips.  With test strips costing approximately $1.00 apiece, this would be a savings of $2,920 per year. ... Wait a minute, that's saving more than the sensors are costing.  Looks like you guys just made $40, not to mention co-pays for these items! 

We should also factor in the cost of an ambulance ride, if I were to have another low that required assistance.  Medical intervention could cost upwards of $1,000.  The CGM is a measure that could prevent this cost from occurring.   

These are just the immediate cost savings to your company.  Never mind the savings that will accrue long-term, when my body remains healthy as a result of achieving a tight A1C instead of developing expensive diabetes-related complications.

Overall, it makes more financial sense to invest in a CGM for me.  Proactive measures will keep me from costing insurance companies large sums in the future, when more serious issues may arise as a result of several decades of diabetes.  

And, as an added bonus, I will be healthier.  Imagine that.

I am looking forward to your response.  

Sincerely,
Kerri Morrone Sparling 

June 27, 2008

Jeff Vader Runs the Death Star?

The Friday Six:  June 27, 2008 editionIt's hazy.  Hot.  Humid.  Perfect weather for a snitt fart.  Or the Friday Six.

1.  Yesterday, I received my copy of Laurie Edwards' book "Life Disrupted: Getting Real About Chronic Illness in Your Twenties and Thirties."  I'm honored to have been a part of this project as one of the five people with chronic illness that she interviewed.  If you are living with chronic illness, or if you care about someone who is, this book should be on your bedside table. 

2.  So what are you up to on July 12th?  If you're a diabetes blogger and in the New England area, you should meet-up with Bernard and others at the first New England Bloggers Meet-up.  I'm trying my best to be there that weekend, but I know there will be plenty of PWDs peddling around.  Check out the events page at TuDiabetes for more events in your area!

3.  Also, July 1 has been dubbed CGMS Denial Day.  Have you been battling with your insurance companies for continuous glucose monitoring coverage?  I've been writing about my experiences with Dexcom and insurance coverage here on SUM, and I'm definitely not the only diabetic who is trying to gain coverage.  Should insurance companies be covering these CGMs?  Should the manufacturers be charging less for their product?  Share your thoughts on your blog next Tuesday!

4.  With the CWD conference coming up quickly (I am so excited to be attending this year!), it's time to brush up on your Disney with diabetes skills.  Thankfully, Bennet of YDMV has written a terrific tip sheet that's published on dLife.  Check it out - and also find out about how he cooked insulin in a fridge.  (Yes, really.) 

5.  In non-diabetes stuff, we're still doing wedding wrap-up.  This week has been busy - and FAST.  We've just heard from our photographer who won't have our photo disc and album to us until August.  ARGH.  In this digital, instant-info age, that time frame infuriates me.  But in better news, our thank you cards/emails are almost completed, but we received several gifts without cards.  If you sent something to my office and I haven't sent you a card or an email, PLEASE email me!  I want to thank everyone for their tremendous generosity and kindness - you are such an amazingly giving and wonderful community and Chris and I are so grateful for all of your well-wishes.  I want to properly thank everyone who thought of us!  (Especially whoever sent the cat wine topper thing.  I freaking love it and haven't been able to track down who sent it!) 

6.  And this weekend is going to be awesome, for several reasons.  First, we aren't going to be schlepping back to RI and spending hours on end in traffic.  (Boo on not seeing friends and family, but holy YAY for relaxing!)  We're off to see Wall-E tonight - because I am a five year old - and tomorrow night we're going to see Eddie Izzard at Radio City Music Hall.  I.  Cannot.  Wait.  We ordered these tickets MONTHS ago and I've been looking forward to it since.  I have loved Mr. Izzard for quite some time now and am thrilled at the opportunity see him perform - at Radio City, no less!!!

Monday, Monday, Monday ... I'll see you then.  :) 

June 20, 2008

Dexcom, Batman, and Gaseous Emissions.

The Friday Six:  June 20, 2008 editionWelcome to this week's edition of The Friday Six - your source for diabetes information, random websites worth checking out, and the occasional fascinating game about farts.  (Because farts are perpetually funny, despite my best intentions to grow up and act like the adult I'm supposed to be.)  Consider it "brought."

Uno.Now that my insurance appeal letter has been sent, I'm in the 30-day waiting game that Oxford Health plays.  I'm hoping that I don't need to go through a second appeal process, but I'm assuming that will be the case.  So while I wait for a response from my insurance company, I'm compiling data.  I've officially switched over to the OneTouch UltraLink, so now every time I test, I hear the subsequent "beeeep" of my pump receiving and logging the result.  When I upload my data this weekend, I'll be able to see what my numbers were and how my boluses correlated.  I'm also pulling records from when the paramedics were called in 2003 for a hypoglycemic episode and my last string of A1C results.  When the insurance company comes back with a "no," I'll have an arsenal of information to offer up.

2.  Also, the diabetes community is indeed a tight one - this was proven to me beyond a shadow of a doubt this week.  While I was away on my honeymoon, the dLife CEO met with a Dexcom representative in our area.  While they were talking, it came out that I worked for dLife.  Turns out that the Dexcom rep was someone from my diabetes past.  This representative is the woman who used to baby-sit me when I was young, when my parents went away on vacation.  Her son is a type 1 diabetic and she was the person who guided me and my parents through those first tenuous years after diagnosis.  Now, she's my Dexcom rep, and she's coming to hang out with me next week to discuss the finer points of Dexcom'ing.  Small world, eh?

3.  In decidedly non-diabetes news, I came across a link yesterday that really brought out the grown-up in me.  It's a very serious online game that deals with such mature topics as gaseous emissions and space exploration.  In fact, PuzzleFarter was one of the most serious links I've ever sent around my office.  No, it did not make me giggle like a five year old, silly.  (Hat tip to my brother, who continues to find the oddest damn things on the internet.) 

4.  Another link I've come across in the last few days has been the one where people are recreating their childhood photos.  Have you seen this?  The pictures are part of a site called ColorWars 2008 and the pictures are the "YoungMe:NowMe."  I love this one.  It makes me happy.  And this one just plain makes me laugh.

5.  Tonight we'll be trekking back to RI to hang out with friends and family, and to celebrate Batman's birthday!!  My superhero friend is ringing in her big day tomorrow and this is the first time in seven years I haven't been able to buy her the new Harry Potter book for her birthday.  Strange rite of passage.  But if you are feeling like wishing a happy birthday to the Batman friend, feel free to leave her some love in the comments section.  :)

Six!And lastly, this one last website almost caused me to end up on the floor in shock.  Prior to today, I wasn't aware that cat sharks existed.  Now I know.  And knowing is terrifying. 

Have a good weekend, Blogosphere!  :D  See you on Monday.

June 18, 2008

Dexcom Days.

Thanks to the wonders of my pre-wedding disorganization, I managed to misplace a Dexcom sensor.  Luckily, I found it in the linen closet on Monday night and slapped it on.  Just in time to see some weirdo numbers, apparently. 

Since I've been back from my honeymoon, I've had some trouble getting my numbers back under control.  Seems like all the basals and ratios I was using as "Kerri Morrone" don't seem to work for "Kerri Sparling."  ;)  Thanks to the CGM big picture, I'm trying to isolate what's causing me to go high and low at different times.  Like the morning highs. 

Part of the reason for these highs has to be my morning shower routine.  I have a tendency to wake up, test my blood sugar, disconnect my pump, and then hop into the shower.  After the shower, I need to blow-dry my hair.  Then find something to wear.  (Notice I haven't mentioned reconnecting yet. Whoops.)  Suddenly, I realize that over 35 minutes have passed and I haven't been tethered.   

This wouldn't be such a big deal were it not for the fact that my morning basal rate is cranked up to 1.0u (vs. my normal 0.4u) between the hours of 6:30 am and 10:00 am.  Therefore, I'm losing over half a unit while I'm showering and getting dressed.  This insulin-skip causes my blood sugars to leap up around 9:00 am on some days, leaving me mucking around with a high until almost 11 am.  

"Armed" with the Dexcom 7.

Armed - literally - with the Dexcom, I was able to view this phenomenon first-hand yesterday.  Holy spike.  Today, I tried bolusing 0.3u before I disconnected for my shower, then taking another 0.7u once I reconnected.  The results were much better, and I'm hoping to see even better results tomorrow.  (Has anyone else worn a Dex sensor on their arm?  How did it work for you?  Getting it on there was a hassle, I'll admit.  Thank goodness for Chris's patience!)

Last night I was able to see my overnight patterns.  Dex woke me up at 3:00 am, hollering that I was 49 mg/dl.  I didn't feel low at all, so I tested to confirm the result.  My meter claimed I was 64 mg/dl.  Fourteen point spread, but close enough that the wake-up BEEEEEP! was timed early enough for me to catch the low before I hit the trenches.  I grabbed a swig of juice and checked the graph on Dex - sure enough, I had been falling for over an hour.  

It's very enlightening to have access to these patterns.  When before I thought my mornings were decent, baesd on a test at 7 am, 9:30 am, and 11 am, I'm now seeing that there is a significant amount of fluctuation between these snapshots.  I'm curious to see what the graphs show me tomorrow, when I tweak a bit further. 

And THANK YOU to everyone who offered their insurance battle feedback.  I'm in the 30-day waiting period now, compiling data and trying to follow everyone's suggestions to present my second appeal.  Thanks to Manny for his compelling video, and to everyone who is fighting this same fight.  The technology exists, and we should all be able to access it.

June 17, 2008

First-Level Appeal Letter re: Dexcom Denial.

Hear me.I received a letter today from Oxford Health Plans, denying my request for CGM coverage.  "Our Medical Director has determined that the request is:  Denied - Not Medically Necessary."

My First-Level Appeal letter is below.  This is the first round of a potentially long battle, but I'll see it through as far as I can, I promise.  A price tag on my health?  I don't think so.  Here's hoping they listen.

"June 17, 2008

Clinical Appeals Department
c/o Oxford Health Plans, Inc.
PO Box 7078
Bridgeport, CT  06601-7078

To Whom It May Concern:

On September 11, 1986, I was denied a normal childhood when I was diagnosed with type 1 diabetes.  My parents were taught to measure my food, test my blood sugar, and inject insulin into my body.  We were taught about diabetes complications and how they may end my life.  We were taught to plan for the worst and hope for the best.  This was my mortality, handed to me when I was just a child.

On January 27, 2003, I was denied the ability to control my blood sugars with insulin injections alone.  My medical team determined that my diabetes would be best controlled with an insulin pump instead of multiple daily injections.  Thanks to my hard-working medical team and my personal dedication to good health, I started using an insulin pump.  My A1Cs have been lowered and my risk of diabetes-related complications lessened, thanks to the benefit of this technology.

On April 15, 2006, I was denied the symptoms of a low blood sugar while I was at the movies.  Thanks to my years of hard work and my desire to keep my diabetes as well-controlled as possible, my body was less sensitive to the symptoms of low blood sugars.  Therefore, a blood sugar of 27 mg/dl snuck up on me without warning, leaving me moments from a diabetic coma.   Currently, I experience severe hypoglycemic unawareness, leaving my body at risk for potentially lethal, undetected low blood sugars.

On May 18, 2008, I was denied a wedding without diabetes.  Surrounded by friends and family, and with my husband-to-be standing proudly at the front of the church, I walked down the aisle.  My mother cried, later admitting she always feared I would not see this day in good health.  My blood sugar plummeted, without warning, before the first dance as a result of my excitement.  I did not feel the symptoms.  I spent my first dance with my husband clinging to his arm, trying to focus and waiting for the glucose tabs I had just eaten to raise my blood sugar.

On June 13, 2008, I was denied health insurance coverage for a continuous glucose monitor by Oxford Health Plans. 

I am twenty-nine years old and have spent more than two decades living with type 1 diabetes.  My wedding was barely a month ago.  I am so excited to start a family with my loving husband.  I will not be denied the chance to have a healthy pregnancy.  I will not let my mother be denied a good night’s sleep because she’s worried her daughter will have an undetected hypoglycemic episode in the middle of the night.  I will not let my husband be denied a healthy wife. 

A Dexcom continuous glucose monitoring system receiver costs $800. The sensors cost $240.00 for a pack of four.  Over the course of a year’s non-daily use, the Dexcom system will cost approximately $1,800.00.   

Compare this cost to that of laser surgery to treat diabetic retinopathy.  Or the cost for kidney dialysis or transplant.  Or the cost of daily medications to treat high blood pressure, cholesterol elevation, or kidney disease.  Or the cost of an amputation, as well as any attendant costs for rehabilitation and lifestyle adjustment.   Please be advised that keeping me healthy now will save your company from greater expense later; preventative measures taken at the present time will mitigate the overall financial loss your company would otherwise incur in the future. 

Denying my claim to protect your company’s bottom line is to deny my chance for a long and healthy life. You have marked my claim as 'not medically necessary.'  You have boldly put a price tag on my health. 

Your denial may cost me my life.  I urge you to reconsider your decision.

Sincerely,
Kerri Morrone Sparling"

June 16, 2008

You Wouldn't Like Me When I'm Low.

You wouldn't like me when I'm low.  Or maybe you would.

While we waited for the traffic to disperse this past Friday night, we went to see The Incredible Hulk.

So Ed Norton (who I love ... loved him in Fight Club and The Illusionist) plays The Hulk and spends the better part of the beginning of the movie trying to keep his rage under control because ... you know ... you wouldn't like him when he's angry.  He wears a heart rate monitor to help keep him safe and controlled.  It's one of those wristwatch bits that beeps as his heart rate climbs and wails insistently when his numbers are too high.

"Dude,"  I lean in to Chris.  "I didn't know the Hulk wore a CGM!"

He whispered back, "I know!  I thought the same thing!"

The movie continued, and Ed Norton finally loses it and becomes The Hulk.  After his episode is over, he's shivering, weak, and holding his tattered pants close to his body.  He looks completely spent and in need of a solid nap.  Much like how I feel after a wicked low blood sugar.

"Only minus the tattered pants part," I explained to Chris after the movie.  

It's strange how movies depict diabetes.  I remember watching Panic Room and seeing the little girl experience a hypoglycemic episode.  She was blue-lipped and sweaty, lying helplessly on the floor while her mother scrambled for sugar.  But I didn't see myself in this Panic Room character, even though she was written as a diabetic and her symptoms were "appropriate." 

Instead, I empathized more with The Hulk as he closely monitored his heart rate, those numbers taking precedence over all other things, their fluctuations determining many of his actions.  And I felt a pang of recognition when he came to after an "episode," bewildered and fragile and not knowing quite what happened. There are strange bits of empathy and recognition found in the most unlikely of places.

I bet if The Hulk needed a CGM, insurance companies wouldn't deny him.

"Hulk smash ... insurance companies!"

June 13, 2008

The Long Road Towards Insurance Coverage.

Pay to keep me healthy?  Or pay when I am sick?  Your call.(This is a loooong post.  And contains many terms that I just learned today.) 

Dexcom and I are looking forward to being reunited (out of sensors at the moment), but before we can do our Dex-y dance again, I need to get this stuff covered by my insurance plan.  My contact at Dexcom put me in touch with their insurance management team, and they've been working hard to get the proverbial ball rolling.

I spoke with one of the reps earlier in the week.  She was very hopeful about insurance coverage, telling me she'd start processing the claim through Oxford Health (they are my insurance provider) and would touch base with me with the good news.  I laughed.

"Good news?  Let's be honest.  There's rarely ever any good news when it comes to insurance ... anything.  So let's assume they'll reject it, and we'll create a battle plan from there."

She laughed.

"Right.  A battle plan!  I'll contact you as soon as I have any new information."

True to their word, an email came in from Dexcom yesterday. 

"Hi Kerri,
We have not had any luck in getting other patients through Oxford. We also tried to go through a distributor without any luck. So, we are going to ask Oxford for a predetermination or "one-off" approval. We may need to come back to you for more information should they request it. We will keep pushing on our end.

Your plan does provide for DME devices (the DexCom products are a DME benefit). However, you have a $1,000 deductible, with $0 met to date. After that, your coverage is at 70%.

Thanks,

(Dexcom Guy)"

Arghh - directed at insurance companies, not at Dexcom.  $1,000 deductible, and even after that's met, a 70% coverage rate?  Blast, that's pricey.  And am I ignorant because I have never heard of a DME before?  I asked my boss and she explained that DME stands for "durable medical equipment."  I looked up these kinds of requests on the Oxford site and found the following:
 
"Durable medical equipment (DME)* No charge - Deductible and coinsurance"
 
Uh oh.  What's that asterisk all about? 
 
"These services require Oxford precertification. You must call us at 1-800-201-3080 at least 14 days in advance of request. Mental health and substance abuse services can be precertified through the Oxford Behavioral Health Department by calling 1-800-201-6991."
 
Okay, so that notation means I need Oxford precertification.  What the heck is that?
 
Before I could research too much into it, another email came in from the folks at Dexcom.  It was from one of the reimbursement managers and she carefully outlined what actions she had taken with my insurance company.  She spoke with the benefits department at Oxford, the Medical Management Department, and letme know what the next steps are.  I really appreciated her thoroughness and at least had a timeline to attach my frustrations to.  
 
At this moment, my request for precertification is in play with Oxford Health, despite the fact that the Oxford rep told my Dexcom rep that the sensor codes are not covered by Oxford insurance.  These are the hoops we must jump through?  Blast again.  The policy and rationale of Oxford's "nah, we don't want to" is as follows:
 
"Due to insufficient clinical evidence to support medical efficacy, the rental and/or purchase of continuous glucose monitoring systems for long-term use in the treatment of diabetes mellitus will not be reimbursed by Oxford.  This service and/or device is not proven to be clinically effective and, therefore, is not considered to be medically necessary."
 
Not effective?  Didn't this thing save me from losing it at the bank?  And didn't Chris say to me this week that he's glad I'm pushing for insurance coverage because he sleeps better knowing I'm protected on the overnights?  And aren't these questions rhetorical?  (Yes.)
 
Looks like the deck is a bit stacked against me at the moment.  But I have the attentive staff at Dexcom on the case.  And I also have a team of terrific doctors, both at Joslin and here in CT, that are going to go to bat for me on this.  I'm currently drafting up a letter of medical necessity to be sent to my insurance carrier.  And I'm also not giving up on this.  Chris and I are a married couple now, and starting a family in the next year or two is in the cards.  I experience severe low blood sugars at times and have a tendency to run high when under duress (yay), so the idea of a CGM to help keep me and my future child safe while he or she incubates inside of me sounds like a necessary safety measure for both me and my baby-to-be.  
 
So ... I'm on the long road towards CGM insurance coverage.  I will show these insurance reps that diabetics have every right to the tools available to manage their disease.  Cover me now, and I'll achieve tighter control.  My blood sugars will be more closely monitored and managed.  The risk of debilitating diabetes complications can be reduced.  My life may be improved, just as an insulin pump improved my control.  I may live longer, for crying out loud.  That's a plus, right?  I tend to think so, and I'd venture to say that my family agrees.
 
I know insurance carriers don't care if I'm happy.  They don't care about my children or my husband or my mother.  They care about their bottom line.  Well how about this:  Make the investment in me now and I will be healthier. 
 
It costs less to manage diabetes than it does to manage diabetes complications.

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.

June 09, 2008

A Delayed A1C.

Stuff that needs to get done.I used to be a more organized person, though you wouldn't know by looking at my desk or in my bag.  Like most creative people, I'm a bit of a slob.  But an organized slob, if such a thing exists.  (I know precisely what pile of papers that story idea is hidden, I swear!)

I spent the last year with diverted attention, trying to plan a 200 guest wedding while working both a full-time job and managing a freelance career.  Things like changing my pump site, exercising, and testing my blood sugar didn't fall by the wayside, but things like A1c check-ups, endocrinologist appointments, and prescription maintenance did.  Now that the wedding dust is starting to settle, I'm noticing I haven't had an A1c done in eight months.  I also have an envelope of prescriptions I need to send to the mail order pharmacy.  I should plug in my meter and pump and siphon out all these results.  Nevermind the several appointments that need to be scheduled, namely with a dentist, endocrinologist, and gynecologist.  (Whoops, TMI, perhaps?  Shake it off, F.R's.)

I find it a bit tough to chase down the wagon after I've taken a tumble.  After so many months of being focused on things other than diabetes management, these distracted trends have unfortunately become habit.  I need to keep up the good habits that are already in place and start wrangling with the bad ones.  

My diabetes to-do list is short, but sweet.  (Too many puns there to pick just one.)  I need to start downloading my blood sugars.  I'm a moron for not doing this, because it's so easy with all the computer software available now.  I need to make (and KEEP) my doctor's appointments.  And I definitely need to reacclimate myself to the Dexcom.  With all the wedding stuff, I never had a chance to start the insurance process.  I'm now waiting to hear from the insurance representative at Dexcom so I can arm myself with the information I need to make Oxford Health listen up. 

Time to buckle back down and regain some semblance of control.  Of my diabetes.  (The Sausage cat?  Well shoot, the cat ate so much while we were on our honeymoon that her little gray body is no longer little.  She's less sausage and more haggis at this point.  Time to slim down the ol' feline, because when she jumps on the bed, she leaves a Siah-sized dent.  Once I get my diabetes reigned in, Siah is next.)

Editor's Note:  Thanks to those of you who let me know that comments weren't working on this post.  I hope the problem is fixed now! 

June 06, 2008

Scampering Paws Friday Six.

The Friday Six:  June 6, 2008 editionThere has been so much work going on this week that we're all in meltdown mode on a Friday afternoon.  Columns are being edited, podcasts are being uploaded, and deadlines are being met.  But there's an air of Friday meltdown in the office, which includes outbursts of laughter, iced coffee, and fun.  Time for a post-wedding Friday Six!

1.  There is a dog here in the office today.  Usually, this dog is extremely chill and very well-mannered.  But for some reason, today Lucy the Dog is training for a marathon.  She's been racing up and down the hallways, occassionally munching on a squeaky toy.  So every few minutes, you hear the frantic scampering of doggy feet, accompanied by squeeeeeeeak squeeeak squeaky. This is what it sounds like in my brain when things get very hectic.  Strange to see it and hear it happening in real life.

2.  We spent a lot of time last night loading up the honeymoon pictures to Flickr.  There are some fun shots of Chris and I horseback riding on the beach, dining on the beach, and enjoying the evening scenery.  We're proofing our wedding album and hoping to receive our photo disk from the photographer next week, so wedding day photos are coming soon.

3.  I received an email from Austin Cooper last night, asking for a mention of his medical ID site, Evasion ID.  He created these bracelets as medical alert jewelry that PWDs would actually want to wear.  Check out his creations - they are pretty cool.  And 10% of all purchases goes towards the JDRF, so there's a little charity involved in this venture as well.

4.  Also, Tandem Diabetes Care in San Diego, CA is launching a new insulin pump soon.  They're also sporting a new, yet almost completely empty, website.  I received an email from their team yesterday, looking to gain some traction in the blogosphere.  I asked them for some information on the product but they didn't have any they were willing to share.  Hmmm ... would've been better to have some product details instead of a "coming soon" website, but hopefully they'll have something to show us in the near future.

5.  Back in the world of diabetes social networking, Lindsey Guerin of dLife's Blogabetes has started her own diaebtes network on Ning - Diabetic Echoes.   According to the site, "Echoes wants to provide an international place for every diabetic to get information, support and ideas. We hope to provide new treatments, physician's information, emotional support and a global community to you."  Will another new network survive?  Only time will tell. 

6.  And Nick over at Diabetes360 is looking for a new name for his insulin pump.  As he is Waldo's godfather (oh just typing that sounds ridiculously silly, as the dog scampers by with the squeaky toy in her mouth one more time), I have a vested interest in the moniker assigned to Nick's pump.  If you're feeling a bit silly this afternoon, offer up some suggestions for Nick. 

This weekend will be filled with thank you notes, a visit to a few local arts fairs, and maybe a trip to the beach.  It's supposed to be 90+ degrees in western CT this weekend, with enough humidity to make Siah as flat and listless as a kitty pancake.  Stay cool this weekend, and for my friends and co-workers at ADA's 68th Scientific Sessions in San Francisco, have fun!! 

June 03, 2008

Diabetes On My Wedding Day.

Yesterday I wrote about my wedding, focusing on the parts that meant the most to me:  the man I love, our families and friends, the church service, saying "I do," and dancing ourselves silly at the reception.

But diabetes was a part of my wedding day.  We did our best to keep it quiet and unnoticed, though, using several tricky methods.  I'm like a diabetes wedding magician ... sort of.

First things first:  the dress.  Wearing an insulin pump is the easiest and least intrusive way for me to take my insulin, and I wasn't about to go off the pump just for the sake of fashion.  My solution?  Design a pocket to hold my insulin pump, hidden in my wedding dress.  I spoke with the seamstress at Ye Olde Bridal Shoppe and she and I designed something that left the pump accessible, yet hidden.

Insulin pump hidden in the wedding dress

Even if you were looking for it, the pump pocket was almost impossible to find.  Hidden along the seam of my wedding gown, it was held shut with a small piece of velcro.

Reaching into the pocket.

The hole cut in the seam was just big enough to fit my hand into, so I could reach for the pump.

Pulling the pump from my pocket

The hole was big enough for the pump to be pulled through. 

Wedding day bolusing

And once it was free, I could make whatever adjustments I needed and then slip the pump back into its pocket.

Insulin pump hidden in pocket.

The pocket itself was underneath the main fabric of the dress, attached to the petticoat.  It was sized to be about half an inch bigger than my insulin pump, leaving room for my hands to reach in and access the pump.  We stuck a safety pin to the top of the pocket so that when I reached in, I could feel around quickly for the pin and know exactly where the top of the pocket was located.  This made pump retrieval and replacement very easy.

Concealed!

The tubing itself went from the top of the pump, through a hole cut into the petticoat, and attached to the infusion site on my right thigh.  I had to plan ahead of time where my infusion set would be located so the pocket could be properly situated.

And during the entire course of my wedding, no one had any clue that I was wearing my insulin pump in my wedding dress.  Even my friends who know about it couldn't find it unless I pointed it out.  I felt empowered and like a secret agent ... only the bridal version.  

So insulin pump:  check.  And I had a few other tricks up my sleeve.  Like the flowers carried by my maid of honor:

Flowers with low blood sugar backup treater

After speaking with the florist, she devised a small pocket in the ribbon of NBF's bouquet.  This pocket could hold a life saver (as pictured) or even a tube of cake gel.  As I stood at the altar, I felt safe knowing that NBF had a quick dose of sugar at the ready, if I needed it. 

Diabetes, on the whole, didn't affect my day enough to matter.  I danced, ate cake, and experienced a wild array of emotions.  But there were a few moments when it required some attention.  Like after the ceremony at the church, when I tested and realized my blood sugar had cruised up from 156 mg/dl pre-ceremony to a whopping 380 mg/dl afterwards.  (Nerves - they hit me right in the A1c.)  Before the ceremony, I was running on the high end, cresting up around 160 - 180 mg/dl and holding steady.  And during the reception, I was too excited to eat much, so I let my numbers run higher there, too, to compensate for all the dancing. 

I did have a pretty aggressive low blood sugar just before our first dance, but thanks to my fast-as-lightning maid of honor, a glass of orange juice from the bar held me steady as we were announced on the dance floor as Mr. and Mrs. Christopher and Kerri Sparling. 

"I'm a little low," I admitted to Chris as the opening bars to "The Luckiest" played from the speakers.  He held me close and gave me a smile.

"You'll be fine.  Just focus on me.  As far as I can tell, there's no one else in this room but you." 

You may have had your moments, Diabetes, but my wedding day was mine. 

May 07, 2008

Medtronic UltraLink.

As I mentioned last week, there was a random package from Minimed left on my doorstep.  And being the big geek that I am, I think I actually clasped my hands together and said "Oooh, what's this?"  Funny how an unexpected diabetes gadget can bring such instant joy.  The techno-joy in me implodes and I'm eager to rip open the box and push all the shiny new buttons.

But I've digressed again.  Imagine that?

I've been using the Medtronic UltraLink for a few days now, watching as the results ping directly to my insulin pump.  This is a good thing, because I never, ever entered my blood sugars manually before this.   I'm quick to test but not very vigilant with data management.  Having tools like the Dexcom and now this UltraLink are useful because I can go about my daily diabetes business and then load up the data every few days.  For someone like me, with a schedule that doesn't allow for much mucking around, this convenience is crucial.

UltraLink vs. Ultra2.  Go to your corners and let's have a clean fight.

The UltraLink is a bit bigger than my Ultra2 - not by much but apparently by enough to make the meter case about 25% bigger.  Thankfully, syncing my meter up to my pump was very easy.  I just needed to go into my pump settings, input the serial number on my meter, and viola! it's pinging results with a happy little beep.   The ping is almost instant and the results are logged in my pump, so when I upload my data to Carelink, it's easier to see the Big Picture, with insulin doses and corresponding blood sugars hanging out there together.

I'm all for convenience.  Because I, unfortunately, do not have the time to do all this blood sugar logging.  Making the process all-inclusive is a nice change from "Okay, grab the meter, load up the results to my blood glucose spreadsheet, then write in the insulin doses manually ... what the ... ugh, the thing turned off while I was scrolling through ... I can't remember if this bolus went with that result ... is Nip/Tuck on?  I'm sick of this crap already."

Lancing devices ... aren't they cute?  Awww ...

The lancing device that came with UltraLink is smaller, by comparison, than the older device I was using.  Funny how the meter got bigger but the lancer got smaller.   It's the same one that came with my UltraMini, so I was already accustomed to it's teeny shape.  A smaller lancet device works best for when I am sporting some fancy dress and teeny purse combo, forcing me to ditch my meter case and leave my testing goodies roaming loose in my purse. 

Overall, I'm finding the UltraLink to be a convenient, relatively painless switch over.  I'm still using my Ultra2 in addition to the UltraLink because I don't have enough brain cells these days to make any management changes.  Once the wedding is over and my brain starts to regain a recognizable shape, I will most like swap meters and go with this UltraLink version. 

So, rest o' the blogosphere, what's your take on the UltraLink?  Are you using it faithfully?  Does its size make you a little "eh" about it?   Are you tempted to cover it with stickers and give it a name?  (I'm looking for small squirrel stickers and am planning to call it "Harrison," but that's yet another digression.) 

May 01, 2008

Empty or Full?

I am not the one who just lives in the moment - I'm the one preparing for the moments to come, as well.  I live it up and have a great time doing whatever it is I'm doing, but as I'm hanging with my friends or having dinner with my fiance, my brain skips ahead a few hours.

"Do I have juice in my purse for the drive home?"
"Is there enough insulin in my pump to get me through dessert and coffee?"
"How many test strips are left in that bottle?"
"I called in the prescription, didn't I?"
"If this train ends up being delayed, do I have enough snacks on me to get through?"
"Don't forget to bring home the charger for the Dexcom."
"Shoot, did I send out that article?"  (Whoops, not diabetes-related.)
"I need to buff out that scratch on my car."  (Okay, not diabetes-related either, but it looks terrible.)

It's hard for me to tell if I am this way because I'm diabetic, or if I would be this way regardless.  Would I be so prepared and fastidious if I didn't have to worry about the minutiae of diabetes?  Whatever the case, I'm always noticing how much juice is left in the fridge.  I know exactly how many bottles of insulin are in that styrofoam container.  I keep track of the co-payments, the medical insurance, and when it's time to make a doctor's appointment.  (Yet I can't keep track of my email inbox to save my life, but I've digressed yet again.)

I notice how many AAA batteries are stashed in the bathroom cabinet.  I think about when my next site change is.  And when both the insulin and battery life indicators on my insulin pump start pinging, those facts burrow themselves in my brain and stay there, gnawing until I fix the problem.

Empty and empty.

Diabetes causes me to keep a constant tally of moments, a ticker tape of tasks that run through my mind and has me always thinking ahead to the next possible scenario.  Diabetes requires so much preparation in efforts to enjoy even the smallest moments.  This is not a depressing fact - just an honest one.  But after more than two decades of doing this, it becomes autopilot.  And not just for me.

Friends:  "Ready to go ... and do you have your meter?"
My Mother:  "Do you need the carb count on that?"
Chris:  "Is there juice on the nightstand?"
Me:  (smiling because I know they love me and I know they care)  Yes. 

It's good to be prepared.  Thinking ahead keeps me safe.  (But after I refill my pump, I'm going to buff that damn scratch out of my car and send out that article.  And move closer to my wedding - 17 days!)

April 10, 2008

Straight Dex'ing It.

It's official:  I'm applying to have my Dexcom 7 covered by insurance.  I'm choosing to make the Dex part of my management plan.  Over the next week or so, I'll be battling my insurance company to cover my sensors.  Yes, I'm taking the leap.  I don't plan to wear it every single day, but I know I will be sporting it several times a month, more so when I'm closer to planning a pregnancy.

"How's the accuracy?"

It's as accurate as can be expected for new technology - and by accurate, I mean that the Dex7 says I'm 143 mg/dl, my meter says I'm 154 mg/dl.  Those it's higher than I'd like to be (more on that in a minute), those numbers are close enough for me to trust both the trends and the snapshots of Dex.  If I'm going to bother wearing a second device, I want it to be worth it.  And for the last four days, these numbers have been close to one another, so long as my blood sugars are under 260 mg/dl.  Above 260 mg/dl and the gap starts to widen, but I'm not shocked by that considering how my MiniLink trial played out.

"How about comfort?  Is it comfortable to wear?"

I have to be completely honest - comfort is the other deal-breaker for me.  My criteria for a CGM is a. be accurate and b. be comfortable.  Accuracy is reasonable (as stated above).  The only other CGM I've used is the MiniLink, but the Dexcom is far more comfortable.  And I know exactly why.  The MiniLink sensor is not completely adhered to the skin, leaving the "shell" part flopping about a bit.  Even when I taped it down, the sensor still had mobility and the needle shrugged around uncomfortably in my skin.  It made the site ache something awful, regardless of whether I wore it on my arm, my thigh, or my abdomen.  The benefit to the Dexcom sensor is that it's all one piece that is backed by an adhesive, leaving every part of the sensor stuck to my skin and holding steady. Therefore, it didn't hurt me at all and once it was installed, it didn't feel much different than a pump infusion set (only it's slightly bigger). 

I realized this crucial difference in the sensors this afternoon.  For the last three days, my Dex sensor has been securely stuck to me.  But I shower every morning before work and go to the gym every night (then shower again), and the combination of shower, intense workouts, and snug clothing rubbed the sensor a bit the wrong way.  Even though it's meant to last for seven days, it peeled away from my abdomen and came loose a few minutes ago.  Blast.  And for the last 12 hours, it's been floppy and felt sore, leading me to believe that it's the steady adhesive of the Dex that makes it way more comfortable than the MiniLink.  It makes sense - who wants a wire scraping haphazardly around in their skin for hours on end?  Not me. I want that wire to sit still and behave itself.

The Dexcom 7 sensor after it leapt from my body.

"I heard software comes with this one?" 

I loaded up the Dexcom software this morning for the first time.  It's remedial-looking (much like the OneTouch software I have at home), but it serves its purpose of downloading and organizing blood glucose results.  This is a definite upgrade from the old Dexcom software, which was nonexistent. ;) And thanks to my ridiculously awful blood sugars all week long, I've been able to really see all the pretty colors that the Dex software has to offer. 

Screenshot of Dexcom software

"So what now?"

Now I'll make use of the sensors I've received (taking a few days off and reinstalling another one on Sunday morning, post-bachelorette party) and move forward on the insurance verification and approval.  I'll be sure to document my progress with the insurance approval, because I know that's a concern for many people considering a CGM.   

"You mentioned a rough week of numbers.  What's going on?"

Dude, I have no idea.  My numbers have been grossly high all week long, highs in the "Hey, I'm a newly diagnosed diabetic" range like 409 mg/dl, 363 mg/dl, and my favorite, the stubborn 212 mg/dl that visits me without calling first.  I'm changing out my infusion set tonight after work, in hopes that a dodgy set may have been the problem.  Or maybe it was a busted bottle of insulin.  Either way, these blood sugars are reflecting a botched set, or raggedy old insulin, or work/wedding stress, or just plain Blech.  Or maybe all of these things.  One way or the other, I know I need to get things under control FAST because I feel like garbage.  My days with Dex showed me just how bouncy my numbers have been. 

Time to buckle down and focus on what matters most - not deadlines or scheduling or planning, but getting these numbers back under control.  It all starts here.

April 08, 2008

Dexcom Seven: The Warrior Returns.

I made the mistake of saying the following to Chris the other morning:

"You know, I haven't had a low in like two weeks!"

The next morning, the alarm went off and my eyes slowly opened, as though there were weights attached to each lash.  Brushing my hand against my forehead to wipe off the sweat, I reached for my meter and loaded in a strip.  For some reason, the lancet wasn't pricking my finger.  Shunk.  Shunk.  Shunk.  Chris stirred beside me. 

"It won't bleed."  Said as though the blood wasn't mine, the finger someone else's.

Finally, a ruby red spot leapt up from my fingertip.  Five seconds later, 48 mg/dl winked at me from the meter.  I drained the small bottle of juice on my bedside table and snuggled back underneath the comforter, waiting for my body to catch up.

I had two more lows that day, one that left me shaking at my desk at work and another that had me stumbling on the treadmill at the gym.  The next day, I hit a sticky high of 409 mg/dl after a site change, the sweaters knitting up in my mouth and lethargy wrapped around every movement.

The DexSignal

So when the Dexcom Seven arrived at my office, courtesy of the reps out in California, I didn't think twice about suiting up for another round as the Dexcom Warrior.  I installed my first Seven sensor on Sunday night.

I know what you're thinking:  "You had a rough experience with the MiniLink - why are you doing this again?"  

Why?  Because I found the Dexcom to be a superior CGM product.  Minimed makes my pump and therefore has my appreciation, but their CGM unit is sub-par.  Aside from the flopping sensors and the painful insertions, the darn thing just wasn't right.  I know CGMs aren't supposed to be a substitution for manual blood glucose testing, but I had little confidence in even the trends offered by the MiniLink - and I was very frustrated by the errors that were cropping up.

The Dexcom, however, had a more reliable trending ratio and the actual results correlated tighter with my meter.  I'm not thrilled about using a second device (the receiver being its own entire hub device), but if I'm going to make use of a CGM on occasion, I want things to be as "right" as possible.  Like right now:  Dex says I'm 146 mg/dl.  Meter says I'm 137 mg/dl.  It also says I'm on the rise, which is true - I was 92 mg/dl an hour ago.  

So I'm spending this week with the Dexcom Seven, making it part of my work day, my workouts, and my wedding stress.  With wedding planning coming to a wild and all-consuming crescendo, I'm hoping Dex can help me stay more tightly controlled.  Because, between you and I (and the entire internet), I'm having trouble keeping my numbers steady these days.  Diabetes is rearing its head and I, for one, am not feeling very armed for battle.  Hopefully I can sharpen my Dexcom skills and have it as my secret weapon. 

March 28, 2008

The Friday Six: Weekend Prep.

The Friday Six:  March 28, 2008 editionShannon tells me it's snowing like 8 inches up in her neck of the woods.  My mother reports rain in Providence.  And it's chilly with a side of potential frogs raining down here in Connecticut - what the heck is up with this weather?  Here's the Friday Six for this bizarre-weathered Friday.

As I stated in my earlier post today, Children With Diabetes is now a part of the Johnson & Johnson family of companies.  See it ... look closer - it's diabetes, right there on the map.  Nice.  I'm excited to see how this will affect the diabetes community on the whole.  Big news!

In other diabetes-related news, April 14th is Raise Your Voice: Type 1 Diabetes Awareness Day!  There's a Facebook event if you haven't seen it already (and it's not hard to "attend," seeing as how this is a virtual event.)  Now that the troops are rallied, all we need is a logo ... and here's where you come in.  Bill over at EatSmart has offered one of his nutrition scales as a prize for our logo contest - that's a $75 value!   Here are the rules:

  1. Design a logo (the size cap is 200 x 300 pixels). 
  2. Include the event name:  "Raise Your Voice!" 
  3. Have fun designing it.
  4. Maybe have a snack while you're designing - apples are tasty.   
  5. Email it to me as an attachment to kerri [at] sixuntilme [dot] com with the subject line "LOGO CONTEST" no later than 3 pm on Thursday, April 3rd
  6. Grin because it's done and submitted.

That's it.  The winner will be decided on Friday morning and Bill (thank you, Bill!) will send you an EatSmart nutrition scale of your very own.

And one last thing on the scale:  After I posted my review of the EatSmart nutrition scale yesterday, Bill over at EatSmart gave me a call and told me that if you guys want to order your own scale, enter "KerriSentMe" into the coupon field during checkout on the EatSmart site and receive 10% off your order.  I thought that was right-kind of him - so if you're thinking about ordering a scale, score your 10% off, damnit!

I know many of you have seen the Gaping Void cartoons (this one is my favorite today), but did you know you can get business cards with these quippy little suckers on them?  I was unaware.  Now I am intrigued.  I like my business cards, but it would be kicking to have something so bizarre.  Food for thought.  And just as a sidenote:  I love these cartoons. 

Tomorrow is my wedding shower.  (Yes, I know I'm not supposed to know, but since I live out of state, I needed to know what day to come home.  So I know it's tomorrow.)  I know I need to be there at noon-thirty.  And I know it will be fun, because with my mother and my terrific bridesmaids at the helm, it's sure to be an awesome time.  Everything is happening very quickly now:  the bridal shower, then bachelorette party, then the last meetings with our vendors, then the rehearsal dinner, then the wedding ... I'm afraid if I blink, I'll find myself on the plane bound for our honeymoon.  I wish I could slow this time down so I could actually enjoy it!  Instead, I will blog it.  (This may be the mark of a blogging addiction.)

And six.  Ahhh, the final moment for me today before the weekend cracks wide open and swallows me.  This morning, at about 3 am, I woke to the sound of scritch scritching, coming from the bedroom floor.  I ignored it at first, thinking that it was just one of the cats lolling around.  But it came again, louder this time:  scritch scritch.  So I leaned up, looked to the floor, and saw Siah completely wrapped up in toilet paper.  She had completely unraveled the roll from the master bathroom, dragged the bulk to the middle of my bedroom, and made a nest in it.  Like an enormous hamster. 

I do not need a dog.  I have a Sausage cat who laughs at me.

March 27, 2008

Precision Carb Counting.

Diagnosed in 1986 with type 1 diabetes (Kerri, you're diabetic?  I had no idea...), my first diabetes meal plan involved that dreaded exchange system.  Two starches, a protein, a fat, a fruit ... a headache with each meal.  Since my insulin at the time was Regular and NPH, I was matching food to insulin and constantly chasing that bell curve.  Meal times were a constant hassle, with my poor mother whipping out measuring cups and teeny food scales at restaurants, referring to the Big Red Joslin Handbook for exchange values, and swearing under her breath with savvy and discretion.

As a result of this willy-nilly (ooh, fun phrase) mash-up of insulin and food, it was tough to hold my numbers steady.  We could only predict somewhat how my numbers would react to my mealplan.  It wasn't until fast-acting insulin, the precision of insulin pumping, and the frustrating miracle of carbohydrate counting that I was able to eat with more pleasure and better predict the blood sugar outcome.

However.

I am not good at "eye-balling" food portions.  Without second-guessing, I can convince myself that a cup and a half of pasta is only a cup.  What looks like fifteen green grapes captured in a plastic bag ends up actually being 26.  And please don't even ask me what a tablespoon of ketchup is, because I have no clue. 

Which is why, when the guy at Eat Smart contacted me about his nutrition scale, I was all about giving it a go.  He offered to send me a sample scale to review, at no cost and no payment to me.  So FYI - this is not a paid review. 

The Eat Smart scale

The scale arrived in the mail yesterday and it has a jazzy, streamlined look to it, which I like. Figuring out  how to turn the thing on and make sense of all the buttons was not intimidating to me (as I've mentioned before, I have serious techno-joy) but I could see it being a little overwhelming for someone not as tech-savvy.  However, the instruction manual was very straight-forward and within a few seconds, I was weighing in my mid-morning apple. 

According to the Calorie King website, my apple should have contained roughly 19.1 grams of carbohydrate.  This is an estimation based on the size of the apple and my perception of that size.  According to the nutrition scale, my apple contained 15.3 grams of carbohydrate.  At first glance, it looks like a "tomato, to-mah-toe" issue, but when I'm aiming to keep my numbers as steady and eliminate as many variables as possible, even 5 grams makes a difference. 

In addition to weighing random items with precision, the scale also offered up plenty o' nutritional info like calories, carbohydrates, fiber, fat content, sodium ... and on and on and on.  At this stage in my life, I'm mostly focused on carbohydrate content and occasionally sodium or fat values, but I can see how this data would be really helpful for other health conditions.  There's a list of 999 foods that are pre-programmed into the device, with an option to manually calculate using the food label on an item - like a dollop of cottage cheese or similar.  This feature was very helpful for me because I tend to eat a lot of fruits, fresh vegetables, and protein, so I don't have the benefit of an FDA nutrition label on everything I'm chowing.

So the data is helpful.  The scale is a little on the bulky side (see the picture for comparison against your average, garden variety office pen - grown fresh here in the dLife garden) and it's also on the pricey side ($75 bucks for this sucker!) but the return on this investment could be worth it.  I haven't tooled around with it enough to make a long-term assessment, but my initial feel is "Hey Scale, You're damn useful!"

Do you guys use scales to measure the "unpackaged" food?  Or are you more apt to wing it?  I'll admit - I wing it more often than I'd like, even though I'm eating a very healthy diet for the most part.  Hopefully a scale like this, a more focused determination to carefully account for my carb intake, and more coffee (yay!) will help me fine-tune this chaos.

Now let's see if this booklet has a value for "cheesecake" ... yum...

(Also, Hannah wrote a great post on the old exchange system from ADA - check it out!) 

UPDATE:  If you want to order your own scale, enter "KerriSentMe" into the coupon field during checkout on the EatSmart website and receive 10% off your order.  How's that for cool?

March 21, 2008

The Friday Six: Spring Edition

Friday Six!Yay for Spring!  Despite the chilly temperatures outside, I've switched over to my spring coat.  Granted, I froze my ass off walking into work today, but yay!  It's spring!  I'm beyond ready for winter to be ovah (thank you, RI accent that I wish I had) and I can't wait to hit the beach this summer.

Okay, on to The Six.

1.  This is wicked cute, just in time for spring, and courtesy of a fellow AisledasherClick anywhere on the screen and watch the flowers bloom.  It absorbed my attention for at least ten minutes.  And now it's absorbing it all over again.  Mmmmm flowers ... I mean, doughnuts ...

2.  And in keeping with the complete nonsense theme, it's been a walk down the proverbial memory lane here at work lately.  Between a co-worker bringing in her son's copy of Harold and the Purple Crayon and discussions about whether or not Lady Elaine was an alcoholic (look at that nose and tell me she's not drinking daily in the Land of Make Believe), it's been random.  This randomness led neatly into the rediscovery of this memory:  Meow Meow Telephone.  I've watched this clip so many times that it's permanently stuck in my head.  If I could make it my ring tone, I would.  If I could get it out of my head, I would do that, too.

3.  In diabetes news, there's a new site for young people with diabetes.  (Aren't there always new sites?  The Internet - it dizzies me.)  According to Daniel, the developer of the site, "Young Diabetics started with a few college students trying to make a difference for their diabetic friends, family, and acquaintances."  Check it out!

4.  Chris and I are heading home to RI (again) for Easter weekend.  I'm hoping that, between our nieces and nephews and younger cousins, we'll score some colored eggs to take home.  I loved coloring eggs as a kid.  The Paas tablets in my mother's tea cups, all lined up on the kitchen counter, are the concrete memory of Easter that I have as a kid.  However, since we've all grown up and are out of the house, so many of those traditions have been lost.  Traveling for the holidays has become an unfortunate trend in so many families, my own included.  How do you keep hold of those family traditions when so much time is spent flitting from house to house? 

5.  Busy, busy.  That's the trend, or at least it has been for several months now.  But a co-worker recently sent me a link that could help make sense of the mess I muck around in all day long - Sandy!  Sandy is touted as "your personal email assistant."  Looks like it works along the same model as Twitter (with the @todo sending messages directly toThe Friday Six:  March 21,, 200 edition "Sandy") and by cc'ing Sandy on emails with sentences starting "Remind me to ... ", this service keeps a running tally of crap you need to do.  I haven't really explored this, nor do I have the time today to teach myself how to make sense of a new service, but it's an interesting idea.  Having my own intern would also be interesting, but do interns clean litter boxes?  Hmmm...

6.  And lastly, today is Chris's birthday.  Happy birthday to my supportive fiance, my best friend, and my hero. 

Have a great weekend! 

March 19, 2008

Dear Medtronic.

These are the sneakers I have.  Just as a sidenote.Dear Medtronic,

How are you?  It's been a few weeks since we've touched base, but I wanted to let you know that my new insulin pump is chugging along just fine at the moment.  It's finally a bit scuffed and I have all my new carb ratios and basal patterns plugged in there - just like the old one.  So thanks for making such a great pump and for having a commendable level of customer service.

Why am I sucking up a bit?  Well, this is a little awkward.  I'm really disappointed in something I've read today.  I've always liked you as a company and I've always been proud to be a part of your user base.  But I received an email from Marcus last night that upset me. 

He sent me a link to the Medtronic Global Heroes campaign, aimed at highlighting the achievements of runners with diabetes.  According to your website:  "A Global Hero is a runner. An inspiration. A person whose life has been improved by medical technology."  Aside from earning some recognition and plenty of product benefits, the Global Heroes will also have this option:  "Medtronic Foundation will donate $1,000 on behalf of each Global Hero to a non-profit patient organization that educates and supports individuals who live with the runner’s condition."

What an awesome opportunity!  I know plenty of strong, talented runners from the blogosphere.  Like Marcus Grimm.  And Anne.  And Ed.  People who are conquering their condition and pushing themselves to higher levels of physical fitness and health.  But only if they fit the specific criteria.

Because you have added a stipulation this year that states: "Runners 40 years or older with insulin pumps and who have had diabetes for more than 15 years are ineligible."

Medtronic, would you care to explain to us how you justify leaving them behind?  Your Global Heroes program is inspiring and can really show people with diabetes how limitless their lives can be.  I understand the need for a CYA caveat, but to forbid them to even participate?  Taking away their option to earn funding for their chosen charity?  That's shameful.

Medtronic, you make a great pump.  But you've made better impressions. 

-- Kerri. 

March 14, 2008

St. Patty's Six.

The Friday Six:  March 14, 2008 editionWhat a week.  And even though Monday is actually Saint Patrick's Day, I'm observing the holiday this weekend.  So here be the St. Patty's Six. 

HUGE news from Abbott yesterday regarding their version of the continuous glucose monitoring system: The Navigator.  I am itching to try this system out, too.  I am looking forward to the day when CGM models all but replace traditional glucose meters.  The power of real-time results is unparalleled, but we just need a company to make it work.  I'm curious to see how The Navigator compares against what we've already seen from Medtronic and Dexcom.

Also, the JDRF website is featuring a Blogger Roundtable discussion this week - and there are plenty of people from the diabetes community that have been highlighted.  Read the insights and perspectives offered up by Bernard, Scott J, Sandra, Amy, Gina, Scott S, Allie, Manny, and me!  Thanks to Allison for compiling these profiles. 

And thanks to a tip from Bernard, the first human trials towards a cure for established type 1 diabetes are on the verge of starting.  According to the release, "The first step in the human study, which is currently enrolling volunteers, is to determine whether the same strategy using BCG vaccination can be used to modify the abnormal autoimmune cells that are present in type 1 diabetes, sometimes called 'juvenile-onset' diabetes."  This is tremendous news, and I'm already checking to see if I could be a possible volunteer.  Exciting times, but I'm reserving my hope for once the trials produce some results.  Still ... pretty darn exciting.

On a knitting note (stretching for the segue), I came across these neat little knitted ... bodily organs thanks to this week's Grand Rounds.   The blogger over at FreshMD is the source for these images and highlights the creators of these crafts.  I'm impressed, and personally, I like the little corn-on-the-cob looking pancreas in a pretty butter yellow.

And with the last of the invitation list sent out to the printer and our invitations en route, I'm taking the weekend off from thinking about anything wedding or diabetes-related. I'm off to Newport, RI to celebrate St. Patrick's Day starting with the big parade and ending up ... who knows where. :)  My maid of honor is in charge.  I'm just happily following her lead and will do my best to not stress out about a damn thing.

Have a great (and safe) weekend and I'll see you Monday!!  (Editor's Note:  I just realized there are only five items here.  Whoops.  As a quick sixth, check out this wonderful tribute by SuperG about his father.  His post brought tears to my eyes, and made me want to drive home to RI and give my dad a hug.)

March 10, 2008

A Little Fitness Info.

The folks at Fitness4Diabetics contacted me with information about their upcoming webinar - with Hope Warshaw, who was at Divabetic last week!  Here's the scoop from the release:

"On Thursday, March 13th,at 7pm EST, Fit4D will be hosting Hope Warshaw, author of multiple books on healthy eating, including Eat Out, Eat Right, along with Fit4D Director of Nutrition Services, Susan Meeke, MS, RD, LD,CDE, for a very special presentation for nutrition month. This promises to be a lively and interactive discussion about healthy eating and increased activity levels as a means to long-term lifestyle change.

In honor of Fit4D's two year anniversary providing diabetes coaching services, Fit4D will contribute $5 to JDRF for the first 100 hundred people who register and attend the March 13th webinar.   We want to thank you for your help in promoting our monthly webinars. 

Participants can register at http://www.fit4d.com/newsletter.php?a=signup  or sign up for our newsletter and updates on future seminars including Mom, Can I Have Cookies? Diabetes in Childhood and Committing to Your Health.  For more information, please visit www.fit4d.com or call 866 411 0254."

March 04, 2008

Cold Sting of Insulin.

Icy pinprick of an infusion set.I have had plenty of infusion sets that don't hurt.  I wipe the site with an IV prep wipe, load up my trusty Quick-Serter, and shunk in a new infusion set into my skin.  Pull back the needle, leave the cannula inserted, and hook up the tubing.  Prime, stash the pump somewhere on my body, and move on with the day.

But lately, I've had a few infusion sets that stung like snakebites.  I'll be sitting on the side of the bed, pull back the white plunger on the Quick-Serter, and then send that infusion needle hurtling into what must be a happy little nest of the most sensitive nerve endings in my body.  At this point, I usually hop up on one leg, tears stinging in my eyes, and I bring forth my best Yosemite Sam impression (reserved for moments like this and for when my car makes me fume). 

Sunday night, I put in a new set and the string was unbelievable.  Determined to soldier through until the pain passed, I gritted my teeth and laced in my dinner bolus.  I could feel the cold of the insulin spreading underneath my skin like snowflakes.  I ate my dinner (spinach salad with chicken, as previously discussed) and tested two hours later at 228 mg/dl. 

Sometimes it feels like it takes a few extra hours for a new infusion set to "stick," so I decided to correct the blood sugar, go to sleep, and see what the morning brought.  

7:30 am - 156 mg/dl.  Though higher than I normally run in the morning, I didn't worry about the site.

All day yesterday, my numbers were crunched - 189 mg/dl, 221 mg/dl, 192 mg/dl, 201 mg/dl, and then finally 102 mg/dl.  It's like it took all freaking day to come down.   And oh how that site smarted like holy hell all day long.  Just the brush of my pants against the edge of the thigh sent spirals of pain down to my knees.  This was so not normal.

When I came home from work, I ripped the site out as fast as I could.  While the cannula was perfectly unkinked and appeared to be normal, the site gushed pus (ew, sorry) and blood immediately.  Over the course of the night, I'd managed to riot up an infection in that site - no wonder it was on a 2 hour delay accepting all my boluses and no wonder it was swollen up like someone had shoved a Mento under my skin.  

(Note to self:  If it hurts and you're high, just suck it up and change out the set.  Stop being so darn stubborn!)  

Today's numbers:  78 mg/dl, 138 mg/dl, 158 mg/dl, 108 mg/dl ... and holding steady.   

February 26, 2008

Countdown to Wedding.

Over the past two months, I've been slacking - big time.  I've been indulging in desserts on the weekends.  I've been going away with Chris and enjoying decadent dinners at French restaurants and sipping cappuccinos every chance I had.  Work has been extremely busy and I've been putting in plenty of hours.  Freelance projects have included some late nights to meet deadlines and some trips into the city for different events, so I've only been able to get four workouts in per week. 

And I've seen a bit of a flux in my body - nothing noticeable on a scale but I don't feel as strong as I did a few weeks ago and I feel a little sloppier.

No more of this namby-pamby crap "I'll do my best and see what happens."  Change needs to be made and I just need to plain make it.

So, with the guidance of my fitness-freak fiance and armed with enough information to safely manage any diabetes disaster, I'm starting a whole new regimen.  I will roll with this until my wedding date, after which time I will be on my honeymoon, happily married, and not plagued by the white dress stress.

My plan is to take a standard approach to every day, eating almost exactly the same thing daily and following as much of a schedule as possible.  I know that when I eat similar items, I see similar blood sugar responses.  I'm hoping that a more finely-tuned diet will eliminate blood sugar fluctations and help me keep better tabs on what I'm eating.  (Because those almond Hershey kisses on my co-worker's desk are delicious and I keep snaking them throughout the day.  No more of that for the next two and a half months.)

I'm going to try to follow this meal plan at least Monday - Friday:

8:30 am:  Oatmeal and walnuts, with my morning cup of tea.

10:00 am:   Yogurt.

Lunch:  Salad of baby spinach with baked chicken, cherry tomatoes, and portabella mushrooms with balsamic vinagrette dressing.

2:30 pm:  Apple and peanut butter.

5:00 pm:  Breakstone cottage cheese double.  (These things are delicious.)   

Dinner:  Eggs, or soup, or chicken and that zippy white bean salad, or something else healthy along those lines.

Bedtime snack:   Light, low-carb snack, like nuts or a cheese stickPhoto credit:  www.rewardlicious.com

As far as the workout goes, I'm changing things a little, but not completely.  Generally, I'm at the gym Monday - Friday and doing 15 minutes of weight training, then a 30 minute cardiovascular workout.  I'm doing a variety of weight exercises (like tricep dips, push-ups, box jumps, jumping rope, lunges, I'm exhausted just writing this stuff, ab exercises, etc.) and doing 2 minutes walking - 10 minutes running as my cardio workout

Re-reading this, it sounds so regimented.  BORING.  But I've worked very hard over the last few years to change my body and I'm so hopeful that this new routine brings me to a new level of fitness and diabetes health overall, making me ready for my walk down the aisle. 

Because I tried on my wedding gown again this weekend and it fits like a glove.  A glove without much room for weight gain. 

No more nervous nibbling - it's time to buckle down and make this work. Let the sweating begin!

February 20, 2008

Strip.

I am a relatively clean person.  I don't like dirty dishes, hampers filled with needs-to-be-washed laundry, and I despise knowing the cat box has those teeny morsels of yuck in it.  Sometimes, late at night when I should be getting ready for bed or relaxing on the couch, I'm hit with these cleaning fits.  I'll scrub away at every last stain on the counter, reorganize my underwear drawer (yes, it's organized for the most part), or start chucking the expired items from the fridge. 

I clean up my desk whenever I leave the office.  I can't stand messy piles of paper or a filthy, unwashed coffee cup with that tell-tale ring of grinds the bottom.  I don't like when the garbage can isn't emptied every night.  

Clean.  I like it that way.

So why, oh why, do I find myself completely and utterly inept when it comes to properly disposing of used test strips?  

These little buggers are everywhere.  I've written about them before (stuck to Chris's face, on the floor at the gym, and even discussed in dictionary entries), yet I still haven't found a way to solve the problem.  I test anywhere from 8 - 15 times a day, so these used strips accumulate and are inadvertently stashed in parts of my life like those hidden picture things from Highlights for Children

Glucose meter strip on the floor.

On the floor just next to my garbage can. 

(And that's a sticker from an apple.  I couldn't get it to peel back up.) 

Bag o' stuff.

At the bottom of my massive work bag (with many other assorted bits).

Even in the damn camera bag.

Even in my relatively-new and almost always zipped camera bag.  How the hell did it get in here?

Crafty little testy suckers.  I do my very best to make sure I do not leave a pocket of test strips when I visit new places or people, but I always find a pile of them hanging out in the spots I frequent the most:  my car, my office, and my home.  I keep trying to get them in the garbage can but it's like the bin takes a step to the left every time I go to toss one out.  Are garbage cans across the country uniting to thwart my best intentions?

I need to sharpen my disposal skills.

February 13, 2008

Ketones.

Headache.  Check.  Eyes that weighed at least a pound apiece.  Check.  Mouth full of sweaters.  Check.

Looks like they're all here - the symptoms of a high blood sugar.

Sitting down to catch up on some emails, I absently fish my meter out of my gym back and lance my fingertip.  I hit send, graze against the new infusion set on my left thigh, and see a meter result of 420 mg/dl.

"Oh, that is just fantastic."

Taking out my pump, I calculated the massive correction bolus and felt the quiet sting of the insulin as it coursed through the infusion set I had placed an hour earlier.  Normally when I'm at an elevated blood sugar, I feel lethargic and generally Crumbs Morrone, but this one had a different feel to it entirely.  My stomach felt like it was playing host to a hamster wheel, and my headache was blinding.

I brought the ketone strips into the bathroom and watched uneasily as the pad on the ketone strip turned a deep purple.  Large ketones.  I hadn't seen those suckers since my days at Clara Barton Camp.  I never, ever have ketones, and I test regularly for them.  So where did this come from?

My stomach in knots, I wandered back into the living room and filled Chris in on the situation. 

"I'm high.  Like crazy high - 420  mg/dl.  And I just tested for ketones.  I have large ketones.  I feel like complete shit, and my stomach is really nauseous."

He rubbed my back.  "So what do we do?"

"Drink a ton of water and try to flush out the ketones, I guess.  If I can't keep the water down, we're off to the emergency room."  It dawned on me that I had the process of treating a low blood sugar down to a science, but navigating a serious high was unfamiliar territory.  Normally, I just bolus and wait for the numbers to fall, but this high came with an added bonus of ketones.  The word "ketones" was enough to send me scouring for my old Joslin manuals from 1986, breaking open that red binder and searching for the antidote. 

I drank several bottles of water and willed myself not to throw up, even though my body disagreed with that decision.  "Do not throw up.  Do NOT."  The mantra ran through my head and I tried to relax on the couch, drinking water all the while.  After about an hour, my blood sugar had fallen to 248 mg/dl and the ketones had retreated to "moderate."  Three hours later, my system was flushed clean,Ketones ... huh ... what are they good for? ketones were down to "trace," and my numbers were hovering around 170 mg/dl.

But I was still confused - where is the emergency room threshold?  DKA is defined by Wikipedia as "a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). Near complete deficiency of insulin and elevated levels of certain stress hormones combine to cause DKA."  Okay.  And Joslin had it beaten into my brain that ketones + vomiting = emergency room.  This is serious stuff.  But there is that gray area where large ketones are present and proper management steps are being taken, should I still be under the care of a medical professional?

I opted to stay home and wait it out, since I wasn't throwing up and my blood sugar was falling from that obscene high.  And today, at my doctor's appointment, I asked Dr. Connecticut about when I should be checking myself into the ER due to high blood sugar.  She confirmed that as long as I wasn't throwing up and that my blood sugar was coming down, it was okay to treat at home.  She did add that if I was showing signs of another infection, like a urinary tract infection or a sore throat, that the emergency room should be on my "must see" list.

Over 21 years with this disease and there are still uncertainties that touch in at any given moment. 

February 07, 2008

My Own Accord.

I'm reading through the pile of emails about the ACCORD (Action to Control Cardiovascular Risk in Diabetes) - there are several already this morning - then clicking through to the Dallas News, then to the NY Times front page headline. 

It's all about what sells, right?  Getting the attention of people?  Telling them that "tight control can kill you"?  Anything to get people to click through, right?

Tight control, whether you're type 1 or type 2 diabetic, keeps diabetes-related complications at bay.  This is a fact, proven by countless studies and evidenced by a whole host of patients.  To start telling people that tight control will kill them is irresponsible.  As stated in the dLife Today blog:  "It's important to note that the increased risk was slight, and was specific to only a subset of patients who had two or more risk factors for heart disease outside of diabetes or who had pre-existing heart disease upon entering the study."

But these specifics aren't what sell papers.  Headlines like "Patients getting aggressive diabetes treatment have higher death risk" are the ones my friends and family will click on and become fearful of, knowing full well that I am diabetic and use an insulin pump (considered aggressive treatment).  Thanks to all of the media chatter, people are up in arms about this study, assuming at first glance that results apply to all people with diabetes.  Click here ... for nothing to happen.

Kelly Close of diaTribe and Close Concerns said it best:  "... if you are type 1, you can read this piece with interest, but know that ACCORD has zero to do with you. If you are type 2 and newly diagnosed, keep moving on your plan - ACCORD has zero to do with you. If you have had type 2 for awhile but don't fall into the "high risk" profile, keep your goals intact."

Mom, this study doesn't apply to me.  My control goals remain the same.

January 09, 2008

MiniLink, Armed.

MiniLink sensor in my arm.My Minimed rep was meeting me at the dLife offices after work to hook me up with the Medtronic Minilink and I joked in an email that he should hoot like an owl upon arriving so that I would know he was there.

Around 6 pm, my cell phone buzzed.  The message left was not someone saying, "Hi, Kerri.  [RepName] from Medtronic calling," but instead, "Whoooooooo!  I'm here."

That's the mark of someone who's on my level, that's for damn sure.

After exchanging grins, we settled ourselves at a table at a local coffee shop and laid out our drug paraphernalia on the table.  The box of CGM sensors, the MiniLink transmitter, the insertion device, and our respective glucose meters (my rep is also type 1) littered the table.  Conversation flowed easily as he set me up with the MiniLink.

"Okay, so now we're ready to place the sensor."  He loaded up the inserter with my first MiniLink sensor.

"Great.  Let's pop that in on my arm."

He paused. 

"Inserting a sensor at a coffee shop is a first, that's for sure.  But in the arm?  This is a series of firsts for me." 

With a little help and almost no pain at all, the sensor was inserted and the transmitter connected.  (I didn't have the opportunity to take pictures of the actual insertion, but I will do a photojournal for the next sensor I use.) 

After the first three hours, the pros and cons were beginning to show themselves. 

PROS:  The sensor is small - about the diameter of a quarter (maybe a small bit bigger) and about three stacked quarters high.  It's on the back of my arm and is pretty low-profile.  It's also water-proof, so no crazy-sticky shower patches that leave red rings on my skin for days.  The MiniLink transmitter, like the Dexcom, takes two hours to fully calibrate when you first put the sensor on.  (This term is called "wetting," which I think is revolting.  My rep and I called it "percolating."  Much less icky.  And hearkens to coffee, which I need desperately.  I'll explain why in the "cons" section.)

This sensor also works in tandem with my Medtronic 522 insulin pump, so I'm toting around one device instead of a receiver and an insulin pump.  It also is able to calibrate using any glucose meter, so I could continue on testing as usual, using my One Touch Ultra2.   One hub device is a huge selling point for me. 

CONS:  The transmitter is floppy and needs to be secured against my skin with a bandaid to keep it from coming loose or dislodging the wire.  This is the biggest con for this transmitter so far.

HOWEVER:  This frigging thing kept me up all night long.  After being instructed that the CGM results are about 15 - 20 minutes behind my actual blood glucose (i.e. the CGM says 100 mg/dl, my sugar is actually 80 mg/dl or thereabouts), I set my low glucose alarm for 80 mg/dl, assuming my number would actually be close to 60 mg/dl once the alarm sounded. 

Thanks to my vigilance with my overnight basals and the fact that they're set with precision, my numbers run close to 90 mg/dl all night long.  Due to this tight control on my overnights, the low glucose alarm went off eight million times last night.  That was issue one.

Issue two involved another alarm - this one reading "Bad Sensor."  Unfortunately, this alarm went off at 2:53 in the morning and I was not going to wake up again just to reinstall a new sensor.  So, against the advisement of my Minimed rep, I manually told the pump that I had installed a new sensor and recalibrated it.  It reset its timer for the two hour calibration, thus waking me up again at almost 5 am. 

Then the low glucose alarm went off again at 6:15, because I was 79 mg/dl.MiniLink - ha ha ha ha ha!

(Note to self:  Kerri, set the low glucose threshold at 65 mg/dl, for crying out loud.  Or you may never sleep again.  Seriously.  Every time the thing went off, you groaned, the cats howled, and Shoes most likely plotted revenge.  Raise the threshold.  Do it now, you silly girl.)

I have not slept well, but it's obvious that my numbers hold tight and steady throughout the night.  I'm hoping last night's escapades were a fluke thing and that a little tweaking will have me living in relative harmony.  

I'll have more on the technical aspects of this device throughout the week, but for now I'm going to check my number - ah, 113 mg/dl on the Link, 99 mg/dl on my OneTouch - and get another cup of coffee.

I am MiniLink.  :)

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December 20, 2007

Tune Up.

I spend a lot of time thinking about health and fitness.  

There's my job, where I am often found perusing diabetes-related press releases, checking out the latest websites about endocrine health and wellness, and writing about what day-to-day life with diabetes is all about. 

Then there's my handsome fiance, who has spent time as a personal trainer, writes for various fitness venues (including AOL), eats a regimented, healthy diet, and has a physique that is evidence of time well-spent at the gym.

Oh, and then there is the whole "white wedding dress" thing, where everyone will be looking at me in a few months on a (hopefully sunny) May afternoon.  Not to mention my disease, which I manage with an insulin pump, my meter, attempts at healthy eating, and regular exercise.

So I'm constantly checking out different websites about health and fitness, as the themes touch so many different parts of my life.  My magazine collection is a mish-mash of Women's Health, Shape, and Modern Bride.  These pages are dog-eared and occasionally ripped out and pinned to my cube wall or my office bulletin board. 

Never mind the daily webcrawl I make, bouncing from my daily check of Women's Health online for some daily tips and inspirations, FitDay to continue on with my goal of keeping a food journal for a full month, Slashfood for some foodie snippets.  Recently, I've been checking out iVillage's Your Total Health site, Healthbolt, and Lift Magazine for some newer viewpoints. 

It's all bit-sized bits of health information, which fit into my multi-tasking sort of lifestyle.  But the part that I'm having trouble with is cutting down the workout to a sensible size.  Fitness doesn't appear to come in teeny bits for me.  I need to work out long and hard in order to see results, constantly fighting the uphill battle of treating low blood sugars and the demanding schedule of any fully employed twenty-something.  (Scratch that - the schedule of anyone is demanding, ranging from kids to senior citizens to circus clowns.)  I need to buckle down and make efforts to really reach my goals.  Bit of a tune-up.

A few months ago, I decided I needed to change my workout.  My legs were killing me.  But, as with anything else, my body adjusted and I needed to switch things up again.  I now have a few different methods of attack:  keeping a food journal, avoiding all holiday sweets until the New Year (it's like the Pre-New Year's Resolution), and making some awkward attempts at bringing running into my routine. 

Oh how I hate to run.  I feel awkward and like a great, traipsing gazelle.  But over the last two weeks, I've been trying to work in a circuit of running to help me tone up a bit more before the wedding.  (Five months!)  A combination of weight training and running was constantly touted by all those fitness sites as a killer fat loss program.  So I'm trying it.  First, I did five minutes running, five walking.  Then seven on, five off.  Last night, I did twelve on, five off. 

And I watched as my blood sugar fell from 160 (started the whole workout at 200 mg/dl) to 68 I only wear two sneakers, unlike my little pal here.mg/dl.  When my workout changes, my diabetes management methods need to change, too.  Hopefully I'll find a way to trot with a bit more grace.  And hopefully my body will shift into shape by the time I'm donning my white dress for my big walk down the aisle.

Oh hell, maybe I'll run.  Just to prove a point.  ;)

December 18, 2007

Armed.

When I got home from the gym last night, I ripped out that belly site with relish.  (And a small bit of ketchup, as it bled a teeny bit and that makes me wonder if I had nicked something and if that had contributed to excess pain.  But I've digressed.  Again.) 

After showering, I slid a little IV prep on the back of my left arm, where I took daily injections for so long, and held the circular, blue Quick-Serter against my arm.  Leaving no time for anticipation, I hit the buttons on the side and plunged the needle into my skin.  No real pain, not much impact, and when I pulled the Quick-Serter back, I exposed a neatly nested circle of white on the back of my arm, with the blue needle sticking out of it. 

"Gotcha now," I muttered. 

Pulled out the blue needle and fixed primed the set with 0.3u of Humalog.  No burn.  I clipped the pump to my yoga pants.  It felt weird to have the tubing all "up north" instead of the southern hemisphere of my body.  I laced the tubing underneath the side of my sports bra and kept it along the side of my body.  This worked for the most part, aside from the fact that it tickled a bit on the underside of my arm.

I pulled on a black t-shirt and surveyed the scene.  I could see the set bulging out a little bit underneath my arm, but since it was on the back, it seemed barely noticeable.  I fell asleep more aware of the fact that the pump wasn't on my leg, instead of hyper-aware of the set on my arm.

This morning, not much different.  Showering proved to be no issue, as the shower poof didn't come into direct contact with the site (it does when I'm using my leg -- I'm obsessive about shaving).  I got dressed in a pink sweater and black skirt and snaked the pump tubing underneath the side panel of my bra and along the side of my body again, coming to a rest tucked into the top of my skirt.

Pros to wearing it on my arm are that the area has been virtually untouched for the last four years, save for the rare injection.  It's up and out of the way, so using the bathroom isn't a tricky "hey, did I just skim the site with my pants?" excursion.  It's not creating a bulge that I can see without lifting my arm a little bit, and once the tubing is secured under my bra, it doesn't budge.

Cons to this site are that dressing/undressing is a bit tricky, as there's plenty of braided tubing to contend with.  It aches a teeny bit, but nothing too dissimilar from a thigh site and nothing even close to the ache of an abdomen site.  It's a bit tricky to connect/disconnect because I can't really see it, but since I don't usually look when I reconnect, I can do it by feel.  The main con is that I can't extend the tubing to my sock and hide my pump there, so I'm experimenting with different "above-the-belt" hiding spots.  Today it's tucked inside my tights, against my hipbone.

So, thanks to your encouragement, I think I have a new spot to rotate my infusion sets to.  And it wasn't too scary!  Now it's your turn to try something new.  :)

December 17, 2007

Site Unseen.

About 90% of the time, I do not mind wearing an insulin pump.

Yes, of course, I would much prefer to be cured of this disease and I don't enjoy the day-to-day maintenance of a chronic condition, but for me, pumping these past four years has been far superior to multiple injections.   I can hide it in the folds of my clothes.  I can disconnect for exercise, intimacy, and beachin' it.  And it delivers my insulin with a precision and stealth unrivaled by my orange-capped syringes.

However, the past few days have been holy hell.

Instead of sticking the infusion set on my thigh, like I usually do, I opted to give my legs a rest and revert back to my abdomen.  I originally started using my thighs because I thought stomach sites burned and felt like fire in my sensitive, nerve-riddled skin.  I liked having the tubing snaking down my leg instead of jutting out from underneath my shirts, and I preferred to have my infusion set nested on my out-of-the-way leg instead of my front-and-center abdomen.

But, in the interests of site rotation and absorption tests, I stuck the site in my stomach and went about my merry way.  Unfortunately, it was far less merry than usual.

The site is currently about three inches to the right of my naval, about two inches down.  While wearing sweat pants, this site location is not an issue because the waistband of the pants rests about two inches below the site.  HOWEVER.  The waistband of my jeans rest, with precision, where the infusion set sits, rubbing and pressing and making the site incredibly sore.  Every time my arm brushes against it, here on its third day, it's as though the cannula has made its home in a pile of ultra-sensitive nerves.

We're out at dinner the other night, and one big laugh had me squirming because the site had caught against the edge of my pants.  Driving home to RI was entirely uncomfortable because my seatbelt was snug against the bulge of the site.  Every bolus has a bit of a burn to it.  The sweater I wore to work today shows the faint outline of the infusion hub orbiting near my naval.  Even sleeping has me rolling over, folding my arm underneath myself, and mashing up against the site. 

For the last three days, that infusion set has gone from "something I barely notice" to "alien in my belly."  An alien in my belly has been a bit of a startling enterprise, to say theNow he's wearing an infusion set.  Gotcha. least.

I admire people who can do a full site rotation, hitting places like their rear ends, their arms, and even their breasts.  (Note:  I will never, ever use my breast as an infusion set site.  I cannot imagine that kind of ouch.)   But I officially hate the belly sites.  I can't stand them.  I feel like a stubborn kid, crossing my arms over my chest and pouting, "No more belly sites.  I'm going home."

So, in efforts to be more of a grown-up, I'm going to give an arm site a pass.  Once I'm home from the gym and neat and clean from the shower, I'll be trying out the back of my left arm as a home for my infusion set.  You guys have given me the confidence I needed to at least give it a whirl.

If an alien takes up residence in my arm, I'll be back to legs by Friday.   

December 11, 2007

Not So Grrrrrrrreat!

The games we play.  Not grrrrrreat.Sometimes I come across odd bits of news.  And often, these news bits have to do with diabetes.  Last year, it was this newsflash about Santa Claus being diagnosed with type 2 diabetes and how he ho-ho-ho's his way back to good health.  Today, I stumbled upon a write-up about the unfortunate death of Tony the Tiger ... from type 2 diabetes complications.

Now I'm all about a laugh.  Laughter is part of my genetic make-up (we have very giggly DNA) and I think that poking fun is one of my methods for dealing with difficult situations.  There's LOL Diabetes, for crying out loud.  I get the jokes.  Often, I'm making them. 

But this crap about fictional characters being diagnosed with diabetes makes me less than amused. People spend plenty of time raising awareness.  Diabetes, either type 1 or type 2, is serious stuff and the consequences of not actively managing it can be devastating.  Pointing the finger at Santa's jolly belly or Tony's sugar habit might bring more attention to diabetes, but it's not the right kind of attention.  This sort of stuff makes diabetes the butt of jokes.  Would you point your finger and laugh at someone who is dealing with cancer?  Of course you wouldn't.  So why would people think it's okay to mock someone who has diabetes?  Because they assume a diabetic caused their own disease?  Explain that to my mother and father, who dealt with my diagnosis when I was a little girl.

"Kerri, those jokes are aimed at people with type 2 diabetes.  Geez, don't you know that?"

No, I don't.  And how does that make it right?  Regardless of the types of diabetes, the complications caused by uncontrolled blood sugars are essentially the same.  And besides, most people don't know the difference between type 1 and type 2.  Most people don't know there are even different types to begin with.  Jokes are aimed at "diabetes" in general, and I fall into that broad category.  Even if they do recognize the difference, does anyone with diabetes deserve to have the guilt, shame, or blame placed on them?  Jokes aimed at them?  Is it easy because the jokers assume the diabetic is also overweight?  That is a horrendous excuse.  How is "fatism" still an acceptable prejudice?  

I watched Super Size Me the other night.  During one part of the documentary, someone pointedly mentioned that "diabetes will cut 17 - 27 years off your life."  The factoid crept into the part of my brain that fears diabetes-related complications.  Yes, I can take every precaution to keep my A1C as tight as possible and do everything I can do avoid complications, but people don't realize that my life is already complicated by this disease. 

Adding the burden of "guilt" or "shame" doesn't help. 

How about more diabetes education that actually educates, instead of mocks?  That would be grrrrreat.

August 10, 2007

Another Round as the Dexcom Warrior.

After a whirlwind week of travel, eating sloppily, and missing a few crucial workouts, my blood sugars were in a tailspin of chaos and I needed to reign things in.

I grabbed my flashlight and sent out the Dexcom Signal. 

Sending out the Dexcom signal.

Help me, Dexcom!

Dexcom responded with a shrill cry and leapt from the box.  Within a few minutes, the sensor was making its first appearance on my outer thigh and I started the two hour calibration waiting game.  (And why do I always start this thing at ten o'clock at night, forcing me to be fussing around with diabetes toys at the stroke of midnight?)

As I prepared for Round Two as the Dexcom Warrior, I noticed that I was very particular about where I chose to pop in the sensor.  Last time, I wore the site on my abdomen and while it was accessible and easy to put in, it bumped up against every piece of clothing I wore and was visible underneath both my gym clothes and my work attire.  As someone who prefers to keep all diabetes hardware relatively quiet, I opted for a thigh site this time.

I inserted the sensor, which pinched a bit but not to the point where I clenched my teeth, and pulled out the needle, leaving the hub attached and the wire inserted.  (Yes, this sucker has a wire in there instead of a plastic cannula.  If I think about it too much, it makes my stomach feel a bit queasy, but I couldn't feel it at all when it was in there.)

With my pump infusion set on my right thigh and my Dexcom sensor on my left, I felt like some kind of diabetic pack mule.  My hips felt vulnerable, as though banging into any door jamb would send me into a robotic meltdown. 

My euphoria wasn't as intense for this second round of testing.  No Techno-Joy.  (Cannot access printer?  But it's here.) I wasn't obsessed with the new gadget, but instead treated it like it was "just another meter."  I traveled with the receiver in my purse and kept it on my desk while I worked, instead of forcing myself to keep it clipped to my clothes.  Not wearing the receiver felt liberating. 

I noticed it physically, though, while I was at the gym.  Lying on my side for an ab exercise, I felt my pump infusion set mashing against the floor.  When I flipped to work out the other side, the Dexcom sensor was pressed hard on the floor.  I remember back to when I had the sensor on my abdomen and I felt it pressing then for sit-ups.  While I appreciate the technology of this device, I would appreciate it even more if it were smaller and less intrusive.

For anyone who thinks the Dexcom results are supposed to perfectly match the glucose meter results, that's not going to happen.  While I had some very closely matching results, the Dexcom remained a bit higher, on the whole.  Like here:

Overnight readings

This reading of 146 mg/dl was countered by my meter as 101 mg/dl.  Bit of a difference there.  But the trending I saw was spot on.  That 101 mg/dl (or 146 mg/dl according to Dexcom) was the upswing of a 72 mg/dl I had earlier in the morning. 

More Dexcom readings.

And then I watched as the correction for the 146 mg/dl brought me back town towards 120 mg/dl.  I like that positive reinforcement that my insulin is working and that my body is able to hold steady for a spell, despite the fact that I'm trying to compensate for a busted pancreas.

I gained a good feel for what times of the day I needed to pay more attention.  (Can anyone say "late afternoon snacking tendency"?)  I also noticed that wearing the site on my thigh instead of my abdomen made me less aware that I was sporting the site in the first place. 

Dexcom and I have parted ways once again, as I need to order more sensors.  Onward towards the weekend, where the Rhode Island Film Festival and a concert in Boston await!  See you Monday!

August 07, 2007

AADE: Chaos Theory

While my pancreas is woefully unemployed, I did find one at the AADE conference that had a job.

Pancreas, me, N, and Muscle

Only at a diabetes conference would there be a Pancreas and Muscle Tissue wandering around for photo opportunities as though they were Mickey and Minnie Mouse. 

Freestyle Butterflies were working at the booth across from dLife's - I sincerely hope they were paid handsomely for their time. 

"So can I have my picture taken with you guys?"

ButterflyOne adjusted her wings and tucked her ponytail back into her hood.

"Of course."

Freestyle Butterflies.  And me.

That night, a few of my co-workers and I shuttled down to a St. Louis jazz bar and saw Kim Massie - quite possibly one of the most talented singers I have ever stumbled upon.  Her voice grabbed my sternum and reverberated in my soul.  (Yes, she was that good.)  The bar was perfect, in that in the middle of nowhere, picnic table sort of way.  Empty beer bottles stuffed with white Christmas lights offered ambiance.

Beer Lights.

And the plane home.  This was my only messy moment.

We ended up switching flights to grab an earlier plane, so our dLife team was scattered all over the plane.  I was more towards the back, sitting in a row completely by myself.  Conveniently enough, my anxiety and nervousness threw me into a neat little low blood sugar, leaving me alone in my seat at 52 mg/dl and stuffing glucose tabs into my mouth.  Tears of panic caught at the corner of my eye.

A young stewardess, recognizing my symptoms, leaned in and handed me an orange juice.  I thanked her wordlessly.

Drinking my juice and waiting for the plane to take off, I wiped my low-induced tears from my eyes and clenched my hands nervously in my lap.  The xanax pills started taking their effect, making me a little looped.

"Excuse me?"  A man sat in the outermost seat of the trio as I remained nervously mushed against the window.  "You seem a little nervous.  It's going to be just fine.  I'm a pilot."

My brain couldn't register.

"You're the pilot?  You need to be flying the plane!"  (Thank you, Xanax, for making my brain melt at the most inopportune moment.)

He laughed.  "It's going to be fine.  You don't like to fly?"

"Not particularly."  Sniffle.  (My goodness, I'm a baby.)

"Well this is a short flight to NYC, so we'll be there in no time."

The plane and my blood sugar rose in unison.  My panic subsided once we were in the air and I caught this view from my window. 

Beautiful view from the plane.
Maybe flying isn't so bad afterall.

August 06, 2007

AADE Goodies - The Info Version

The AADE conference was pretty damn interesting, if I do say so myself.  (And I believe I just did.)  Between having my picture taken with a pancreas, meeting some of the most influential members of the diabetes community (i.e. Kelly Close, Jeff Hitchcock, James Hirsch, and others), and drinks at a jazz bar in St. Louis, my camera is now crammed with photos.

There was plenty to see in terms of diabetes developments.  Today's post is the "Info Version" of the trip.  (Tomorrow will be the "Chaos Theory.")

The conference itself was like a petri dish of the newest treatment and technology for diabetics and those who are caring for diabetics.  I saw every company from Dexcom and Agamatrix to Groovy Patches and Murray's.  It was almost overwhelming to see how many products there are for diabetics.

The Jazz by Agamatrix.

The team over at Agamatrix continues to impress with their Wavesense-powered Keynote meter.  (Read my review here.)  I had a chance to speak with some of the team about their next generation meter, the Jazz.  The Jazz is smaller, sleeker, and looks less like it was ripped from the guts of my old TRS-80 computer.  The accuracy of the Agamatrix meters is solid and the software is among the best I've seen.  And they were giving away iPod shuffles to the educators.  Accurate meters and tunes?  Good deal, that.

I also spent some time talking with Scott Dunton, world class surfer guy and a friend of Medtronic Minimed.  We hung out and I caught a glimpse of the soon-to-be released Medtronic "Seal."  It's a waterproof case for Minimed pumps, perfect for surfing or white-water rafting.  More details coming soon on this, but here's what the proto-type looks like:

"The Seal" from Medtronic.

Over at the dLife booth, we were talking about our MyDiabetesEducator sites and signing up the educators with their personal websites.  We also had a one-armed bandit machine and were giving away prizes all conference long - we handed out a spa vacation on Friday!   

dLife booth

I also had the honor and pleasure of meeting Cathy Feste, author of "Tips & Tales from 50 Years with Diabetes," and my new personal hero.  She has been living with type 1 diabetes for over 50 years and when I told her that I had been diabetic for almost 21 years, she grabbed my hands and said, "You're going to be just fine, my friend."  Her smile is vibrant and inspiring.  I'll admit it - I teared up when she hugged me.

Over at Patton Medical, I saw the i-Port injection port.  After chatting with Rick Wittenbraker, COO of Patton Medical, I took at look at the device itself.  It is essentially a pump infusion site that you inject a syringe into instead of hooking up a pump.  This product seems to be a good gateway to pumping, letting a diabetic get used to a "port" on their body without the added hardware.   I haven't had a chance to try one yet, but I'm interested in hearing other people's experiences.

Oh yeah, and then there were the incredible vocal stylings of jazz singer Kim Massie.  And the adventure at White Castle.  And my photo shoot with a pancreas and a few bugs.  More tomorrow for the Chaos Theory Edition!

July 19, 2007

A Handful of Items

Item One:  Arching in as topic one (oh ha, the puns!), I will be at the Annual AADE meeting in St. Louis this year.  (My poor editor-in-chief is my travel companion.  I hope she doesn't mind when I'm half on the moon from xanax for my fear of flying and rambling on nonsense about my cat until the medication wears off.)  Will any of you be there?  I'm very excited to participate in this event as a member of the dLife team.  And I'm very excited to see the big ol' Arch. 

Item Two:  Back when we went rafting, the raft guides has some rogue kayakers who skipped ahead, perched themselves on the rocky sidewalls, and snapped photographs of the rafters as we passed by.  Here is how we rolled:

Rolling down the river.

Item Three:  Wedding planning, though having taken a bit of a backseat to different work projects for both Chris and I, is in full swing.  We've booked our reception hall and nailed down our actual wedding date, so now it's time for all the other stuff - like the photographer, the church, dresses, and deciding how many flowers is really "too many."  Admittedly, I have no idea what I'm doing.  I have several books and have consulted with The Knot on several occasions (only to notice that my post about Oliver's gas was linked from their discussion boards - I laughed until I cried), but time is going by so quickly and I fear I'm falling behind. 

Our engagement party invitations came in, so that's all set to take place on August 18th (yay!), but aside from that, I'm sort of lost.  How exactly do you find a photographer?  (If anyone has any recommendations for a photographer in the RI area, I'd love to hear from you.)  How far in advance do you need to find a wedding dress?  How hard is it to wrangle all the bridesmaids into one style of dress or can I have varying styles along the same color theme?  How much wood would a woodchuck chuck, were he so inclined? 

Item Four:  Social networking is all over the place these days.  LinkedInTwitterFacebookNing networksMySpace.  Whoa.  (No, "whoa" isn't a social networking platform.  At least not yet.)  There are plenty of networking opportunities.  I'm sure there are plenty that I have no clue about.  Any new ones that you know about?

Item Five:  I don't know if you caught this link on my sidebar, but I want one of these in the worst way.  And I can't figure out why it appears to have a hand brake.  Bizarre indeed!

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