Abby loaded this post into the queue, saying that she couldn't come up with a title for it.  Which explains the crap title I subbed in, which is making me laugh but she'll probably hate it.  Shhhh ... don't tell her.  Abby's writing about diabetes and exercise, taking into account the days when she's the only PWD in the yoga studio, and when she's surrounded by her dia-friends.

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I'm kind of into Yoga these days. It's taken me about seven years to really find any form of physical activity I don't hate and have to force myself to do. I was always involved in sports growing up, so I had set times I had to be at practices and physical goals that were set by someone else. I took all sorts of dance classes (the most interesting was a super-scandalous-probably-shouldn't-have-been-performed tap number to a Chicago medley my senior year... we all make mistakes) and was a cheerleader from 7th grade to sophomore year of college. Needless to say, I don't have a competitive bone in my body. I'm an excuse maker and a giver-upper when it comes to pain or breathing heavily.

And frankly, I'm fine with that.

This passiveness does not make for a highly skilled athlete, however. Or even an avid gym goer. Give me a time or day and I can think of a brilliant excuse that even the worlds best lawyer couldn't defend as to why I can't go to the gym. I'm a pro. I probably should've gone into politics instead of nursing. Except I wouldn't have wanted to run for a position in office.  [Editor's note:  Run?  Is that supposed to be an exercise joke there, Abby?]

Anywho... I found yoga in October while healing from a really stupid running "injury" (if you could even call it that) and got hooked. But I've already talked about this. I'll get to my point.

I convinced some Insulindependence friends to do yoga classes for our winter months here in Vermont (it's too damn cold here to be outside for more than a nanosecond without freezing your first layer of skin off). For our January, February, and March Dawn Phenomenon events we took yoga classes. These classes were a whole lot different than the normal practice I take - both in class style and atmosphere. They were more relaxed, and more filled with beeps and radio frequencies.

We all had Dexcoms at the upper edge of our mats, and quite a few tubes/bottles of glucose tabs were stacked next to the yoga blocks we used. There were awkward bumps due to devices under clothes other than mine, and at one point I pushed the button on my Dexcom and nobody looked at me. Nobody cared.

It was awesome.

I don't take any diabetes technology into my regular yoga practice with me. I cap off my infusion site and leave my G4 receiver with my pump in my purse (side note: I've done a lot of experimenting with my blood sugar and know this works for me. This is not medical advice. YDMV. Seriously). I forget about diabetes during these classes - which sometimes doesn't work out so well. But being in a class filled with diabetes was a different feeling all together. I knew that if I was low and had to step out nobody would question it. I knew that nobody was looking at me like an alien robot when they saw a giant plastic lump stuck to my arm. I also knew that if anyone else in the room needed help, they were in good company.

I don't know which is better - escaping diabetes life for 60 minutes three times a week, or those rare classes I took with my dia-friends. But I appreciate that I had the opportunity to share a form of exercise that I love with some of my very best pancreatically-challenged friends.

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YES.  I love this.  I love exercising on my own, and with my friends who don't have diabetes, but there's something really, really cool about getting your fitness on with people who absolutely understand what it's like.  Strength, both core and emotional, in numbers. 

Posted by Abby (the Person) at 08:22 AM | Permalink | Comments (1)

Diabetes and stress seem to go hand-in-hand (or white-knuckled fist in white-knuckled fist?).  Today, Abby is tackling the stress of dealing with labwork results that are - what? - normal? 

I'm a nurse, right? So says my name tag at work. When other people call me with their questions and concerns, I'm quite level headed. I can think through things, and tell people what they need to hear. I can see a potassium of 6.4 and not freak out (well, I do freak out, but I keep my cool at the same time). I can talk to a patient who took 5 units of Humalog for "funsies" before bed and had to be glucagoned that night and calmly explain to them why that was a bad idea. I can also talk to patients who call freaking out because they are having "extreme highs" after seeing one number of 178 mg/dL. I keep my cool.

Until I'm the patient. And then I'm a freak just like everyone else does. I Google and click and over-think and call and tell everyone and FUHREAK out.

So today when I got my yearly routine labs back and they were all perfectly normal, I had to find something to stress about. I mean, I just had to. Except there was nothing. And that lack of something stressed me out.

The problem we have is that with diabetes, the numbers we see always cause stress. Even if we're always 100 mg/dL - that's stressful because what if my meter is broken? What if my blood is tainted? What if my strips are expired? Diabetes wires us for high levels of stress. Add a nursing degree (which may also known as "hypochondria") and I'm screwed.

I'm stressed because my thyroid labs are exactly the same as last time even though I increased my levothyroxine dose.  Except they're normal. And I feel fine. So there's no reason to stress about this.

I'm stressed that my triglycerides might be TOO low. Is that even possible? Why am I worried about this?

My BUN is one point below normal. HOLY CRAP MY KIDNEYS ARE IN TROUBLE. except that's not what that means. Also, I'M FINE.

By tomorrow, I'll have forgotten about this. I'll go on with my day knowing I'm doing a great job with my health with the tools and knowledge I have to work with. I'm healthy, and I feel good. I'm able to do the things I want to do. For that, I am thankful.

*   *   *

Stressing about the absence of stress?  Have you been there?

Posted by Abby (the Person) at 10:37 AM | Permalink | Comments (10)

My goal when applying to nursing school in 2009 was simple: become a Certified Diabetes Educator. I wanted NOTHING to do with nursing, and I for sure did not want to become a "regular nurse" like my mom because her job, to me, was gross.  (I'd seen the videos and heard the stories. No thanks.)

As I'm sure you're aware (or if you're not, check out the website), the requirements to be certified are not simple, nor quick. In fact, they almost seem impossible and over-the-top strict. Diabetes is not that difficult to understand, if you're living with it - and those of us who have had it for more than half our lives should be given some slack, as far as application goes, right? Or at least be able to by-pass the medical credentials?

Wrong. Wrong, wrong, wrong.

I am here to explain to you WHY becoming a CDE is so gosh darned difficult, and why you should really appreciate those who have passed the exam and kept up their title - and how freaking smart they are.

Type 1 diabetes can be fairly simple, in description. The basic gist is to add insulin, add exercise, treat the lows, and prevent DKA. Arguably and theoretically "easy" if there is nothing else going on with the patient. But what if that patient all of a sudden also has to be on prednisone for their cancer treatments? Game changer. What if your patient is 74 years old, on dialysis for four years, and now is in liver failure and needs to keep their blood sugars between 80-140 mg/dL all the time? Think you can handle that? Ever heard of CFRD? No? Well you need to know what it is and how to adjust insulin for it if you're going to be a CDE. Keeping a pregnant woman's A1c between 5.5 - 6.5%? Needs to be on your "no sweat" list, with those three "CDE" letters after your name. You have to be able to do all of these things - not just pick and choose.

Conversely, you need to put most of your own diabetes out of your mind when talking to patients. With the exception of recommending some good tape or pump case or medic-alert companies, your diabetes is just that: yours. Not anybody else's. You also need to be sure not to tell all of your patients you have diabetes, and if you're ready to be a CDE, you'll understand why this varying level of disclosure matters.

My last point is the medical degree requirements, and why they are such a fantastic, and necessary, requirement.  My life experience as a person with diabetes can only teach me so much.  When I get a call from a pre-op nurse telling me they have a patient scheduled for a procedure the next morning and they are wondering what to do about their insulin, Metformin, Januvia, and Glimeperide - I need to know what that procedure is, how it will effect their body, and approximately how long they'll be recovering - as well as how long before/after they won't be eating.  And all the variables that may end up in the mix.  I learned this in nursing school, and not in "I've had T1D for 14 years" school. 

While becoming a CDE was my ONLY goal four years ago, I have quickly realized that becoming a good nurse is much more important to me, and if I happen to feel ready for that CDE on my name tag when I'm eligible, I'll wear those letters proudly, too.  

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Thanks for sharing this post, Abby.  I feel that I have a high level of awareness and eduction about my own diabetes, but instructing others on how to manage theirs?  No way. I'm looking forward to when you're a CDE and drawing from both anecdotal experience and schooling.  You'll be badass.  :)

Posted by Abby (the Person) at 10:00 AM | Permalink | Comments (21)

Larry Bird is great, but only as a basketball player.  We don't need to see him on our meters after exercise.  Abby shares her brush with Larry in today's post.

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"Time for your final rest. Savasana. Let it all go."

This is usually the time of a yoga class where you lay down, meditate, and lose all contact with your body. (I also call it nap time.) Generally it's very relaxing, and most of the time I DO forget that my hands and feet are attached to me (which is awesome).

Except for this time. As I'm laying there trying to cool down, I'm getting warmer by the second. I can't let my mind wander, the thoughts won't stop racing. My hands are twitchy, my feet are uncomfortable. Everything is wrong.

I rolled up my mat and got to my cubby with my purse and jacket as fast as I could. All of a sudden a panic filled my head. I NEED TO LEAVE IMMEDIATELY. I could not be in that space filled with people anymore, coming and going to yoga practice. I needed to be alone, in my car, NOW. I popped one Sunkist candy (my favorite low treatment), shoved my feet into my clogs, and walked as fast as I could to my new car.

"I should test. Yeah. That's what I should do. But I should drink water first. I'm probably dehydrated."

15 seconds later I saw that "33" on the little purple screen. The only thoughts in my head were:  "The screen looks dim on my meter, I should check the battery," and "I'm sweating all over my new car seats, that sucks."

Two more candies, a chug of my water bottle that I have no turned into Gatorade, and two ounces of raisins later (I keep a little thing of Gatorade powder and another of raisins in my yoga bag for backup) and it hit me. Holy crap I was just 33 mg/dL, and my instinct was to isolate myself.

I guess I was afraid people would see me panic. I'm not someone who asks for help. I hate when my diabetes makes me stick out in any situation, especially in a room full of people I don't know. I'd rather quietly take care of myself and put myself in dangerous situations then to ask for help with my diabetes. I've always been this way, and it doesn't look like it's changing anytime soon. I know this is something I need to work on - I need to make it okay that sometimes I do need help, and that nobody will think less of me next time I'm in yoga if I'm chomping on glucose tabs during class. (Which reminds me ... I should probably bring some tabs in with me during practice.)

I learned my lesson. I wasn't prepared, and I could have gotten myself into some serious trouble. I could've passed out in my car and nobody knew I was even at yoga.

But I didn't. And I'm fine. And now I know.

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Do you ever get smacked upside the head by a low blood sugar?  ... yeah, me, too. 

Posted by Abby (the Person) at 08:43 AM | Permalink | Comments (16)

Pockets: So many more pockets to store all my diabetes stuff in. I also found a tube of glucose gel and a four pack of Dex4 glucose tabs in my winter coat. It's like a free treat from last year!

Sticky-ness: Nothing gets slimy and sweaty in the winter. My Dexcom sensors stay on like glue for a full five days before I need OptSite FlexiFix. Except when they fall off in yoga. (But that doesn't fit in my list.)

Thin Air: I can hear my Dexcom beeps so much better in this thin freezing air. In the parking lot of my building it actually echoes when I'm outside now. Borderline creepy, but extra extra safe!

Refrigerator Nature: I use mail order for my insulin, and now that it's sub-zero out there I'm not worried about it boiling if the mail man can't figure out how to get inside my building. "But insulin can freeze," you might say - and I know. I like to go with, "Not if you just don't acknowledge that as a possibility it won't." [Editor's note:  If you see crystals or a discoloration in your insulin, it might be time to acknowledge the possibility.]

Lack-o-Dia-Tan-Lines: This is self explanatory. Now that my skin is sufficiently winter- see-through white, I have no Dexcom or pump site tan lines. Or any tan lines at all for that matter. Hmpph.

That's it. I want summer back.

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Having boiled a bottle of insulin in my car once during the summer, I do like the refrigeration factor in the winter.  Do you have any diabetes positives found in the freezing cold of winter?

Posted by Abby (the Person) at 10:00 AM | Permalink | Comments (14)

Posted by Abby (the Person) at 09:27 AM | Permalink | Comments (14)

While I've been trying my hand (my feet?) at running, Abby is tackling a new exercise endeavor:  yoga.  And for her, it's been an experience in teaching her where her comfort zone is.  Today, she's writing about finding a fitness routine that fits your life and doesn't cause you to break bones.  ;)

• I gained 8 lbs;
• My A1c went up 0.4% in 2 months;
• I had the lowest lows I've had in years;
• I broke my ankle.

• I haven't lost lbs, but my fat is turning into, less jiggly fat;
• My A1c is back to where I want it;
• My blood sugars are practically a plank during yoga (see what I did there? Plank? :) ), and I only go a little low (like I need an 80% temp for a few hours) about 6-7 hours later;
• I haven't broken anything yet.

What's outside of your exercise comfort zone that you're looking to check out?  For me, it was running. You?

Posted by Abby (the Person) at 09:25 AM | Permalink | Comments (10)

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

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

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

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

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

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

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

And diabetes didn't stop me.

Abby The Runner - 1
Diabetes - 0

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

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

Posted by Abby (the Person) at 09:36 AM | Permalink | Comments (18)

Myth #3: ALL METERS SHOULD BE ACCURATE ALL THE TIME - ALWAYS!
I love me some accuracy. I fully appreciate and take advantage of the photo opportunity that is a matching finger stick and Dexcom reading. That being said, I want people to remember something about the 20% frustration factor. Think about the fact that labs are little tiny experiments, whether a finger stick glucose reading or a lab draw for yearly cholesterol - it is measuring a small (like, really really small) sample of fluid and figuring out how many of that "thing" is in that sample. You try making technology that requires a micro-amount of capillary blood that will give you the same reading every time. The bigger problem here is that when you think about it there is NO WAY that the glucose concentration in your pinky finger is the same as in your antecubital as in your ear lobe. It's impossible! How could it be the same throughout your body?

What helps? Using the same meter all the time, using unexpired strips, getting a new meter every two - three years, and only base your medication dosing on that meter. When you think about it, if your particular meter reads 100 mg/dL, but your venous blood is 120 it's fine because you're going to do the same thing every single time with that meter reading of 100, which will result in a consistent A1c that will match. See? Stop using 48 different meters and getting mad because they are 8 points off from each other. The key to science is consistency, and diabetes is science.

Note: if you feel low, and your meter reads an in-range number, get back to basics. Wash your hands, chose a new finger, and test again with an ample sample. Test strips are mass manufactured and they are not perfect all the time.  Also, remember than any blood glucose reading is more accurate than a urine strip that gives a vague reading of "in between brown and greenish but more on the brown side" on it.  There has been progress!

Myth #4: My hydration status does not effect my diabetes. Water is not insulin.
Okay, this is sort of kind of true and not true. Fact: Water is not insulin. Fact: Hydration has a HUGE effect on diabetes. Like, arguably the biggest effect of anything short of pasta. I actually heard a doctor say in a lecture a few weeks ago "I've seen people admitted with HHS (the type 2 version of DKA) whose blood sugar went from 1500 mg/dL to 800 mg/dL after two liters of fluids and no medication." Want more evidence of hydration influence? Think about the symptoms you have when you are dehydrated - thirsty, dizzy, nauseous, headache ... sound familiar? If not, you've never felt a high blood sugar. More fluid dilutes your blood, which lowers the ratio of glucose to blood, which is also known as mg/dL - which is how you measure your finger stick glucose on your tiny little meter. So, it's safe to say, that if you are dehydrated your "blood sugar" will increase. Thirsty yet?

(Please note that water is not a substitute for medication. Ever. In any sense of the idea. Ever. Do not drink a bottle of water and think you don't need insulin or your pills. It's not true. It never will be true. What you can do, is if you have a stubborn high that you're afraid of rage bolusing into a low, drink some extra water and wait a little bit - it might not do anything, but a little extra water never hurt anyone right?*)

*If you have kidney, heart, or any other sort of medical issue PLEASE PLEASE follow your doctor's plans for fluids. I am aware that many people have a strict fluid intake limit. Again, this is Absolutely Not Medical Advice. Ever. Seriously.

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Posted by Abby (the Person) at 09:19 AM | Permalink | Comments (9)

This is NOT medical advice.  Not even close.  But Abby has some opinions that are influenced by her years with type 1 diabetes, her nursing degree, and all the stuff she hears people saying about diabetes, and she wants to share those opinions here.  

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Diabetes is confusing. Sometimes you think you have it figured out, and then - BAM - you do the same thing that worked the last five days but today it doesn't work. I believe that 90% of the time, there is a reason for these disturbances.  I've decided to take my educated little brain and put some myths to rest, and spread some pearls of wisdom. I am a Registered Nurse, but I am still learning about diabetes, and everything that comes along with it, every day.  So this is not medical advice.  This isn't written to influence how you take care of yourself or how you should take care of yourself.  Talk to your doctor before you make any changes to your healthcare.  Seriously.

Welcome to Absolutely Not Medical Advice: Diabetes Hearsay. 

Myth #1: Insulin Makes Me Fat, So I Need To Use Less, Goshdarnit.
Here's the science (it's an abridged regular-people version): Insulin helps you metabolize your food, so that your body can use it (carbohydrates to glucose, specifically). The problem comes in when you eat TOO MUCH of these foods, and your body doesn't need so much of them. Where does it get stored? As FAT! We store excess glucose as fat. We can thank our ancestors for this skill. When they lived in times when food was sparse, they needed to store it in their bodies for later use. So, okay sure, you take more insulin, you gain weight - I can see why you'd think the insulin is the culprit. But really it is all those carbohydrates and, ahem, CALORIES, you're consuming that makes you gain weight. You gain weight when your CALORIE INTAKE EXCEEDS your calorie USE. It really is that simple. I dare you to take a look at calories in your food while you're looking at carbs/protein/fiber whatever else you're looking at. I bet you'll be surprised at what's actually in there.

Myth #2: If I'm going for a run right now I should turn off my basal. RIGHT NOW.
No. Please, no. If you can promise me anything today, it's that you will not do this. Here's the skinny: short acting insulin (Humalog (lispro), Novlog (aspart), and Apidra (glulisine)) lasts approximately four hours in your body. This kind of insulin doesn't even start working for about 15 minutes, and there is also a ginormous peak around 30-60 minutes after administering it. So, it stands to reason that, unless you're going for a four-hour run/hike/bike ride/swim/whatever, changing your insulin now will not help, and could make you high later. What you should do, if you are wary of lows, is make a change to your basal 30-60 minutes before you work out. (This gets really complicated based on food, type of exercise, recent boluses, time of day, how often you exercise, what color shirt you're wearing, etc - talk to your doctor about making ANY and ALL changes to your medication regimen.) In general, however, stopping your pump or skipping a meal bolus right before you work out will not ... ahem ... work out well. [Editor's note:  This doesn't even begin to tap into ketones and how important it is to have insulin on tap at all times, so talk to your doc before disconnecting your pump for exercise!]

Please feel free to email me (abby at sixuntilme dot com) with questions or diabetes myths you'd like to see discussed, or if there is something you have a desire to know more about. I'd love to research and answer any questions. I love to learn, and I am on track towards becoming a CDE, so this is really helping me do my future job better. No question is too random, or issue too insignificant, because trust me - someone else out there has the same question or struggle.

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Posted by Abby (the Person) at 10:08 AM | Permalink | Comments (19)

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

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

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

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

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

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

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

Posted by Abby (the Person) at 08:09 AM | Permalink | Comments (14)

Abby jinxed herself.  ;)

Ever get in those ruts of weird blood sugars that just don’t make sense and you know it’s because you have recently told someone that you’re in really good control, so you basically jinxed yourself?

Yeah. That.

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

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

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

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

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

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

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

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

Posted by Abby (the Person) at 09:07 AM | Permalink | Comments (19)

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

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

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

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

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

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

And then chugged the whole cup in the car.

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

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

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

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

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

Posted by Abby (the Person) at 09:05 AM | Permalink | Comments (29)

Memorial Day is behind us, so that means summertime has officially begun.  Bring on the white pants, white shoes, Will Smith song references, and ... diabetes devices?  YES!  Abby talks about being an adult, sporting diabetes devices, and dressing for summa.  I mean, summer.

Here in Vermont, it's beginning to look a lot like summertime. Temperatures are hovering in the 70s, occasional 80s, with the occasional crazy 20 minute afternoon thunderstorm thrown in. I love summer in the Northeast. I like that the temperature is perfect between 5 - 7pm, and now that I'm working grown-up hours, I can sit in air conditioning during the hot,hot mid-day sun, but then get to go outside and enjoy the weather after work. (I love sleeping with my windows open to the sounds of crickets and random people driving into the condo parking lot.)

For the past four summers, I have been at Clara Barton Camp. Basically from June to the end of August, I was surrounded by diabetes. This also meant that my summer wardrobe does not have to be pump-friendly or "professional." Most of my summer attire, since 2008, has consisted of gym shorts and t-shirts. (This is an ultra-friendly pump hiding combo. Clip it on the shorts waist band. Clip it on your sports bra. Clip it on your shirt collar, clip it on your sneakers, wear it in a child-size pump pack outside of your shirt or as a head band - all completely valid pump storage options at diabetes camp.)

But I'm not at diabetes camp this summer.  I'm a grown up now, with a grown up job. Which is making my summer wardrobe in need of an upgrade.

Today I wore shorts outside to read on a bench in the sun. My pump site was showing on my thigh. I didn't even think twice about it, until I stood up and realized my neighbor was on his porch and probably saw the little pink sticker stuck to my leg (he's a doctor, so for some reason this eased my mind a bit).

A lot of us blog about diabetes and fashion. The amount of tricks we have to hide our d-gear (especially girls) is endless. I'm fine with hiding it, and I'm also fine with showing it off, but I'm generally a hider when it comes to my pump. You will rarely find a picture of me and be able to spot my pump unless I'm surrounded by d-people, and even then it'll be a glimpse of tubing here or there. I'm not ashamed; I just feel more comfortable with it tucked close.

So this summer will be exciting. I will wear dresses, shorts, capris, tank tops (not all at the same time, and not at work of course - health care dress codes and all that) and if my pump shows, so be it. I probably won't be wearing my tally-gear outside of my clothing in public ever, but I also won't be afraid to wear a sleeveless dress with an arm pump site.

*   *   *

Rock the arm site, Abby.  Sometimes you just need to rotate the real estate options, you know?

Posted by Abby (the Person) at 09:03 AM | Permalink | Comments (5)

Abby shoots from the hip (groan - terrible pun) this morning for D-Blog Week's "Fantasy Diabetes Device" prompt:

So, here at SUM we don't use bullets ever (have you noticed I hate sarcasm?) so I thought I'd bang this one out (bang ... bullets ... see what I did there?) with a nice little list. This is what I"d like in a meter. I chose a meter because I really love my pump and have no requests to change it. My meter options, however, need improvement.

• It needs to be color-customizable. I'm so sick of everything with any sort of options being black and silver. (sparkles are appreciated - always)
• Sounds need to be optional - and also customizable
• Accuracy - but that (should) go without saying
• Beam results to my pump without draining my battery
• Speaking of battery - rechargeable please?
• Need to REQUIRE a tag (before meal, after exercise, other, etc.) I love this feature and I never use it because I forget to
• Bolus me from my meter is required (c'mon Medtronic, catch up)
• Beaming to a cloud would be nice. Any cloud, of any shape or category. [Editor's note: Cumulonimbus?]
  
• A great, useful, color-coded, customizable printout for my doctor. Emphasis on the 'customizable,' because we don't all have the same goals.
  
• A little "congrats" for doing 6 fasting BGs or 4 post-dinner BGs per week. Some positive re-enforcement from my meter would be really encouraging.
• Oh, and handing out a $5 every time I check would be nice too :)

So - I'll keep choosing between these options because every meter has it's positives. I just want one that has all the good features. I'm sick of the company competition. Learn from each other people! (And add glitter!)

*   *   *

Posted by Abby (the Person) at 08:05 AM | Permalink | Comments (12)

It's hard to pinpoint one thing I do well with diabetes. Let's face it - I do everything well. Diabetes is so easy for me. I'm constantly 104 mg/dL.  My blood sugar never strays from 80-120 ... ever.

Long story short, I live my life, I survive, I have fun, and I do the best I can with my diabetes. Most days are unremarkable, I check my blood sugar 6-8 times daily, I change my pump site every 3-4 days, I bolus for pretty much everything I eat. I just live, and diabetes tags along.

*   *   *

Yup, you definitely have sarcasm nailed.  In addition to making us grin.

Posted by Abby (the Person) at 09:00 AM | Permalink | Comments (27)

From Abby - her take on the first day of Diabetes Blog Week (my entry is coming up later this afternoon :) ):  Wow, that's of a lot of punctuation there.  Incorporating a smiley face within a parenthesis is complicated.

I'm kind of cheating today. (Ok, so I'll probably cheat on a lot of these topics; I'm a nurse not a writer :).) I don't read any blogs that the rest of you don't read. I have a blog reader thing on my phone and I catch up every week or so. There is my confession.

That being said, I have some other diabetes resources that are disguised as plain old internet fun and I'd like to share them with you.

First is Pinterest. If you haven't joined the Pinterest world yet, you are seriously missing out. You can create these crazy "pin-boards" and categorize them as you wish. For example I have one called "OMGShoes" and its just pictures of shoes I like. It's literally that simple. I also have a board titled "Diabeetus" and here I put recipes I want to try or pictures of food that looks just plain delicious. Admittedly I've only tried two of these recipes (big life changes this past year, but now I have my own beautiful kitchen and a real job so I'll be trying more) but the ones I found were healthy, delicious, and easy on the blood sugar. I'm a terrible cook. I can make anything taste like cardboard. The more I try to make things taste good, the less they taste like anything - it's almost comical. But finding recipes online that people have tried, or made up on their own, and made with healthy ingredients? I'll try that any day.

The second resource that is completely disguised as fun but actually has diabetes benefits is Instagram (it's a smartphone app). It has recently been released for Droid (finally!) and I'm hooked. I have a lot of followers, and follow a lot of people with diabetes. We post ridiculous pictures of things like cats and flowers, but there is also a lot of support surrounding pictures of CGM graphs (both awesome and mountainous) and blood sugars on meters - even the occasional picture of a vampire cannula will get quite a few likes. There is no point to this means of social networking, except it's nice to know that people out there see my struggles and successes disguised as artsy photos.

So, this is not a "meet my blog friend" post, because I am not good at that. You all already know all the blogs I read, or you will by following the D-Blog Week participants. But it's always fun to hear of social media sources being used in a diabetes-friendly way.

*   *   *

To catch more from the folks who are participating in D-Blog Week, check out the topic and link lists here!

Posted by Abby (the Person) at 09:08 AM | Permalink | Comments (4)

Diabetes advocacy and education moments aren't limited to coming from certified diabetes educators, or going to a group of people who signed up for a seminar.  Sometimes it comes in little bits.

You can teach about diabetes everywhere. Today I got a phone call from my insurance company to tell me that my pump supply coverage was approved. While I already knew they would be calling to confirm, since I had called the day I was officially covered to find out how much of my paycheck would go toward the tiny plastic pieces that keep me alive, it was still nice to hear that the process was complete (for now).

But I was a little surprised with the insurance company rep asked if he could ask me a question.

Of course I responded with, "Yeah, sure! Absolutely" because I love answering questions. (Hello, I'm a triage nurse.)

"I see that you use a Medtronic pump. But I also see that you're using a continuous glucose monitor made by Dexcom ... is that correct?"

"Yep, sure is."

"Oh, well I thought Medtronic made that too? I thought you can't use a Dexcom system with a Medtronic pump?"

"Well, they aren't integrated - you're right, but I tried Medtronic's similar product and it really didn't work for me - so I carry both with me. Which can be a pain, but it really works for me and I've had the Dexcom for almost a year now."

"Interesting. I'll have to tell the medical director that these products can be used at the same time and that since you were already approved for the Dexcom before that we should approve you again - whenever the request comes through."

"Well that would be really super if you could do that, thank you."

Sometimes little bits of calm, reasonable education can get you far. Or at least make the insurance process a little easier to navigate.

Educating, one phone call at a time.  Have you ever had an unintentional moment of advocacy?

Posted by Abby (the Person) at 08:35 AM | Permalink | Comments (7)

(Note from Abby (actually, this whole post is from Abby, but this is her disclaimer part):  The following story comes from Abby the PWD and not Abby the RN. Abby the RN is totally non-existent when I walk through a patient room door as a patient, even if it is in the office where I work.)

Today I had a really tough endo appointment. Really tough in a way that I never thought possible. I got my lowest A1c ever, and I was really bummed out about it. I thought the day I saw 6.5% I'd be planning a party and buying new shoes, but instead I got a sick feeling in my stomach and fought back tears.  I know that you're thinking, "What the hey, I'd KILL for a 6.5%," and so would I, if I earned that number through good, steady, in-range numbers. But the way I "achieved" this number is through being way too low, way too often. Something like 30% of my sugars were under 70 mg/dL. In the last month, I've seen 40 mg/dL more times than I can count. I knew my A1C would be lower, and I was not excited about it.

I downloaded my meter at work last week to get a feel for what was going on pre-appointment. It hit me like a ton of bricks when I saw the printout, and all those numbers in italics. I proceeded to use the dreaded red circle technique (except I used a highlighter, and I highlighted the low numbers instead of the highs). The amount of yellow spots on that paper left me speechless. It was only then I realized how much work I had ahead of me. I immediately found a few patterns, adjusted some basals, and put the numbers out of my mind.

Until today.

See, the issue is that I don't feel my lows until I'm in the 40s. And then I get hit with slight confusion and the inability to form coherent thoughts. My doctor explained to me this morning, that I've lost the ability for my parasympathetic nervous system to respond to low blood sugars - which is supposed to happen in the 50-60 mg/dL range. My body now skips straight to a neuroglycopenia response - or lack of glucose in the brain, which is very similar to having a stroke. Not saying it's the same as a stroke - the biology is way different - but your brain reacts the same way.

This is not good news. She assured me that if I let my sugars run higher for a few weeks, I should get the typical low feelings back, as my body adjusts to higher numbers. Unfortunately at this point in the appointment I wasn't able to come up with any good questions or plans. I kind of just sat there nodding and taking in what she was telling me. A quick physical and some refills later, I was back at my desk attempting to regain my "nurse brain."

A few hours (and lots of coffee later) I wandered down to the CDE office and they helped me adjust my pump to achieve some higher numbers without feeling like crap all the time, doing it gradually and safely. (CDEs are my best friend when dealing with my own diabetes, because I'm useless at fixing myself. Just can't do it.)

I think the hardest part of the day, aside from the whole "this is your brain on drugs" portion, was the reaction I got online from people when I announced my 6.5%. We work so hard every day for that dreaded quarterly report card, that we often forget to think about how that number came to be. I appreciate the love intended in the responses I got on Twitter and Facebook, but I just wanted to scream because this number shouldn't be so important to us! An A1C isn't meant to prove our worth as people with this stupid disease, it's a guideline to let us know how our long term control is. And that is not how we use it, at all. I'm the first one to admit that when I see an A1c under 7%, I think "Wow, great job!" even though I have no idea what influenced that number.

Anyway, I guess the moral of this wicked depressing story is that while we get a lot of criticism for A1cs over 7%, and an unfair judgement for over 8% - I think there is so much more to the story that we need to be asking of each other. A nurse in my office asked me, "And how do you feel about that?" after I told her about my 6.5%, and it made me feel so much better to be able to really talk about it.

So the next time you hear someone's A1C, whether it be 6.1% or 11.8% - ask them how they feel about it. Because there is more to diabetes than someone's A1C.

*   *   *

Numbers, in diabetes management, need context. I hear you on this one, Abby. 

Posted by Abby (the Person) at 08:52 AM | Permalink | Comments (37)

No intro needed on this one.  Abby shares her thoughts on diabetes, dating, and disclosure.

This weekend as I was working through some of Kerri's "Generation D" columns on dLife, and reading a few here and there while watching a Whitney Houston Marathon on Lifetime (judge me all you want, folks), there was one post that literally made me stop what I was doing and say, "Hmph, I think it's time I talked about this."

I am so afraid of being silently discriminated against because I have diabetes. So afraid, and I don't talk about it with anyone.

Luckily the field of work that I've chosen saw my dead beta cells as a resume booster, and my family is full of medical professionals, so they accept me. I also have some really great best friends (one of whom also has type 1 diabetes) who embrace the awkwardness of my pump tubing and the test strip trail. But boyfriends? This is where my anxiety lies.

I don't really feel comfortable talking about my dating life online - just not at that point in internet comfort yet. But I think there's an aspect of it that needs to be talked about more ... namely, that fear that I will meet someone and when they find out my body is dysfunctional, they will delete my phone number.

If you don't have diabetes, or a some chronic illness, you might think this sounds crazy. Heck, even if you DO have a dead organ, you might think this is ridiculous. However, I think it's fair to say, that there are a lot of us out here living in the dating world who are scared to death that Prince or Princess Charming will have a phobia of needles.

As strong as I am in other areas of my life, I will never feel 100% confident with anything that I do because diabetes looms in the back of my mind. Diabetes effects everything that I do, everywhere I go, and everyone I encounter. This can be extremely intimidating, and I'm not sure I could blame a guy for running at mach 3 in the opposite direction of my glucose tabs. That is what scares the c-peptide out of me.

I know that I should just tell myself that "The One" will accept my diabetes and probably be like, an Endocrine Fellow or something. I know that diabetes probably isn't as scary to the general population as it is to me. I'm fully aware that this fear is partially ridiculous.

But for right now, I'm scared.

*   *   *

My relationships in the past (and my marriage now) haven't ever been perfect, but diabetes wasn't ever an issue in finding love or being loved.  (I actually just submitted a vlog post to Animas about this topic - coming soon on their site.) But it can be an intimidating thing, bringing diabetes into relationships. It can impact sex and what you're comfortable sharing may vary depending on how you're viewing your health on a day-to-day basis. I've been where Abby is, and I know so many of us have been wary of how our health may impact our relationships. Any words of advice are welcome.

Posted by Abby (the Person) at 09:31 AM | Permalink | Comments (38)

While I was dealing with Dexcom errors, Abby has been dealing with some pump errors.  Namely, "the whiteness."  Has this ever happened to you?

It seems like once you think "Oh, that'll never happen to me," someone somewhere in the world hears you and then makes sure that it does happen to you, very shortly after.

Or at least that's what keeps happening to me.

Yesterday at work, I was filling a script for a patient who was going on a vacation and wanted back-up Lantus in case her pump died. Totally a legitimate reason. I do this all the time. But this particular time I got to thinking "Hmph, i've never had backup Lantus, because my pump never dies."

And that mysterious force heard me. Less than 48 hours later, my pump crapped out.

I got home from the gym and checked my blood glucose in preparation for dinner. It was 44 mg/dL (shocking - I was low after the gym). I was also 42 mg/dL about three hours earlier (my sensor is about nine days old, so it's definitely time for a new one if it's not catching these lows). After I treated the current low and ate dinner (and bolused for it), I looked at my pump about to check how much insulin I had taken all day, in hopes of finding the culprit for these lows. But I didn't get that far, because I saw on the screen this white substance all around the edge of the inside. Kind of like when a mirror fogs up - that weird, foggy whiteness.

The weird, white screen on Abby's pump

Me, being the faithful "call-Medtronic-about-everything" customer that I am, I called. The woman on the phone was INCREDIBLY nice and we arranged for a new pump to be shipped to me the next day. Such a simple process. It's frustrating though, because I have this awesome pump sticker that I'm not sure will transfer to my new pump. And also that I have to use my zebra pump until it gets here is disconcerting since it doesn't have the same accurate basal rates as my Revel. (And I don't like Lantus - my body requires such variable basal rates that Lantus really doesn't work for me... I also don't have any).

This pump is only nine months old. It shouldn't be giving me problems. I have no idea what happened, other than this is the first time I went to the gym without my TallyGear (I forgot it) but I'm pretty sure being clipped inside my yoga pants shouldn't have caused this (I am NOT that sweaty I swear).

Some things are just a mystery. Hopefully new pumpy will last me the duration of my warranty.

*   *   *

When you're wearing medical devices 24/7, the wear and tear on them is tremendous.  And weird.  (Like the time I dropped my pump into the toilet.  Fun moment.)  What's the strangest thing that's ever happened to your stuff?

Posted by Abby (the Person) at 10:29 AM | Permalink | Comments (14)

Abby is working 9-5 now, (What a way to make a livin'!) (Actually, she's working 8 - 4:30.)  (Is it weird to have three sets of parenthesis in a row?) and her schedule is throwing diabetes management out of whack.  Here's a little glimpse into her "silly schedule."

Whenever I go through a significant change in schedule, my silly blood sugars don't let me forget it. (I'm sure I'm not the only one.)  For the past few months I've been on a schedule that varied from day to day. I got up whenever I wanted, babysat either all day or all evening some days, or would have the occasional appointment here and there. I guess I just didn't have a "set schedule," but my body got used to that.

Now that I'm living this silly grown up life of an 8-4:30 job, I have to readjust everything all over again. This is fine, and I can do it. Lots of testing an Dexcom wearing and pattern searching. Do-able. Except that while it's happening, I'm also supposed to be learning everything there is to know about my new career, while I've been on the ultimate blood sugar roller coaster.

I know that I can fix this. I've done it before, and I have the tools and the knowledge. I have the support from my co-workers and my friends, and especially from the DOC. I just really wish I didn't have to. I wish I could've sat through the past week of lectures and training sessions, could have met those 30 new people with a stable sugar that enabled me to remember their names.

What really gets me is that I tried so hard all week. I can't even blame these roller coasters on burnout, because I was testing at least six times a day, and wore my Dex the entire time. I counted my carbs, and ate what I thought were safe foods. Sometimes no matter what you do and how hard you work, diabetes wins.

Next week will be better. I know what to expect, I can have snacks on my desk, everyone in my office knows I have type 1 (and they all are RN's in an endocrinology office, so that helps a little), and I know what worked and didn't last week. So it will be better, it has to be better ... I think.

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I rely heavily on the Dexcom to help me attempt to identify patterns when my schedule changes, but like Abby's previous lifestyle, my schedule is up in the air, all the time.  For me, a little structure goes a looooong way in keeping things under better control.  How do you change your diabetes to accommodate a changing schedule?

Posted by Abby (the Person) at 09:18 AM | Permalink | Comments (6)

Abby is officially working as a Registered Nurse, and in the last few weeks, she's moved to a new state and started her new job.  Lots of change on tap for her.  Today, she's sharing a little bit about her first day on the job and how a little diabetes understanding eased her through her first few hours.

My first day of orientation at my new job brought a lot of stress. From getting on the shuttle bus and asking a total stranger if I couild sit with her, to sitting through a lecture about the Nurses Union I now belong to while having no idea what they were talking about, to that low blood sugar that hit right before our lunch break.

Luckily, that day I sat next to a nurse who I had had a "pre-orientation" meeting with, so I was a little more comfortable in this room filled with 75+ strangers (and at a table near a super cute male nurse - made the boring day a little less boring).  Through chatting with her, I found out that her husband has type 2 diabetes, so she knows what this whole diabetes thing is all about.  I told her what my Dexcom receiver was (I had it sitting next to my coffee on the table) so that she wouldn't think I was texting throughout the lectures.  (And then we talked about how ridiculous it was that the muffins provided for breakfast were covered in brown sugar on top.)

Then I saw that 54 mg/dL on my Dex about 15 minutes before the scheduled lunch break. As I chomped on two glucose tabs (I was symptom-free at this point) my new nursefriend next to me looked over at me. She looked down at my Dexcom, studied my face for a few nurse-seconds and said:

"Are you okay?"

I nodded, and continued chomping.

Then the nursefriend just smiled, and went back to listening about parking passes.

If you have diabetes, you know why this made me feel so comfortable. There was no stress from her side conveyed to me. She didn't freak out and ask someone for juice. At no point did she have a worried look on her face. She just knew. My new nursefriend understood that those three words - "Are you okay?" - were all it took. If I needed help, she gave me the opportunity ask, but she also gave me the opportunity to take care of myself, knowing that someone was looking out for me at the same time.

I'm quite sure that it is extremely difficult to be a person who cares about someone with diabetes, without actually having it yourself. One minute, we want you to fall all over our low blood sugars and and stop time to help us, and the next minute we want you to completely ignore the fact that we even have diabetes. And there is no reason for us to feel this way; we just do and probably always will. But sometimes you type 3s get it spot on. You just know what way to react is best, every time, and for that I am grateful.

New nursefriend's future patients sure are lucky to have her.

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Again, Abby, I'll assert that your future patients are lucky to have YOU.  And for others who are disclosing and dealing with diabetes in new situations, how do you prefer people handle your diabetes?

Posted by Abby (the Person) at 10:06 AM | Permalink | Comments (12)

The other half of Team Tupperware takes a crack at her own vlog post, talking about how diabetes isn't always necessarily "cute," but the stuff we tote around with us can be.  (Also, there are some wise words about the power of zebra insulin.  You'll see.)

How do you personalize your diabetes ... stuff?

Posted by Kerri Sparling at 09:09 AM | Permalink | Comments (21)

Hi again!  Thanks for checking in with Abby's experience with the diabetes closed-loop study.  Here's part two of Abby's feedback on the closed-loop study, including her questions and concerns about what happens next:

The great thing about this study, and the people running it, is that they are fully aware of the human component. The engineer I spoke with has a 12-year-old son with type 1, so he “gets” how this system needs to function, and under what circumstances. The nurse practitioner who runs the study also has type 1, and so did the night nurse) who watched me puke for two hours). These people know what its like, and why we need this system to function and help us.

While I'm not sure how much I can share publicly about what the engineer of this computer program told me, he did fill me in on where he sees this whole shindig ending up.  His plan is to develop an iPhone application that would be controlling everything.  The OmniPods would be replaced by a tubed pump (one that can hold glucagon and insulin in a very small pump; they have a contract with a company) and we, as patients, would wear two infusion sites about two inches apart, but connected to the same pump.

While this might seem like an excessive amount of stuff to wear, i don't actually think it would be, considering how tiny infusion sets have become. Also, he's really pushing to use the Navigator CGM system because of it's accuracy. Unfortunately that technology is no longer being made so he's trying to figure out a way for another company to make the same system - aka "reverse engineer" it. So patients would be wearing a Navigator (he's pushing for a smaller transmitter, since the current Navigator one is huge) a pump, and two infusion sets. The other problem is the lack of stability glucagon shows after 24 hours. So again, they're working with a company to develop a glucagon that is stable for three days at room temperature.

Assuming they get this pump generated, glucagon stabilized, and Navigators back on the market, the plan is to have an iPhone app that controls all three aspects. The algorithm would figure your body and habits out over the first few days, and then use a 10-day model to dose your insulin and glucagon. What this means is that your basals for the last ten days might not be the same as the next ten days, but the computer learns from what it's seen. The really coolest part to me, though, is how you bolus for meals.  You would literally push a button that says either small meal, medium, or large meal. If you're eating less than 15g, for example, you don't bolus at all and let your computer react to your blood sugar. 

At first I thought this was totally insane, but he said that during the trials they're finding this is actually an okay way to do it, and that your blood sugars won't skyrocket because you're being controlled so tightly. Also, the system learns what you consider a "medium" meal. So I may eat meal that is actually 60 grams of carb and guess it at 45 grams, so I call that medium - while you would see the same meal, guess it at 90g, and call it large. It won't matter after a few days, because the computer will just know what you consider small medium or large - as long as you're consistent with your guessing. How awesome is that!!

This team will build into this program things like sick days - the computer will adjust your basal rates if it is seeing consistent lows or highs for three hours. Also, it would shut off insulin for a while if you're dropping from something like exercise, but since it wouldn't be for over three hours it wouldn't totally change your basal pattern.

I have questions and concerns about this, as I'm sure you do. First of all this whole system, when available to us, will be SO expensive. Heck, I don't even have an iPhone now.  [Editor's note:  Neither do I.]  Also, this is so complicated, you'd need to be in very close contact with your medical team. A large part of the population can't handle insulin pump therapy because of it's complexity - so how will people be able to grasp this concept? I suppose with time it'll become more readily covered by insurance, and easier to understand. I'm excited about the future of technology, especially after seeing it at this stage.

Posted by Kerri Sparling at 09:21 AM | Permalink | Comments (20)

Okay, so the birthday girl (HAPPY YESTERDAY BIRTHDAY, ABBY!) was part of a clinical trial last week that involved the closed loop system, and she both Tweeted her experience and wrote it in two parts here on SUM.  I think this trial is fascinating, and Abby's first-hand experience was inspiring.  Here's part one of her feedback:

(During the summer of 2009 at CBC, I heard about a Closed Loop Trial in Boston.  For one reason or another none of us on staff were able to participate at the time.  I personally couldn't because I was unable to commit the time to coming to Boston, but I stayed in touch with the trial coordinator and this fall, she contacted me with some openings in the trial. Here is the extra-long story.)

There are a lot of requirements that factor in to being approved as a participant in this closed-loop-trial.  For example, you can’t make any of your own insulin (you need a negative c-peptide blood test) and you also have to have an A1C under 9%. At the first screening visit, I had to fast from 10 pm the night before, then I had to deal with a ton of paperwork and a physical examination before they eventually gave me a Boost milkshake (that I wasn’t allowed to bolus for).  The point of this was to draw blood 90 minutes later to screen for c-peptide. (Lucky me: I make zero of my own insulin.) So by the time they drew blood, I was starving and my blood sugar was pushing 300 mg/dL. It was a rough morning but worth it, because I ended up being accepted into the trial!

The next step took place about a month later when I had to select my food for the three days I’d be participating in the trial. They base your carb counts on your weight, and I had to eat between 85 and 120 grams of carbs at every meal, but the trick was that I would only be eating three times a day (will explain this more later). Choosing food was fun, but hard. That's a LOT of carbs for me, I generally don't eat more than 100g carbs all day, let alone in one sitting, three times a day.  There were tons of good food choices, like pizza, and lasagna, and sandwiches. I was excited to stuff my face with delicious fatty food in the name of science.

Finally, it was trial time. The day before the trial started, I had to go in for a quick visit to have the continuous glucose sensors placed.  I wore two Freestyle Navigators (one “active” for the computer program and one “dummied up” in case something happened to the active one.  Navigator sensors take 10 hours to "warm up," so having two saved time in case there was an error) and one Dexcom for control purposes. All three sensors went on my belly, which was totally weird since I NEVER wear any diabetes gear there, but for research purposes they have to do everything in a uniform fashion. They also drew outlines of where the OmniPods would be placed the next day. Once the sensors were on, I went back home to get used to sleeping as a robot.

What won't this girl do for science?

The day of the trial, I couldn’t sleep. I woke up around 6:00 am, even though I didn't need to leave my apartment until 9:00 am. Whoops.  I arrived (after taking the packed T with a giant backpack and a purse and a pillow in sweats while everyone else on the train was in fancy-shmancy work clothes - oh hey awkward) and was put into my hospital room for the weekend. Everyone who works on this research floor is SO NICE. I can't even explain how caring and wonderful these nurses and personnel are. Amazing.

After a quick physical and orientation to the floor, things were off and running. I had an IV placed that was hooked up to a machine called a GlucoScout which checks your blood sugar through this weird tubing and machine and then puts it back into your vein, so you don't lose a lot of blood and don't have to have your finger pricked all the time. It was great being able to just look at a machine and see what I was every 15 minutes and really trust the number. After this IV was placed, I ate lunch and manually bolused my insulin for the last time for the duration of the trial. At this point, the GlucoScout was checking me but I was reacting to everything, meaning they had no control over my insulin yet. I bolused for lunch, and watched my blood sugars from there using the Scout, not my meter - the nurses just recorded what I did. I went from 141mg/dL to somewhere around 180mg/dL and came back down, even though I ate 97g of carbs and took 12.6 units which is totally ridiculous amount of insulin (for me to be taking at one time). Things worked out fine. 

Next, two Omnipods were placed on my abdomen (using up every last available spot of skin, I looked ridiculous and felt even more ridiculous). One Omnipod had glucagon in it and the other contained Humalog. (Fun fact: OmniPods don't hurt nearly as much as you'd think they would considering that very loud click they make when the needle goes in.)

At 2:50 pm, I took my personal insulin pump off, and at 3:00 pm the whole closed loop system was turned on. At first, it wasn't totally weird, because I don't pay attention to my pump between meal times, but it was super cool to see this computer reacting to the Navigator number and bolusing me every five minutes.

The Glucoscout

Part two of Abby's feedback will be posted in a little bit.  :)  But for now, I just want to thank Abby for doing this, and for sharing her experiences with us.  What you did helped move us forward, Abby.  You rock.

Posted by Abby (the Person) at 09:43 AM | Permalink | Comments (20)

I could NOT be happier for Abby, who has just scored her dream job.  Congrats, Abby!!!!!

Attention world, I have just landed my dream job. And I'm SO FREAKING PUMPED!

I want to be that nurse kids remember as the one who taught them how to give injections and teenagers remember teaching them how to be secure in their disease while dealing with the tragedies that are the teen years. I want to be the nurse that adults remember for teaching them about how to cut a hole in their tape to keep that sensor on a few more days.

I applied to nursing school because of diabetes; because I have diabetes, and because you have diabetes, and I want to help.

Folks, I have just been given the opportunity to do all of the above.  This job is entry level, I'll be refilling a lot of prescriptions and answering patients phone messages and giving the occasional injection, but it's a start - and all of my hours there will count toward being able to take the exam to become a CDE (not to mention that everyone I met in the office during my interview is SO incredibly nice and helpful and just overall amazing).

For those reasons, this job is perfect. And I owe a lot of this to you out there. The DOC has given me the courage to go after what I really want, no matter how difficult the process. You've given me the strength to apply to that out of state job even though I still have nine months left on my lease here in Boston. Most importantly, you've all given me the purpose to go out there and be a positive and helpful nurse even to patients with the most ridiculous problems, because everyone needs help sometimes.

So celebrate with me please, because I'm am super, duper happy today :)

(Special shout out to Sara for helping me not freak out about my interview and answering my silly email questions. You are so fantastic :) And to Kerri for dealing with a completely scatterbrained assistant during my job hunt, which defeats the purpose of an assistant, but please don't tell her that ;) )

*   *   *

Abby, you should be happy today.  Congratulations - and we're all so, so proud of you!!  You will change the face of diabetes, one patient at a time.

Posted by Abby (the Person) at 09:06 AM | Permalink | Comments (25)

Newly-minted as a nurse, Abby sees the health care system from a myriad of perspectives. Thankfully, today is about Dr. Awesome. 

There is often a lot of talk in the Diabetes Online Community about health care professionals. We deal with them on a regular basis, and we deal with quite a variety of different providers - so I'd say our opinions are valid when it comes to ranting about or praising HCPs. As a newly-licensed Registered Nurse, I take everything that I read and hear into consideration as I begin my own journey in this field, as someone who will (hopefully) have her own set of patients some day as a Certified Diabetes Educator (hello life goal).

That being said, I talk about my own providers as much as everyone else. I've encountered some nasally sensitive lab techs, and some doctors at conferences that like to put everyone on pills no matter what their test results. Fortunately, as far as my own physicians go, I've got an arsenal of excellent people on my team. (Seriously, my ophthalmologist calls my retinas "beautiful" - and he wears cartoon ties.)

Principally, my endocrinologist. She is everything I want in an endo AND she emails me. WOAH.

When I first transferred to Dr. Awesome's practice from my pediatric endodrinologist at a large hospital, I went to her purely because her office was closest to my house. I didn't do any research; I didn't try different doctors. My first A1c with her was in the 10s (so she says, I don't recall this at all - ignorance is bliss I suppose, and college was rough for me).  Needless to say, we didn't see eye-to-eye those first few visits. Dr. Awesome put me on an upgraded Medtronic pump (I had been wearing mine for over five years), and started in with her plan of attack, or so I assume.

Long story short, within a few years, a lot of hard work, and an awakening from going to Clara Barton Camp and realizing diabetes was something to embrace and not avoid, my A1c has now been under 7% for over a year (I'm not bragging, seriously - I have only myself to take care of and a ton of free time and get really lucky at carb guessing), I'm wearing a Dexcom almost all of the time, and I feel great.

The point of this whole story, is that sometimes it can take one bad apple to ruin the taste of the pie - er, one bad HCP to ruin our image of doctors? But there are a plethora of helpful, caring, patient, and understanding professionals in this world that really do worry about us.  Case in point, an excerpt from the email I just received from Dr. Awesome, in response to me thanking her for dealing with my new hypothyroid diagnosis from four hours away:

"Please give some heads up when you are in town so that I could arrange patients and get you in.  I don’t want you to feel you are hanging out there doing this on your own ... Hope to hear from you soon.  I am in the office several days over the Christmas holiday week if you want to try and come in then."

So if you have a doctor that makes you feel guilty when you admit to eating an entire cheesecake and dealing with the 350+ mg/dL blood sugars just because it was delicious, or a nurse that scowls at you when your A1c isn't under 7% - talk to your provider about how you feel, or keep searching and don't think they (we) are all like that. There is a Dr. Awesome out there for you too, I promise!

(Please note Dr. Awesome has no idea I'm writing this, and she probably doesn't even read this blog - I was just so freaking astonished at this email I had to tell everyone :) ) 

*   *   *

Just like every patient, Abby has had really good, and some not-so-good experiences with health care providers.  (Just like every HCP has had good, and not-so-good experiences with patients.)  Do you have any "my HCP is awesome!" stories to share?

Posted by Abby (the Person) at 07:04 AM | Permalink | Comments (24)

Abby, like me, grew up with the JDRF as her go-to organization for diabetes.  She's recently reconnected with her local chapter, and people recognized her from Twitter.  (HA! Abby! I told you you'd love Twitter. ;) ) Here's an update on how she's getting in touch with the JDRF locally.

When I was a kid I was such a big fan of JDRF. I walked on my friend's advocacy walk team even before I was diagnosed. (I was diagnosed with diabetes two months later - that stuff is contagious apparently.  And yes, I am kidding.) I went to every dinner, kick-off event, fundraiser; You name it, I was there. I even got to the point where I was speaking at these events. Telling my diabetes story to get people to "understand," and donate money. I loved it.

The JDRF is an amazing organization, they do so much for diabetes, they make kids and families feel like they aren't alone, and that they have support whenever necessary.  They have even made huge strides in the Artificial Pancreas Project, which is quite literally the closest thing we've had to a cure in - well - ever.

In short, I love me some JDRF.

Unfortunately for the past eight years or so I hadn't been as involved as I probably should have, or have wanted to be.  Once I went away to college, it was hard to keep up with my walk team, and to raise money when people thought I had the kind of diabetes that the press likes to make out to be the patients' fault. I eventually gave up on it, and turned to camp instead.

Since moving to Boston, however, I have realized that I need to get back into helping - and it just so happens that the Bay State Branch of JDRF is starting up a Young Leadership Committee here in Boston.  I don't know much about it, but Briley invited me to go to a meeting a few weeks ago with her to check it out.  I figured at the very least it would get me out of the house and to meet new people.

After the initial "Hey, are you Abby? Do you work for Kerri? I recognize you from Twitter," silliness, the meeting got started and I was quite impressed.  I did feel a little out of the loop since it was my first visit and they were talking about all these other events that had happened that I was completely clueless about.  This YLC group is targeting the "lost generation" of people with type 1.  Those of us who are 21-35 years old who have had this disease forever and kind of get forgotten about since we're past the cute kid stage.  So far, they are planning on doing a holiday meet-and-greet type of event in Boston, so we can get to know each other better and have a more solid support system here in the Boston area.  I absolutely loved this idea.  There was also talk of a Marathon Monday fundraising event at a bar on the route. Again, such a great idea.

I guess what I took away from this meeting is that even though I was definitely an outsider in this group, there are people who acknowledge this population of PWD who have been lost in the shuffle, yet have a lot to contribute.  We have friends and contacts and interests that are much different than the child demographic, and tapping into this resource could generate a lot of support of JDRF.  I'll definitely be keeping up with this group, and hopefully getting back into JDRF as much as I can.

*   *   *

Not everyone has to support the same diabetes advocacy organizations or even the same goals.  Our strength is not what divides us; it's in what unites us.  What are your favorite ways to advocate for diabetes? 

Posted by Abby (the Person) at 08:48 AM | Permalink | Comments (15)

I'm still in South Carolina this weekend, so Abby is chipping in to talk about kids.  And no, not her kids.  But sort of her kids.  You'll see ...

*   *   *

Since I moved to Boston, I've been babysitting to earn enough money to survive. (That whole registered nursing thing is not working out so well, but that's beside the point.  Still on the job hunt here.) I'm currently watching a family of three girls, ages two, six, and eleven. The oldest one has some health issues of her own, so she totally dismisses my diabetes as simply a cool coincidence.

The six-year-old is far more concerned with cheating at UNO than anything to do with me.

But the two-year-old ... this little girl is hilarious. We were reviewing body parts last week and she told me that her mom has a chin but her sisters don't.  Also, she LOVES everything about my diabetes technology. She pulls my Dexcom out of my pocket on a regular basis to push the red button. (I've taught her that she's allowed to only push that one because the rest of the buttons will break it.)  When I eat a granola bar in response to a Dexcom reading of 84 mg/dL and a diagonal down arrow, she sits next to me and refers to the food as my "medicine." 

Today I was sitting next to her while she was eating snack, she pulled out the tubing of my pump from my pocket and said to me, "Do you have to wear that all the time?"  I responded with, "Yep I do; it helps me feel good and I'd get really sick without it." 

This smart little kid just looked at me and said, "Oh, well, I wish you didn't have to wear it. And I wish it was pink; that's my favorite color."

Me too, kid.  Me too.

*   *   *

Kids have a way of whittling things down to their most manageable size.

Posted by Abby (the Person) at 11:23 PM | Permalink | Comments (5)

I'm en route to Los Angeles for the BlogWorldExpo conference, where I'll be speaking on a panel about what companies can do to support patient needs.  While I'm flying the friendly skies, Abby has offered to share a few stories today, starting with the one about ... pee?  Abby went in for routine labwork and learned a little bit about "that diabetes smell."  Read on and you'll see what I mean ...

*   *   *

Last week, I went in for my yearly lab work. You know, that visit where the little old lady asks which arm you'd like to use, and when you show her your pathetic excuse for veins in your left arm, she proceeds to stab some steel into your scarred up right arm where the only vein in your body lives? Yeah that one.

That visit where you have to drink 48 bottles of water beforehand because she's going to take out 18 gallons of blood to make sure every little thing in your body is still functioning properly, with the exception of that silly pancreas.

I suppose I should back up a little, and tell you about the part where when I walked into the lab (which is a floor down from my endo's office) the little lab lady was coming out of the bathroom in a hurry. I didn't ask questions, but this is important for the rest of the story.

After the antecubital puncture [Editor's note:  Only Abby the RN would bust out a word like that one in a blog post], the little-lab-lady hands me a cup and says, "Here, please fill this.  The bathroom is down the hall on your right."  First, okay great - love peeing in a cup. Secondly, been in that bathroom plenty of time, but thank you none-the-less. I wander down the hall, ready to prove my kidneys are just fine, and walk into the bathroom. 

I won't go into detail here, but the smell of that room made me almost pass out ... and that's saying something since I'm a nurse and I've worked in an advanced Alzheimer's wing of a nursing home. Thanks to 13-years of diabetes and a history of peeing-in-the-cup, I finished this task in record time and high-tailed my way out of that tiny smelly room.

So here's the point of the story ...

When I handed my perfectly filled cup wrapped in paper towels (pee is gross to look at) to the little-lab-lady, she said to me, "Does the bathroom still smell terrible?"

"Yeah, it's pretty bad," I replied.

"Sorry about that.  There was a man in there before you from the hearing center. A diabetic ... you know how that smells. I've been trying to clean it up but that smell lingers."

Dumbfounded look on my face with absolutely no words, I replied.

All I could come up with to say at this point was, "Um, well, am I done here?" and I walked out.

And from now on I will always be self-conscious about how my pee smells - with or without asparagus.

*   *   *

Do I even want to let my mind wander on this one?  Abby, what does "that smell" smell like, and once you tell me, will I be able to un-hear it?  Also, did this lady know you were a PWD?  ;)

Posted by Abby (the Person) at 08:46 AM | Permalink | Comments (13)

Sleep.  It is the thing I covet most, especially when I work late into the night and Birdy starts chirping oh-so-early in the morning.  Sleep is a luxury when there's a little one trolling around your house, but when diabetes is the cause of my sleepless nights, it's less cute and more frustrating.

Seems like I'm not the only one battling it out on the overnights.  Take it away, Abby!

Ever have those nights when you sleep like a zombie, and wake up to a CGM graph that was firmly planted between 110 mg/dL and 120 mg/dL the entire night, or a fingerstick that shows a fancy 100 mg/dL?

Yeah.  Until last week, I can't remember the last one I had either. Steady diabetes nights are one of those like, super mysterious only-heard-about-in-commercials kind of nights.  That steady graph or fingerstick lets you just sit in your bed an extra 30 seconds and think, "Heck yeah."

So anyway, this happened to me recently and of course I Tweeted about it (because despite my best efforts, I have been completely sucked into the Twitterverse).  [Editor's note:  HA!  Mission accomplished.]  My reaction to this straight line and rested feeling, after the initial, "I'm freeking awesome" was "Wait.. did I sleep so well because of the stable blood sugars, or was my sugar so stable because I was sleeping like a log?"

Chicken or egg, people; I was boggled. A few Twitter friends responded. One said that he attributed the stability of blood sugars to the good sleep. Another friend said she was also as clueless, but equally as thankful.

Add in the fact that I got about five hours of sleep the night before, and the fact that I haven't slept through the night my entire life unmedicated (there was that week I don't remember after getting my tonsils out, but that's a whole different story) - I don't know what to attribute this success to.  Did I accurately carb count that pizza-feast I had for dinner, added to my perfect basal rates, mixed with some sleep deprivation ... does that all adds up to this win of a night?  Or was it complete luck? Did my body need a solid night's sleep so badly that it overrode my diabetes' intentions and just let me sleep?  (And, if so, how did it do that?  Can it even do that??)

The world may never know, but I hope I can someday experience another slumber so sweet.

... pun intended.

*   *   *

Do you sleep well when your diabetes is under steady control, or is your diabetes under steady control because you sleep well?  How much does a good night's sleep play into your control the next day?  For me, it's a combo deal, leaving my mental chicken AND eggs ... fried.  (Sorry.  Couldn't resist that one.)

Posted by Abby (the Person) at 01:31 PM | Permalink | Comments (9)

Abby tackles clinical trials and that feeling of "catch-22" in today's post, and this is an issue that's very top-of-mind for me.  I wrote an article about clinical trials in the latest issue of diaTribe, and I share a lot of Abby's concerns. 

A few weeks ago, the Twitter chat #dsma topic was about clinical trials.  There is and was a lot of conflict about this topic - online and in my mind.  Last summer a few of us at Clara Barton Camp looked into participating in the Closed-Loop-System trial at MGH. It was something we fully believed in and seemed easy enough to help with. I personally couldn't do it because I was still in nursing school in NY at the time and didn't have a schedule flexible enough to spend the amount of time necessary in Boston for the trial.  I know that another staff member at camp got through the blood test portion of the trial but found out she was still making a small amount of her own insulin, and was unable to further participate.

Clinical trials are a vital step in the process to approve new technology, medication, therapies - pretty much anything - through the FDA. I fully support the trial process (it's the scientist in me), I understand why it takes so long and I'm quite comfortable waiting for the FDA to be very, VERY sure that this product or system they're approving is safe for me.  I know that every trial needs a lot of people to test on. I'm also more than willing to be that person... in certain cases.

I've been looking at trials for a few years now, on and off. Now that I'm living near a lot of the hospitals that are conducting the trials I'm looking into them more seriously and more in depth.  There are trials for everything - from using asthma inhalers to raise blood sugar, to getting a full medical history of PWD to track disease process, to taking experimental medications.  I know it's selfish, but I'm definitely not going to ingest, inject, or inhale any medication that hasn't previously been FDA approved or that could harm me or change my health in the future. I'm young, I'm healthy, and I have a lot of plans for my body in the future.  That being said I know someone has to try these new things to find what works.

It's a catch 22, I guess. They need "me", and "I" want them to cure us, but "I" am not willing to try some of their methods. The question is, I suppose, who will? I think about this a lot, and I haven't changed my mind, but it is for sure something that pulls on my moral heart-strings.

For now though, I'll stick to applying to trials that won't permanently change me or my body, and trials that I believe can make our lives better. Not just for me, but for all of you out there, and all of the people who have yet to be diagnosed. 

*   *   *

Have you participated in clinical trials?  Why or why not?

Posted by Abby (the Person) at 09:12 AM | Permalink | Comments (17)

Abby is on a mission:  the girl is off to get fit, make use of some diabetes gear we were sent to try out, and tap into her inner diabetes scientist.  Here's Part One of her Mission.  :)  Go, Abby, go!!!

Exercise is one of those words in my life that brings mixed emotions. I love what a solid workout routine does for my blood sugars, my weight, my energy level, and the way my clothes fit. The actual exercise part though, blows. I seriously hate it. I hate being out of breath. I hate sweating. I hate worrying the entire time that it was all for nothing if I go low after and have to eat all the calories back. It sucks.

That being said, sometimes things in life just suck and you have to do them anyway. (See: insulin).

So last year I was working for the YMCA and had a free gym membership. I went quite a bit until I broke my arm (snowboarding, not at the gym) then took so much time off and school caught up to me and I had a stack of excuses bigger than the stack of schoolwork looming over my head. So exercise flew out the window.

Now that I'm here in Boston, with tons and tons of time to spare, I figured I had no excuse. Like, seriously... not a good one at all. One of my very dear friends at CBC has just transformed her life by getting healthy, losing a bunch of weight, and she looks freeking awesome (hey Kerry!) and she did it by eating healthy, and working out. She posted frequently about her struggles with it on Facebook, and about her triumphs. Long story short, she is my inspiration. I know that at one point toward the beginning she used the Jillian Michaels' 30-day-shred DVD and she really loved it. A lot of girls at camp this summer were using it too, and raved about it - so I ordered it on Amazon last week. It came yesterday. 

Another addition to this little story is TallyGear.  While visiting camp this summer, Kerri gave me some TallyGear pouch band things to try out. (I had secretly wanted one for a while). So today I finally gave it a go while doing day one of the shred routines.

Last player in this game of health: Ginger Vieira.  A really long time ago she sent me her book Your Diabetes Science Experiment and I LOVE it. I read it immediately, and it's great. I won't recap it for you (yet!), but basically she puts your body's experience with diabetes and exercise into really understandable language. The book also makes learning how your own body deals with things really easy.

So today, September 20, 2011 [Editor's note:  So I'm late in posting this.  Sorry!!], I vow to do this 30-day-shred while wearing my flowery TallyGear tummy band thing, and write down my blood glucose before and after every workout, and two hours out, every day for 30 days.

You heard it here people. If I'm not going to be employed, I'm going to be healthy. Time for a change.

Go, Abby, go!!!!! I personally think that the cooler seasons are an easier time for me to get in shape, because summer has us doing a lot of travel and playing outside.  Following a steadier workout routine is more viable for me in the fall and winter.  (Even though I should be more motivated in the summer - bathing suit, and all.)  How about you guys - what motivates you, and how do you follow through?

Posted by Abby (the Person) at 10:40 AM | Permalink | Comments (12)

I'm still in Philly, but thankfully Abby is on the ball.  Unfortunately, she's dealing with a little bit of diabetes burnout overload, but she's not alone.  (As I just consumed about fifteen glucose tabs this morning, and now I hate everything orange and chalky.)

*   *   *

You know that saying "ignorance is bliss?"

I totally get that, in a big,fat pancreatically-challanged way.

I get it in a "I'm pretty sure the first ten years I had diabetes I was in burnout" sort of way.

I get it in a "I used to be stoked with an A1C of 8.0 and now I freak out if my blood glucose is over 300 mg/dL" way.

I feel as though the more I talk/think/learn/do about the way I handle my own diabetes, the more freaked out and resenting I feel toward it.  And I have no idea what to do with this feeling.  I love learning about diabetes, I love talking to people about it, and helping my friends when they are stuck with a diabetes problem.  I love helping little kids get through a life roadblock and fitting diabetes into it. I love talking to freaked out parents of tiny type 1s and reassuring them that their kids are going to be totally fine.

I don't love, however, explaining why I'd rather not have a beer while hanging out because I've had a wicked blood sugar roller-coaster day. Or why I order food at restaurants that I don't completely mouth-water for sometimes because I opt for the easier to carb count meals.

I resent diabetes in my life, for now.  The past few years I have basically surrounded myself with diabetes things in my life, between becoming involved with the DOC, accepting the job as Charge Nurse at CBC, and working extremely hard to keep my A1C under 7%, I have realized that I freeking hate diabetes.

In like a "now I have to face it and take control and stop avoiding it" way.

My relationship with this stupid disease needs marriage counseling... does this happen to everyone?

*   *   *

Posted by Abby (the Person) at 10:18 AM | Permalink | Comments (20)

Abby is new in town (Boston) and she's exploring her new city while I'm off in Philadelphia at this conference. Adjusting to life in a whole new place brings change to everything ... even in the ways you prop your windows open on warm days.  ;)  Take it away, Abby!

So I just moved to a city (Boston, you may have heard of it. They have stupid sports teams but the rest of it is okay, I guess). I grew up in upstate NY - like really upstate. I'm talking where the deer outnumber the people.  Then I spent four years right outside of Burlington, VT for college.  The past two years I went back to deer-land for nursing school.  Needless to say it was time for me to live in a city.  You don't know what you love or hate until you've tried it, right? So anyway, I chose Boston because: 1. I have loved this city since I visited for a class trip in 6th grade, 2. a ton of my camp/ SMC friends are here and 3. I have my best friend ,who also has diabetes, to live with (which is a little safety net, both for me and my mother).

Propping the window open with a box of reservoirs. No worries.

Living here is awesome.  I have a TJMaxx right down the street, and a CVS that I can see from my window. Dunkin Donuts is three stores down from the TJMaxx. Everything about this place is great. Including what all this walking does to my insulin requirements and blood sugars. I’ll be the first to admit I freeking hate going to the gym. I hate exercising. I do, however, love when exercise disguises itself as shopping and exploring.  My first five days here I only used one 180 unit reservoir. On my second day here, I only took 27 units of Humalog. I normally average around 40 units per day. THIS IS CRAZY PEOPLE.

The other day my friends and I went to lunch and ate these colossal cheeseburgers. I did a dual wave, as I usually do with cheeseburgers. Usually it works ok, I end up hovering in the low 200mg/dLs for a while, but since we walked around a ton afterward I peaked around 190mg/dL and came right back down.  Amazing!
Or how about when I’m headed out for a walk and I check in at 176mg/dL so I bolus for a little proteiney snack but don’t correct the 176 and when I get back an hour later I’m 83mg/dL.  If I did that before the gym or formal exercise, I’d end up super high.

Sneaky exercise gets the best of all of us sometimes.  Like when Kerri talks about her gardening extravaganzas, for example.  Or that whole housecleaning thing that acts the same as insulin.  I always keep a tube of ten glucose tabs in the bag with my meter, and usually don't use them often.  Since I've been wandering around here though, I've been refilling it quite a bit.  I tend to treat based on my Dexcom (shh don't tell) when I see something in the 80-90mg/dL range with any sort of downish arrow - a  few tabs and a temp basal and I'm good to go.  I much prefer these casual lows from sneaky exercise to those silly 39mg/dL or 270mg/dL that like to pop up at the gym. (I also much prefer this free exercise as opposed to the ridiculous $60/month fee that is the gym across from my apartment.)

I know that a lot of people have this whole diabetes and exercise and life thing all figured out, but I don’t... yet. And it’s really fun to discover new things in every day life that actually work well with diabetes as opposed to fun things that ruin it. It's also exciting to discover restaurants walking distance from my apartment that are all about BBQ sauce (my biggest weakness next to ketchup), and going outside and getting lost in a book while sitting on your porch reading/people watching.  Not to mention going grocery shopping for myself only and getting things that I'll actually eat and feel good about.

As great as all this diabetes-in-a-new-place thing is, I think my favorite part of life here so far is surviving on my own. I've got some great friends, a supportive mom, and a bit of a savings account to help, but it feels nice to be starting my own twice-graduated-from-college-and-still-full-time-jobless life :)

Posted by Abby (the Person) at 10:45 AM | Permalink | Comments (18)

Abby has her list of 30 Things for Invisible Illness Week.  (And she cracks me up, because she wrote, "I used to do things like this all the time in high school, on a silly online journal I had. They were usually about my favorite flip flops and what i was eating at the moment. This is like a grown up version :)" in the notes with this post.  She's so right - this is like MASH for diabetes.)

1. The illness I live with is: Type 1 Diabetes

2. I was diagnosed with it in the year: 1998

3. But I had symptoms since: Less than a month before, my mom was a wicked smart nurse

4. The biggest adjustment I’ve had to make is: Resisting Lucky Charms every morning. Okay, so I’m still adjusting at 23.

5. Most people assume: Well, I’m not sure what they assume – I think most people probably just don’t know much about it rather than make assumptions. I’d like to think that anyway.

6. The hardest part about mornings are: Getting out of my cloud-like bed. It’s awesome.

7. My favorite medical TV show is: Oh man it’s hard to pick a favorite. I love Grey’s and Private Practice and House. I also really like all the strange ones on TLC and Discovery. I’m a nerd/nurse.

8. A gadget I couldn’t live without is: My meter. And pump. And lately my Dexcom but I think I could live without that if I had to. 

9. The hardest part about nights are: Staying asleep, but I attribute that none to diabetes. I am a really light sleeper.

10. Each day I take 1 pills & 0 vitamins: Why no comments? That’s mean. I also take a bunch of insulin all day err day. I’d love if I could make it 2 pills and no insulin : )

11. Regarding alternative treatments I: Know that there are none for T1D. Only insulin. Although, I suppose you could consider injections as an alternative to pumping? I’m down with MDI.

12. If I had to choose between an invisible illness or visible I would choose: I love that I can hide diabetes until I’m ready to talk about it. Although I don’t think any illnesses are entirely invisible.

13. Regarding working and career: I’d really like someone to hire me as a nurse, preferably sooner than later. Seriously, though, I’m entering a field that is very accommodating to diabetes, because everyone knows about it.

14. People would be surprised to know: Having an A1C under 7.0 doesn’t mean that I’ve got all the answers.

15. The hardest thing to accept about my new reality has been: This reality isn’t new, it’s almost a teenager!

16. Something I never thought I could do with my illness that I did was: Well we moved to Boston together, which was fun.  It didn’t help much with the moving process though. I think it should be kicked out of the apartment.

17. The commercials about my illness: Sometimes make me laugh (Wilford) but usually frustrate me to no end (all meter companies).

18. Something I really miss doing since I was diagnosed is: It was so long ago I really don’t remember anything else.

19. It was really hard to have to give up: My dreams of becoming a commercial pilot? I don’t think I gave up anything, fortunately. Except maybe my Lucky Charms addiction (See: Question 4).

20. A new hobby I have taken up since my diagnosis is: Knitting. Also totally not diabetes related.

21. If I could have one day of feeling normal again I would: I think I feel pretty normal. If I could have one day without lows and highs I would probably just go outside and play and eat a ton of weird food and not even think about how many carbs are in it.

22. My illness has taught me: How many carbs are in everything. And also to be accepting and interested in people’s differences.  And world peace.

23. Want to know a secret? One thing people say that gets under my skin is: “What can you eat?” I know it shouldn’t, I know they’re just being concerned and helpful… It just gets me sometimes.

24. But I love it when people: Ask questions and then genuinely listen to the answers.  And remember what I tell them. Or ask more questions. This is probably why I want to become a Diabetes Educator.

25. My favorite motto, scripture, quote that gets me through tough times is: I’m not sure I have one, but knowing that there are very young children out there going through the same thing, as well as 50-year Joslin medalists with Type 1 – they both motivate me to care for myself. (Bananarama)

26. When someone is diagnosed I’d like to tell them: I promise, promise, promise that it gets easier and more comfortable. Diabetes is just something that is changing your life, not ruining it.

27. Something that has surprised me about living with an illness is: How much healthier I am than I would be without diabetes. I eat foods that are good to my blood sugar – which are usually better foods.

28. The nicest thing someone did for me when I wasn’t feeling well was: One time I had ketones and was throwing up and my friend brought me a Vitamin Water and a bagel for when I felt better. It was awesome.

29. I’m involved with Invisible Illness Week because: Kerri did it, so I did too. She finds the coolest stuff!  [Editor's note:  You are the best, Abby.  Here, I got you this small, gray cat as a present!]

30. The fact that you read this list makes me feel: Important. Not me individually, but people with diabetes in general.

Posted by Abby (the Person) at 01:38 AM | Permalink | Comments (4)

It's not just our pancreases that are busted at times - there are often moments of diabetes techno-burps that leave us scratching our heads.  Abby recently had a "WT ...H" moment with her insulin pump.  And she also experimented with word smashing; you'll see. 

Since I got home from camp, my lifestyle is much more ... umm ... sedentary (read: I sit in my room unpacking all day, just to repack in a week).  This is a big change from my lifestyle at camp in which I was walking everywhere all the time.  So when I was having a lot of persistent high blood sugars, I chalked it up to this change in activity (and cranked up the basals).

When I woke up at 3:30 am on Wednesday night to my Dexcom annoying the crap out of me (saying I was 329 mg/dL with two up arrows), and I was feeling like absolute death, I decided to check for ketones. This is where the story gets complicated. After seeing that I had smoderate ketones (yes, I’m allowed to smash the words small and moderate together), I looked at my site. Total vampire cannula. I ripped that thing out and found a huge bruise. Great.

Here comes the strangest part ...

Since I use Mios, it’s just easier/safer to change the whole setup when having cannula issues.  (With a Medtronic Revel and Mios, I’m so pump trendy.)  When I took the reservoir out of my pump, it literally dripped insulin all over my bed. And the little place where the reservoir lives in my pump was FILLED with insulin, with like at least ¼ of an inch in there. I soaked up two Q-tips to get it out.

What. The. Heck.

I was a little concerned about my pump, since it’s not waterproof, and it’s brand new (I just got this upgrade in May), but at 3 am I was far more sleepy and ketone-sick than concerned.  I called Medtronic the next morning and the customer service person basically told me I had a defective reservoir and hit a weird spot in my arm which lead to the blood (I was expecting a scolding for using my arm, but she was fine with that – thankfully).

But she thought this was a totally acceptable reason - "Defective products are pretty common." In this woman’s defense, she went through all the steps she could to make sure my pump was okay. But a lot of the expectations don't really apply to "real life." For example, "Please find the lot number on the package from the pump site and reservoir."  Maybe I’m the only one, but I throw all that junk away as soon as I put the new site in. And I also dump out all of my pump supplies in a drawer when I get them because the boxes and all the paper inside takes up way too much space.  So finding those lot numbers?  Not going to happen.

I love me some technical support, but sometimes I wish the people on the other end of the phone had diabetes and were a bit more sympathetic as to how that casually defective reservoir made me feel. She kept telling me “I’m very sorry this happened to you, we can replace those products right away” which is helpful, I suppose.  I guess I just want someone on the phone to be like "Aww that is awful, I totally know how having ketones feels, and it’s no good at all."  So I guess what I’m saying is life would be easier if everyone in the world had diabetes :)

(I’m totally not dissing on Medtronic. I get that it’s not their fault if one reservoir doesn’t work. And they’re always super nice and super helpful ... it’s just frustrating when things that keep us alive are allowed to be faulty. See also: Kerri’s meter discrepancy extravaganza.)

In the end, pumpy is fine. Since there are no cracks or anything in it, and apparently because when I shake it, it doesn’t make a sound (yet another test the tech support girl had me do) my pump is safe.  She told me to keep an eye on it, and call back with more problems. Crisis mostly averted.

*   *   *

As someone who recently cracked their Animas Ping against the floor and had to rock MDI due to my awkward pump failure, I totally understand the need for people to understand the "real life" implications of pump failure.  Have you ever busted up a bit of your diabetes technology and had to reset your management plan?

Posted by Abby (the Person) at 10:05 AM | Permalink | Comments (15)

I’ve had my Dexcom for almost three months now. While most of the time I hardly pay attention to it, sometimes I like to make a big deal out of certain graphs. I also had a habit of showing the really good and really bad graphs to people at camp this summer, and sometimes they took pictures of them. (Diabetes camp is a special kind of place, where we celebrate Dexcom graphs … it’s awesome.)

Anywho, here are a few of my favorites:

This was the closest I’ve come to a no-hitter and needed to show EVERYONE at a Tuesday dance at Camp Joslin. Normal. (Please ignore the gross shininess of my camp self.)

Then there was the time we went hiking and the combination of a 15g protein bar and a 75% temp basal kept me at a wonderful 140-150 mg/dL range the entire time.

I call this one "Dyslexy-Dexy," when I put a new Dexy sensor in and it was entirely confused about everything. My meter showed 117 mg/dL when this picture was taken.

This one is epic. I corrected after totally bombing a guess on pizza and ice cream (it was the day after I left camp, leave me alone) and then my correction factor worked BEAUTIFULLY overnight. Take that, beta cells. I don’t need you at all (unless you want to work again in which case I take it back and I totally need you).

This one is my absolute favorite. We got a cake at camp when all the nurses had passed their boards (I was the last one to take the exam, of course) and my bg was holding steadily under 100 from the time the cake arrived to the time we could eat it. I had to document this, obviously.

All this talk about photos is making me feel veeeeery guilty about not keeping my Diabetes 365 feed up to date.  I need to get on that. :)  Are you a diabetes paparazzier?  Do you like to keep visual tabs on your diabetes bits and pieces?

Posted by Abby (the Person) at 09:07 AM | Permalink | Comments (13)

Abby getting inked.

*   *   *

I agree, Abby.  Anyone else out there sporting dia-ink?

Posted by Abby (the Person) at 10:18 AM | Permalink | Comments (37)

Abby was on vacation last week (and was missed - sorry for throttling your inbox!), and while she was on 'real vacation," she also took a pump vacation.  But diabetes wasn't playing according to plan, and she tells the story of how vacation wasn't all rainbows and ... you-know-whats.

So I graduated from nursing school, signed a lease on an apartment for the fall, and helped my mom pack up and move the house I grew up in … all in one week. I needed a vacation.  A good friend from College Round 1 and I had planned a trip to Virginia Beach about a month prior, and it came at the perfect time.  I just really wish I could have left diabetes in New York ...  I wouldn’t say that it ruined our vacation, or even really negatively impacted it, but diabetes made its presence known plenty of times.

I decided to go on Lantus and Humalog again, because I hate pump tan lines, I get eeked out that my insulin will go bad sitting on a hot beach in my pump all day, I’ve gotten some nasty pump site infections after being on a beach, and I didn’t want to have to disconnect and leave my pump under my towel when we decided to go in the water. I’ve done this plenty of times.  Lantus and I have gotten along really well in the past, but I guess we are no longer friends.  I have to say, I should’ve seen this coming. My basal rates vary from 0.60u per hour to 1.1u per hour, so that steady flow of Lantus just doesn’t work for me right now.  (Live and learn, I guess?)

The really cute middle of the night lows I had were fun. The first night at 3 am I was 36 mg/dL, and the next night around 2am I was 44mg/dL. That was cool. (Probably why I have a 0.6u basal rate from 12 am - 4 am … duh.)

We found this wicked cute restaurant across the street from our hotel that made these DELICIOUS drinks called “Orange Crush."  We went out one night after dinner and discovered these most wonderful concoctions, and that they were half off at happy hour – which meant we had to revisit.  That first night didn’t do much damage to the blood sugars (upper 200s with a 56mg/dL at 6 am).  It was the happy hour drinks that killed me. We also got some crab dip to go with our super sweet drinks, and I left my Humalog in the room (again, insulin on the beach seems bad to me) so by the time I got home I was 479mg/dL. This resulted in dinner at 9 pm when I was finally back in the low 200s and starving. I realize this was totally my fault, and that there were much smarter ways of having fun, but gosh darnit it’s frustrating to not be able to go to happy hour on vacation without a stupid blood sugar after.

And don’t forget about the pre-creamed and pre-sugared iced coffee that they conveniently have at 711 (which is on every single corner in Virginia Beach, yet not a Dunkin Donuts in sight).  Took one sip of that delicious liquid candy and had to pass it on to my friend while we set out on a hunt for some place that would hold the sugar for my pancreatic problems (McDonald’s to the rescue!).

Diabetes didn’t totally get in the way though.  We ate really sensibly (minus the one lunch out with a giant BBQ burger, and those two days of drinks) which helped things, and my sugars ran a bit high but I was okay with that.  (There’s nothing worse than a low on vacation on the beach while your hands are all sunscreeny and sandy.) I also made it out pump site tan-line free, and with only a few spotty sunburns. 

Lesson Learned: Practice with Lantus and Humalog for a few days next time, or bring pump for backup, or figure out a way to turn pancreas back on for a week.

*   *   *

Welcome back, Abby, and thanks for posting.  Also, HAPPY GRADUATION!!!!  We're very proud to have you as "one of the good ones" out there in the medical community. 

Posted by Abby (the Person) at 09:05 AM | Permalink | Comments (14)

Abby's Take on D-Blog Week, Day Four:

I try not to think about these things all that often, but it sure does feel good to write them down and tell the world that sometimes diabetes just sucks, like, entirely. (Also, I realize I smushed a bunch of things into #10, so sue me.)

1. I hate feeling high at the most inopportune moments. For example: any moment of any day, ever.
2. I hate feeling low in the middle of something very important, like a lecture about trauma nursing which would probably be more beneficial to my future patients if I could focus.
3. I hate the ugly marks my stupid pump sites leave on my body.
4. I hate trying to find places to hide my pump in new outfits, and the way that a pump-in-the-pocket looks like I have an extra 5 inches of hips that I don’t really have. Cute.
5. I hate waking up with a bg over 150 mg/dL and forcing myself to wait to eat my favorite meal of the day.
6. I hate that I have to ingest so many more chemicals than people without diabetes in the form of fake sugar to drink a cup of coffee. (Truthfully I’d probably still use fake sugar without diabetes, but I’d like to have that choice.)
7. I hate that I have to tell people I have diabetes, especially professors, employers, people who have a pulse, etc.
8.  I hate that constant fear that people will not want to be my friend (platonic or otherwise) because my pancreas has been on strike for 13 years. Superficial or not, it hurts to think about.
9.  I HATE NEEDLES AND NOBODY EVER GETS USED TO THE FEELING OF SHARP THINGS STABBING INTO THEIR SKIN EVER.
10. I hate that so many people are living this way every single day and there is no cure. I hate that this disease causes so much worry, controversy, and pain. I hate that I've put a pump site into a 6-year-old while she was crying alligator tears screaming for her mom. I effing hate diabetes. #rawr

Posted by Abby (the Person) at 08:54 AM | Permalink | Comments (8)

Abby's Take on D-Blog Week, Day Three:

While sitting here thinking about my bloopers, and I am quickly realizing most of them concern my pump. So pumpy, I’m sorry, for all that I have put you and your mom-pump and gradmom-pump through.

One time I got into my mom’s car so quickly that I didn’t realize my pump had fallen out of my pocket. The tubing/site combination was conveniently located so that the pump sat right where the door meets the car. You guessed it, big ol’ smash-a-roo.  My green Minimed 508 came out of that debacle with only a crack but had to be replaced anyway. Whoops.

And then there were all those times I forgot my pump. Now, I know what you’re saying. “How could you possibly forget your pump??” Let me tell you, it’s easier than you’d think. I always took my pump off during dance class and cheer practice, unless I had been running high or we were having less-active practices.  This lead to many phone calls back to the studio/gym/school asking if they’d found my pump and if so to keep it safe for me until I got there. My dance teacher in college actually got to the point where she reminded me before I left to make sure I had it with me.

Embarrassing, but thank goodness for her, because it was a long trek to my dorm room from the studio in those cold Vermont winters.

I also distinctly remember one time in high school when my family and I went up to Lake George on a Thursday night to watch fireworks and get ice cream. Left pumpy on my bed for that one. Didn’t realize it until halfway through a small soft-serve cone. Double whoops.

Even though my pump currently dons a zebra print skin sticker from skin-it (which I got for free from camp because I refuse to pay $15 for a piece of fancy duct-tape with designs on it), my pumpies have seen less attractive days. Interesting choices including, but not limited to, nail polish, my name in sharpies, a sticker version of a picture of me and my 10th grade boyfriend, a collage of tiny stickers at camp thanks to my nurse-friend who I think majored in pump decorating in college, and the collection of neoprene zip-up cases I had in middle school to match every outfit/costume/uniform I ever wore.

Then there was that time I fully corrected a 370something at 10pm with no symptoms, and 15 minutes later was 45. Probably should’ve triple checked that weird high reading, rather than spending the night with small doses of glucagon and PB&J sandwiches.

How about when I forgot to bolus LAST WEEK for dinner. Yep, even after thirteen years, I forget I have diabetes.

In conclusion: diabetes bloopers are funny, but only in hindsight.

(This post is part of the Second Annual D-Blog Week.  To participate, check out the details on Karen's blog!  And thanks, as always, to Karen for organizing such a great advocacy effort.)

Posted by Abby (the Person) at 09:14 AM | Permalink | Comments (7)

Welcome to Abby's Collection of Short Notes to Key Diabetes Players, Volume 1:

Dear Pinky Fingers,

I know that my toes get all the press when it comes to diabetes, but I have to tell you, you are my favorite digit in diabetes land. You never result in an 'Err5' on my meter, I almost never get re-gushers from you, and no matter how cold my little fingertips get, you never fail to step up and give me blood. Thanks for everything you do, and keep up the good work.

-Abby
---

Dear Abdomen,

You and I don’t see eye-to-eye and haven’t since the Silhouette era when I used you, and only you, for about 5 years.  I get that you are tired of sharp things invading your space, but I have to tell you I think it’s time to stop complaining. Can we come to a compromise? You function without extreme pain and occlusions with the new fabulous pink Mios that I use, if I promise to never use you for a sensor? How’s that sound? Let me know what you decide.

-Abby
---

Dear Everyone I’ve Ever Known,

Sorry for talking about diabetes, camp, friends with diabetes, friends from camp, my blood sugars, my pump, my doctor appointments, and Diet Coke so much. I’ll try to tone it down.

-Abby

P.S. If I know you from nursing school, I’m sorry for the way I acted in every class that diabetes was mentioned.
---

Dear Mom,

You can have the vegetable drawer back in 4 months.

-Abigail

*   *   *

(This post is part of the Second Annual D-Blog Week.  To participate, check out the details on Karen's blog!  And thanks, as always, to Karen for organizing such a great advocacy effort.)

Posted by Abby (the Person) at 08:27 AM | Permalink | Comments (15)

Abby's take on D-Blog Week:

I’m selfish. I’ll admit it. I’m 23 years-old, have never lived on my own (with the exception of sharing a house with 4 other girls – but I didn’t pay rent or utilities or even my own car insurance), and for the most part I have survived in this AbbyBubble my whole life. This past year has opened my eyes a little, though, to a LOT of the world around me. Especially when it comes to the perspectives of others with diabetes in their lives.

The blog type that has opened my eyes the most are the ones from parents of kids with type 1 diabetes. I was a kid with type 1, and I have absolutely no idea how my mom dealt with that. Reading some of the blogs of people who are currently raising tiny humans with diabetes is astonishing.  I have no idea how you guys do it, and I really plan on never finding out if I can help it (yes, I have The Thought and I’m not having kids for a verrrrrry long time).  The blog that I read most often is Reyna’s, probably because I babysat for her a few times back in my SMC years.  I remember how fun those kids were, but let me tell you, by the time Reyna and Dave came back, I was tired. Seriously how do you do that 24/7 AND manage Joe’s diabetes? I don’t get it at all. Mad respect, yo. 

As much as I want to have kids someday, I’m really deathly afraid of producing another busted pancreas.  And I know that type 1 isn’t all that bad, I mean, I’ve had it for thirteen years and I’m still completely awesome, but I’d rather just not take that risk.  I also have a few really intense genetic issues in my family which I’m also not looking to pass on (which is a whole different story for a whole different day and probably a whole different blog that doesn’t belong to Kerri).I

have so much admiration for you, the parents of kids with diabetes. I can’t even put it into words. The way you bend over backward to make your children feel as normal as possible is the most selfless lifestyle I could imagine.  You all give me hope, that if I do decide to reproduce my mostly superb genes, that there is life after hearing “your child has type 1 diabetes” and a ginormous support group out there just waiting to help.

(This post is part of the Second Annual D-Blog Week.  To participate, check out the details on Karen's blog!  And thanks, as always, to Karen for organizing such a great advocacy effort.)

Posted by Abby (the Person) at 09:57 AM | Permalink | Comments (12)

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

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

*   *   *

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

Or it could mean SugarStats.

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

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

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

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

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

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

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

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

Posted by Abby (the Person) at 08:32 AM | Permalink | Comments (18)

Posted by Abby (the Person) at 09:51 PM | Permalink | Comments (28)

Abby (the person) queued up this blog post and it made me smile, not only because I agree with her points, but also because I wrote a very similar post back in 2009.  (Right down to the bullet points.  Ah, how I love a bullet point list.  Abby is a girl after my own non-functioning pancreas.)  Diabetes can suck at times, but there are moments that make you look on the bright side.

Take it away, my kindred editorial spirit!

There is a lot to be said about the down sides of diabetes. Like, a real lot. Possibly more than I can even write about in one day. And those downsides are shoved in our faces on a daily basis.  That part sucks, too.

But I like to think about the up side, the sunny side, the silver lining, the greener pastures. It’s simply more fun. Here’s my list:

• Diabetes camp
• Putting dia- in front of any word and making it funny
  
• Knowing how my body responds to food
  
• Having an excuse to get regular pedicures
  
• Realizing how terrible Chinese food really is for you
  
• Diabetes camp (Editor's note: I love CBC.  I'd list it twice, too.)
  
• More medical knowledge than your average bear
  
• Meeting other people with diabetes (see also: diabetes camp)
  
• Always having a backup topic to write papers about
  
• Not being grossed out by blood and needles
  
• Having a lot of technology to accessorize with stickers
  
• Constantly being aware of my health, body, and knowing when an illness is coming far before it actually comes
  
• Walking to cure my own disease and people think I’m being philanthropic
  
• Camps for kids with diabetes
• Meeting some amazing people who have changed my life that I wouldn’t know otherwise
  
• Justifying the purchase of new accessories to carry my test kit in
  
• Passing exams/quizzes about diabetes in nursing school without studying
  
• Having numerical (high blood sugar) motivation proving it’s time to work out again
  
• Hearing my 1st graders at work saying “that’s Abby’s insulation pump so she can eat snack”

I’m sure there are more. Some are funny, some sincere, some absolutely ridiculous. You may relate. Or you may not. I’m just not all that comfortable with focusing on the negatives, diabetes or otherwise.

Next time you see a completely unjustified 351 mg/dl on your meter, or feel a little weird and see a 32 mg/dl and wonder how you are still a functioning human being, make a happy list. It’ll help, I promise!

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A little happy goes a long way.  What would you put on your list?

Posted by Abby (the Person) at 08:56 AM | Permalink | Comments (24)

Note From Kerri:  Lows suck.  Larry Bird blood sugars shouldn't be making appearances in the wee hours of the morning.  And not waking up right away for these kinds of lows can be terrifying.  Abby (the Person) writes about a low that left her reeling and the superhuman strength of her wonderful mom.

8:00pm – 276 mg/dL (no idea why)

10:30pm – 288 mg/dL (negative ketones, and the correction bolus that ruined everything - give me a minute to explain)

12:00am – 120 mg/dL (3/4 bolus for a snack, and to bed I went)

1:45am – 33mg/dL (awesome)

I know why this happened. When I took that second correction at 10:30 pm, I thought to myself, “I might go low from this, but I feel like crud, and I’ll just eat a snack before I go to bed.” And so I did: a very small bowl of Raisin Bran cereal, only bolusing for 3/4 of it, and off to bed I went with a blood sugar of 120 mg/dL, feeling like I avoided that low.

Feeling pretty dia-successful.

When I woke up at 1:45 am feeling a little warmer than usual, but with no other symptoms, I decided I should probably check.

33mg/dL. (Editor's note:  Whoa, Larry Bird) 

Defeated. You win tonight, diabetes. A 6oz juice and a 19g granola bar later, I lay back in bed. And that’s when things got scary: seeing stars, extreme sweating, nausea, crying (which is new to me, and frankly I’m not a fan). I grabbed the glucose tab bottle, and obviously it was brand new and had that cannot-open-without-a-chain-saw plastic thing under the lid.

By this point I was freaking out. I stumbled into my mom's room (yes, I’m 23 and I live with my mom; times are tough, people and I’m a full time college student with two jobs, don’t judge me) where she saw the tears and the shaking hands and presumably my face sans any sort of color. She grabbed the bottle and ripped the plastic off with that “my daughter is in danger” sort of strength that I still don’t understand. All I could manage to eat were three glucose tabs.

I really thought I was going to die, like straight up fall on the floor (only with a blood sugar probably in a safe range at this point) and just die. The re-check showed me a 66mg/dL. Then I got really frustrated because I was almost back in range but I had EVERY low blood sugar symptom on the face of the earth, only on steroids. (For some reason updating my Facebook status and texting a few friends at this point seemed like a grand idea.) This is not the first time I haven’t woken up until I was under 40mg/dL. I’m sure it won’t be the last, thanks to my lack of a continuous glucose monitor. Actually, I take that back … I have a CGM, but I hate it. I try it at least once a month, I do everything by the books, and if I get one or two readings that are within 20 points of my finger stick, it’s a miracle. I’ll be starting a 7-day-trial of the Dexcom soon, and I already have an email into my endocrinologist asking her for one of my own.

The point of my story is to ask this question:  Why aren’t CGMs a standard of care for diabetes? I bet if I asked my friends who have diabetes for similar stories, I’d get a boatful.  (Then I would send that full boat to insurance companies and ask them if they’d rather dish out a few hundred dollars every month for their patients to have sensors and stay safe, or keep refusing us, keep making it a huge hassle to achieve safety, and instead keep sending me 87 million boxes of test strips that expire before I even think about opening them.) 

The technology is here, but there is clearly nobody working for those insurance companies that knows the first thing about the fear I’ll have when trying to fall asleep tonight.

*   *   *

What makes me nuts is that people who want and need a continuous glucose monitoring system still can't find coverage through their insurance companies.  We've come such a long way, technologically-speaking, and it's frustrating when a fellow PWD can't readily access that technology.  What insurance battles are you fighting?

Posted by Abby (the Person) at 08:37 AM | Permalink | Comments (38)

While the snow piles up outside, I'm busy aiming to hit a writing deadline this morning.  So I talked with Abby the other day and it seems like she's hit a patch of burnout, much like the one I'm going through.  She's offered to post today about "forgetting," and how, even though it seems impossible, it's sometimes too easy to forget about the whole diabetes thing.

I’m 23 years old. I don't have Alzheimer's. I don’t have any kind of dementia. I’ve never lost my keys for more than three minutes. I remember my homework even though I have a planner that I write it in and never look at.

But yet yesterday I didn’t check my blood sugar until 5 pm. Seriously? My average number of checks in my pump is like seven. I habitually grab my test kit when my alarm goes off in the morning, but yesterday I didn’t set an alarm.  It was my first day to sleep past 5:45am in a week (clinicals), so I just slept and slept and slept. Then I woke up and stuffed my face with cereal, bolused without measuring or checking first, then lay in my bed some more.

After some tedious errand running, it’s 5 pm and time for dinner (or "Dinner: Part One," I guess, because sleeping until 11 am messes that whole meal title thing up) and I realize I hadn’t checked all day. A 157 mg/dl shows up on the tiny meter screen. I didn’t check again until bedtime (10:30pm - don’t judge me, I was seriously sleep deprived) and I saw an 87 mg/dl. Days like that make me think “I can forget about diabetes and things turn out just fine.

This is NOT a good mindset.

An even worse example: When I bolus first thing in the morning for breakfast, then proceed to get ready for school/work/wherever I’m going, and forget to eat breakfast until I’m walking out the door. I usually have bloused for toast on such occasions, or a half bagel or something I can bring with me, but if I forget to eat until I walk out the door, I’m extremely low (I don’t feel lows in the morning until the 40mg/dL area) halfway through my travels to my destination. Whoops.

Another "good" one: I wake up to a “Low Reservoir” alarm and a fun aqua-colored light on my pump in the morning, and I see something like 13 units of insulin left. Somehow, I forget to change my site before I leave for a 10 hour day at school/work. Running out of insulin halfway through my day with a whole extra site change but no extra insulin with me is the most interesting, and most frustrating, "forget."

How do I simply forget that I’ve bolused, or forget to check my blood sugar, or forget to refill my insulin? How is it that I can forget about something so big, like diabetes?

I need like, a little creature on my shoulder to remind me of these things.

Except that would be weird.

I know I'm not the only PWD who has left the house with 10u of insulin left in my pump and without a backup bottle for a refill.  (Or dreamed of a "reminder creature," only I can't decide if I want it to be cute and snuggly-friendly or something with fangs.  Still debating.  /digression) How do you guys help remind yourself to bring and to do all the "stuff" that comes with maintaining diabetes care?

Posted by Abby (the Person) at 09:46 AM | Permalink | Comments (34)