Main

March 20, 2013

The Opposite of Like a Boss.

I wish we had one of these phones.  Or a rotary phone.  Or a rotismat, with a chicken roasting on it.  Yum.  My blood sugar was tanking after over-correcting a high that morning.  (Actually, tanking after correcting a high and adding in my breakfast bolus, only the actual breakfast ended up being delayed because it took 15 extra minutes to get Birdy and Chris out the door for school today and by the time I was waving good bye as they pulled out of the driveway, I was already trembling and my mind was racing about how many socks still needed to be paired up in the laundry basket.)

Back in the house, I tested and my blood sugar was 48 mg/dL.  I was already four glucose tabs into the morning and waiting (im)patiently for my blood sugar to rise, but the phone was ringing.  And it was a call I needed to take, from my PCP's office.  I didn't pause to weigh the options of "answering" and "not answering," because the low fog was so heavy that I just answered the phone as if I were opening the fridge door - absently, routinely, and forgetting that there was a purpose in doing it.

"Hello?"

"Hi, this is [oh, let's call her Patient Receptionist, because she didn't hang up on me], from Dr. Bowtie's office.  I wanted to follow up on our discussion from yesterday?"

"Yes, hi.  I was hoping it was you guys.  I only answered the phone because I thought it might be you.  I'm having a very low blood sugar right now, so if I'm not making the most sense, I'm sorry."

She didn't need to know a lick of this.  I could have just let it go to voicemail, but now the awkwardness was on, full-force, and I couldn't stop it.  There was a long, empty pause.

"Okay.  Um, that's ..." and she didn't even bother finishing because I was already giggling uncomfortably.

"I'm sorry. I didn't want to miss your call but I probably shouldn't have answered.  How about you talk like this is voicemail and I'll listen really intently?"

She probably thought I was wasted.  I sounded drunk, but wasn't.  Just low. And housing glucose tabs like it was my job. 

"Right, okay, well ..." and Patient Receptionist filled me in on the details of some upcoming labwork.  This was information I needed, and that I had been waiting for, and I was trying to be an attentive adult and focus on her words.  But I was making an already really awkward situation worse by interrupting her and apologizing for interrupting her.

"I'm sorry. This is all good information.  Oh, I interrupted you - I'm sorry again."  Chomp, chomp on the glucose tabs while the Patient Receptionist must have been rolling her eyes, and rightfully so.

"It's okay.  So we're set to see you next week," she said.

I nodded.  And then, "Oh, I'm sorry.  I nodded, which you can't see since we're on the phone."  An ill-timed and unreasonable chuckled escaped my mouth.  "Hee hee - I might be a little low still but I'm sorry."

"Not a problem, Mrs. Sparling.  No need to be sorry.  We'll see you next week."  And she hung up, probably ready to relay the story to her coworkers of talking to a wicked drunk lady at 9 in the morning who claimed to be "low."

Oh how I wish I had chosen voicemail over answering.  Blood sugar now is 109 mg/dL and holding steady.  But the embarrassment level is a double-arrow straight up to my face.

February 13, 2013

Down the Stairs.

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

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

"Sure, yeah."  

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

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

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

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

Foolish.

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

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

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

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

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

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

February 06, 2013

Context.

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

Hey, this looks okay ...

Until you see the whole picture, in context:

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

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

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

January 31, 2012

What We Document.: Solving for "Why."

Dexcom graphs that look like gigantic Ms and Ws?  I see those all the time.  But when I sift through the pile of photos I have on my computer (in the folder marked "Diabetes Crap;" I can write real good, Ma), the Dexcom graphs I see are all pretty.  Nice, straight lines or soft bell curves, without the sharp angles.

I know these pictures aren't representative of how my diabetes is controlled, on a day-to-day basis.  There are way more times that I'm muttering "You stupid jerkface pancreas ..." than moments when I want to whip out my camera and take a snapshot for posterity.  But I like having these happier photos outnumber the ones that make me grimace, because when I need a lift, it's nice to have a catalog to draw from.  This is what I chose to document, visually, because it inspires me to earn this photo opportunity again, you know?


I chose to document this, because it made me feel good.

May will mark the end of my seventh year blogging at SUM (and starts the eighth year - jeepers), and when I look back through the archives, I'm weirdly proud to see a diversity in what's documented.  There are some really high moments (high as in "emotionally high," not "OMG, how did that 312 mg/dL sneak in there?" high), like when the Bird was born or when Chris and I got married.  And then there are low moments, like trying to be a strong advocate for PWDs while going through burnout, or when blue candles start peppering our Facebook feeds

And then I look at other people's blogs (holy crap, there are a lot of us!), and see that they're chronicling the good, bad, and decidedly 'eh' of life with diabetes.  The real stuff.  It's crazy how honest we are with the Internet.  I see people writing about things online that they might not be sharing with their doctor.  Or their coworkers.  Or their very closest friends. But it's shared here, and there's a power to sharing our stories.

I'm amazed at what we chose to document, as a community.  From celebrations of a no-hitter to scoring a quality pair of blue shoes, to difficult moments of feeling burnt out and admitting that we're struggling, what we document shows our strength as a community.  We're not afraid to share the stuff that really scares us, or empowers us, and we have one another to mark different milestones with.  What we share, as a global community, could help any one of us improve our health, emotionally and physically. 

Diabetes isn't a perfect math where you can just solve for X.  Usually, we're solving for "why."  And part of that equation is acknowledging, and appreciating, the sum of our community and what we document, every day.

December 14, 2010

Larry Bird, No One Invited You.

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

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

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

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

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

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

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

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

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

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

Diabetes is messing with my head.

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

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

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

November 11, 2010

Parking Lot Lows.

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

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

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

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

"Am I getting old?"  I asked BSparl.

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

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

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

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

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

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

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

"You okay?"  he asked.

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

This poor kid must have thought I was on drugs.

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

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

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

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

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

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

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

October 21, 2010

Look Forward to Today.

We stand together, even when things get really tough.Last night, I woke up at three in the morning and listened to the sounds of the crickets outside my bedroom window.  Not a human sound could be heard.  When I closed my eyes, I could hear my own heartbeat.  And even though I don't spend the majority of my time worrying about diabetes complications, my mind went immediately to the news I heard yesterday, about another young child with diabetes taken while she slept.   (The both tragically named and tragically accurate "dead-in-bed" syndrome was to blame.)  She was 13 years old, her parents were active and engaged in her care, and there wasn't anything that anyone "did wrong."

The Children With Diabetes website describes "dead-in-bed" happening "after having [the patient] having been observed in apparently good health the day before.  No cause of death can be established."  The article also goes on to say, "In a recent review, clinical reports strongly suggest that nighttime hypoglycemia is a likely prerequisite of the event, but that the death is sudden and probably caused by cardiac arrhythmia. It is postulated that early signs of nerve damage (autonomic neuropathy) can result in a disturbance of the autonomic nervous system." 

I don't know what to think.  I can't comfort myself with the fact that I have access to a blood glucose meter and I'm testing my blood sugar regularly.  Or that I've been to the doctor more in this year alone than I have been in all other years combined.  I don't feel confident that I have 24 years of what some have called "borrowed time" under my belt.  Even the CGM, with its protective bells and whistles and warnings of both highs and lows, doesn't offer me solace right now.

I felt scared.  I'll admit it.  I felt so sad for her family and for all the families who have had to weather this kind of storm.  Because there isn't any rhyme or reason to this disease.  Even when signs all point to "fine," there's a chance your body can just give out.  And that's something that keeps you up at night.  It's something that kept me up last night.  My brain was spinning and grief for a family I didn't even know was prickling.

This is scary, without a doubt.  This is the kind of stuff that I, as a blogger, want to pretend doesn't happen.  I want people to find my site, and the sites of my fellow diabetes bloggers, and feel comforted because we're all alive.  Our health levels vary, but we're all alive.  And the idea of the parent of a newly diagnosed child stumbling upon this story breaks my heart, because this is not the rule of diabetes.  

Dead-in-bed is the exception.

I wondered if premature deaths in people with diabetes are rising, or if we're just hearing about them more often.  I used to be the only diabetic I knew, but then the Internet introduced me to hundreds of others living with or caring for the same disease.  And now I have an extended family of people with compromised immune systems.  So I wonder if these tragic deaths have been occurring for as long as I've been diabetic, only I haven't heard about them so readily because information didn't spread at the rate it does now.  And as awful as the feelings must be for those who have lost a loved one, I wonder if it would be worse to not have the larger diabetes community to lean on for support?  Would I feel better not ever hearing about these difficult times or would I rather deal with diabetes alone?  I think everyone's experiences vary, and emotions run high in times like these.

I thought about my daughter, asleep in her crib, and the instinct to protect her from everything rose up in my throat.  But I can only do so much.  I can only protect her, and myself, from so many things.  The rest becomes part of life and part of circumstance.  I can't make myself lose my mind with paranoia, even though I love her endlessly.  I need to let her live her life.  Just as my mom lets me live mine, despite her fears as to what role diabetes may play.

We do our best, as parents.  As children.  As diabetics and the caregivers of diabetics.  As people.  Tragedy will come and go in all of our lives, but the best is all we can do.  Life goes on for those of left behind.  And we can't exist in fear.  Even though it can be so scary at times.  We owe it to ourselves to be as educated about diabetes as we can, as empowered as patients as we're able to be, and as healthy as we can manage.  We lean on one another for support in these difficult times, and we look forward to today for inspiration. 

Hug your loves ones today.  As many as you can (even your cats).  Because when it all boils down, we're all we've got.

October 08, 2010

Stubborn Fool.

Last night, I went to the gym later in the day - around 7:30 pm.  Chris was home with BSparl and I couldn't wait to have an hour to myself and to watch Project Runway on the gym televisions.  (Yes, a month of hospital bedrest will indeed make you addicted to weird reality tv shows that make you talk about what an obnoxious sasshole Gretchen is, as though you know her.  /digression)

I'm on the elliptical and plugged in, watching tv while I work out.  About four minutes in, I see this weird spot in the bottom right hand corner of my right eye.  Nothing too dramatic, but just this nagging little floaty thing that makes my eye feel like it has a filmy cotton ball covered the bottom portion of it. 

I continue my workout, and at the seven minute mark, my sneakers feel like cement blocks and that eye thing is still foggy.  And this thought actually goes through my head - "Should I test?" - but because I am a stubborn fool, I don't quite yet.

I reach for the Dexcom receiver, only to realize it's at home on the coffee table.  So I walk for a few more minutes, not realizing I'm listing to one side and hanging on to the hand rail.  (But once my brain starts musing about how I'd maybe wear some of those Project Runway outfits, it dawns on me that I should probably test like right now.)

A bright, shiny 43 mg/dl smiles back up at me from my meter.  The eye thing, the cement feet, and the headache suddenly magnify.  But I am a stubborn fool.  And for some stupid, stupid reason, I decide to keep going.  I bring the treadmill back to a 0% incline and reduce the speed to 2.0 miles per hour.  The sports bottle I brought with me, filled with juice, is drained in a millisecond, and then I just plod along.  Plod, plod, plod.

Internal Motivational Speaker pipes up in my ear.

"Kerri.  Get off the treadmill, you stubborn fool.  You are going to hurt yourself.  Your blood sugar is way too low for you to be physically exerting yourself."

I keep plodding.

"Are you ignoring me on purpose?  Because I can go all night, lady.  You'd better listen up and get yourself off the treadmill and sitting tight until your blood sugar comes up."

I furrow my brow.  "I don't want to.  This is the only time I get to myself all day long and I am determined to banish this abdominal fluff and seriously?  This low is making me so mad at diabetes crap that I want to throw something.  So no, I'm not stopping.  I'll go slow.  I already drank the juice.  And I'll test again in a few minutes.  But I'm not stopping."

I know I should have quit as soon as I saw that low number, but I didn't.  I am stubborn.  I walked slowly and unsteadily for a few more minutes, and then my sneakers felt a bit lighter.  And my eye fog was lifting.  It wasn't until the Project Runway outfits started to look ridiculous again that I felt completely better.  Quick blood sugar check showed me an 81 mg/dl.

"This could have ended badly, you know," said my Internal Motivational Speaker as she filed her nails. 

"I know."She totally looks like this.

"You're a stubborn fool, Ms. Kerri.  You need to listen to me sometimes, even when you don't want to."

"I know that, too."

"Okay.  Next time, you sit out for a few minutes, just to be on the safe side." 

"Fine.  I will."  I glanced up at the tv again.  "Dude, Gretchen looks just like Skeletor."

"She totally does."

August 26, 2010

My Hat Was Kicked.

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

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

BEEEEEEEEEEEEEP!

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

Shunk.

Another blood sugar test confirmed yet another low.

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

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

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

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

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

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

July 26, 2010

Your Mom is Low.

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

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

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

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

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

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

BEEP!

Shunk.

49 mg/dl.

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

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

"Hey sweetie girl.  Good morning!"

She kicked her legs and grinned at me.

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

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

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

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

July 21, 2010

Trends.

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

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

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

This is not a trend I want sticking.

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

This is not a trend I want sticking, either.  

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

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

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

May 26, 2010

Oxygen Mask.

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

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

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

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

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

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

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

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

Oxygen mask, you know?

May 25, 2010

The Suck.

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

It's The Suck.

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

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

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

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

"36 mg/dl"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

February 24, 2010

The Good, The Bad, and the Eh.

The good, the bad, and the egg.  I mean, the eh.We'll start with The Bad:

  • Getting my sorry arse to Boston proper yesterday should have been a quick ride.  My first appointment was at 8 am, I was leaving my house with an hour and 15 minutes to spare (I had hopes of grabbing breakfast before my appointment and getting a little work done on the trusty laptop) but traffic on the way into the city dashed all hopes of getting there on time.  It took me two hours and fifteen minutes to make a 35 minute drive.  Needless to say, I was livid by the time I had arrived at Joslin.
  • And while I'm driving, I'm watching my blood sugar climb.  Crap on several levels, because as I edged closer to 170 mg/dl, I started to wonder if my insulin to carb ratio needed to be changed, I fretted about the effects on the baby, and I also realized that two hours in the car at an elevated blood sugar equaled "OMG I have to pee like you read about."
  • Also, felt a dampness in my armpit and became disgusted with myself, realizing I was sweating through my shirt?  Gross, Kerri.  That's just gross.
  • Arrived at my appointment 30 minutes late, they squeezed me in, and after I gave a urine sample, they told me that I was spilling ketones for the first time in my pregnancy.  FanTAStic.

Which leads me into The Eh:

  • Turns out that my blood sugar was climbing because my infusion set wasn't connected to my body.  The pump was on my hip, the site in my arm, but the two weren't joined at the set, leaving every bolus and every basal unit pooling into my armpit.  Thus explaining the stain on my shirt (and the fact that what I thought was sweat was, instead, vital insulin units).  Two hours without insulin explained the high, the headache, and the ketones.  And also made me feel extremely dumb.
  • My eye dilation was deemed "inconclusive" by the retinologist.  She said that my right eye was perfectly fine, but the left did still have two spots close to the macula.  Again, less an issue with the spots themselves and more with their precarious location.  "But I feel comfortable with you attempting a vaginal delivery.  But if you have a long labor, or a difficult labor, you'll need to have a c-section."  My initial response was "Oh, but I'd really like a healthy baby and healthy eyes for myself, so would a section be a better chance at having both?  Or do you just want me to push, possibly harm my left eye, and then possibly still have the c-section?  Does not compute."

But thankfully, there's still The Good:

  • BSparl remains at a steady, healthy weight, and her heartbeat was lovely enough to make my own skip a beat.
  • My doctor called me at nine o'clock last night to tell me that she reviewed my eye exam with the other high risk OB/GYN and they feel confident in recommending a c-section.  Their main concern is the Factor V Leiden issue, which could cause a clotting concern with the delivery wound, but I've already had my medical team advise me that I'd be on Heparin for a few weeks after delivery.  They just want the baby out safely, and for my eyes to remain intact.  I'm on board for that, as I'd like to be able to clearly see this creature we've created. 
  • And now I know how she's arriving, and I can start Googling that and freaking out.  No, I know not to Google and not to completely melt down.  But honestly, the whole "giving birth" thing, no matter the method, has made me nervous for years.  And it's strange to know that in eight weeks, I'll be doing it.

Which brings me to the best part of The Good:  Only 64 days until I can hold her in my arms and tell her I love her.   It's on. 

February 19, 2010

It's All Rainbows and Unicorns.

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

That being said ...Rainbow not included.

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

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

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

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

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

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

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

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

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

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

February 11, 2010

Need to Get Juiced.

BEEEEEEEEEP!

Reaching for the alarm, but it's not the clock.  Check the cell phone, but it's not a text message.  Grope for the cat, but she's not beeping, either.

BEEEEEEEEEP!

Oh yeah, how could I forget?

52 mg/dl.  Not too low, but apparently I've over-corrected with those basal changes I made two days ago, and I need to retweak just a little bit. 

Wandered out to the kitchen, leaving the BEEEEEEP!ing behind in the bedroom, and also leaving the tube of glucose tabs resting on the bedside table untouched.  Make a beeline for the bottle of grape juice that sat, unopened, in the fridge.

I put it on the counter and tried to open it.

And you know, those freaking bottles are childproof when you are low in the middle of the night.  I couldn't break the seal on that white Ocean Spray cap for the life of me.

"Oh come on," I muttered as I braced my hip against the counter and flexed my wrist against the bottle top.  Abby circled, in shark-mode, meowing in support (or mocking me for not having the strength to open a freaking bottle of juice, but since she doesn't meow in English, I'm going with "supportive.")

Bottle cap didn't budge.  And despite the fact that the kitchen cupboard has three large jars of glucose tabs (in varying flavors, for my chalky pleasure) and a bottle of honey in it, I still pressed on with this stupid bottle.

BEEEEEEEEEP! from the bedroom.

"Open, you stupid thing!"

And the seal finally started to break, cracking open slowly and releasing like a loose tooth.  I wasn't too low, and I'm constantly wary of the highs while pregnant, so I just took three small sips.  Abby meowed her congratulations, while Siah snickered behind her paw at my clumsy weakness.  What is it about those lows in the wee hours of the morning that make my muscles into mushy oatmeal?

Next time, I'm eating the glucose tabs.  It's less embarrassing.   ;)

February 03, 2010

We Can Work It Out.

The Dexcom seems fit enough.  I need to get my yellow legs in gear.(Great song.)

Now that we're back from our trip, it's time to reintroduce myself to the "swing of things."  While we were away, Chris and I were up late, eating fancy food at fancy restaurants (including desserts and carb-fantastic sweet potato french fries and gelato ... things we wouldn't normally eat but we devoured in spades - and in our mouths - all week long during the festival holy run on sentence), going to bed at 3:30 in the morning, battling the frigging hills, and waking up the next day only to do it again.  For nine days running.

It was exhausting. 

But now we are home.  And in the comfort of my own schedule, I can wake up early, eat a breakfast that doesn't include sausage (not the cat), get enough sleep at night, put my feet up as necessary, and get some exercise in.

Oh, the exercise part.  How you plague me.

I used to be awesome at getting to the gym.  Not to toot my own horn - more to toot Chris's, actually - but his dedication to the gym helped me keep my proverbial (and literal) butt in gear.  It was just part of our routine, and it was easy.  And the benefits were tremendous:  good health, pants that fit, and that feeling of "ooh, I'm sort of strongish."

But now?  As the baby belly grows and my sense of balance leaves the building for the next 75 days?  Exercise is hard.  Wicked hard.

Since we've been home, I've been back at the gym with Chris, only the workouts I'm doing now feel completely lazy-ass, compared to the ones I was doing before.  No weights (thank you, retinopathy), no jumping rope (thank you, bouncy belly), and no increased heart rate over 130.  

So I walk.  For like 40 minutes on the treadmill, without an incline and at a speed of only 3.0 miles per hour.  On paper (screen?) that looks wussy, but in reality, it's kicking my behind.  I'm not sure if it's the weight I've put on in the front or the fact that my lungs are squished in there, or maybe just because my whole body is completely different now than it was seven months ago, but just walking on the treadmill is a challenge these days.

I'm going to see how long I can keep exercising.  I've heard that many pregnant women make it to the day before they give birth, and I've also heard that the more active I can remain, the better my recovery will be after having the little baby.  Activity helps keep BSparl healthier, too, which is even more incentive to keep plodding.

Weird thing is, my blood sugars don't drop during exercise anymore.  In fact, they seem to go up a little bit.  Before becoming pregnant, I would disconnect my pump and exercise without insulin, but now I need to leave it attached.  And I sometimes need to bolus during the workout, depending on how the Dexcom is trending.  It's very odd, what my hormones are doing to my blood sugars these days.  I also had to increase part of my wee hours of the morning basal today, after two mornings in a row of waking up at 150 mg/dl.

"Kerri, you're rambling.  You realize that, right?  You're just rambling on about exercise and blood sugars and do you actually have a point with this post?"

Why thank you, Internal Motivational Speaker.  I appreciate you bothering me.  Yes, I'm rambling, but I'm just trying to get all these thoughts out before I lose them.  Which seems to be the case lately.

"Why don't you just tell them that the real reason you're fixated on exercise this week is because when you came home from Sundance, each cat had gained 5 pounds?  Now you have a trio of porkchops racing around the apartment?  Why don't you admit that Siah can't even fit under the couch anymore because she's too darn fat?"

Sigh.  I need to get back into the exercise groove. 

And apparently so do my cats.

January 22, 2010

Looking Back: Rage Bolus, Anyone?

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

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

*   *   *

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

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

RAGE BOLUS!!

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

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

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

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

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

January 08, 2010

BSparl: She's a Mobile Biscuit.

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

Baby Girl Sparling, 23 weeks along

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

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

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

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

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

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

January 04, 2010

Oh, High!

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

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

Oh how I wish that was still the case.

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

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

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

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

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

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

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

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

(Thank goodness for cute baby girl clip art.)

November 13, 2009

Pregnancy Progress.

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

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

BSparl, 15 weeks and 2 days

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

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

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

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

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

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

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

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

November 04, 2009

Dexcom and Desperation.

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

Dexcom tossing "???"

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

Dexcom sensor - FAILED!

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

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

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

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

“Holy shit, I’m 29?”  

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

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

“Are you okay?”  

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

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

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

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

When it works, it works.

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

[Dexcom disclosure]

October 29, 2009

Diabetes Can be a Five Letter Word.

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

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

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

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

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

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

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

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

Diabetes and guilt - nasty combination.

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

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

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

September 18, 2009

The Perfect Storm of Stupid.

Perfect storm of stupid.  And balls. I didn't check my pump before I left for work yesterday morning.  Not a big deal - I live close to work and I have back-up supplies at my office anyway, so there wasn't much I couldn't pinch hit for.  When the day started, I had about 20 units left in my pump to get me through to 5:30 pm.

No problem.  I'm using about 16 throughout the course of a day at the moment, so I wasn't worried about running out.  I went to work and did my thing.

But I forgot about our editorial dinner plans after work, taking place at my coworker's house, located about 40 minutes away.

And I also completely blanked when I went home for lunch because I was so hungry and so distracted by what I was working to finish before deadline at work that I neglected to refill my pump reservoir.

And I also was so elated by a freelance opportunity that came in late afternoon that I ended up racing out of the office, en route to dinner, without grabbing the insulin pen from my desk drawer.   

So I'm in the car.  Driving up to dinner.  With six units of insulin in my pump. 

"We're having apple crumb cake for dessert!" said my coworker's excited email.

I am Kerri's perfect storm of stupid.   

A few things were working in my favor:  the Dexcom had me flatlining, for over three hours, at 98 mg/dl.  I also had enough insulin in my pump reservoir to draw out a unit or two with the syringe I keep in my insulin case.  So there were options.

I didn't panic.  I just thought I'd lay low, eat conservatively, and ride it out until I got home and could change my pump.

Throughout dinner, I kept a close eye on the Dexcom and tested every 30 minutes or so to confirm.  But after a dinner of vegetables, chicken, and delicious rice, I saw the graph starting to spike a little bit.  Not crazy, but edging towards 150 mg/dl for the first time that day.  I avoided the crumb cake.  And knowing I had very little insulin left after dinner (only 0.3 retrievable units), I started to get a little anxious.

So I reached into my kit for that syringe.  

Which wasn't there.  

I am a maelstrom in Kerri's perfect storm of stupid.

In an idiotic move, I waited.  And then, about an hour later, went into the bathroom, removed the insulin cartridge from my pump, and stuck my pinky finger into the end of it to press more insulin into the tubing.  I've done this a few times when desperate, and knowing I had about an hour before I'd get home, even if I left right then, made me willing to take the foolish risk.

Another 30 minutes went by.  My numbers hit 177 mg/dl and stalled there, which made me think it was going to be okay.  I left my coworker's house and drove back home.  Once I got home, I switched out my pump immediately and then relaxed for a little bit.  Numbers were steady-ish, but nothing that made me jumpy.  

"Oh, starting to dip a bit."  The Dexcom said I was 101 and falling, and my meter confirmed with an 81 mgm/dl.  "I'm going to down a swig of juice and a kiwi before bed."

Chris:  "Why are you talking to yourself?"

Me:  "Because ... I don't know.  It's expository for the blog post, I suppose."

Chris:  "Okay."

Right before bed, I was 111 mg/dl, steady Dexcom, and feeling okay. So I went to sleep.

What makes this perfect storm of stupid particularly ... stupid is that my move in the bathroom with the unmeasured bolus was a disaster.  I had no idea how much insulin I'd taken, and I only knew some made it into my skin because of the little pinch I felt.  I could have taken one unit, four units ... or who knows how many.  But I'm obsessively stalking these highs and I was willing to take the risk.  Which wasn't smart at all.

Because at 2:51 am, I woke up completely drenched in sweat, my tongue a deflated balloon in my mouth, and panic buried underneath my exhaustion.  A full glass of juice, a concerned husband, a messy Kerri, and a prowling, yowling Abby.  A blood sugar of 38 mg/dl a few minutes after downing the grape juice. 

A perfect storm of stupid.

Preparation can't be overemphasized.  When your pancreas doesn't make it's own insulin and you're relying upon external sources, and when every food excursion depends on your careful calculation, winging it can cause problems on either side of the scale.  And all the lectures and blog posts and well-intentioned moments can't replace good, old fashioned stupid human behavior.

I am Kerri's hairdryer, running at 3 am because the sweat from the low was so copious and nasty.  I am Kerri's low blood sugar walk of shame.  I am speaking in third person because I'm so beat down tired today.

Diabetes, dude, you are The Suck.    

September 10, 2009

A1C Payoff.

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

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

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

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

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

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

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

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

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

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

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

And that's that. 

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

August 21, 2009

Staying Accountable.

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

Yet.

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

But DUDE.  I'm still doing it.  

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

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

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

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

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

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

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

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

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

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

August 19, 2009

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

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

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

Especially in the airport.

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

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

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

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

"You have glucose tabs?"

"Yup.  Chomping now."

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

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

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

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

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

"Sort of." 

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

30 mg/dl.

Oh that's lovely.

And then the panic hits with intensity.

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

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

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

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

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

Twelve minutes. 

"Test, baby."

51 mg/dl. 

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

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

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

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

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

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

He took it.  We boarded.  And headed home.

June 30, 2009

Penguin Truck.

We're planning for a pregnancy, so I've been working tirelessly to stalk my blood sugars.  I'm wearing the Dexcom, testing regularly, and really aggressively chasing highs and lows in pursuit of that nice "between the lines" look on my blood sugar graphs. 

So when I changed my infusion set last night and neglected to take the 1.0 u bolus in anticipation of the high (which seems to be the only way I can keep the highs at bay after a site change), I knew I was in trouble.  Sweaters on my teeth, and my tongue thick with dehydration, confirmed by the 254 mg/dl on my meter.  I cranked up a correction bolus and sent it cruising in, along with some frustration and a few choice curse words. 

A few hours later, I was on the steady but seemingly safe decline, with the Dexcom keeping tabs and my meter serving to confirm.  No worries.  I ate a snack (cottage cheese with some frozen raspberries) before bed and snuggled against the pillow (read: cat) at a blood sugar of 187 mg/dl.  Higher than normal, but I knew it would continue to come down.

Didn't anticpate the 3:30 am wake-up call of BEEEEEEEEEEP!, though. 

I have no idea what my blood sugar was.  The Dexcom showed me only as "low" and I woke up crying, for some reason.  Chris was next to me, fast asleep, but I didn't wake him up.  I don't know why.  A bottle of glucose tabs sat on the bedside table but I didn't reach for them.  I don't know why.  The shape of my body was outlined in sweat on the bedsheet and my hair was sticky, and for some reason combing my hair down before I went to get juice took priority over eating something to correct the low. 

I don't know why.

I don't remember a lot of this low, and that scares me.  I was dizzy.  I was stupid for not waking Chris up and asking for his help.  I remember hearing the Dexcom wailing from the bedroom as I stood at the fridge in the kitchen.  I drank the juice directly from the carton, drinking well past my eight sips and gulpinThese guys can just go right to hell.g until I couldn't catch my breath.  Yet, I remembered to wipe down the floor to clean up what I spilled.  I don't know why.

Hitting that stride, hugging close to the center lane of 100 mg/dl, is really what I'm aiming for.  I've been doing better lately, so every time I'm way off target, I feel the symptoms too late for lows and very intensely for highs.  I know this is a signal that I'm in tighter control, but once I'm stuck in the spin cycle of high-to-low-to-high and back again, it's hard to climb out.  And a lot of time my morning number sets the stage for the rest of my day.  Last night's low blood sugar left me at 199 mg/dl this morning, and I still haven't settled back into range.  I feel frustrated, knowing my A1C is being drawn at the end of July.  But last night's events kicked my ass too thoroughly for me to focus on anything other than muddling through the day.

It's that pesky penguin truck again.  I hope the tire tracks aren't too visible this morning.  

June 17, 2009

Magic Beans.

Lows are The Suck.  I am not a fan.

The pear ones are the best.

But if I could treat every low blood sugar with Jelly Belly jelly beans, it would almost be okay.

(The pear ones are my favorite and even when I'm low, I save them for last.)

That is all.

June 09, 2009

Zombie Lows.

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

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

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

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

Until last night, of course.

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

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

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

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

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

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

I smile.  

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

May 29, 2009

Old School Diabetes: Meters.

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

Like this brick from Accu-Chek:

Old meter from the dark ages of diabetes.

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

Another oldie.

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

Like this morning.

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

The Dexcom said I was 39 mg/dl.

I tested again and saw 101 mg/dl.

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

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

Today, I'm spent.   

May 14, 2009

I'm Sorry ... Glucose Spray?

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

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

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

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

So I took a picture of it, for posterity.  

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

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

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

Just to satisfy my own curiosity.    

May 12, 2009

A Little Bit Naked.

For the last five months or so, I've been wearing the Dexcom with frightening regularity.  Having it on the bedside table or on the headboard became commonplace, and the receiver laying on my desk at work was as normal as my Blackberry sitting there.

The Dexcom Seven Plus upgrade bit made a difference for me, too.  It updates in accordance with my calibrations wicked fast now, instead of taking anywhere from 15 - 30 minutes to synch back up.  The trending arrows are awesome and very helpful for me, because my blood sugar skyrockets and tumbles fast at times.  I know when I heard about the new system I was a little "Ooooookay,"  because it didn't LOOK any different.  The sensors are the same, the transmitter is essentially the same (gray instead of black), and the receiver is the same.

I missed this thing.

Only it's not.

The size and shape of the device and it's components hasn't changed, but whatever they tweaked on the inside there really made a huge difference.  Since switching to the Seven Plus back in March, I've seen big changes in how this system performs.  It was accurate enough before, but now it's scary accurate.  To the point where I've eaten based on double-down arrows, and I've conservatively corrected the highs.  (Note to readers:  CGMs aren't supposed to replace blood tests, so this is definitely a "do as I say, not as I do" moment.  Test before you treat any number.)

So anyway, I'm all nice-nice with the Dexcom these days.  But just like with the pump, my skin gets a little irritated from overuse.  Shuffling around pump infusion sets and Dexcom sensors for weeks on end, coupled with my abdomen avoidance techniques, left my hips and thighs a little tender.  I needed a few days to let my sites heal.  So I went home to RI last weekend without my Dex.

And I felt a little bit naked.

I didn't miss the sensor being on me, but I felt weird not having access to that information.  I took my mother out to breakfast for her birthday on Saturday morning and I felt the need to test three times over the course of a three hour breakfast because I "needed to know" how I was trending.  Same thing at dinner that night.  I've grown accustomed to the graphs and charts and instant blood sugar information, and being without it made me feel exposed.  My numbers were roaming around unsupervised, or at least not with the supervision I was used to. 

I went to calibrate it before bed and didn't realize it was MIA until Chris said sleepily, "It's at home."  I spazzed out when I couldn't find the receiver in my purse.  And when we were driving on 95 on the way back, I checked the center console (where it lives when I drive) and actually felt sad that it wasn't there.  I missed it - is this possible?  To miss a device? 

So weird.

I wondered how long it would take for this to happen.  I felt the same way about my pump when I took it off two summers ago for a white water rafting trip.  I was used to the pump, so to be without it was odd.  And now, I'm finally used to the Dexcom, so taking a break for a few days threw me off my game.  Even though I am not always comfortable wearing the physical hardware, I'm more comfortable managing all this diabetes crap when I'm wearing the devices.  More information, at least for me at this stage in the game, is better.

The Dexcom is back on.  I haven't decided fully if it will travel on our cruise with us, but at least for now I'm fully dressed.

[Dexcom disclosure]

May 11, 2009

Diabetes Mor(r)on(e).

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

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

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

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

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

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

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

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

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

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

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

Fine.  Don't say I didn't warn you.

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

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

"Oh em gee, I'm dying.  Like today."

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

"Wait."

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

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

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

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

Oh.  And then there's that. 

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

April 30, 2009

I'm in the Zone: Cortisone.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I was all, "Ow."

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

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

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

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

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

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

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

And I was all, "This sucks."

April 02, 2009

Employee of the Month.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He turned back to me.  "You good?"

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

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

March 26, 2009

True2Go Meter - It's THAT Small.

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

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

True2Go - wicked tiny.

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

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

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

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

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

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

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

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

March 20, 2009

Dexcom Seven Plus: First Impressions.

So far, so good.

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

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

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

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

Oh so dexy ... I mean, sexy!

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

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

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

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

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

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

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

[Dexcom disclosure]

March 17, 2009

I Had Nothing To Write About.

Low again.  F this noise.Last night I was sending off a quick email before bed, and I lingered on the Movable Type platform for SUM. 

"Hey Chris, I think I'm out of stuff to write about.  My brain - she is empty."

"It's okay.  You'll think of something tomorrow.  Now let's eat Jell-O."  (The Jell-O part is not completely relevant, but it was delicious and worth mentioning.  Red Jell-O with fat-free cool whip.)

The night progressed, and eventually we went to bed.

At 2 am, the Dexcom starting singing.  And because I am a very tuned in, dedicated diabetic (oh the lies!), I pulled it from the headboard and threw it across the room.  

"BEEEEEEEEEEEEP!" it wailed relentlessly from the corner.

About 15 minutes later, I woke up with that heavy, sandbag feeling, like all my organs were ten times their normal size and fuzzy on the edges.  I felt as though I was covered in something grainy, almost tangible, but I couldn't shake it off. 

A low. A nasty one, proving its strength by keeping me flat on the bed.  I tried to sit up but my brain was too dizzy and the sandbags were heavy.

"Hey.  I need juice.  It's a bad low."

Chris woke up immediately and grabbed a bottle of juice.  I drained it, not counting out eight sips, not caring about the carb content, just wanting the sugar back in my body and the function back to my brain.  A bit of juice started to drip from the side of the bottle and I went after it, not willing to let any bit of sugar escape my mouth.  It was a desperate and pathetic low, where I could have consumed a whole cake without thinking twice.

I lay back down against the pillow and tried to pretend the waves of unconsciousness weren't happening.

"Next time, let's not talk," I said, mumbling.

"Not talk about what?  What don't we want to talk about?  You are okay, you drank the juice, you'll come up.  I'll wait here with you."  Chris was propped up on his elbow, a hand on my shoulder while he talked.

"Let's not talk about how I have nothing to write about, okay?"  I laughed and it sounded jagged against the dark, like it wasn't actually coming from my mouth.   

"No kidding, right?"

"Yeah.  This isn't what I wanted.  I would have been happy writing about the cats or something, you know?"

The low passed.

This morning, I have dark circles under my eyes and a headache that even the strongest coffee can't cure.  My body keeps edging back towards low and I'm not sure how much to dial my basal rates back to.  I'm tired.  Of a lot of things.

I'd rather be wracking my brain, trying to think of what to write about today. 

February 19, 2009

Length Matters.

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

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

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

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

A little tubing goes a long way.

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

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

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

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

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

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

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

February 18, 2009

Blood Sucking Meter.

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

This has been the routine for years now.  

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

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

"Apply blood!"

Okay.

Blink, blink.

"Apply blood!"

Um, we tried this already.

"Hey, um ... apply blood!"

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

Blink.

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

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

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

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

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

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

Can a whole bottle go rogue on you? 

February 05, 2009

Vlogging While Low.

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

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

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

Oh hell yes we need our cure.

February 03, 2009

Frustrated.

I am absolutely furious.

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

Nice.

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

But I'm already starting to climb.   

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

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

BEEEEEEEEP!  Still climbing.

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

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

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

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

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

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

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

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

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

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

January 29, 2009

Abby and Dex.

(This is embarrassing.  But true.)

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

Until the cats come calling.

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

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

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

BEEEEEEEEEEEP!

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

"Ahhhhhhhh!" 

BEEEEEEEEEEEP!

Unzip meter.  Shunk.

35 mg/dl.

"Chris.  I need juice."

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

Slurp.

"Meow!"

BEEEEEEEEEEEP!

"You okay?"

"I will be in a minute."

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

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

 At least she keeps my head warm.

January 22, 2009

BEEEEEEEEEP!s and Basals.

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

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

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

"You okay?"

"Yeah.  Frigging beeping.  I have diabetes."

Laughter.  "Oh yeah."

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

It worked.

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

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

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

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

"I treated. It's okay now." 

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

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

[Dexcom disclosure

January 14, 2009

A1C - Sigh.

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

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

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

January 12, 2009

Diabetes Rebellion.

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

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

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

I can't figure it out. 

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

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

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

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

"Did you bolus?"  Chris asked.

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

"You'll come down.  It's okay."

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

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

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

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

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

January 08, 2009

The Year of the Log.

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

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

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

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

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

Blush. 

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

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

So I did a very grown-up thing.

I bought stickers.

Stickers work for adults too, right?

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

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

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

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

December 29, 2008

Insulin Issues.

What to do about cheesecake??"Now I thought you couldn't eat that?  Or can you just dose for it and it's okay?"

She wasn't being the dreaded "diabetes police," but she was just asking a question.  Type 2 diabetes is a familiar disease for some of Chris's relatives, so I can understand his aunt's confusion about how my type 1 diabetes is handled.  Wasn't I supposed to just avoid sugar?

"I can eat this," I gestured to the slice of cheesecake on my plate, "So long as I check my blood sugar beforehand, take the appropriate amount of insulin from my insulin pump, and I avoid a high blood sugar spike afterwards."

"So you can eat anything you want with that insulin pump?"

And this is where I get a bit confused.  Being a type 1 diabetic since I was a kid, I've always taken insulin.  Always.  I don't know anything about type 2 oral medications and I have no concept of managing diabetes solely through diet and exercise.  It's either been multiple injections or the insulin pump. 

Insulin is cool stuff.  It keeps me steady and solid on days when I'm following "the rules," but for things like holidays (where there is a whole dessert table and all kinds of sugary treats), I do have the option to up the bolus ante.  But a cure?  Nope.  Using insulin requires a lot of work.

The thing is, I think that insulin makes it seem like I can eat anything I want.  While I indulged in that piece of cheesecake after Christmas dinner, it was a risk I took.  I took more insulin, and I've read all these obtuse reports about how taking more insulin is tougher on our bodies. (Is that true - does anyone have a study they can point us to that states how insulin ages us or something?  I'm so curious.)  I risked the immediate spike and the latent spike in my blood sugar after eating the cake.  I wanted to indulge and I weighed the risk of this indulgence.  It's a split-second decision that my brain is programmed to make by this point.  Diabetes is all about coloring in the lines, i.e. keeping blood sugars well-controlled to minimize the impact on my body.

But I wonder what people think sometimes when they watch me eat.  How does it look from their eyes?  They know I have diabetes, and from their less-familiar vantage point, they view it as "serious" because I take insulin.  I use Equal in my coffee and I never drink the eggnog or have regular soda.  I almost always avoid the mashed potatoes and sweet potato casserole, and at family gatherings, there is usually a "sugar-free" dessert.  They hear me talk about blood sugar control and they know I work in diabetes advocacy.  They understand as much as they can, not actually living with the disease themselves.

But what to they think when I reach for a piece of cheesecake?  Do they think I'm "off the wagon?"  Do they think I'm being irresponsible because I'm eating a sweet?  Responsible because I'm testing and shooting accordingly?  Does it confuse them to see me clamor for a glass of grape juice when my blood sugar is low?  Do they wonder why every time they see me, there appear to be new "rules" for managing my type 1 diabetes? 

Diabetes is a constantly shifting platform that we're trying to balance on.  Every day is different, every diabetic is different, and the rules do seem to change every day.  On Christmas, I ate cheesecake and never sported a spike.  Last night, a cup of tea tossed me towards 200 mg/dl.   

"A pump isn't a cure, though, right?  I mean, you still have to prick your finger and tell the pump what to do, don't you?"

She's learning, petal by petal.  And despite all these years, so am I.   

December 22, 2008

Dexcom Pros and Cons.

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

CGM CONS:

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

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

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

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

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

Ouchy Dexcom

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

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

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

CGM PROS:

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

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

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

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

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

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

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

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

Conquering diabetes, damnit.

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

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

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

December 18, 2008

Minimed Trick I Didn't Know About.

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

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

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

Minimed pump features I had no clue about.

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

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

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

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

December 12, 2008

Low Blood Sugar Woes. (And Whoas)

Next week will be better.

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

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

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

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

I tested.  45 mg/dl.  Stupid lows.

Low blood sugar:  45 mg/dl.  Damnit.

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

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

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

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

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

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

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

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

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

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

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

December 10, 2008

Stupid Diabetes Move.

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

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

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

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

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

"Do you need more than one?"  

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

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

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

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

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

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

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

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

December 01, 2008

Dexcom Discard.

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

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

Dexcom sensor before I pulled it off.  All tattered.

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

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

Bye bye, Dexcom sensor!

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

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

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

November 19, 2008

Need Some Adjustments.

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

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

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

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

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

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

Thank goodness for Dexcom.

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

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

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

"All set."

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

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

November 18, 2008

No More Larry Bird.

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

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

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

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

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

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

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

33 mg/dl.

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

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

One look is all he needs.

"How low?"

"Thirty-three."

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

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

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

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

He smiled and we waited for the numbers to climb.

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

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

Dex, I need you back, buddy. 

November 11, 2008

When You Aren't Looking.

When you aren't looking ...The clock stared back at me.  5:22 am.  I stared at the green, digital numbers for a few minutes.  They stared back.  5:24 am now.

I reached over to the bedside table and pressed the spacebar on my phone - it told me the time was 5:28 am.

"That's not right.  My clock was set against my phone.  How are they different now?"  I thought about this for a few more minutes.  Chris was asleep on my right, his chest rising and falling with his even breaths.  The little gray cat was curled up at the foot of the bed, but her ears were starting to tilt towards me.

Exhausted.  I could just roll over and go back to sleep, but my hands reach out automatically towards the black zipper case on the bedside table.  I unzip the case and my hands fumble to retrieve a strip from the bottle, then clumsily shoved it into the top of my meter.

"Meow."  Abby called from the floor.  A statement, from the cat who always seems to know when I'm tumbling down the well.

"I'm testing."  I said to her.  To the cat.  I'm talking to the cat at 5:29 in the morning while I test my blood sugar.  Even as the result came back at 44 mg/dl, I had to laugh at the ridiculousness.

But something about seeing that number made the symptoms of the low show themselves.  Seeing that 44 made me notice the dampness on my forehead.   I felt like I was about to burst into tears and into a fit of laughter at the same time.  Chris was still asleep - shouldn't I wake him up and tell him I am so low?  

No.  Instead, I threw back the covers and made my legs move me towards the door.  One step, two steps, a few more steps, get to the fridge, open the juice bottle, drink, close the fridge, skate back towards the bed, collapse back into bed, stare at the clock which is blinking 5:32 now.

"Hey.  You okay?"  Chris stirs towards me.

"Yup."  Just lying on my back, waiting for the feeling of sinking through the mattresses to stop.

"Did you have juice?"

"I did.  A lot.  Grape juice."  Details he doesn't need to know, but I just want to hear my voice and confirm I still have some control over what's going on.

Clock is now at 5:34 am.  The sky outside the picture window is just starting to turn the dark blue-gray of the witching hour, and my lips are stained with grape juice.

Low blood sugars haven't been a part of my routine for several months now, and I credit the end of wedding stress, less aggressive bolusing, and the power of Dexcom.  But last night, my last sensor came loose and I haven't received my new sensors yet.  I had a 230 mg/dl before bed and I took a correction bolus.  And for some reason, the bottom dropped out in the wee hours of the morning.

You can be prepared.  You can plan.  You can have a medical team and an emotionally supportive team and a basket full of technology that can help you manage your diabetes, but a high or a low can still come and grab you when you aren't looking.

Tricky little suckers. 

November 06, 2008

Petal By Petal.

I'm picking my priorities, petal by petal.

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

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

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

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

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

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

Diabetes management, petal by petal.

November 05, 2008

More Sweet Irony.

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

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

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

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

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

I tested, and sure enough:  34 mg/dl.

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

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

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

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

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

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

Dear diabetes, if you wanted a brownie, you could have just said so.  Seriously. 

Diabetes wanted a brownie.
  

October 20, 2008

Crumbs Sparling. (Different from Crumbs Morrone)

The weekend weather was so excellent that we had to take advantage of it.  On Saturday, we took the quick train ride into NYC with a Chris-driven agenda:  hop on a row boat in Central Park and then devour cupcakes at Crumbs Bakery on Amsterdam.  (He saw the idea written up in InFlight magazine last week, and tore out the page.  We're easily persuaded, as a couple.  The mere mention of cupcakes is enough to send us on a cross country adventure.)

Kerri at the Bethesda Fountain in NYC

We stopped by the Bethesda Fountain (near the Boathouse), which I recognized from photos I've seen online but hadn't ever scoped out in person.  The park was busy, thanks to the beautiful weather, but we managed to grab a few photos.

View from the boat

I did not know you could rent rowboats in Central Park and tool around the Pond.  Chris rowed, rowed, rowed our boat and I did my best not to tip the boat over.  And after all that work rowing (and trying not to fall in), we had worked up quite an appetite.  It was time to bring on the cupcakes!  Trying to guesstimate the carbohydrate content in this sucker was an adventure in and of itself.  

Holy cupcake

"Maybe sixty?"

"Dude, a bagel has eighty-five.  I'm going to guess at least sixty-five."  I cranked up the pump to six and a half units, knowing that the frosting alone was more than my daily carb allowance.  (But it was DELICIOUS.  Easily the tastiest cupcake I've ever had, and almost worth the $4.00 price tag.) 

Dosing for high carb, high sugar dessert treats is always tricky, and I usually over compensate in efforts to avoid the spike.  I bolused and also requested that we walk back to Grand Central (I hate the subway, and I avoid it at every opportunity), which had me chomping on glucose tabs around 56th.

"Thwarted by that cupcake.  I guess I'll have to have another one sometime and see if I can fine tune the bolus."  I'll do my part, even if it means consuming another cupcake or two.  It's for science.

(Crumbs bakery + Kerri Sparling = Crumbs Sparling.  Very different from Crumbs Morrone.)

October 03, 2008

Whine.

Wine, whine?I woke up high this morning, thanks to a late-night snack of quinoa that didn't get into my system fully until well after I'd gone to bed.  Pre-bedtime test was 94 mg/dl, but I woke up at 7:30 am with a full bladder, sweaters on the ol' teeth, a backache, small ketones, and a blood sugar of 298 mg/dl.  I cranked in a correction bolus and went about getting ready for work.

I don't usually fall fast after highs.  It takes me about two hours to really settle back into a steadier range, and sometimes longer to even start the blood sugar tumble.  So I showered, reconnected the pump, got dressed in a hurry, and shuffled my almost-always-late ass out the door.   Mind you, only 38 minutes had passed from the time I bolused.

Got to work, turned on my computer, and started picking through my work emails.  But I had that feeling of foggy distraction - the sound of a coworker tapping her fingers against the keys were resonating in my brain too loudly.  And I clicked on "new" about three times before realizing that I was trying to "reply" to an email instead.  Brain was malfunctioning.  So I tested, knowing something was up.

Or down, since the result was 53 mg/dl and falling fast.  

I reached into my small, compact work bag (lie: the bag is enormous and I'll end up deformed from carrying around so much unnecessary crap) and pulled out a bottle of juice I'd had stashed for a few weeks.  It was a bottle I used at the gym once before and just refilled for an emergency.  I twisted off the cap and heard a distinct hiss, like I woke up an angry grape juice rattle snake.

Juice doesn't normally hiss, does it? 

I gave the contents a quick sniff and realized that the grape juice had fermented and was now spoiled and closer to "wine" than "reaction treater."  Thankfully, I had a can of juice in the fridge at work, so a quick pull helped elevate my blood sugar.

Kerri, take note (from yourself in third person):  Juice becomes wine when you have it go from hot to cold a million times.  No juice when you're low becomes whine.  Though the pun is delightful, stick with glucose tabs, okay?  They're less apt to spoil.

September 25, 2008

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

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

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

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

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

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

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

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

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

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

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

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

(I hope.) 

September 23, 2008

Irony.

I cooked last night.  (Contain your shock, please.)  I made chicken and vegetable soup, whipped up some delicious sugar-free pudding, and baked a chocolate cake for my co-worker's birthday.  Nothing caught on fire, nothing turned to sawdust, and consuming aforementioned tasties did not kill anyone.

Damn you, chocolate cake!

However, the cake baking was a little bit of a thorn in my side, because I was soooo tempted to lick the mixer beaters (no, not while they were spinning) and to stick my finger in that thick, chocolate frosting.   

But HA!  I did not succumb to temptation!  I baked that cake, frosted it, and put it in the fridge, all without even a taste.  HA HA!!!  Take that, diabetes! 

After the cake was all done, I sat down on the floor with my laptop to go through my emails.  But the screen was too bright.  The colors were all ... off.  And my hearing was fading in and out, like someone was shaking a blanket out to spread over the bed.  My head was in a complete fog, and Abby was weaving between my elbows, meowing frantically.

So I tested.  

And after all that baking, after avoiding that delicious treat and trying to "stick to the plan" and "be a good little diabetic," I saw "35 mg/dl" winking back at me from my meter.  Eight gulps of juice later, I was laying on the living room floor, telling Chris, "I didn't feel that one coming at all," and "If I lay still enough, I sort of feel like I'm on a record player, spinning."

Damn you, irony!

September 15, 2008

The Temptation of Cookies.

But are they bolus-worthy?!"I'll just stand here and keep you company."  He crossed his arms over his chest and kept his eyes on the red bowl I was stirring.

"Chris, you aren't keeping me company.  You're lurking."  The butter and the sugar were starting to mix up in the bowl, giving off that sweet aroma of cookies-to-be.

He smiled.  

"I love cookie dough!"

I'm not much of a cook, but I can definitely bake.  Flourless chocolate cake.  Banana bread that's made with extra bananas so it's all moist and decadent.  I can make chocolate crinkle cookies and Hershey kiss cookies, chocolate chip with oatmeal, peanut butter cookies ... you name it.  And last night, at the begging of my husband, I made chocolate chip cookies with extra chocolate chips.

It's almost Murphy's Law, my cooking talents unable to be used for "good."  I can't cook up a turkey dinner, or make a delicious dinner, but I can create the most sinful desserts without effort.  And the irony of standing there with my insulin pump clipped to my hip as I mixed up a bowl of brown sugar, chocolate chips, white flour, and butter was enough to make me laugh.

I've become decent with the willpower bit, able to say "no thanks" to indulgences if I have my head on straight, but sometimes I completely buckle and make stupid decisions.  I caved to the temptation of cookies last night.  They were fresh from the oven and sitting on the cooling rack, making the whole house smell ... simply: awesome. 

And Chris and I settled in to watch Vantage Point (mini-review: decent enough of a movie, but I could have done with the rewind device every fifteen minutes or so), I grabbed three cookies for Chris.  And then I grabbed three for myself.  My willpower went pfffft.  And the cookies tasted delicious.

Indulgences, for me, make me fear the highs.  I'm not as concerned with the calories or the effects on my weight (maybe I should be), but I try and ward off any post-indulgence highs anyway that I can.  Usually, I bolus aggressively, and sometimes hit the mark perfectly.  Other times I end up chasing a low, making the indulgence go from "reasonable" to downright gluttonous.   Last night I managed to do both.  Those three (delicious) cookies sent me up to 204 mg/dl, then I hit 54 mg/dl about an hour later.  

But was it worth it?  

I hadn't had cookies fresh from the oven in years.  Can't even remember the last time.  And these cookies were moist, hot, freshly baked, delicious, just the right amount of chocolate chips, and delicious.  So yeah, I'd say that little blip in my willpower radar was okay.  One cookie won't kill me.  Neither will three.

But Chris, eating spoonful after spoonful of raw cookie dough?  I think that may be more of a problem.  ;) 

August 27, 2008

You Gotta Fight ... For Your Site.

I am pretty crap with site rotations.  This is a fact, evidenced by the same pad of callous on my fingertips from testing and the smudge of dots on my thighs from infusion sets.  Back when I was taking injections, I favored my arms for a few years, then my stomach, then my legs, building up layers of scartissue and absorption issues with every prick.

I know site rotation is important, but it's never been my strong point.  Until I'm forced to do it.  Change is something I'm reluctant to make sometimes, especially when it comes to managing pain.  I have to be honest - most of the time I prefer using the same site locations because they sting less.  I test on the tips of my fingers because those nerves aren't as responsive and the lancet doesn't sting, for the most part.  Same for my thighs - the infusion sets don't sting as much when they are nested in an already-broken in area.  

But those wild highs forced me to change my stubborn ways.  (Yes, wicked stubborn.  Ask Chris.  Or my mom.  Or ... anyone, I guess.)  And now, after over two weeks of using expanded body real estate, my numbers are faring a bit better.  I'm seeing much better absorption using lower back sites and even though the infusion sets sting like hell for a few minutes after going in, my postprandials are more in range.  I feel like a bit of a stooge for being so stubborn and letting a little sting or a smidge of fear keep me from taking control of this crap. 

This has nothing to do with being stubborn, but I liked the photo.

Ruts - I get in them.  I'll do the same thing, every day, expecting something to change.  And I get all moody when it doesn't.  I frustrate myself because I let complacency or comfort or sometimes fear keep me from making even the tiniest of changes.  I'm now accustomed to having my infusion set on my lower back and I feel comfortable using it.  And my body seems to be enjoying the change, too, because my thighs are starting to heal up and the speckled red dots of old sets are disappearing (helped along by some high octane moisturizers, exfoliation, and some good old fashioned neosporin). 

It's not all awesome, though.  With this new site location on my lower back, the tubing is a bit more exposed and I've found myself forgetting to tuck it back into the waist of my skirt.  It's also less-than-cozy on the first site night, because I sleep on my back and I can feel the infusion set.  But these discomforts are worth it when I'm seeing my blood sugar at 147 mg/dl an hour and a half after lunch.  I'll freaking take that. 

Stubborn Kerri ... she needs to shake things up now and again!  (Only in first person, not in third person.  Third person is not as effective.)

August 26, 2008

Corn On The Carb.

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

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

*   *   * 

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

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

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

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

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

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

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

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

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

*   *   * 

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

August 22, 2008

Friday Face-Time.

Six Until Me - Vlogging Since ... Three Weeks AgoLow blood sugars are not fun.  Over the past ten weeks or so, I hadn't experienced many lows, but I've hit more than my fair share of highs.  (And not normal highs - instead, those warm, feverish highs that made my eyes ache and suits my teeth up in sweaters.)  But the lows seemed to have returned a bit, in part to a tendency to aggressively correct highs and the lack of carbs in my house this week. 

Like this morning:  I woke up and sat on the side of the bed for a full five minutes before getting up to test. I knew I was low, but it's like I'm unable to let myself drink the juice before testing.  Instinct?  Impulse? The room was thick with a cottony fog and my head was spinning, but I couldn't function clearly enough to grab the bottle of juice from the bedside table.  I grabbed my meter, waited patiently for the 52 mg/dl to pop up on the screen, and only then would I let my hands wander towards the grape juice bottle. 

It's frustrating.  My lows over the years have become progressively stickier, taking longer to come up and with symptoms that linger far beyond their textbook-issued 15 minute window.  This week's vlog entry is about lows and their irritating ways.  (And I tried my best to speak  more slowly, but I think I'm somehow related to the Micro Machines guy.  I just talk too damn fast.) 

Click on the logo to visit my YouTube channel, don't laugh at my crappy flashcards, and let me know what kind of vlog topics you want to see covered in the future! 

August 18, 2008

Diabetes Real Estate.

Control is tough to come by these days - and it seems like the more I fret about it, the more tangled my numbers become.  I'm trying a more relaxed approach (yes, I am as high-strung as I seem, why do you ask?!) to diabetes management.  Like this past weekend:  instead of shlepping myself home to RI and spending more time in the car than with friends and family, I decided to stay home in CT and relax.  I watched movies.  I worked on some writing I was trying to finish.  I made iced tea and cleaned my house.  (And I also tried on my wedding dress for no reason, but that's neither here nor there.)

Overall, I tried to freaking relax.  And it helped - my numbers didn't act out.  Apparently the absence of cortisol helps blood sugar stability - who knew? 

In addition to decompressing a bit, I also tried out a few new site locations last week.  I'm wondering if my thighs are a bit overused and if absorption is suffering as a result of the scartissue.  To give my legs a rest, I made good use of an arm site and a back site.

Infusion set on the back of my arm.

The arm site I've done before.  I can insert it myself (on my left arm, since I'm right-handed), it is pretty pain-free, and is away from my abdomen, which I prefer.  The mechanics of an arm site are a bit tricky, though.  If I aim the tubing towards my shoulder (see the photo), the tube goes up my shoulder, through the sleeve of my shirt, down the side of my body and then comes to a rest at my waist, where the pump is clipped.  It's a little complicated, because the tubing sometimes pinches where it's snaked underneath the side of my bra and it tickles a smidge, too.  Also, I almost ripped the site off a few times when putting on/taking off a sports bra, but overall, I just need to remember where the hell the site is and I don't screw it up.

Using my lower back as a site for an infusion set scared the crap out of me, but I knew it was possible because I saw Sara stick her CGM trial sensor there at the CWD conference.  It just made me feel squeamish thinking about the needle being inserted into my back ... actually, just writing that is making me feel all eeeew.  But, after psyching myself up and reminding myself that if it hurt, I could just rip it right out, I used the ol' Quick-Serter to stick a set into my lower back, towards the side.

Infusion set on back.  Thought it would hurt.  Was wrong, thankfully!
 

This site didn't sting much going in (totally unused real estate here), but the first bolus was a bitch and a half.  It stung like crazy!  Thankfully, it only took a few boluses to really get the site settled in and by the end of the first day, I didn't feel it at all.  I've worn it to the gym, to the movies, and in clothing with varying waist bands with no problem.  The only difference between this and wearing it on my thigh is that it's higher and the tubing doesn't naturally tuck down my leg, so snagged tubing is a risk.  Overall, I'm digging it, and grateful for the option.

New real estate options for my pump?  Check. Chillin' out, maxing, relaxing all cool?  (Name that sitcom!)  Check.  Have any of you guys tried these sites?  Any options for new places? 

And how was your weekend?  :)

August 14, 2008

CGM Denial - Yes, Another One.

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

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

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

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

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

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

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

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

I look forward to your response.  

Best,

Kerri Morrone Sparling

August 07, 2008

Because I Got High.

High blood sugar nightmares?About two months ago, I woke up at around 3 am after a terrible nightmare.  The dream was graphic and felt so real that it took me several seconds to realize it didn't actually happen.  (I dreamt that I had run over my own cat in the driveway and was holding its twisted and bleeding body.  Horrendous dream, and I woke up crying.) 

Once I was fully awake, I tested my blood sugar and saw "291 mg/dl" on the screen.  Holy middle-of-the-night  high.  I dialed in a correction bolus and went back to sleep.  I didn't think anything of the nightmare correlation until last night.

I dreamt that my husband was murdered by the guy who lived next door to me growing up.  It was a horrible dream!!!  I heard the gunshot in my mind, felt the heat of panic, and the tears on my face were hot and real.  I woke up with a start and reached for Chris, who was safe and asleep next to me. 

The clock read 4 am. 

The meter read 354 mg/dl. 

(The reason for this high was unknown, but it was a gross, sweaters on the teeth kind of high that made me want to pee and brush my teeth at the same damn time.)

I don't usually have nightmares, and I find it odd that the nightmares I remember most clearly corrrelate very neatly with a blood sugar issue.  Normally, my dreams slip away from me once I've been awake for a few minutes, and I rarely remember the entirety of them.  But this nightmare, I can still taste.  It was terrifyingly clear.   

I have heard about low blood sugars causing nighmares, but has anyone heard of highs doing the same thing?

July 21, 2008

Blue Bird of Happiness.

We drive.  Friday night, after taking in the new Batman movie, we hopped in the car late at night and drove home to RI.  (Late-night driving means less sleep but also means less traffic, and we'll take the latter, thanks.)  Saturday morning had me at the beach with a few of my college roommates, then dinner out with family on Saturday night, then breakfast with Batman (my friend, not Christian Bale), then a cookout at my mother's house on Sunday afternoon.

It sounds like a lot of driving because it IS a lot.  Chris and I try to connect with as many of our friends and family as possible when we come home on the weekends because we don't have the opportunity to see them for several weeks on end.  Connecticut, though filled with career opportunities for us both, doesn't have much in the way of family.  And lately, family and friends are something I've been missing tremendously.

I've hit a very rough patch, diabetes-management wise.  My A1c came back the highest it's been in five and a half years, and I didn't take the increase with any grace at all.  Even though I can attribute the rise to wedding chaos and honeymoon laziness, I still felt so disappointed.  In addition to an elevated A1c, I've also been diagnosed with a disorder called Factor V Leiden, which can cause blood clots and has forced me to change some of my routine (read: birth control pills are now a no-no).  Despite the fact that this disorder is unlikely to cause problems, it's still a new blip on my health radar and contributed to my feeling of "eh" last week.  I was feeling overwhelmed with health concerns, frustrated with insurance issues for the Dexcom, and pretty damn grumpy.  Crumbs Morrone ... er, Sparling.  Crumbs Sparling.

I needed some time with friends and family this weekend, to help take the edge off a roughish week.  And it worked.  Yesterday afternoon, I was hanging out in my mother's yard, taking pictures of her garden.  My mom is very whimsical and a little silly, and her yard is crammed with flowers and these strange little garden critters that she finds from the Christmas Tree Shop:  small ceramic ducks, little turtles, and garden gnomes.  It sounds like her lawn is littered with trash, but these creatures aren't just flung about haphazardly.  They're carefully placed, hidden between hydrangea bushes and underneath rhododendrons.  You have to look for them to find them.

Bluebird of Good Health 

I came across a big, fat, ceramic bluebird yesterday.  It was in her front lawn and guarding an azalea bush.  

"Bluebird of happiness!"  My mother came by, checking out what I was photographing.

"I see that."

"Well?  Doesn't it make you happy?"

I thought for a minute.  I felt revitalized after being socially reconnected with my friend and family.  I felt ready to make the medical changes necessary to accommodate the new condition and to take change of my diabetes management once more.  I felt loved.  Supported.  Happy.

"It does, Mom.  That fat bird totally makes me happy."  She grinned at me. 

Onward, right?  All I can do is get over the bad news and move forward towards something better.  Good health is one day at a time.

July 17, 2008

Give Me The Sample!

Antisocial little droplet
Hiding in my fingertip.
I called for you - you did not answer!
Forcing me to now reprick.

I lanced again, into the tissue,
Calloused hard from all these thuds,
I squeezed my finger with the purpose
Of procuring bright red blood.

But no!  My body stayed so stubborn,
Not giving me a proper sample.
"I'll change the lancet - then I'll finally
Get results."  My smile was ample.

Knowing that it wasn't time
To change the clocks or check detectors,
I still swapped out my old lancet
For a fresh, sharp blood collector.

I pressed the button, heard the shunk
And felt the sting of proper lancing,
Squeezed my finger, saw the blood
And did a jig of happy dancing.

I'd forgotten how convenient
It could be to just prick once -
Leaving me, the lancet horder,
Feeling like a mild dunce.

I suggest, my Faithful Readers
That you heed my sage advice.
Don't forget to change the lancet -
Prick your finger once, not twice!

Three little blood droplets, all in a row...

July 11, 2008

A1C You Soon.

Image courtesy of the BloodBankOnWebThe paperwork has been on my desk, but I kept staring at it for a long time.  And by "long time," I mean three full months.  I kept finding reasons to put it off - my wedding was coming, I was busy at work, my shirt sleeves were too long - but the real reason was because I knew the number would be kind of crap.  A1Cs are never fun, and they serve as a sort of diabetes report card.  With my stress levels being a little out of control during the wedding ramp-up, my numbers followed suit.  And I didn't want to know what my A1C was, out of fear and stubbornness. 

But on Tuesday, I turned my brain off for a bit.  I grabbed the paperwork, left my office, and drove directly to the blood work lab.  I refused to psyche myself out (and I tried really hard not to think about the pinchy needle easing into that tender part of my arm ... not a fan). 

"Hi, I'm Kerri.  I need to have an A1C drawn."

"Okay, write your name on the sheet here and have a seat."  

I wrote my name, thus making it official.  I was there, for my A1C, and there was no turning back.

I'm not sure why I shy away from this test so much.  I think it's because I have spent over twenty years putting so much of my self-worth into this percentage.  When it comes back under 7%, I feel like these moments of diabetes difficulty are worth the effort.  I feel strong and confident, like I'm really making strides in achieving good health.

But the bummer numbers.  The ones that are over 7% and cause the endocrinologist to check the "uncontrolled type 1 diabetes" box.  My Internal Motivational Speaker screams in protest at this box checking.  "Hey!  Uncontrolled?  Dude, she's paying attention and really putting forth a huge effort to manage this disease!"  I get overwhelmed by the possibility of complications and maybe not having a healthy pregnancy.  The parts of this disease that I try not to think about, try not to focus on, creep into my thoughts and whisper in my ear.

The phlebotomist put the rubber thing around my bicep, asking me to make a fist.  "To bring out your vein," she said, preparing the needle.

"Oooh, I'm not a fan of needles," I admitted.  

"But you take needles all the time, right?  With the diabetes?"  She tapped my arm a few times with her finger.

"Sort of.  I have a pump.  And a CGM," I gestured to the Dexcom sensor on the back of my arm.  "This takes blood sugar results for me so I don't have to prick my finger so much."

"Aye!  The finger prick!  I do not like that so much at all.  I am a diabetic type 2.  The finger pricking makes me all ... " she made a face to let me know how much the finger pricks stung.  "I do not enjoy it."

"Well I don't enjoy having blood taken.  That's why I am nervous."

She laughed at me softly.  "And that's why you are staring at the wall instead of looking at your arm, right?"

"Damn straight."   

Now I wait.  I should have my results in a few days, and I'm really hoping that this A1C result doesn't reflect the weeks of stress and honeymoon and worky bits.  I hope it shows the hours at the gym, the healthy eating, and the constant monitoring.  Either way, knowing this number is important.  Some would say it's half the battle.  But I wouldn't end this post with a silly reference to GI Joe ... would I?

June 18, 2008

Dexcom Days.

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

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

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

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

"Armed" with the Dexcom 7.

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

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

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

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

June 13, 2008

The Long Road Towards Insurance Coverage.

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

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

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

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

She laughed.

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

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

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

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

Thanks,

(Dexcom Guy)"

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

June 11, 2008

Unreliable.

Meter accuracy - that's the target!We're back in the swing of things at home:  working, writing, laughing at the stupid cats, going to the gym, exploring our surroundings.  Stress levels are lower, thanks to the wedding being behind us, and our routine is a bit more predictable. 

BUT - before the wedding, everything was running amuck.  My schedule was erratic, work was insane, and I was stressed to the point where I couldn't wrap my head around anything.  For the six weeks or so before the wedding, I tweaked my basal rates and bolus ratios several times.  On our honeymoon, I had to tweak again due to a completely relaxed schedule.  And now that we're back, I need to re-tweak once more.

As a result of this readjustment to normal life, my blood sugars have been sort of scattered.  An occasional morning high of 197 mg/dl (which never, ever happens - my overnights are the only thing I have nailed down), some tricky lows at work, and a sticky high after lunch one day.  I'm in the process of working towards Dexcom insurance coverage, but in the meantime, I'm out of sensors and going on my meter results alone.

Last night, after we returned from the gym, I tested.  165 mg/dl post-workout.  No problem - I reconnected, took a correction bolus, and then jumped in the shower.  About five minutes into the shower, my head started to fog up as quickly as the mirror.  My brain was only half-focused on the lather-rinse-repeat routine and instead was starting to wander down that "should I test?" road.

"Nah."  I said to myself.  "I was 165 like ten minutes ago.  Insulin doesn't bullet in that fast."

I yelled out into the hallway.  

"Chris?  I feel kind of low.  I just wanted to let you know.  I'm getting out soon."

"Why don't you just get out now and test?  Do you want me to bring you juice?"  I could tell by his Doppler-voice that he was walking down the hallway towards me.

"No.  I'm fine.  I'll get out when I'm ready, okay?" 

Internal Motivation Speaker yawned in my ear, still not adjusted to being back from vacation.  "Kerri, why the highly bitchy response?  He's right, you know.  Just get out and test."

"I just tested."  I muttered to myself.  

Internal Motivational Speaker sighed.  "Just test.  God, you can be so freaking difficult."

"Fine."  Miserable.  What was with this headache, and why aren't my hands responding to my requests?  I fumbled awkwardly with the towel as I wrapped it around myself, my skin bristling at my own touch.  I grabbed my meter and dried my hands off.  Shunk.  102 mg/dl.

"102.  Maybe I'm sick or something.  I feel like shit."  I sat on the floor for a minute.  Chris stood above me, concerned.

The sound of the air conditioning unit was becoming louder with each second.  Abby came waddling up, urging her head underneath my hand so I would pet her.  Minutes passed, but they felt like hours.  What the heck was wrong with me?  I felt miserable.

I unzipped my meter again.   "I just feel so bad.  I'm going to double check."

Shunk.  35 mg/dl.

"Ah ha!  I knew it!"  I yelled.

"I knew it, too." 

"Okay, let's get some juice."  I drained the bottle in eight quick gulps, leaned back against the side of the bed, and waited for my blood sugar to rise.

It's a strange battle in my body at times.  I knew I was low.  I felt low and should have trusted my instincts.  But sometimes my instincts are unreliable, like when I feel low but am just hungry, or when I feel completely fine and am instead 345 mg/dl.  Maybe I should have trusted a CGM.  But CGMs are best for trending, not spot-checking.  So I should trust my meter.  But sometimes my meter gives me botched results that aren't the fault of hand lotion.  Arghhhh ... who can I trust?

All of these new products being buzzed about.  All of these bells and whistles and colored screens and fancy upgrades and ambitious developments.  I am so thankful for the advances, but all of these companies need to remember that we use this technology to keep us alive.  These bells or whistles aren't substitutes for old-fashioned accuracy.

June 03, 2008

Diabetes On My Wedding Day.

Yesterday I wrote about my wedding, focusing on the parts that meant the most to me:  the man I love, our families and friends, the church service, saying "I do," and dancing ourselves silly at the reception.

But diabetes was a part of my wedding day.  We did our best to keep it quiet and unnoticed, though, using several tricky methods.  I'm like a diabetes wedding magician ... sort of.

First things first:  the dress.  Wearing an insulin pump is the easiest and least intrusive way for me to take my insulin, and I wasn't about to go off the pump just for the sake of fashion.  My solution?  Design a pocket to hold my insulin pump, hidden in my wedding dress.  I spoke with the seamstress at Ye Olde Bridal Shoppe and she and I designed something that left the pump accessible, yet hidden.

Insulin pump hidden in the wedding dress

Even if you were looking for it, the pump pocket was almost impossible to find.  Hidden along the seam of my wedding gown, it was held shut with a small piece of velcro.

Reaching into the pocket.

The hole cut in the seam was just big enough to fit my hand into, so I could reach for the pump.

Pulling the pump from my pocket

The hole was big enough for the pump to be pulled through. 

Wedding day bolusing

And once it was free, I could make whatever adjustments I needed and then slip the pump back into its pocket.

Insulin pump hidden in pocket.

The pocket itself was underneath the main fabric of the dress, attached to the petticoat.  It was sized to be about half an inch bigger than my insulin pump, leaving room for my hands to reach in and access the pump.  We stuck a safety pin to the top of the pocket so that when I reached in, I could feel around quickly for the pin and know exactly where the top of the pocket was located.  This made pump retrieval and replacement very easy.

Concealed!

The tubing itself went from the top of the pump, through a hole cut into the petticoat, and attached to the infusion site on my right thigh.  I had to plan ahead of time where my infusion set would be located so the pocket could be properly situated.

And during the entire course of my wedding, no one had any clue that I was wearing my insulin pump in my wedding dress.  Even my friends who know about it couldn't find it unless I pointed it out.  I felt empowered and like a secret agent ... only the bridal version.  

So insulin pump:  check.  And I had a few other tricks up my sleeve.  Like the flowers carried by my maid of honor:

Flowers with low blood sugar backup treater

After speaking with the florist, she devised a small pocket in the ribbon of NBF's bouquet.  This pocket could hold a life saver (as pictured) or even a tube of cake gel.  As I stood at the altar, I felt safe knowing that NBF had a quick dose of sugar at the ready, if I needed it. 

Diabetes, on the whole, didn't affect my day enough to matter.  I danced, ate cake, and experienced a wild array of emotions.  But there were a few moments when it required some attention.  Like after the ceremony at the church, when I tested and realized my blood sugar had cruised up from 156 mg/dl pre-ceremony to a whopping 380 mg/dl afterwards.  (Nerves - they hit me right in the A1c.)  Before the ceremony, I was running on the high end, cresting up around 160 - 180 mg/dl and holding steady.  And during the reception, I was too excited to eat much, so I let my numbers run higher there, too, to compensate for all the dancing. 

I did have a pretty aggressive low blood sugar just before our first dance, but thanks to my fast-as-lightning maid of honor, a glass of orange juice from the bar held me steady as we were announced on the dance floor as Mr. and Mrs. Christopher and Kerri Sparling. 

"I'm a little low," I admitted to Chris as the opening bars to "The Luckiest" played from the speakers.  He held me close and gave me a smile.

"You'll be fine.  Just focus on me.  As far as I can tell, there's no one else in this room but you." 

You may have had your moments, Diabetes, but my wedding day was mine. 

May 14, 2008

Good n' Fruity.

When I left work last night, I was en route to running a number of wedding errands.  First stop was Bed, Bath, and BEYOND (what is the "beyond" part anyway) to pick up a few things for our trip.  Felt fine walking around the store, but as I was waiting in line to check out, I was immediately hit by a weird headache, dizziness, and started to feel sweaty. 

Quick meter consultation:  91 mg/dl.

"No way.  No way am I ninety-one.  I must be dropping like a rock."  (People have most likely realized I'm crazy, since I'm constantly muttering to myself.)  Scanning the checkout line, I don't see much in the way of food.  Shouldn't that be part of the "beyond"?  Teeny cheese grater, wine cork with a plastic man on top, a bag to wash unmentionables in so that the dryer doesn't eat them ... where are the snacky bits in this blasted establishment?

I grab the closest food-like item I can spy:  a box of Good n' Fruity candies that look as though they were shipped to this particular B,B & B in 1987.  Cracking it open, I chomped on a few while the cashier rang out my purchases.  I wasn't going to ignore the classic "low blood sugar" symptoms, even if my meter said I was fine.

A cure in every box!

Out in the car, I was less fine.   Still shaky, still dizzy, now 58 mg/dl.  Have a few more of those moldly old Good n' Fruities.  Fifteen minutes passes and I lance my finger again - 54 mg/dl.  Oh for crying out loud.  I check the glove compartment for my glucose tabs - nothing.  I forgot that I moved them to my gym bag for my workout the night prior.  It's just me and these fruity good things.

Another handful.  Two more handfuls, just for good measure.  It's now been 40 minutes since I rang in at 91 mg/dl.  Isn't this straight sugar?  I test again - 68 mg/dl.

"Are you serious?  Be less good and fruity and be more glucosey and sugar-crammed!"  I gobble down two more handfuls.  More than 2/3 of the box is gone at this point.   I wait (not) patiently, making phone calls to my friends while my blood sugar plods back into range.

Finally - 76 mg/dl.  I'm comfortable driving with that number.

Two hours later, 84 mg/dl.  

Three hours later, 93 mg/dl. 

I'm convinced those Good & Fruity candies were nothing but capsules of insulin with a sugar coating. There is NO WAY I should have been anywhere even close to "in range" after consuming a massive box of them.  I can't figure out what was keeping me running so low for such a long period of time.  Persistent little sucker. 

So note to readers - if you're ever stuck with only these G&F's as your low blood sugar treatment option, beware.  They apparently have a cure tucked in that box somewhere.  ;)

(Oh Google, go ahead and have your way with that phrase.  No, Good & Fruities don't cure diabetes.  They don't even taste good.  Give me Twizzlers any day.)  

May 05, 2008

3 am Paralysis.

Sticky sweet, from his head to his feet yeah.No sound woke me up.  I'm not sure how long I was lying there awake and staring off into nothingness, but eventually my shirt felt too sticky and my hands weren't responding to my commands.  Flat on my back and listening to the sounds of Chris's even breathing next to me, I wasn't sure what I wanted to do.  Did I want to go back to sleep?  Did I want to try and get out of bed myself?  Did I want to flip on the lamp and finish reading my book?

I knew I was low.  I needed juice so badly and my torso was damp from panic, but I still couldn't stop thinking these completely ridiculous thoughts.  Was I ready to call the church tomorrow morning and confirm the readings we'd selected for our wedding service?  Was that the sound of one of the cats picking at the couch?  I really wanted to just read my book.  Or go back to sleep.  Could not focus on the task at hand.  My brain just wasn't operating.

My eyes slipped shut and I fell into a nervous few moments of sleep, waking to feel those waves of nausea and lethargy wrapping around my body like a snake. 

"Wake up, Kerri.  Wake him up.  Get some help.  Now is not the best time to finish your book."  Internal Motivational Speaker piped up in my ear, yawning.  It was 3 am and she was irritated I had woken her up.  "You're low, kiddo.  Wake him up and ask for help." 

"Chris."  

He woke up instantly, as though he had been waiting for me to say his name.

"Chris.  I need juice.  It's right there on the table but I can't get it.  Please?"  I sound so rational, like I'm in control but inside my body is rattling.

Seconds later, I've drained the bottle and am lying back down, the covers tossed aside and Abby prowling nervously at the foot of the bed.

"I'm dizzy."  My voice felt like it was stuck at the back of my throat, too timid to venture out in full.  "I feel very dizzy, baby.  I'm nervous I might pass out.  Okay?  I need you to know that."

He turned on the light and sat beside me.  "Stay awake, okay?  You drank the juice.  It's going to be better in just a minute."

All I could think about was that damn book, sitting on the bedside table.  I was about 20 pages away from finishing it and it seemed a lot easier to immerse myself in someone else's fictional life than to attend to this low blood sugar.

A few minutes pass.  Chris reaches for my meter and clumsily unzips it.  I can tell just from the sounds that he's not loading up the strip the same way I do, or clicking back the lancet device with the same cadence. Setting up the meter and testing has become autonomic for me and I do it without thinking.  I could hear him struggling, so familiar with the sights but not as fluid when he does it himself.

Shunk.

43 mg/dl.  After juice.  

"Whoa.  I must have been low.  That's after juice."  My brain works rationally, my sentences sound slow, deliberate, but not tangled.   "I can't lift my arms.  My fingers aren't working."  These are not complaints.  These are matter-of-fact statements, spoken to my fiance and hanging there in the air.  "I still feel dizzy.  Can you get the honey?"

Instantly, he's back with that little jar shaped like a bear.  I open the top and wait clumsily for the honey to trickle to the top of the spout.  I take a long pull, my mouth recoiling at the sticky sweetness. 

"Can I sleep?  I've eaten so much.  I'll end up at 300 no problem.   How about we sleep now?"

"How about you lay down and I'll stay awake with you."

I think about that book again.

"Okay.  Just a few minutes.  Then we'll go back to sleep."

Twenty minutes pass.  I regain control of my hands and they reach over to rub his shoulder.

"Thank you, baby.  I feel much better now.  It's okay to sleep now.  I'm better."

This morning, 108 mg/dl.  After all that juice and the honey, I should have been upwards of 270 mg/dl.

I have no idea what causes these late night lows.  Ive only had the Dexcom off for a few days but it seems that this high-stress time is the best time to be wearing it.  I'm dealing with the insurance companies tomorrow. 

(But, for the record, I finished reading the book while I was blow-drying my hair this morning, the little honey bear sitting on the bathroom counter, watching me.)

April 23, 2008

Lunchtime Lows.

I'm standing at the counter at the bank and I hear my cell phone buzzing.  Then I hear the Dexcom wailing out its BEEEEEEEP.  My pump starts to buzz from inside my bra (wearing a dress today).  Every bit of technology I have is exploding all at once and I'm just trying to make a damn deposit.

"Miss, I just need your account number."

"Account number, sure.  I can get that for you."  BEEEEEEEEP again.  Why is it beeping again?  It should only beep once when I'm high.  My goodness, I'm awfully warm, despite standing underneath the bank air conditioning unit.

I stick my hand into my bag and forage about.  My fingertips feel like they're trapped in cotton balls and I can't quite get a good handle on my wallet.  Instead, I grab the Dex, which is BEEEEEPing again, and press a button.

Oh shit, LOW.  Below 40 mg/dl.  I press the down button and see "39 mg/dl" next to the blood sugar graph, which now looks like the Cliffs of Insanity from The Princess Bride.

"Here is my license.  Can you pull my account numbers by looking up my name, please?  I'm diabetic and having a little low blood sugar at the moment and I need to drink this juice."  I hand the teller my license and raise up the bottle of juice with my other hand, like one of the Price is Right models.

"No problem.  I'll get your account numbers.  Do you want to have a seat?"

"No, no thanks."  I drain the bottle between words.  "I'm good.  I just need to focus a bit and let my blood sugar come up."

He typed some numbers in on his keyboard and passed my receipt through the bank printer.  "This isn't some elaborate plan to rob the bank, is it?"

I laughed.  Just drinking the juice alleviated the low-panic enough for me to act like a normal (slightly sweaty) person.  "I'm not robbing the bank.  But I may take one of those free lollipops, if that's okay."

He hands me my receipt, along with three purple lollipops.  "Here you go.  Why don't you wait a few minutes over there," he gestures towards the bank reception area, "for your blood sugar to come up?  I don't want you to drive yet."

SUM lollipops from the bank."Okay.  Thanks for your help."

And I teeter carefully on my heels (far too high for such a low blood sugar) over to one of the plush, blue chairs.  Sinking into the chair and waiting for the juice to do its thing, I unwrapped one of the lollipops.  My feet didn't quite reach the floor, as I was sitting so far back in the chair.  But I was starting to feel better.

People came in and out of the bank over the next ten minutes while I rested, looking over and most likely wondering what that grown woman was doing there, face flushed, swinging her feet, and sucking happily on a lollipop. 

April 16, 2008

Dexcom's Laboratory.

The Dexcom has added a whole new dimension to my existence:  Muttering.

Kerri:   (muttering, of course)  Okay, so you say 176 mg/dl.  My meter says 150 mg/dl.  But you say I'm rising. 

Dex:  (silence)

Kerri:  (checking her pump for any insulin on board)  Hmm.  I don't want to end up high.  I can see that the numbers are climbing on the Dex and ...

Dex:  (like a lion roaring through a megaphone, or maybe a jet plane taking off inside an empty pool)  BEEEEEEEEP.  High - above 180 mg/dl.

Kerri:  Ahhhh!  

Kerri's Office Mates:  Kerri, are you beeping?

dLife CEO:  (from office)  Is that you or me?

Kerri:  Yeah, it's me.

Dex:  Beeeeeeeeeeeep!

Kerri:  (muttering again) I don't want to be high.  Dex says I'm high.  I should take a little bolus to correct this.

Pump:  Boop beep boop.

Dex:  Beeeeeeeep!

dLife CEO:  (from office)  Did you bolus?

Kerri:  Ahhhhhhhh!

Working with the Dexcom has really enlightened me as to how quickly my blood sugars skyrocket during times of stress.  It has also shown me that my overnights are so finely-tuned that my numbers are flat-lined throughout the night.  (That makes me very, very happy.)  But Dex is also making me a little more OCD than usual, and I'm feeling oft-compelled to correct blood sugars when I should instead let them ride and settle neatly on their own.  I'm quickly developing a nasty habit of pinch bolusing for EVERYTHING, which is causing some tricky little lows. 

I need to learn to be patient with this new technology.  I also need to remember that the Dexcom updates much faster than my insulin works, so I can't be chasing every Dex result with the boop of a bolus.  Sometimes I just need to let my insulin work and learn to better manage the emotional blow of an upward cresting graph.   

(Unrelated:  I saw llamas today on my lunch break.  They did not have diabetes, but they did have wonderful personalities.)   

April 10, 2008

Straight Dex'ing It.

It's official:  I'm applying to have my Dexcom 7 covered by insurance.  I'm choosing to make the Dex part of my management plan.  Over the next week or so, I'll be battling my insurance company to cover my sensors.  Yes, I'm taking the leap.  I don't plan to wear it every single day, but I know I will be sporting it several times a month, more so when I'm closer to planning a pregnancy.

"How's the accuracy?"

It's as accurate as can be expected for new technology - and by accurate, I mean that the Dex7 says I'm 143 mg/dl, my meter says I'm 154 mg/dl.  Those it's higher than I'd like to be (more on that in a minute), those numbers are close enough for me to trust both the trends and the snapshots of Dex.  If I'm going to bother wearing a second device, I want it to be worth it.  And for the last four days, these numbers have been close to one another, so long as my blood sugars are under 260 mg/dl.  Above 260 mg/dl and the gap starts to widen, but I'm not shocked by that considering how my MiniLink trial played out.

"How about comfort?  Is it comfortable to wear?"

I have to be completely honest - comfort is the other deal-breaker for me.  My criteria for a CGM is a. be accurate and b. be comfortable.  Accuracy is reasonable (as stated above).  The only other CGM I've used is the MiniLink, but the Dexcom is far more comfortable.  And I know exactly why.  The MiniLink sensor is not completely adhered to the skin, leaving the "shell" part flopping about a bit.  Even when I taped it down, the sensor still had mobility and the needle shrugged around uncomfortably in my skin.  It made the site ache something awful, regardless of whether I wore it on my arm, my thigh, or my abdomen.  The benefit to the Dexcom sensor is that it's all one piece that is backed by an adhesive, leaving every part of the sensor stuck to my skin and holding steady. Therefore, it didn't hurt me at all and once it was installed, it didn't feel much different than a pump infusion set (only it's slightly bigger). 

I realized this crucial difference in the sensors this afternoon.  For the last three days, my Dex sensor has been securely stuck to me.  But I shower every morning before work and go to the gym every night (then shower again), and the combination of shower, intense workouts, and snug clothing rubbed the sensor a bit the wrong way.  Even though it's meant to last for seven days, it peeled away from my abdomen and came loose a few minutes ago.  Blast.  And for the last 12 hours, it's been floppy and felt sore, leading me to believe that it's the steady adhesive of the Dex that makes it way more comfortable than the MiniLink.  It makes sense - who wants a wire scraping haphazardly around in their skin for hours on end?  Not me. I want that wire to sit still and behave itself.

The Dexcom 7 sensor after it leapt from my body.

"I heard software comes with this one?" 

I loaded up the Dexcom software this morning for the first time.  It's remedial-looking (much like the OneTouch software I have at home), but it serves its purpose of downloading and organizing blood glucose results.  This is a definite upgrade from the old Dexcom software, which was nonexistent. ;) And thanks to my ridiculously awful blood sugars all week long, I've been able to really see all the pretty colors that the Dex software has to offer. 

Screenshot of Dexcom software

"So what now?"

Now I'll make use of the sensors I've received (taking a few days off and reinstalling another one on Sunday morning, post-bachelorette party) and move forward on the insurance verification and approval.  I'll be sure to document my progress with the insurance approval, because I know that's a concern for many people considering a CGM.   

"You mentioned a rough week of numbers.  What's going on?"

Dude, I have no idea.  My numbers have been grossly high all week long, highs in the "Hey, I'm a newly diagnosed diabetic" range like 409 mg/dl, 363 mg/dl, and my favorite, the stubborn 212 mg/dl that visits me without calling first.  I'm changing out my infusion set tonight after work, in hopes that a dodgy set may have been the problem.  Or maybe it was a busted bottle of insulin.  Either way, these blood sugars are reflecting a botched set, or raggedy old insulin, or work/wedding stress, or just plain Blech.  Or maybe all of these things.  One way or the other, I know I need to get things under control FAST because I feel like garbage.  My days with Dex showed me just how bouncy my numbers have been. 

Time to buckle down and focus on what matters most - not deadlines or scheduling or planning, but getting these numbers back under control.  It all starts here.

April 08, 2008

Dexcom Seven: The Warrior Returns.

I made the mistake of saying the following to Chris the other morning:

"You know, I haven't had a low in like two weeks!"

The next morning, the alarm went off and my eyes slowly opened, as though there were weights attached to each lash.  Brushing my hand against my forehead to wipe off the sweat, I reached for my meter and loaded in a strip.  For some reason, the lancet wasn't pricking my finger.  Shunk.  Shunk.  Shunk.  Chris stirred beside me. 

"It won't bleed."  Said as though the blood wasn't mine, the finger someone else's.

Finally, a ruby red spot leapt up from my fingertip.  Five seconds later, 48 mg/dl winked at me from the meter.  I drained the small bottle of juice on my bedside table and snuggled back underneath the comforter, waiting for my body to catch up.

I had two more lows that day, one that left me shaking at my desk at work and another that had me stumbling on the treadmill at the gym.  The next day, I hit a sticky high of 409 mg/dl after a site change, the sweaters knitting up in my mouth and lethargy wrapped around every movement.

The DexSignal

So when the Dexcom Seven arrived at my office, courtesy of the reps out in California, I didn't think twice about suiting up for another round as the Dexcom Warrior.  I installed my first Seven sensor on Sunday night.

I know what you're thinking:  "You had a rough experience with the MiniLink - why are you doing this again?"  

Why?  Because I found the Dexcom to be a superior CGM product.  Minimed makes my pump and therefore has my appreciation, but their CGM unit is sub-par.  Aside from the flopping sensors and the painful insertions, the darn thing just wasn't right.  I know CGMs aren't supposed to be a substitution for manual blood glucose testing, but I had little confidence in even the trends offered by the MiniLink - and I was very frustrated by the errors that were cropping up.

The Dexcom, however, had a more reliable trending ratio and the actual results correlated tighter with my meter.  I'm not thrilled about using a second device (the receiver being its own entire hub device), but if I'm going to make use of a CGM on occasion, I want things to be as "right" as possible.  Like right now:  Dex says I'm 146 mg/dl.  Meter says I'm 137 mg/dl.  It also says I'm on the rise, which is true - I was 92 mg/dl an hour ago.  

So I'm spending this week with the Dexcom Seven, making it part of my work day, my workouts, and my wedding stress.  With wedding planning coming to a wild and all-consuming crescendo, I'm hoping Dex can help me stay more tightly controlled.  Because, between you and I (and the entire internet), I'm having trouble keeping my numbers steady these days.  Diabetes is rearing its head and I, for one, am not feeling very armed for battle.  Hopefully I can sharpen my Dexcom skills and have it as my secret weapon. 

March 04, 2008

Cold Sting of Insulin.

Icy pinprick of an infusion set.I have had plenty of infusion sets that don't hurt.  I wipe the site with an IV prep wipe, load up my trusty Quick-Serter, and shunk in a new infusion set into my skin.  Pull back the needle, leave the cannula inserted, and hook up the tubing.  Prime, stash the pump somewhere on my body, and move on with the day.

But lately, I've had a few infusion sets that stung like snakebites.  I'll be sitting on the side of the bed, pull back the white plunger on the Quick-Serter, and then send that infusion needle hurtling into what must be a happy little nest of the most sensitive nerve endings in my body.  At this point, I usually hop up on one leg, tears stinging in my eyes, and I bring forth my best Yosemite Sam impression (reserved for moments like this and for when my car makes me fume). 

Sunday night, I put in a new set and the string was unbelievable.  Determined to soldier through until the pain passed, I gritted my teeth and laced in my dinner bolus.  I could feel the cold of the insulin spreading underneath my skin like snowflakes.  I ate my dinner (spinach salad with chicken, as previously discussed) and tested two hours later at 228 mg/dl. 

Sometimes it feels like it takes a few extra hours for a new infusion set to "stick," so I decided to correct the blood sugar, go to sleep, and see what the morning brought.  

7:30 am - 156 mg/dl.  Though higher than I normally run in the morning, I didn't worry about the site.

All day yesterday, my numbers were crunched - 189 mg/dl, 221 mg/dl, 192 mg/dl, 201 mg/dl, and then finally 102 mg/dl.  It's like it took all freaking day to come down.   And oh how that site smarted like holy hell all day long.  Just the brush of my pants against the edge of the thigh sent spirals of pain down to my knees.  This was so not normal.

When I came home from work, I ripped the site out as fast as I could.  While the cannula was perfectly unkinked and appeared to be normal, the site gushed pus (ew, sorry) and blood immediately.  Over the course of the night, I'd managed to riot up an infection in that site - no wonder it was on a 2 hour delay accepting all my boluses and no wonder it was swollen up like someone had shoved a Mento under my skin.  

(Note to self:  If it hurts and you're high, just suck it up and change out the set.  Stop being so darn stubborn!)  

Today's numbers:  78 mg/dl, 138 mg/dl, 158 mg/dl, 108 mg/dl ... and holding steady.   

February 20, 2008

Strip.

I am a relatively clean person.  I don't like dirty dishes, hampers filled with needs-to-be-washed laundry, and I despise knowing the cat box has those teeny morsels of yuck in it.  Sometimes, late at night when I should be getting ready for bed or relaxing on the couch, I'm hit with these cleaning fits.  I'll scrub away at every last stain on the counter, reorganize my underwear drawer (yes, it's organized for the most part), or start chucking the expired items from the fridge. 

I clean up my desk whenever I leave the office.  I can't stand messy piles of paper or a filthy, unwashed coffee cup with that tell-tale ring of grinds the bottom.  I don't like when the garbage can isn't emptied every night.  

Clean.  I like it that way.

So why, oh why, do I find myself completely and utterly inept when it comes to properly disposing of used test strips?  

These little buggers are everywhere.  I've written about them before (stuck to Chris's face, on the floor at the gym, and even discussed in dictionary entries), yet I still haven't found a way to solve the problem.  I test anywhere from 8 - 15 times a day, so these used strips accumulate and are inadvertently stashed in parts of my life like those hidden picture things from Highlights for Children

Glucose meter strip on the floor.

On the floor just next to my garbage can. 

(And that's a sticker from an apple.  I couldn't get it to peel back up.) 

Bag o' stuff.

At the bottom of my massive work bag (with many other assorted bits).

Even in the damn camera bag.

Even in my relatively-new and almost always zipped camera bag.  How the hell did it get in here?

Crafty little testy suckers.  I do my very best to make sure I do not leave a pocket of test strips when I visit new places or people, but I always find a pile of them hanging out in the spots I frequent the most:  my car, my office, and my home.  I keep trying to get them in the garbage can but it's like the bin takes a step to the left every time I go to toss one out.  Are garbage cans across the country uniting to thwart my best intentions?

I need to sharpen my disposal skills.

February 13, 2008

Ketones.

Headache.  Check.  Eyes that weighed at least a pound apiece.  Check.  Mouth full of sweaters.  Check.

Looks like they're all here - the symptoms of a high blood sugar.

Sitting down to catch up on some emails, I absently fish my meter out of my gym back and lance my fingertip.  I hit send, graze against the new infusion set on my left thigh, and see a meter result of 420 mg/dl.

"Oh, that is just fantastic."

Taking out my pump, I calculated the massive correction bolus and felt the quiet sting of the insulin as it coursed through the infusion set I had placed an hour earlier.  Normally when I'm at an elevated blood sugar, I feel lethargic and generally Crumbs Morrone, but this one had a different feel to it entirely.  My stomach felt like it was playing host to a hamster wheel, and my headache was blinding.

I brought the ketone strips into the bathroom and watched uneasily as the pad on the ketone strip turned a deep purple.  Large ketones.  I hadn't seen those suckers since my days at Clara Barton Camp.  I never, ever have ketones, and I test regularly for them.  So where did this come from?

My stomach in knots, I wandered back into the living room and filled Chris in on the situation. 

"I'm high.  Like crazy high - 420  mg/dl.  And I just tested for ketones.  I have large ketones.  I feel like complete shit, and my stomach is really nauseous."

He rubbed my back.  "So what do we do?"

"Drink a ton of water and try to flush out the ketones, I guess.  If I can't keep the water down, we're off to the emergency room."  It dawned on me that I had the process of treating a low blood sugar down to a science, but navigating a serious high was unfamiliar territory.  Normally, I just bolus and wait for the numbers to fall, but this high came with an added bonus of ketones.  The word "ketones" was enough to send me scouring for my old Joslin manuals from 1986, breaking open that red binder and searching for the antidote. 

I drank several bottles of water and willed myself not to throw up, even though my body disagreed with that decision.  "Do not throw up.  Do NOT."  The mantra ran through my head and I tried to relax on the couch, drinking water all the while.  After about an hour, my blood sugar had fallen to 248 mg/dl and the ketones had retreated to "moderate."  Three hours later, my system was flushed clean,Ketones ... huh ... what are they good for? ketones were down to "trace," and my numbers were hovering around 170 mg/dl.

But I was still confused - where is the emergency room threshold?  DKA is defined by Wikipedia as "a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). Near complete deficiency of insulin and elevated levels of certain stress hormones combine to cause DKA."  Okay.  And Joslin had it beaten into my brain that ketones + vomiting = emergency room.  This is serious stuff.  But there is that gray area where large ketones are present and proper management steps are being taken, should I still be under the care of a medical professional?

I opted to stay home and wait it out, since I wasn't throwing up and my blood sugar was falling from that obscene high.  And today, at my doctor's appointment, I asked Dr. Connecticut about when I should be checking myself into the ER due to high blood sugar.  She confirmed that as long as I wasn't throwing up and that my blood sugar was coming down, it was okay to treat at home.  She did add that if I was showing signs of another infection, like a urinary tract infection or a sore throat, that the emergency room should be on my "must see" list.

Over 21 years with this disease and there are still uncertainties that touch in at any given moment. 

February 05, 2008

Jet Lagged.

I was on a plane, high above the clouds, looking down onto the world below me where everything looks too small and too distant to be affected by a number.  Cruising altitude.

I felt his hand on my shoulder, shaking me a little bit. 

"Kerri.  Kerri, wake up.  You're really sweaty.  Wake up." 

Was it the captain speaking?  No, it was my fiance.  I was half-draped off the edge of the bed, pulling the long-sleeved blue t-shirt away from my body.  The space above my collarbone was damp.  My hands went to it, blotting it with my sleeve.

"I'm awake."  I could hear my own voice but it sounded like it was coming from the end of a long tube of Christmas wrapping paper.  "I'm going to test." 

I unzipped the meter case, lanced the end of my finger, and watched as "39 mg/dl - do you need a snack?" popped up on the screen.

"Oh,"  Everything was nonchalant and dreamy.  "I'm 39." 

Chris sprang from the bed and returned in just a few seconds with a glass of grape juice.

I drank it down in a few gulps, being careful not to let any spill out.  "I'm pretty low.  I don't feel that low."  The words sounded so matter-of-fact, like we were discussing the thread count of our sheets.

"Did the thing go off?"  He motioned to the CGM as he rescued the empty glass from my unsteady hands.  I reached down for my pump and clicked a few buttons. 

"No.  It says I'm 74 mg/dl.  But it's showing this crazy sharp dip - see, right there? - so it knows I'm dropping."

"Feeling better yet?"

"Not yet.  I changed my site before we went out tonight.  That always happens - I change my site, I end up higher, and the correction bolus crashes me down so hard."  This conversation is happening as my blood sugar hovers around 40 mg/dl.  Aren't people supposed to be on the cusp of a coma or something at this point?   How is my brain busy explaining the mechanics of this crisis?  Where is the SkyMall catalog?  I'm still mid-flight on this low.

I clicked off the lamp and we both settled back into bed.  As my blood sugar rose, I felt increasingly worse, shivering and cloudy-mouthed, my mind racing and my hands clenching against threats Rocketman.unseen.   I felt like I was landing now.  But the closer I came to landing on the safety of the ground, the more terrifying it became until the landing gear in my mind touched down and I was okay.  Safe at 130 mg/dl.

The alarm went off this morning - my blood sugar was 119 mg/dl.  I collected my baggage from the night before and rubbed the sleep from my eyes. 

Today, I'm feeling a bit jet-lagged. 

SUM Tags: , , , ,

January 15, 2008

CGM Sensibilities.

An Exercise in Jotted Thoughts, by Kerri Morrone:

Ahem.

I am on day five of the sensor (placed it last Friday into my arm) and it seems that the longer I MiniLink transmitter - photo from Google.wear this, the more accurate the results become.  Last night, I tested with my OneTouch and saw 132 mg/dl.  My CGM said 130 mg/dl.  I'll take that.  I just want accurate results.

The thing is, this sensor stung a bit going in.  The site itself is slightly reddish and a little sore to the touch.  I know I should change the site today, but I'm reluctant to because I don't want to wait the 24 hours for decent results again.  I spoke with another Minimed Rep last night and she told me that the first 24 hours tend to be a little dodgy for everyone.  It's a difficult decision, making the leap from "trialing" to "purchasing."  Every time it buzzes when I'm high or low, it's hard to think about taking it off.  But every time it buzzes because it's bored or lonely (or whatever the hell it's buzzing about), it's hard to think about not feeding it to the cats. 

I'm still on the fence as to its place in my diabetes life.  But for now, I'm trying to learn from this experience.

I was working out last night at the gym and during my run, watched my numbers hold steady for about 15 minutes, then make a sharp turn towards hypoglycemia.  Testing to confirm and then taking a quick swig of juice, I finished my cardio workout at 108 mg/dl.  Watching workout trends helps me better determine when I should hit the ol' juice bottle and when I need to watch out for falling sugars. 

Also during my workout, while wearing a sports bra and a tank top on the treadmill, I noticed a woman staring at the exposed sensor on my arm.  It made me feel self-conscious for a minute, then oddly empowered.  Go ahead and stare, lady.  See if you can find it next week, when I put the transmitter somewhere else. 

One thing I'm definitely picking up on, like I did with the Dexcom, is that my numbers cruise around when I'm not counting carbs with precision.  I know this sounds like diabetic common sense, but when I bit into that sharon fruit this morning, I didn't bolus for the actual carbs, but I dosed instead for the estimated carbohydrate content.  Apparently, this sharon fruit had more than 18g of carbohydrate in it - more like 22g - and my numbers after consuming were in the 190 mg/dl range.  Lather, rinse, repeat.  If I want a tight A1c, I need to buckle down and pay attention to all the details, both delicious and detrimental.

It's been a week of serious diabetes stuff, with tangled emotions and blood sugars alike. 

Good thing I had a little Siah Sausage to wake up to this morning, her small nose pressed against my cheek and her paws on my face, the sound of her purring like a jet engine in my bedroom.  It felt strange to wake up laughing.  Damn cat.

SUM Tags: , , , , , , ,

January 09, 2008

The Best Laid Plans of CGM.

Meep meep, says the Roadrunner Sensor.11:30 pm. 

Meep meep meep.

"What?"  This thing sounds like a little RoadRunner attached to my hip.

More mournful this time.

Meep meep MEEP.

"What is it?"  Exhausted from the night before, nursing the beginning of a nasty head cold, and already tucked into bed, I snake my hand under the covers to retrieve my pump from the waistband of my pajamas.  The screen beams green light my way - "BG HIGH.  Above 180 mg/dl target." 

"Okay, okay."  After clearing the alarm, I grab my meter from the bedside table to confirm this result and, sure enough, I'm 202 mg/dl according to One Touch.

"Here."  I push against the buttons and bolus up a unit, realizing I'm talking to my pump the same way I talk to my cats when they wake me up early in the morning to fill their empty food dishes.

The beeping stops.  I rest my head against the pillow and fall into a deep, blissful sleep, with the pump on my hip, the infusion set on my thigh, the CGM on my arm, a cat at my feet, and my fiance by my side.  Full house.

What happened next is not something I remember clearly, but the memory of my machines filled in the gaps for me.

3:19 am - Pump Alarm.  BEEP.  BEEP.  BEEP.  LOW BLOOD SUGAR.  64 mg/dl  WAKE UP, KERRI.  WAKE UP.

4:08 am- Meter Result.  49 mg/dl.

7:15 am - Morning Carnage.  One empty juice bottle, meter unzipped and used test strips all over the floor, covers tossed off in my low-induced sweat, body freezing due to being exposed and damp all night long.

Oh CGM, you tried to warn me.  I changed my low glucose threshold value to alarm at 65 mg/dl and you did.  You just weren't loud enough.  Or maybe I just turned you off, like I have mistakenly done with the alarm clock on occasion.  Either way, the best laid plans of my CGM were thwarted (or at least muffled). 

Today, my numbers have been all over the place.  I know this because instead of the plateaus of graceful blood sugars, I'm seeing stock market indexes all over the screen of my pump.  Thanks to the sneezing, stuffed up head, and feverish feeling I'm currently enjoying, I at least know why my numbers are erratic.  Even though we've just started our relationship, now CGM and I can enjoy a head cold together and I can see how my numbers dance when I'm feeling ill. 

I have so much I want to write about - the CareLink software that I'm going to try out tonight, my challenges and successes with CGM-ing at the gym last night, and the insurance angle of things, but I'm almost fully immersed in this freaking sneezy cold and can't form another complete tho ...

SUM Tags: , , , , ,

MiniLink, Armed.

MiniLink sensor in my arm.My Minimed rep was meeting me at the dLife offices after work to hook me up with the Medtronic Minilink and I joked in an email that he should hoot like an owl upon arriving so that I would know he was there.

Around 6 pm, my cell phone buzzed.  The message left was not someone saying, "Hi, Kerri.  [RepName] from Medtronic calling," but instead, "Whoooooooo!  I'm here."

That's the mark of someone who's on my level, that's for damn sure.

After exchanging grins, we settled ourselves at a table at a local coffee shop and laid out our drug paraphernalia on the table.  The box of CGM sensors, the MiniLink transmitter, the insertion device, and our respective glucose meters (my rep is also type 1) littered the table.  Conversation flowed easily as he set me up with the MiniLink.

"Okay, so now we're ready to place the sensor."  He loaded up the inserter with my first MiniLink sensor.

"Great.  Let's pop that in on my arm."

He paused. 

"Inserting a sensor at a coffee shop is a first, that's for sure.  But in the arm?  This is a series of firsts for me." 

With a little help and almost no pain at all, the sensor was inserted and the transmitter connected.  (I didn't have the opportunity to take pictures of the actual insertion, but I will do a photojournal for the next sensor I use.) 

After the first three hours, the pros and cons were beginning to show themselves. 

PROS:  The sensor is small - about the diameter of a quarter (maybe a small bit bigger) and about three stacked quarters high.  It's on the back of my arm and is pretty low-profile.  It's also water-proof, so no crazy-sticky shower patches that leave red rings on my skin for days.  The MiniLink transmitter, like the Dexcom, takes two hours to fully calibrate when you first put the sensor on.  (This term is called "wetting," which I think is revolting.  My rep and I called it "percolating."  Much less icky.  And hearkens to coffee, which I need desperately.  I'll explain why in the "cons" section.)

This sensor also works in tandem with my Medtronic 522 insulin pump, so I'm toting around one device instead of a receiver and an insulin pump.  It also is able to calibrate using any glucose meter, so I could continue on testing as usual, using my One Touch Ultra2.   One hub device is a huge selling point for me. 

CONS:  The transmitter is floppy and needs to be secured against my skin with a bandaid to keep it from coming loose or dislodging the wire.  This is the biggest con for this transmitter so far.

HOWEVER:  This frigging thing kept me up all night long.  After being instructed that the CGM results are about 15 - 20 minutes behind my actual blood glucose (i.e. the CGM says 100 mg/dl, my sugar is actually 80 mg/dl or thereabouts), I set my low glucose alarm for 80 mg/dl, assuming my number would actually be close to 60 mg/dl once the alarm sounded. 

Thanks to my vigilance with my overnight basals and the fact that they're set with precision, my numbers run close to 90 mg/dl all night long.  Due to this tight control on my overnights, the low glucose alarm went off eight million times last night.  That was issue one.

Issue two involved another alarm - this one reading "Bad Sensor."  Unfortunately, this alarm went off at 2:53 in the morning and I was not going to wake up again just to reinstall a new sensor.  So, against the advisement of my Minimed rep, I manually told the pump that I had installed a new sensor and recalibrated it.  It reset its timer for the two hour calibration, thus waking me up again at almost 5 am. 

Then the low glucose alarm went off again at 6:15, because I was 79 mg/dl.MiniLink - ha ha ha ha ha!

(Note to self:  Kerri, set the low glucose threshold at 65 mg/dl, for crying out loud.  Or you may never sleep again.  Seriously.  Every time the thing went off, you groaned, the cats howled, and Shoes most likely plotted revenge.  Raise the threshold.  Do it now, you silly girl.)

I have not slept well, but it's obvious that my numbers hold tight and steady throughout the night.  I'm hoping last night's escapades were a fluke thing and that a little tweaking will have me living in relative harmony.  

I'll have more on the technical aspects of this device throughout the week, but for now I'm going to check my number - ah, 113 mg/dl on the Link, 99 mg/dl on my OneTouch - and get another cup of coffee.

I am MiniLink.  :)

SUM Tags: , , , , ,

January 01, 2008

Bit of a Sloppy Start.

Last night, moderation wasn't exactly the secret word of the day.  In the company of friends, we ate too much, we drank too much, and starting from 7:30 at night and spanning well into the wee hours of the morning, we laughed our heads off.

Maybe that's why my head hurts a small bit today?

Regardless of the empty Corona bottles we left in our wake, my blood sugars remained freakishly steady, holding between 89 mg/dl and 190 mg/dl and never hitting that "drinking low" that I sometimes encounter.  And we had a damn good time. 

2008 was rung in with style last night - dinner at Paragon in Providence, a few hours at the bar, and then a house party - and now I need a good night's sleep.  Tomorrow, once the elephants in my skull stop trampling on my remaining brain cells, I will have something productive to offer. 

Until then, Sausage says happy new year, too.

Happy New Year, from Siah.

SUM Tags: , , ,

December 20, 2007

Tune Up.

I spend a lot of time thinking about health and fitness.  

There's my job, where I am often found perusing diabetes-related press releases, checking out the latest websites about endocrine health and wellness, and writing about what day-to-day life with diabetes is all about. 

Then there's my handsome fiance, who has spent time as a personal trainer, writes for various fitness venues (including AOL), eats a regimented, healthy diet, and has a physique that is evidence of time well-spent at the gym.

Oh, and then there is the whole "white wedding dress" thing, where everyone will be looking at me in a few months on a (hopefully sunny) May afternoon.  Not to mention my disease, which I manage with an insulin pump, my meter, attempts at healthy eating, and regular exercise.

So I'm constantly checking out different websites about health and fitness, as the themes touch so many different parts of my life.  My magazine collection is a mish-mash of Women's Health, Shape, and Modern Bride.  These pages are dog-eared and occasionally ripped out and pinned to my cube wall or my office bulletin board. 

Never mind the daily webcrawl I make, bouncing from my daily check of Women's Health online for some daily tips and inspirations, FitDay to continue on with my goal of keeping a food journal for a full month, Slashfood for some foodie snippets.  Recently, I've been checking out iVillage's Your Total Health site, Healthbolt, and Lift Magazine for some newer viewpoints. 

It's all bit-sized bits of health information, which fit into my multi-tasking sort of lifestyle.  But the part that I'm having trouble with is cutting down the workout to a sensible size.  Fitness doesn't appear to come in teeny bits for me.  I need to work out long and hard in order to see results, constantly fighting the uphill battle of treating low blood sugars and the demanding schedule of any fully employed twenty-something.  (Scratch that - the schedule of anyone is demanding, ranging from kids to senior citizens to circus clowns.)  I need to buckle down and make efforts to really reach my goals.  Bit of a tune-up.

A few months ago, I decided I needed to change my workout.  My legs were killing me.  But, as with anything else, my body adjusted and I needed to switch things up again.  I now have a few different methods of attack:  keeping a food journal, avoiding all holiday sweets until the New Year (it's like the Pre-New Year's Resolution), and making some awkward attempts at bringing running into my routine. 

Oh how I hate to run.  I feel awkward and like a great, traipsing gazelle.  But over the last two weeks, I've been trying to work in a circuit of running to help me tone up a bit more before the wedding.  (Five months!)  A combination of weight training and running was constantly touted by all those fitness sites as a killer fat loss program.  So I'm trying it.  First, I did five minutes running, five walking.  Then seven on, five off.  Last night, I did twelve on, five off. 

And I watched as my blood sugar fell from 160 (started the whole workout at 200 mg/dl) to 68 I only wear two sneakers, unlike my little pal here.mg/dl.  When my workout changes, my diabetes management methods need to change, too.  Hopefully I'll find a way to trot with a bit more grace.  And hopefully my body will shift into shape by the time I'm donning my white dress for my big walk down the aisle.

Oh hell, maybe I'll run.  Just to prove a point.  ;)

December 12, 2007

Wake Up, Test, and Repeat.

It's like that scene in The Graduate, where Dustin Hoffman is floating at the bottom of the pool while life mills around above him.  That feeling of water clouding my vision, leaving the numbers on the alarm clock looking blurry and projected from miles away.  A strange, floating feeling to my limbs, like there are layers of helium between my muscle and my skin.   Yet my hearing is honed to a fine precision, taking in the steady sound of Chris breathing, the cat snoring at the foot of the bed, and the sounds of the wind in the trees outside.

I also hear my own heart beating.

38 mg/dl.

3:42 am on Tuesday morning.

I thought about possible causes for the low blood sugar.  There were plenty, as Monday night was spent laughing, drinking, and partying hard with co-workers.  Then there's the fact that I'm on the "off week" for my birth control pills.  Plenty of factors to consider.  Even though I went to bed at a blood sugar of 173 mg/dl, I knew the chances of an early morning low were elevated. 

I set my alarm for 4 am, but found myself awake, staring at the ceiling, and willing my arms to reach over for my testing kit at 3:42 am instead.

Chalk it up to a moment of miscalculation.  I drank the juice on my bedside table and then eased myself back into sleep.

But last night, I didn't go out.  I didn't drink anything with alcohol in it.  I didn't go to bed excessively late or entertain any dodgy blood sugars.  The only variable I could find was the absence of birth control hormones this week.  Taking that into account and remembering Monday night's low, I lowered my basal rates last night and went to bed, again, at a blood sugar above 150 mg/dl.

4:02 am.

The cat opens her mouth into a wide yawn, exposing her tiny pink tongue, as I scramble for my kit.

38 mg/dl.Wake up, rinse, and repeat.

Nothing freaks me out more than scary lows, two nights in a row.  The same frighteningly low number.  I'm short on sleep and even shorter on confidence in my body.  Tonight, I will lower my basal rates further.  I will set my alarm for 3 am and see if I can catch this low as it happens (it's like tracking a hurricane sometimes).  I'll try and figure out if it's just the off-week for the pill or if my basal rates have suddenly found themselves to be too much on the overnight. 

Calculating, factoring, estimating, guessing, hoping, trying, remaining determined.

Wake up, test, repeat.

December 05, 2007

Chilled.

With a smiley face on it, it actually looks a bit friendly.It's fricking freezing here lately.  Gone are the winters of 2006 where I barely turned on the heat and didn't bust out my wool jacket until almost February.  Here come the constant snow showers, rotten and battered hands, and frozen meters.

Yes, frozen meters.

Last night, after going to the gym, Chris and I stopped at the grocery store to pick up the ingredients for another attempt at soup.  (Pearl onions, chicken, black pepper, and celery.  It was definitely another good recipe from that book.)  Since we were just popping in for a few minutes, I left my gym bag in the car - with my iPod, water bottle, and glucose meter.

The wind was bitterly cold and biting through my sweatshirt.  I scampered over to the car and started it up while Chris loaded the groceries into the back seat.  (What a guy - always protects me from the elements!)  Feeling a little light-headed, I rescued my meter from my bag and unzipped the case.

"Whoa.  This thing is like a block of ice!"  I said. 

"What?"  Chris asked from outside the car, over the rustle of the plastic bags. 

I popped a strip into the meter. 

TEMPERATURE ERROR.  OUT OF OPERATING RANGE. 

Oh fantastic.  I rubbed the meter between my hands and blew on it, trying to thaw out its innards.  After a minute, I stuck the strip back in.

TEMPERATURE ERROR.  GOOD TRY, THOUGH.

Arghhhh.  Still feeling foggy, I cracked open the juice in my workout bag and took a few sips.   Then I opened the battery compartment and breathed onto the disc batteries, hoping they'd warm up. 

TEMPERATURE ERROR.  KERRI, TRY YOUR ARMPIT.

"Excuse me?"

STICK ME IN YOUR ARMPIT.
IT WILL WARM ME UP.
REFER TO OWNER'S MANUAL.

Is this thing serious?  I removed the meter from the plastic holding case, looked from side to side to see if anyone was watching, and then shoved the meter into the armpit of my sweatshirt.  After waiting another minute, I tried again with another test strip.

AH, THANKS.  CODE 22. 

I pricked my finger and applied a drop of blood.  Five second count down.  68 mg/dl.

DO YOU NEED A SNACK?

"I already had some juice.  I'll just wait to come up."

OKAY.  MAKE SURE YOU TEST LATER JUST TO MAKE SURE.

"I will." 

Chris opened the door and settled into the driver's seat.  "You will, what?"

"Nothing.  I was just ... nevermind."

LOL.

December 04, 2007

Paint By Numbers.

Carb management is a paint-by-numbers for me.I looked into the bottom of my purse and saw the Cliff bar and a pack of gum.  "46 grams of carbohydrate."

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

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

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

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

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

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

December 03, 2007

Slow Recovery.

Since just after Thanksgiving, I've been battling against this messy conclave of germs that have taken up residence in my body.  Starting with strep, morphing into what may have been the flu, and then culminating in a nasty little cold, it's been a very arduous few days. 

Blood sugars have been a testament to the worst of diabetes, hitting excessive highs of 477 mg/dl (no ketones - I checked) and a rage-bolus low that caught me in the 50's.  It's amazing how fragile my body is when I'm under the weather.  Something as simple as a cup of coffee without an accompanying bolus is enough to toss me into the stratosphere, leaving numbers orbiting for hours.  And blood sugars like 180 mg/dl feel more like 300 mg/dl, with every fiber on the teeth-sweaters thicker and the lead in my fingertips heavier.  My schedule was mucked up beyond recognition, with random fits of napping every few hours, no time at the gym, and a bedtime in the single digits (vs. in the wee hours of the morning).  Mugs upon mugs of herbal tea.  Add a few documentaries (courtesy of Netflix online) to the mix and I was one hunkered down sicky.

And Chris ended up with it, too.  Poor guy.

Instead of heading out for some late-night fun, my fiance and I holed up in the apartment for the weekend and festered.  It felt like winter, with the soft gray skies and the dusting of snow on Sunday morning. 

To celebrate the beginning of December and to drum up a little holiday cheer, we unearthed the Christmas tree from the depths of our storage closet.  Last year, we did blue bulbs.  This year, we went for red. 

Red ornaments on our Christmas tree this year.

Something about having the Christmas tree in the living room made it feel like Christmas.  (Of course, Sausage couldn't keep her little mitts off the thing and she's been prowling around the edges of it, batting at ornaments and meowing plaintively.)  Chris and I are ready to celebrate our first holiday season as an engaged couple, and our last before we become husband and wife in May.

Just the thought of our wedding helps me feel a little bit better. 

November 06, 2007

Fingertips.

First thing in the morning, I test my blood sugar.

Okay, that's sort of a lie.  First thing I do it stagger over to the bureau and slam my hand against the snooze button.  Then I collapse back onto the bed, shoving aside the little gray cat who took the four second opportunity to scurry up from the foot of the bed to the spot I was sleeping on.  After I fold myself back under the covers, my hand darts out and I retrieve my meter from the bedside table.  Fumble with the lancet device, shove a strip into the meter, and smoosh some blood onto the tip of the strip.  Sleepy countdown from 5.  Alarm goes off again.

A hole is the SUM of its parts.

This is every morning.

And every night before bed, I tuck myself underneath the comforter, do a quick blood sugar test, respond to the result (either bolus, grab a swig of juice, but most often just think, "Cool," and rezip the case), kiss Chris, go to sleep.

Blood sugar bookends to a busy day.

Testing is a big part of my daily diabetes management.  I test all the time, leaving an unfortunate trail of test strips wherever I go.  I'm constantly picking them off the ground in my office.  My gym bag is littered with them.  Don't even look at the bottom of my purses, where they form a solid layer.  I'm vigilant with testing, but not as steady with recording my blood sugar numbers.  

Since I've started at my job, I've been keeping a mangled little post-it note with my meter averages listed on it.  January 17, 2007.  March 11, 2007.  April 9.  May 2.  June 26.  It's just one little, yellow note but it's crammed ful of number notations.  It's just a matter of pressing the "Average All" option on my meter, where I'm instantly given a snapshot of my blood sugar averages. 

Keeping a steady log book is one of my biggest diabetes management hurdles.  I know there are some awesome web applications, like SugarStats, that help keeps numbers tracked, and I really need to make an instant diabetes resolution to start taking advantage of the technology I have available to me. 

I'm going home at lunch to get the cable for my meter.  I'll start downloading today.  Yes, I promise.  NaDoLoBlooMo.  (National Down Load Bloodsugars Month?  Well that's just plain bizarre looking.) 

How do you overcome the hurdle of folding number-tracking into your busy days?

November 05, 2007

Seed.

"Test."

I said it out loud.  Siah was tucked flat against my legs and she stretched out her furry arms at the sound of my voice. 

I can't breathe right.  The room is so hot.  Tangled in my bedclothes, wrapped up in the blankets, trapped.

There is juice on the bureau next to the bed but my fingers and arms and hands are unresponsive, palsied by the weight of the hypoglycemia.  Body sinking lower and lower into the mattress and I knew I would eventually be swallowed.  Part of me welcomed the warmth.  I just wanted to close my eyes and go back to sleep and fall deeper into the mattress until the morning.

I could see Chris lying next to me but he was miles and miles away from my unresponsive hands and I couldn't reach out to tap his shoulder.

My brain entered an eerie calm, all panic smothered by the sounds of my heart beating in my ears and the steady lull of Chris' breathing.  Just reach out and touch him.  Let him know you need his help.  It's okay. 

My hand, lifted by strings I couldn't see, leapt up from the bed and flopped against his shoulder like a fish.  He woke instantly.  "Are you okay?" 

"No."  My voice was eerily calm and dead in my throat.  "No." 

Seconds yawned by.  I aged a thousand years, shattered into a million pieces.

He pressed the bottle of juice into my hands.  I drank the entire thing without breathing.  The stain of the vineyard on my bottom lip, I tested.

34 mg/dl. 

Slick with sweat, the bed damp beneath the small of my back.  Cats circled like concerned sharks on the floor near the bed.  Abby meowed pitifully.  One small seed.

It was the dinner from that night, where I was 202 mg/dl going into it and over-compensated for the Italian pasta meal.  I over-bolused.  This was no one's fault but my own.  These lows toss me deep down the well and I can't even hope for a bucket because I put myself here.  But I didn't mean to.  I didn't realize I had over-bolused for the meal.  I was 180 mg/dl before bed.  I thought I was okay.  I just wanted to go to dinner with my fiance.  I didn't even have a glass of wine or a dessert treat.  It was just dinner.

I did not mean to. 

The next morning, with dark circles under my eyes and guilt a small seed at the bottom of my stomach, I awoke.

October 02, 2007

Sad Robot.

I was 48 mg/dl after dinner.

I thought I had over-estimated a bit for dinner and when his words started swimming in the foreground before they slammed into my ears, my hands unzipped the black meter case without thinking.  Grape juice stained my mouth but the moment ended with a sheepish smile and a "I think I over-bolused a little at dinner."

Before bed, I was 107 mg/dl.  Safe.  I curled against Chris, said a silent prayer for the cat to remain off my pillow, and fell asleep.

At 4:07 am, I woke up with the lamp on. 

Then I remembered that I had woken up about 20 minutes earlier and turned the lamp on, like I was trying to wake up in stages.  Shirt was melted against me, my face was cold with sweat.  My meter case was open and lying next to me, but I couldn't remember testing.

Siah hopped up on the bed and purred loudly. 

Moonlit lows had been leaving me alone lately, letting me cling to the few hours of sleep I was able to catch.  But this one must have been hiding under the bed, knowing full well that my earlier low had sapped my liver of its glucagon storage.  My thoughts were unraveling like a scarf.  Did I test earlier?

Chris stirred next to me.  For some reason, I was determined to let him sleep.  I pressed the "on" button on the meter to recall the last result, my brain stuck in a routine of "test, then treat," even though I knew with every breath that I needed juice now.

Last result was the 107 mg/dl before bed.

Click.  5 ... 4 ... 3 ...

Siah put her little gray nose over the meter screen and pawed at my wrist.

42 mg/dl.

Nodding to myself almost matter-of-factly, I swung my shaking legs over the side of the bed and put my feet on the floor.  I felt like I was made of yarn.  My feet wouldn't plant themselves in place but instead they kept staggering, one after the other, throwing me into the wall.  I tried to take a step forward and crumpled to the floor.

My brain is fully functioning.  I know words.  I know sounds.  I know exactly what I need to do and what the number 42 means but my body has betrayed me and won't move as I have asked, like I was a robot who had been over-oiled.

Crawling back into the bed, I meant to tap Chris on the shoulder but instead my hand took on a force of its own and whacked him solidly in the chest.

"Help me?"The sad robot.

He woke up instantly.

"Sit down."  In a matter of seconds, he was back with a bottle of juice, despite the fact that there were two juice bottles resting on the bedside table.  Autopilot for both of us.

Again with the grape juice.  Wiped my shirt against my forehead.  He held my arm and kept me steady.

Drained the bottle.  Rezippered the meter case.  Routines, routines, robotic routines.  Turned off the lamp.  Collapsed against my pillow and listened to the sound of my labored breathing, aware of the hurricane of juice in my stomach and the tears in my eyes even though I didn't feel sad.  I just felt low.

"It's okay.  You're okay." 

And I lay there, at the bottom of the well but slowly coming back up to the surface, like a sad robot.  Wishing I could tell him "I know," but instead these tears fell out and my mouth wouldn't make the words.

August 27, 2007

Having a Few.

My favorite white wine.Diabetes makes drinking a bit of a tricky topic.  I take very good care of my health and my diabetes - I'm vigilant in monitoring my many numbers, eating well, seeing my doctor, and hitting the gym.  I work hard.  I am determined to be healthy!

But I also am determined to have a life.  And for me, part of "real life" includes having some drinks with my friends. 

This summer has had some fun times, and some of those times included alcohol.  The enGAGment party, a weekend at the beach with my college roommates, wine tastings, this past weekend out with the girls, etc.  No, I don't need to drink to have a good time.  But yes, sometimes my good times include having a few drinks. 

It's weird, though, because not a lot of diabetics talk about their drinking habits, if they have any.  I am not much of a drinker, but I do like to have a drink once in a while.  Not too often because I have such a low threshold for alcohol. (Please - ask any of my friends.  Two drinks and I'm completely silly.  Three drinks and I'll dance.  Four and I'm ... well, four is too many.) 

I'm very careful when I drink.  My meter makes frequent appearances on nights out at the bars.  This past weekend, I was out at a beautiful wedding shower for one of my college roommates, M, and there was an open bar.  So I had a glass of wine.  Blood sugar at 132 mg/dl. 

The night progressed to a group of us getting a case of Coronas, having some beers while we hung out, and then heading out to the bar.  Along the way, I was steady at anywhere between 130 - 160 mg/dl and that's where I'm most comfortable when drinking.  Once I started to edge towards 80 mg/dl, I hit a quick swig of juice from my purse to ward off any lows.  Rest of the night?  170, 143, 130, ended up at 180 mg/dl before bed.  Works for me.

For me, I can't pretend not to be diabetic.  That's less about what other people see but more about how I react to certain situations.  I don't care if anyone sees me test or spies my insulin pump, but I need to make sure that I'm always taking diabetes into consideration.  Does it seem irresponsible to be having some drinks with my friends?  Maybe to some people, yes.  Maybe it makes my mother a little uncomfortable to think that I'm deliberately putting myself into a situation that could become uncontrolled.  But I can't lie and say that I live my life in a big diabetes-bubble - I go out.  I party.  I drink.  (And I know I'm not the only one.)

I do my very best to remain as safe as possible - this includes educating my friends, carrying things like my meter and a bottle of juice with me at all times, and not being afraid to say "No," when it's not the best time for me to be drinking.  Case in point:  at the enGAGment party, I was having a great time and yes, enjoying some drinks.  I tested all the live-long day and once I started cresting up into the 240 mg/dl range, I stopped.  I calculated out an insulin bolus, waited for my blood sugar to come down, and actually decided not to drink anymore once I was back in range.  I know when my body's had enough.  Reaching the high 200's means it's time for me to sober up and regain control.  I'm all about a good time but I hate having my blood sugar that high.  Ruins all my fun.

Thankfully, there's always the other drunk people.  Sometimes they pass out, wasted, in the middle of the street.  And what's better than posing near the wasted guy?  Not much.

Note:  No drunk messes were harmed while taking this picture.  He did this to himself.
(Yes, we made sure he was okay before we posed.)

August 10, 2007

Another Round as the Dexcom Warrior.

After a whirlwind week of travel, eating sloppily, and missing a few crucial workouts, my blood sugars were in a tailspin of chaos and I needed to reign things in.

I grabbed my flashlight and sent out the Dexcom Signal. 

Sending out the Dexcom signal.

Help me, Dexcom!

Dexcom responded with a shrill cry and leapt from the box.  Within a few minutes, the sensor was making its first appearance on my outer thigh and I started the two hour calibration waiting game.  (And why do I always start this thing at ten o'clock at night, forcing me to be fussing around with diabetes toys at the stroke of midnight?)

As I prepared for Round Two as the Dexcom Warrior, I noticed that I was very particular about where I chose to pop in the sensor.  Last time, I wore the site on my abdomen and while it was accessible and easy to put in, it bumped up against every piece of clothing I wore and was visible underneath both my gym clothes and my work attire.  As someone who prefers to keep all diabetes hardware relatively quiet, I opted for a thigh site this time.

I inserted the sensor, which pinched a bit but not to the point where I clenched my teeth, and pulled out the needle, leaving the hub attached and the wire inserted.  (Yes, this sucker has a wire in there instead of a plastic cannula.  If I think about it too much, it makes my stomach feel a bit queasy, but I couldn't feel it at all when it was in there.)

With my pump infusion set on my right thigh and my Dexcom sensor on my left, I felt like some kind of diabetic pack mule.  My hips felt vulnerable, as though banging into any door jamb would send me into a robotic meltdown. 

My euphoria wasn't as intense for this second round of testing.  No Techno-Joy.  (Cannot access printer?  But it's here.) I wasn't obsessed with the new gadget, but instead treated it like it was "just another meter."  I traveled with the receiver in my purse and kept it on my desk while I worked, instead of forcing myself to keep it clipped to my clothes.  Not wearing the receiver felt liberating. 

I noticed it physically, though, while I was at the gym.  Lying on my side for an ab exercise, I felt my pump infusion set mashing against the floor.  When I flipped to work out the other side, the Dexcom sensor was pressed hard on the floor.  I remember back to when I had the sensor on my abdomen and I felt it pressing then for sit-ups.  While I appreciate the technology of this device, I would appreciate it even more if it were smaller and less intrusive.

For anyone who thinks the Dexcom results are supposed to perfectly match the glucose meter results, that's not going to happen.  While I had some very closely matching results, the Dexcom remained a bit higher, on the whole.  Like here:

Overnight readings

This reading of 146 mg/dl was countered by my meter as 101 mg/dl.  Bit of a difference there.  But the trending I saw was spot on.  That 101 mg/dl (or 146 mg/dl according to Dexcom) was the upswing of a 72 mg/dl I had earlier in the morning. 

More Dexcom readings.

And then I watched as the correction for the 146 mg/dl brought me back town towards 120 mg/dl.  I like that positive reinforcement that my insulin is working and that my body is able to hold steady for a spell, despite the fact that I'm trying to compensate for a busted pancreas.

I gained a good feel for what times of the day I needed to pay more attention.  (Can anyone say "late afternoon snacking tendency"?)  I also noticed that wearing the site on my thigh instead of my abdomen made me less aware that I was sporting the site in the first place. 

Dexcom and I have parted ways once again, as I need to order more sensors.  Onward towards the weekend, where the Rhode Island Film Festival and a concert in Boston await!  See you Monday!

August 07, 2007

AADE: Chaos Theory

While my pancreas is woefully unemployed, I did find one at the AADE conference that had a job.

Pancreas, me, N, and Muscle

Only at a diabetes conference would there be a Pancreas and Muscle Tissue wandering around for photo opportunities as though they were Mickey and Minnie Mouse. 

Freestyle Butterflies were working at the booth across from dLife's - I sincerely hope they were paid handsomely for their time. 

"So can I have my picture taken with you guys?"

ButterflyOne adjusted her wings and tucked her ponytail back into her hood.

"Of course."

Freestyle Butterflies.  And me.

That night, a few of my co-workers and I shuttled down to a St. Louis jazz bar and saw Kim Massie - quite possibly one of the most talented singers I have ever stumbled upon.  Her voice grabbed my sternum and reverberated in my soul.  (Yes, she was that good.)  The bar was perfect, in that in the middle of nowhere, picnic table sort of way.  Empty beer bottles stuffed with white Christmas lights offered ambiance.

Beer Lights.

And the plane home.  This was my only messy moment.

We ended up switching flights to grab an earlier plane, so our dLife team was scattered all over the plane.  I was more towards the back, sitting in a row completely by myself.  Conveniently enough, my anxiety and nervousness threw me into a neat little low blood sugar, leaving me alone in my seat at 52 mg/dl and stuffing glucose tabs into my mouth.  Tears of panic caught at the corner of my eye.

A young stewardess, recognizing my symptoms, leaned in and handed me an orange juice.  I thanked her wordlessly.

Drinking my juice and waiting for the plane to take off, I wiped my low-induced tears from my eyes and clenched my hands nervously in my lap.  The xanax pills started taking their effect, making me a little looped.

"Excuse me?"  A man sat in the outermost seat of the trio as I remained nervously mushed against the window.  "You seem a little nervous.  It's going to be just fine.  I'm a pilot."

My brain couldn't register.

"You're the pilot?  You need to be flying the plane!"  (Thank you, Xanax, for making my brain melt at the most inopportune moment.)

He laughed.  "It's going to be fine.  You don't like to fly?"

"Not particularly."  Sniffle.  (My goodness, I'm a baby.)

"Well this is a short flight to NYC, so we'll be there in no time."

The plane and my blood sugar rose in unison.  My panic subsided once we were in the air and I caught this view from my window. 

Beautiful view from the plane.
Maybe flying isn't so bad afterall.

July 13, 2007

Magic Tongs Included.

Standard discussion between my mother and I when I was about nine years old.

"Ma, can I have this twix bar?"

"No, Kerri.  Let's save it for when you're low."

This logic always sucked, as far as I was concerned.  When I'm low, I can't enjoy anything I'm eating.  Saving the "good snacks" for a low sounded like a waste.  Usually, I'm sucking down a can of juice or munching on something laced with sugar, but not tasting it.  Panic eating.  My tastebuds are in time-out when I'm rocking a low blood sugar.  They're in bed with the comforter pulled up to their tastebuddie ears, pretending they can't hear the Twix bar knocking at the door.

"Let me in!  I taste good!"

Now that I'm older, I don't bother "saving treats" for when I'm low.  That's akin to tossing them into a kiln.  I'd rather treat with bland tasting juices and save that Twix bar for when I can actually enjoy the taste.

Yesterday, at the diner near my office, I went in for an iced hazelnut coffee and became distracted by a candy display on the counter.

"Oh, I've seen those before.  My son has had them.  He loves them."  My co-worker nodded approvingly.  I grew up with Nerds candies and Fun Dip - what is this Lightning Bugs Gummy Candy?  (Made by Kandy Kastle, Inc, the company formerly known as Kan't Spell, Ink.) 

Oooh!  Magic tongs are included!

Magic tongs are included.  Yay!

Apparently, this candy comes with like seventeen gummy worm things and a pair of purple plastic tongs that light up.  Therefore, grabbing the gummy wormy thing with the "magic tongs" creates a lightning bug effect.  Therefore making the candy tremendously creepy to eat and difficult to mentally grasp, but tremendously cool at the same time.

Therefore, I had to buy it.

Unlit, squishy buggies.

Packing 31g of carbs for the whole package, this diner-sponsored treat wasn't much to taste.  The gummy worms were a diasppointment and they felt oddly squishy.  Little sugar slugs.

But they did light up. 

Oh, they light up alright!

And I proceeded to light them all up, eat a few, and toss the rest in the garbage.  I then proceeded to test the "magic tongs" on other things in my office, including the English ivy, a loose test strip, and my fingertip.

"Phone home,"  I whispered.   Was food ever this fun and pointless when I was a little kid?  Can this candy even be loosely classified as "food?"

Lazy SausagesLazy Sausages

Overall, Lightning Bugs Gummy Candy gets Two Arbitrary Lazy Sausages out of Five. 

July 10, 2007

White-Water Rafting.

I was completely terrified of getting on the raft.  Jenn (Chris's sister), Steve (her husband), Chris and I fastened on our life jackets.  Armed with a yellow helmet, a paddle, and a life vest, I looked like a Nintendo character and I felt like I was going off to war.  We carried the raft down to the edge of the Kennebec River and got ready to climb on.

"I don't know about this.  I am scared, dude."  I grabbed Chris by the arm and shot him a panicked look.  (I also briefly wondered why I called him "dude," but that's neither here nor there.)

"It's going to be fine.  Once we start, you'll love it.  I promise."  He rubbed my arm and we climbed into the boat.  Scott, our rafting guide, shouted to us from the back of the boat.

"Okay, so the pace-setters in the front," Chris and Steve took the front spots.  "And then file in behind them."  Jenn and I sat behind them and the other four rafters filed in behind us.  Eight rafters, one guide, and one jam-packed fanny pack filled with my meter, glucose tabs, tubes of cake gel, juice, and insulin pens. 

Two seconds into it, I was beside myself with fear.

About 30 seconds into it, I thought it was awesome.

And despite my terror, this whole trip was awesome.  I'm not the woodsy-type (contain your shock), so the idea of being out in the middle of class 4 or 5 rapids with nothing but a paddle in my hand and my legs locked against the center pontoons of the raft to keep me from falling out didn't sound terrific to me.  I was also worried about the diabetes-related implications.

But something about being in the middle of nowhere with water raging on either side and feeling scared, excited, and completely alive all at the same time was worth every damn second.

The great outdoors!

We stayed at the Northern Outdoors lodge in a cabin tent, so we camped out at night, cooked s'mores on the fire, and had the benefit of a bathhouse (read: cabin where there were flushable toilets) within walking distance.

We suited up in our wetsuits and conquered the Kennebec River (read: didn't fall out of the raft).

Chris, me, Jenn, and Steve.

After our day on the raft, we went out and drank with our rafting guide.  Here he is, rather drunk, telling me that I wasn't the only diabetic he's seen on these rafting trips and dagnabit, I did it!

Scott, lecturing me.

Diabetes-wise, this trip wasn't easy.  After spending the week reacclimating myself to Lantus and readying myself with insulin pens and syringes, I felt confident that my blood sugars would remain semi-stable.   My blood sugars were a little higher this past week, but nothing too obscene.   However, the anxiety and excitement of rafting sent my sugars skyrocketing, tossing me up into the 350 mg/dl range about halfway through the trip.  Thanks to the trusty insulin pens I brought with me, I came down quickly, but it was annoying to reach that peak (mainly because it made me have to pee and peeing in the woods is not my thing.  blech). 

After considering all the options, it was a good idea for me to stay off the pump for the trip.  I wasn't confident that it would remain dry, even if I had an aquapack or something similar.  Rolling pumpless allowed me to jump into the "swimming rapids," where we could swim in the class 2 rapids, let me leap off the raft when we were easing down the last part of the river, and I didn't have  that constant worry of "Is it okay?  Am I still connected?  Is it dry?"

My main (Maine?) concern was bringing enough reaction supplies.  Thanks to the terrific rafting guide and my traveling companions, there was enough cake gel on that raft to sponsor a Barbie birthday party.  Chris and Steve each had a tube in their pocket, I had three tubes on me, and the rafting guide had a stash of juice, cake gel, and an insulin pen in his dry pack. 

Testing on the boat proved to be a bit of a challenge.  I had my One Touch UltraMini encased in two plastic bags, so it remained mostly dry, but finding a moment to unearth it from within both bags, set up the strip, test, and keep things dry was tough.  I tested every 30 minutes or so, despite these conditions, and the Green Mini kept things controlled.  (Although the tampons would have been helpful from an absorption standpoint.  It was soggy on that damn raft.) 

I missed my pump terribly, though.  More on that tomorrow.  But pump and I have been reunited, I am now a white-water rafting veteran (or at least I can say I did it), and I'm looking forward to going again next summer. 

I DID IT.  I am quite proud of myself.  Diabetes be damned!

Visitors since November 7, 2005