Main

May 20, 2013

Always Learning.

I just figured out what the hell this thing is for:

It's still kind of useless, but at least now I understand its intended use.

Capping up a pre-filled insulin pump cartridge.  For YEARS now I've been wondering what the hell this was, and then tossing it into the garbage after a site change (but then finding it again, days later, rolling around on the bathroom floor because I clearly missed the garbage can).

And now I know.

Always learning.

May 02, 2013

Time Warp.

I carry this around all day, hot-glued to my wrist.  What?My basal rates remain steady, throughout the day, except for a few hours in the morning when they're cranked up to almost triple the normal amount to take a bite out of the dawn phenomenon that I've experienced for years.  That pesky "wake up at 80 mg/dL but then go up to 200 mg/dL for no effing reason" phenomenon.  That midnight - 5 am at 0.45u, then all the way up to 0.85u at 5 am until 9.30 am, when it goes back down to 0.45u mess. 

It's something like a phenomenon

And it's definitely part of the reason an insulin pump works for me, because without the ability to tweak that morning basal rate, I'd be dealing with highs that frustrate me endlessly since they aren't the product of breakfast or stress.  They just are.  

I forget, though, how important that basal crank is for me.  I take basal bump from the pump (two points for rhyming, or for honesty) for granted sometimes, because once it's programmed, it's a done deal.  It's not until I travel outside of my timezone that I have to start juggling the dosing details again, making me run low at strange times of the day until my body clock adjusts to whatever timezone I'm in.

This happened last week when I was in Hawaii, which is six hours behind Rhode Island.  So noon here in New England is six in the am in Hawaii.  For me, that means my body wants the basal rate jacked up at the wrong time, and it results in blood sugars that are tough to track and attack.

Usually, I change the time on my pump as soon as the plane reaches cruising altitude, and I try to adjust to the local time zone as soon as possible.  This time, for the first time ever, I forgot to change my pump on the ride home.  And then neglected to change it until ... um, yesterday morning, when I looked at my pump at 11 am and saw it boasting a 5 am time.  Which explained the weird, ill-timed highs this week in the morning hours and the strange double-down arrows at lunchtime.

And the whole reason I didn't notice the time difference between the clocks at home and the clocks on my pump?  What caused this time-insulin conundrum?  What eliminated the need to peek at my pump to tell me what time it is?

It's almost too simple.  Too ridiculous. 

I bought a watch.

March 13, 2013

Back to Basics.

Yesterday, after two weeks of clingy lows and then some unreasonable high blood sugars, I took a look at my meter average and saw a climb in numbers that I was not happy with.  Could it really be the switch from Humalog to Novolog two and a half weeks ago?  Does the difference actually matter?  Some say yes, some say no, and some teeter in the space between.

I'm not sure if I'm a definitive "yes" or "no" yet, but I do know that I have no room for stubborn 280 mg/dL's or nights where I'm low three times over.  Could be coincidence, could be my personal response to the insulin change, but either way, I could feel my hard work eeking away with every meter beep.  I'm going back to basics (thankfully, my Humalog supply wasn't exhausted) and contacting my mail order pharmacy today to see if there's any chance they'll take back the three month's worth of accidental Novolog and swap it out for the insulin I'm familiar with.

Back to Humalog for now.

I don't mind spending time figuring things out and making adjustments, but sometimes, it's not worth it to me.  Especially when my A1C is holding steady at a range that I'm happy to hang on to.  I hope the pharmacy agrees.

February 27, 2013

Humalog vs. Novolog.

It wasn't until recently that I started thinking about building up a tolerance to insulin.  Do you build up a chemical familiarity, a resistance of sorts, to a drug after taking it for ... oh, say a few decades? Do PWD eventually become the Dread Pirate Roberts, building up a tolerance to iocane powder

"I realize this is probably ridiculous, and I'm sure there aren't any studies on this," I said to my doctor the other week.  "But it has prompted me to want to try a different kind of fast acting insulin, to see if I have better results.  Is that something I'm able to do, to have a script written for a one-off in order to assess how the insulin might work for me?"

"We can do that."

And I left the appointment, expecting my pharmacy to auto-dial me when my order was complete.

Instead, a three-month supply of Novolog ended up on my doorstep, having been accidentally shuttled through my mail order pharmacy and eating up my insurance order that was intended for my normal course of Humalog. Which is why I'm experimenting with Novolog for the next few months, as a result of a shipping error. 

Does it even matter?  Jury is still out for me.  Also, the smell of the maple candle my mom bought us is making my head hurt.  I'm throwing it out today.  So ends this aside.

I've been taking Humalog for over ten years, after switching from Regular insulin before starting on my insulin pump, so I feel like I'm familiar with how Humalog acts in my pump and on my blood sugars.  Switching to a different, but similar, rapid-acting analog should hopefully be a seamless transition.  Last night was my first pump-load of Novolog, despite the last unopened bottle of Humalog in my stash.  (I didn't want to use up the Humalog entirely, then switch to Novolog, because if I absolutely hated the new insulin, I'd be stuck with it.) 

So far, last night was entirely uneventful, and the biggest change I've noticed (in less than 24 hours of use) is that the bottle of Novolog plays host to way more bubbles, which I hope doesn't translate to a bubblier reservoir.  I'll have a better sense of how this insulin plays once I dial in a few meal boluses and then watch the Dexcom graph play out.

Has anyone switched from Humalog to Novolog?  Or Novolog to Humalog?  The responses to this question, when I posted it on Facebook, varied quite a bit.  Did you notice any changes?  Does it all come out in the wash?  (And if that's the case, why were you washing it?)  Or is it like the Pepsi Challenge, where some people just can't tell the difference and others are left with a bad taste in their mouths?  

February 19, 2013

Not Even a Minute.

Not even a full minute after inserting this infusion set into my arm did a frigging door knob reach out and YOINK it off with such fanfare that it flew across the room.

Effing door knobs.

Infusion Set No. 2 on tap.  Along with a renewed hatred of door knobs.

January 28, 2013

Back It Up.

(Title sounds more like a rappy-type song than I had intended, but I promise, this is safe for work.)

It's 9 am - do you know what your pump settings are?

I'm diligent about backing up my laptop and all of the silly content therein, and I religiously take the little, red external hard drive and make sure my computers are backed up.

Backing up the computer while hanging out on the United States floor map.

But I'm far less fastidious about backing up other important things in my life, like my insulin pump settings.  While I never anticipate an insulin pump malfunction (stealing verbiage from the airline flight attendants who make me squirm while they explain the oxygen masks on planes), in the event that my pump craps out, I'd be lost as to guesstimating what my insulin settings are.  I know I have some fluctuations in my basal rates throughout the day, but if asked to recall those settings on a whim, I'm lost.

So this morning, while I backed up my computer, I also took quick note of my insulin pump settings.  They're now logged as a note in my phone, along with my MDI preferences, as I never remember how much Levemir I take and when during those pump vacations.  (I'm safe now, unless I lose my phone, which is something I never back up, which now that I've typed this, I'm certain to drop my phone into a storm drain, where an alligator will make international calls until I'm broke.  Stupid alligators in the sewers.)

September 05, 2012

Down to the Wire.

After paying out-of-pocket for insulin a few times this year, I appreciate every drop of insulin to the point of hoarding it.  Which is why I was secretly (not that secretly,  because here it is on the blog) proud that, before my infusion set site change yesterday morning, I was able to run my pump down to one, single, shiny, bandaid-scented unit of Humalog. (I also am sure to weasel out the last few bits in the insulin vials, waiting impatiently for the creepy "insulin bubbles" to pop so I can suck them up with the needle tip.)

Let's not discuss the 16 units still hiding in that 42" tubing, or my head will explode with waste-not frustration.

August 13, 2012

Vampire Cannula Redux.

Last week, my blood sugar numbers were great for a day and a half after a site change, but then they went off the rails.  Untouchable 200s that no bolus would bring down and only exercise was able to budge.  Usually, these stubborn highs are the fault of an infusion set issue, and sometimes I am just as stubborn as the highs, refusing to pull the site.

But this time, when I examined the site, I saw the pooling of blood, and figured there was a vampire cannula on tap.  (See also:  No kidding, because there normally isn't blood in the site.)

Suspicions confirmed.

And within an hour of the new site, I was back in range.  Funny how well insulin works, when it's able to get into your body.  ;)

June 04, 2012

Insulin Pump on the Beach.

"Oh, it's like what Cindy has!  That's what Cindy has!"

The lady was about twenty feet away from me, stage-whispering to her husband. 

"Is that the pump?  The insulin pump thing?"  her husband asked, gesturing toward me.  

I lifted the beach blanket by its corners so it would spread out nice and flat.  "It is an insulin pump," I said to them, waving, unaware until that moment how obvious my insulin pump was, clipped to the bottom of my bathing suit, the tubing tucked in kind of haphazardly; it was a diabetes Bat Signal.  "It's nice to meet you!" 

The woman came over, her hands fluttering and her mouth talking and smiling all at once.  She was so excited ...

"... to see a real insulin pump!  My daughter went on one a few years ago, but I've never seen anyone else with one.  And at the beach!!  She's going to love hearing this. Your pump looks different from hers - is it?"

(I loved that she automatically assumed I knew what kind of pump her daughter was on, as if there was a community of people with diabetes who are in constant contact with one another and comparing notes ... wait a second ...)

"Mine is an Animas pump.  Is hers Animas or Medtronic?  Does it have tubing?"

"Yes, it has the wires.  Hers is the Medtronic one.  She really likes it.  How long have you had diabetes?"

"Twenty-five years.  How about your daughter?"

"About twenty years.  She's 31.  She's trying to lose weight and be in better control.  I don't know half of what she does, but I know she's always trying to do better."  The corners of her mouth tugged into a brave smile.  "She doesn't know I worry but I worry all the time."

"My mom does, too."  My mother and Birdy were a few yards away, building a sand castle.  "She worries.  But she knows I'll be okay."

Beach blanket Birdy"Is that little one your daughter?"

"Yes.  She's two."

The woman smiled.  "My daughter would like to have a baby.  That's part of why she went on a pump.  You know."

Birdy came running toward me, her ponytail bouncing and covered in sand.  "Ocean, Mama!!"  The bucket of sand in her hand spilled as she lifted her arms excitedly.  "Sand!  I has sand!"

I gave the woman a big grin as my daughter tornado toddled up the beach, her arms outstretched. 

"I do know."

May 11, 2012

I Hate Belly Sites.

I'm not sure what all the "rules" are when it comes to diabetes devices, but when it's about me making decisions for where to put my stuff, I do whatever works for me.  As far as I'm concerned, if I can pinch up the area and it's not covered in scar tissue, it's fair game.

For a long time, I used my abdomen for infusion sets.  During pump training at the Joslin Clinic, that's where they said to put it, so that's what I did.  Only I hated it.  I don't hate much about the diabetes day-to-day, but I hate abdomen sites.  I don't like when the waistband of my pants shifts against it.  I hate that I can sometimes feel the insulin going into my skin (grosses me out).  And since having my little Bird, I don't like when her feet kick against the site as I'm holding her, because it hurts and makes me squirmy as hell.  (There is the whole "second belly button" issue, as well, because when I wear my site on my abdomen, it looks like a second navel [academy?] underneath my shirt.  Not my favorite look.)

But the absorption is always good.  Predictable.  Even though it's my least favorite spot, it's a fail-safe for infusion set productivity. 

When I gave up on abdomen sites, I switched to my thighs.  This worked great for me, but once I started on the Dexcom back in 2006, I preferred saving my legs for the larger, more intrusive, changed-less-often sensors.  (It's just awkward, because even if I don't have the sensor on my leg, I take my pants off with this exaggerated motion, arcing my clothes out from where the sensor would be.  It looks like I'm pantomiming a lady from the 1930's, putting on bloomers.)

Which left me with the back of my hips and my arms.  The back of my hips works great, so long as it's well-above the waistline of my pants, and absorption is great, and I make sure to rotate regularly and comfortably.  My arms also work well for me (even though I get more reddish sites and little bumps after removing the infusion set), and gives me two areas of good absorption.  The only real problem with arm sites is that I snuggle Birdy all the time, and she always manages to grab me right at the site.  She's picked off more than a few.  

But, as with any site, it needs a rest. Which is why, after a string of gross high blood sugar days, and then some aggressive lows, not to mention a vampire cannula, I needed to switch up my sites for a few days.  I needed to give the back of my hips a rest.  I went back to the old standby:  frigging belly sites.

Rogue belly button frigging infusion set ARGHH

Six days of belly sites, two full rotations.  I wish I could say I loved it, but I didn't.  I hated it.  I still felt awkward.  Birdy still stepped on them when I picked her up.  I still felt like my belly button had gone rogue.  But the insulin absorbed nicely.  My blood sugars were stable.  And when I went to put a new infusion set in the back of my hip, the absorption there was great, too.  I needed just a few days to heal those bits of my over-poked skin.

Much better.

I'm hoping that this is what I needed to bring things back under control this week, because I was the Mayor of Crazytown for a while there.  If it takes going back to abdomen sites on occasion to keep things in range, I'm all in.

... I actually think I'd stick one to my forehead to get 105 mg/dL's all day long.

February 16, 2012

From Abby: A Fogged-Up Insulin Pump.

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

*   *   *

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

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

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

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

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

poor borken pumpy :(
The weird, white screen on Abby's pump

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

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

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

*   *   *

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

September 28, 2011

Not a Princess.

Add 'em to the mix.  Hans Christian Andersen penned the fairy tale "The Princess and the Pea," about the princess who had such sensitive skin that a single pea beneath piles of bedding was enough to keep her up all night.

If fairy tales are true, and I believe they are, judging by my freshly cobbled shoes every morning, I am not a princess.  (Though I used to be, according to this post.)

Because every single night, I sleep like a baby, smashed on top of my insulin pump.

Before I got pregnant, I slept with my pump clipped to my pajamas, and occasionally woke up with the dent of my pump against my hip.  But during the course of my pregnancy, as my belly grew and became hard and gigantic with the brewing Birdy, I stopped clipping my pump to my clothes.  I felt weird when she kicked it, and I kept picturing her face with "Ok" button imprinted on it. 

And after the baby was born, and my body shrank down to this version of its previous shape, I still didn't reclip the pump.  Gone were the days of being princessy and fragile.  According to Chris, I sleep without making a sound, smooshing myself on top of my insulin pump and not caring if it's jammed into my face.   

To be perfectly honest, I usually wake up to find myself trying to actively hatch my insulin pump, cell phone (because its alarm goes off in the morning and my response is to snuggle it), and my Dexcom receiver.  Not to mention the occasional visit from Siah, or the nights when I fall asleep with the laptop under my head.  (Truth.)  Our bed, once a safe-haven for sleep, is now like that machine at the bowling alley with the giant claw, all jumbled with stuff. 

You could pour a whole bag of frozen peas into the bed and I'd simply nest around them.  Sleep is that necessary, and I believe I could take a nap on the kitchen floor or on a bed of nails these days.  Delicate flower?  Nope.

So not a princess.

August 31, 2011

From Abby: Casually Defective.

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

*   *   *

Abby Bayer, who is moving today, so wish her good luck as she shuttles all her crap to New England.  :)Since I got home from camp, my lifestyle is much more ... umm ... sedentary (read: I sit in my room unpacking all day, just to repack in a week).  This is a big change from my lifestyle at camp in which I was walking everywhere all the time.  So when I was having a lot of persistent high blood sugars, I chalked it up to this change in activity (and cranked up the basals).

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

Here comes the strangest part ...

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

What. The. Heck.

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

This is my old Minimed pump, not Abby's, but I figured a visual representation of the pump would be all "Ahhh!"

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

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

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

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

*   *   *

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

August 22, 2011

Changing the Animas Ping Song: Top Gun.

A few years ago, I was talking with (or was I actually hanging out with?) Faye from SugarBump.  She's a talented photographer, baker of some badass Novolog cake pops, and discovered she's apparently a crackerjack Animas composer.  Our very own Beethoven ... only she did something better than Beethoven.  She figured out how to replace his Für Elise on my pump with ... wait for it ... the Top Gun theme song

Problem was, I had to wait forever to make the switch.  I switched to an Animas insulin pump back in January of 2010, when I was seven months pregnant with the Bird.  The last few weeks of my pregnancy were very stressful, and then when the baby was born, life took on a decidedly different list of priority "To Dos."  My desire to reprogram the tunes on my Ping ended up forgotten. 

Until recently, when I re-stumbled upon an email from Ms. Faye, which included the music file for the song upload.  And I was determined to make the switch.

After sending the diabetes-Batsignal up to the TuDiabetes community, I received the instructions on how to change the song.  (Click here to view the user guide, and then scroll down to page 60 for the instructions.)  The result?


(Here's a teaser from an upcoming Animas vlog about new tunage for my Ping)

If you want the Top Gun theme for your Ping, email me and I'll send you the audio file for the EZManager Max software. If you have any tunes that you've composed and you want to share them, let me know! 

And, for the record, I'll be your wingman any time.

August 16, 2011

Missing: The Rest of my Infusion Set.

Last week, I ripped an infusion set off my arm - by accident - with such force that I knocked the "teeth" clean off the part that connects with the "hub."  It happened sort of in slow-motion, with BSparl hollering "Maaaaa maaaaaa!" and the pump site disconnecting in a way that sort of sounded like a wet tennis ball hitting a racket.

The infusion set hub thing flew across the kitchen and landed in an unknown place that even a full (and literal) sweep of the floor didn't recover it.  My arm was sore.  My pride was, too. 

I am Kerri's swift and sudden gracelessness, and I'm as chronic as diabetes.  ;)

August 02, 2011

Birdy Finds a Pump.

Kid won't leave this shit alone.

She is so curious. 

"Whaaaas daaaat?"

July 27, 2011

Overheard: The Mothership.

My alien transmitter, which speaks directly to the mothership.  Clearly."Mom, that lady has special powers and is an alien.  I know because I saw her alien transmitter in her pocket and it has wires and it talks directly to her body using that tube.  I saw it.  She can't hide from me because I saw it and it looked that's how she communicates with the mothership but she's safe and she didn't seem scared, right?"

It's at that point that I felt the need to explain to the eight year old boy's mother that it was an insulin pump.

July 18, 2011

The One About the Dead Pump.

A little pump vacation, anyone?In my almost eight years of pumping insulin, my beloved pumps have died twice.  The first time was the night my diabetes turned 21 years old (clearly, it was out on a bender) and the second time was last weekend.  On a Saturday afternoon.  On Fourth of July weekend.

You know, when EVERYTHING is closed?

What happened is this:  I was getting dressed in the bathroom and was tucking the pump into the front of my bra for a little disco boobs action.  Only my hands went all fumbles on me, and the pump leapt out of my hand like the escargot Julia Roberts attempts to wrangle in Pretty Woman.  Little Ping hit the floor with a perfect BANG after the five foot, four inch fall, and the pump started to spazz.

"BEEEEEEEEP!!!"  Vibrating madly.  "BEEEEEEEEEEEP!"

I've dropped pumps in the past - plenty of times - but somehow, this fall was precise in its destructive powers.  I disconnected the infusion set in a hurry, not sure if a spazzy pump would try and empty out its reservoir.  The pump was beeping, and an error message was lit up on the screen.  I didn't see it for more than a few seconds, but it was something close to:

"Your pump is having a major malfunction.  Error number OU812.  Call Animas Customer Service immediately.  Even though it's a Sunday.  Srsly." 

It's Sunday.  On a Monday-holiday weekend.  Chris and BSparl and I are about to head out to a Fourth of July picnic with family and friends.  We're literally like 20 minutes away from walking out of the house, and this is when my pump opts out? (Read:  Or when I throw it against the bathroom floor in just the right way so that it dies instantly?)

I popped a new battery into the pump, but the screen didn't light back up.  With the battery in, the pump just made sad little beeping noises, similar to the ones Siah makes when I accidentally shut her in the walk-in closet.  ("Mew!")  I knew my precious pump was reduced to froast. So I rang up the Animas customer service line.

Nothing annoys me more than having to "press one if you're having a technical problem ... press two if you are having a bad day ... press three if you'd like to remain on hold for 23 minutes to speak with a representative."  If I'm dealing with a broken medical device, I'd rather speak with someONE when I dial in to customer service, not someTHING. 

Thankfully, with both Minimed and Animas, I've never had trouble with customer service.  I know people have different experiences left and right, but with both companies, I've had my problems resolved fast.  (And I appreciate that.)  However, this was my first time needing an Animas replacement (since switching to the Ping back in January 2010), so I didn't know what to expect.

Within 20 minutes of me sending my pump to its death, I was on the phone with the Animas "emergency service holiday weekend rep" (my term, not their official one), discussing where the replacement pump needed to be mailed. Actually, I left a message for her with the holiday answering service, and she called me back while I was on the phone with a friend who works for Animas (we were trying to figure out how to get a local rep to score me a rogue pump for the weekend). 

"Ooh, that's the customer service line!  Hang on; can you hang on just like a sec?"  I said into my house phone, reaching for my ringing cell phone.  It was like diabetes overload, as I foraged through the fridge for my emergency bottle of Levemir while on two different phones with two different Animas people, and a dead pump corpsing up on the kitchen counter.

"I'm leaving for a conference in Orlando on Tuesday morning, so would it be possible for the pump to be shipped to my hotel?"  It was Sunday.  I was leaving for Friends for Life on Tuesday morning, the pump was due to arrive on Wednesday, and I refused to go a week on MDI to reconnect upon my return to Rhode Island. 

"Not a problem.  It will arrive there, before 10 am, on Wednesday morning," said my Animas customer service weekend angel o' happies. 

"Great, thank you so much!!  I really appreciate all of your help."

"No problem.  If you need anything else, call me.  And enjoy your weekend!"

After unearthing my stash of syringes (kept in a shoebox downstairs in the basement, which meant I had to brave some potentially massive and murderous spiders in efforts to shoot up) and uncapping the back-up bottle of Levemir I had picked up from the pharmacy THAT DAY (talk about ironic timing ... more on that and the impromptu return to MDI later), I was ready for a few days of injections while I waited for my pump.

"Are you sure you're okay to go the party?"  Chris asked.

"Yeah.  Oh wait, hang on a second."  I ran upstairs and changed from my skirt and top to a light, pretty summer dress. 

"You changed your clothes?"

"Dude, I'm not going to waste this pump vacation.  All sun dresses, all the time."

[Animas Disclosure]

June 21, 2011

Adjusting Overnight Basals.

Hoping I hit a balance as lovely and even as depicted in this here clip art from 1994.I do not enjoy basal testing.  Even though I sometimes go six hour clips without having a snack (thanks, Birdy and your busy ways), something about knowing I can't eat or exercise makes me want to do a 5K while simultaneously chomping down on some soft serve.

But when I noticed that I was going to bed at a completely normal blood sugar, but waking up in the 180 - 220 mg/dl range for three days in a row, I knew I needed to do some basal tweaking.  

Making adjustments to my overnight basal rates always skeeves me out.  I'm a very deep sleeper (as evidenced by the fact that Siah prowling around on the bed all night doesn't wake me in the slightest, but makes Chris say "We're sleeping with the door SHUT tonight," in the morning), and I have a very healthy fear of overnight low blood sugars.  My symptoms of a low on the overnights used to be this body-drenching sweat, but since the birth of my daughter, that symptom has all but disappeared.  Now, I don't have any symptoms at all.  Blood sugars of 60, 50, and lower don't even register until I prick my finger and go, "Oh.  I guess I'm low?"

So the idea of raising my basal rates, even though I'm doing it to make a preemptive strike against highs, makes me nervous.  Thankfully, I have my Dexcom, but I'm still a little on edge. 

This morning, I made some small adjustments to my complicated overnight basal (I have three very modest rates in an eight hour span, so each 0.01u counts), and tonight will begin the mad scientist experimentation that is diabetes.  I'll have to get up and test around 3 am, because while I trust the Dex to give me the gist of things, i want my meter to confirm I've made a good change.  Oh you, basal testing!  You want me to sleep even less than my kid does!

Even though I'm traveling for the rest of the week (and then again in two weeks - it's going to be a very busy month), I can't let these highs permeate my overnights.  Sometimes I feel like those precious hours of sleep are the only moments I'm securely in range (I do so love that Dexcom graph flatline of 108 mg/dl overnight ... or at least the flatlines I used to see, until a few days ago), and I want to return to that level of overnight control.

I do not enjoy basal testing, but I understand why it's important to nail these rates.  I just hope I got it right on the first try.  Because I need all the sleep I can get!

(Thank God for iced coffee.)

June 02, 2011

The Coveted Dexcom/Animas Hybrid.

Clearly, the United Kingdom has the edge on us this morning, because they're getting the Animas/Dexcom "hybrid" before we are. 

I received this press release in the wee hours of the morning today (Oddly enough, I was awake when it came in.  Blogger zombie mode.), and I am very excited to see when this technology will be available in the US.  Here are the details (and you can also read the full release).  From the release:

"Animas Corporation announced today the receipt of CE Mark approval for Animas® Vibe™, the first and only continuous glucose monitoring (CGM)-enabled insulin pump system with Dexcom G4™ CGM technology.  Animas® Vibe™ brings together the unique features of an Animas® insulin pump and the convenience of Dexcom CGM, which is the only sensor approved for up to seven days of wear.
 
As a CGM-enabled system, the Animas® Vibe™ insulin pump functions as a receiver for the Dexcom G4™ Sensor.  The system delivers real-time glucose information, alerts for high and low readings, and glucose trend information, enabling patients to make more informed decisions to help control their disease*. Unlike currently available CGM-enabled pump systems, Animas® Vibe™ displays glucose trends in colour [Editor's note:  Awww.  The "u" in color!] and is waterproof.**"
Animas Vibe with the Dexcom G4:  Want.

Two sites, one device?  I'm digging it.  According to the release, the Animas Vibe is offering the following features (all copy pulled from the release, including the extra u):

  • "The latest technology available from Dexcom – Dexcom G4™, a tiny, round and flexible sensor with the smallest introducer needle as compared to Abbott Freestyle Navigator® and Medtronic Sof-Sensor®
  • Advanced high-contrast colour pump screen technology, that displays glucose trends with coloured arrows and lines showing where and how fast glucose levels are shifting
  • Dexcom sensor technology approved for up to seven days of wear, delivering more days of CGM data than those approved for a shorter duration
  • Waterproof durability up to 12 feet (3.6 metres) for 24 hours for the insulin pump, with a Dexcom G4™ Transmitter that is waterproof at 8 feet (2.4 metres) for 24 hours
  • Customizable alarms to indicate high and low glucose levels including a hypo-safety alarm fixed at 55 mg/dL (3.1mmol/L)
  • Low basal increment (0.025 U/hr) across all available ranges (0.025 U/hr to 25.00 U/hr) for precise dosing
  • Compatibility with Diasend® communications software, enabling patients to store, review and print both CGM and insulin pump data"

As both an Animas and Dexcom user, I'm very excited for when this technology becomes available in the United States. I spoke with Caroline Pavis, Director of Global Communications at Animas, about the timeline, and she had this to say:  "Bringing Animas Vibe to the U.S. and Canada continues to be one of our highest priorities.  Our goal is to submit Animas Vibe for approval in these countries as quickly as possible.  We anticipate filing with the FDA and Health Canada in 2011."

Come on, FDA.  Let this one roll through quickly!!  I can't wait to give this a go!

April 08, 2011

Scuffed Pump.

If there's one thing that takes a consistent beating as a result of diabetes (other than my internal organs, of course), it would be this little guy:

The wear and tear on this sucker is tremendous.

My insulin pump.  This is a part of my diabetes management plan 24 hours a day, seven days a week.  Very rarely to I take "pump vacations," so for the most part, I'm connected at all times.  On an average day, the pump endures sleeping in the bed with me, the baby's wake-up routine (which includes her grabbing the pump site, regardless of where it is located), playing all day, working, cleaning the house and my body, conference calls and email blitzes, the gym, routine awkwardness, et cetera ad nauseum. 

Which means that this expensive, life-changing little gadget gets battered around on a regular basis.  Apparently, these things are built to be durable (to a certain extent), as I only cracked my Minimed pump once, and I haven't injured this one irreparably yet.  (Despite the months of clumsy, pre-eclampsia pregnancy hands during which I dropped everything I touched.  I was like Gravity Midas.) But recently, I scuffed into the door jamb, and was left with this new, giant white scuff on the screen. 

So today's project is replacing the lens film.  Because these war wounds aren't the prettiest.

What's the worst you've done to your diabetes device?  Have you ever almost dropped it in the toilet?  Sent it flying when you made the bed (or am I the only one who has done that)?  Launched it accidentally into a plate of food you were eating (not me, either :: whistles ::)?  I'm not the only one beating the crap out of this thing, am I??

[Animas disclosure]

April 04, 2011

The Power of Waterproof.

Going fishing for a delicious ... pump?When my friends and I were on vacation last week, our goals were to do three things:  hit the beach, eat countless times, and enjoy the fancy swim-up bar.  Armed with my insulin pump, my Dexcom, and my NurseBestFriend (who is quick with a lancet and also to jump over any bar to grab orange juice, should the need arise), I was ready to participate in all three things.  

For the beach, my pump remained attached at all times, except when I was in the ocean for a quick cool-off.  My moments of disconnect were very brief.  If we were walking around, I kept it clipped to my bathing suit bottom with the tubing tucked as best as I could manage.  (Some people stared.  One woman asked me, point blank, "What the hell is that?"  "An insulin pump."  Silence, and a bit of a dirty look.  So I responded, louder:  "It's an insulin pump!  That's what the hell it is!"  And smiled.  She didn't.  Moving on …)  Staying connected on the beach helped me keep track of things, and the pump site and Dexcom sensor create some really interesting tan lines.

For the restaurants, the pump did what it normally does: sits either clipped to my waistband or stuck in the front of my bra (a la 'disco boobs').  Bolusing for meals was pleasantly discreet because of the remote option, so my main concern was calculating carbs.  (Which means I SWAG'd the hell out of this vacation, yet only had one high over 225 mg/dl and one low under 45 mg/dl.  Not too shabby, considering.)

But the swim-up bar at the pool gave me pause.  How was I going to hang out with my friends without disconnecting my pump for an extended period?  Also, was I just going to leave my expensive piece of medical technology just sitting unattended on a pool chair, waiting for disaster?  And if I decided to have a drink (and they were all the frozen, high-sugar kinds of drinks at this particular bar), how was I going to bolus without retrieving my pump?

NBF came up with an excellent plan:  clip the pump to the back of my bathing suit top, right at the neck where the halter tied.  This way, it was out of the water, shielded by my ponytail, but still accessible and safe. 

"Because your new pump is waterproof, right?"

"Right. So long as I don't go deep sea diving or something."

And then we both thought of the time I was in St. John with Chris and I ran screaming from the water because some kid saw a tiny octopus waaaay off shore.

"Yeah, no chance of that," she said.

Despite the fact that an older woman asked, "Is that the most high-tech cell phone EVER?" and a drunk 18 year old boy exclaimed, "Yo!  You love your cell phone a lot!", no one paid any mind to the insulin pump at the nape of my neck.  Mango margarita in hand and a blood sugar meter well within reach, I was able to hang at the bar, on vacation, with my girl friends without letting diabetes make an awkward mess of things.

NOTE:  This blog post does not advocate drinking.  It doesn't advocate pumping insulin.  It also doesn't advocate mango margaritas, swim-up bars, or bathing suits.  This is just a post about a vacation, and the decisions I made for myself while on said vacation.  This is not medical advice. It's a disclaimer in italics, advising you to make your own decisions.  Because following my advice is sure to lead to bad things, anyway.  ;)


[Animas disclosure]

February 22, 2011

FYI: Animas Cartridge Recall.

As an Animas Ping pumper myself, I wanted to share the letters that Animas Corporation is sending out to their pumpers who may have been impacted by the proactive insulin pump cartridge recall.  The affected lot numbers  are contained in these letters, so you can check and see if your supplies are on the recall list:

Letter to patients
Letter to health care professionals

These letters were provided by the Director of Global Communications, Caroline Pavis, and these proactive moves by Animas make me proud to be working with their company.  Just wanted to pass the info on!

(More info on TuDiabetes, Diabetes Mine, and Trials and Tribulations of a Type 1 Diabetic.)

February 16, 2011

I See Pump People.

Navy Seal PWDs are everywhere.  LOOKOUT!A few weeks ago, Chris and BSparl and I went out to dinner.  Dining out with our little bird is a bit of a tangled experience, and we don't spend as much time people watching as we used to because we're very preoccupied with the baby wrangling. 

That night, though, we were sitting and settled and throwing gluten-free puffs (yes, all of us) around the dinner table like confetti when I saw this woman walk in with her family.  She settled her family in at the table, and then reached to remove her coat, revealing a beeper clipped to her pocket.

Only it was one of them fancypants beepers with the tubes and the buttons and the accompanying not-making-insulin pancreas.  Reckon it was an insulin pump.

Immediately, I wanted to swing mine over my head like a lasso and say "OMG lady, me too!!!"  I've had this feeling before, of wanting to sidle up next to someone and say, "I like your pump; want to see my pump?" but to me that sounds more like an awkward attempt to flirt instead of a moment of diabetes bonding.  Living in a very comfortable bubble of diabetes advocacy makes me think that everyone who has a visible "symptom" of diabetes wants to talk about it.  I have to remind myself that some people just plain don't want to talk about it.

But since I still wanted to say something, I targeted Chris instead.  

"Dude, 12 o'clock.  Actually, my 12 o'clock, your six o'clock.  Minimed pump on that lady."  I said to Chris without moving my lips, as if a pump sighting was a covert Navy Seals operation.

"Six o'clock?  Okay, do you guys know one another?  And why are you whispering?" he whispered back.

(I love that because she and I both wear pumps, we must know one another.  I've brought him right into this bubble with me.)

"No, I don't know her.  I have no idea who she is.  But I just saw her pump."  I paused, still whispering.  "And I was like a toddler, wanting to wave my arms around and say 'Pump! Pump!'"

He laughed.  The waitress came over to bring our food, and the two of us were immediately distracted by keeping BSparl's grabby little hands away from the hot plates. We had a nice dinner, and I sort of forgot about the fellow Navy Seal at the other table.

... Until we were leaving the restaurant, when I saw her glance at my hip (where my Animas Ping was tucked away), nudge her husband, and give a little nod. 

In my head, she whispered, "Dude, four o'clock.  Animas Ping.  Hooyah!"

January 24, 2011

Hawkey Playah.

I clicked the button on my Dexcom receiver and saw a "212 mg/dl" with two arrows pointed straight on up.  This was the third effortless high in as many hours, and I was convinced my pump site had crapped out.

"I am going to run to the bathroom.  I need to switch out my site," I said to Chris, moving my napkin from my lap to the table.  "Do you mind sitting here ..."

"At this giant hibachi table all by myself?  Sure," he grinned, gesturing towards all the empty seats.  

"I know.  I hope this table fills up while I'm gone.  Otherwise this is going to be awkward, just us and the hibachi chef guy."  I patted his shoulder as I stood up from the table, the small, gray inset tucked into my hand. 

I am not a fan of doing site changes outside of the comfort of my home. When I'm at home, I prefer to put the new infusion set, insulin cartridge, the bottle of Humalog, and any other necessary accoutrements on the bathroom counter.  I like looking in the mirror to see where the site is going to end up, because I have specific preferences as to where it lines up with the waistband of my pants or the sleeves of my shirts.  Picky little parsnip that I am, I like putting my new sites on in a measured manner.  

So when it became clear that my pump site has conked out on me and needed to be changed immediately, my first thought was "thank goodness I carry a purse big enough to throw a spare set into" and then "Oh shoot - now I have to do this in the public bathroom?"

I went into the ladies' room and was greeted by very dark lighting, two large stalls, and no bathroom counter.  (The sink appeared to be suspended in midair.  I think it was deliberately trying to mess with me.)  I casually went to the stall and disconnected the infusion set from my arm.  The cannula was piped with blood, so I knew it was definitely uncooperative.  I set the pump to start rewinding, and the BUZZZZZZ of the pump motor echoed in the empty bathroom.

"Man, that never sounds so loud at home," I said to myself.  "Awesome."

I finished disconnecting and rewinding/priming the pump, and I stepped into the hand-washing area of the bathroom so I could use the mirror to line up my new site.  I pulled up the back of my shirt enough to see my hip, and then placed the inset against my skin.

And then bathroom door opened and a friendly-looking woman came in, just in time to see me pressing the buttons on the inset, pushing the infusion set needle into the skin on the top of my hip.

"Oh, I'm sorry!" she said.  "I didn't mean to interrupt ... what ... whatever you're doing."

"No worries."  I felt a little embarrassed - nothing like being caught with your shirt all gathered and a needle in your side.  "I am a diabetic and I have to fix my insulin pump.  I needed to use the mirror ... it's totally a medical thing."  The words flapped out of my mouth like spastic birds.  

She walked over to get a better look at what I was doiThis is a wicked hawkey playah.ng.  "Insulin pump?  My brother is a diabetic.  Has been for almost twenty years.  He's forty and just got married.  I'm having dinner with him right now!"  She smiled and gestured towards my pump.  "I wish he'd go on that thing.  He's been doing shots for like ... evah.  He has thought about a pump but he hasn't done it yet."

"Whatever keeps you healthy is best, right?"  The new infusion set shot in with a quiet shunk, and I tucked the pump back into the pocket of my jeans after taking a correction bolus.   

"True.  He's done this for a long time.  He and his wife are talking about having kids.  Do you have kids?  Can you have kids?"  

"I have a nine month old.  She's happy and healthy.  And so am I."

The woman put her hand to her heart.  "Oh doll, that's wonderful.  I hope my brother can have kids.  He'd be a good dad.  But if he goes on a pump like you've got there, he'll have to be careful with it.  Gettin' it knocked around, you know?  He's a wicked hawkey playah."

"Hockey is awesome.  Give your brother my best, okay?"

Back out in the dining room, a quick look at the Dexcom showed me that the correction bolus was working, and that the new site was on track.  And from across the crowded room, I saw the woman sitting at a table with her group, the wicked hawkey playah at her side.

January 13, 2011

A Pump Vacation.

Chris created this image ages ago.  I still love it.  :)That insulin pump is attached to me pretty much 24 hours a day, seven days a week.  There's very little down time when it comes to being a "pumper," and for the most part, I don't have attachment issues. The tubing, the infusion sets ... doesn't really bother me.

Except when I'm attending a dressier event.  Aside from my wedding day (where my pump was strategically hidden in the folds of my gown), I've always run into issues when it comes to making my pump an effortless part of my outfits.  For me, this has nothing to do with tubing and everything to do with the overall size of the pump and the desired silhouette.  Because battling baby weight and an insulin pump lump kind of sucks when you're trying to look pretty.

Over the weekend, I decided to take a brief vacation from my pump because Chris and I were attending the National Board of Review awards gala in New York City.  (He was award Best Original Screenplay for 2010.  I am always proud of him.)  And part of attending this event meant potentially having a few photos taken, and I sure as hell didn't want any pump bulges or wires popping up.  Nor did I want disco boobs blowing my cover.  I didn't want to have diabetes discussions that night, but instead just wanted to enjoy the night and celebrate with Chris.

So on Sunday morning, I cracked open a bottle of Levemir and called in a renewal for my Humalog pens.  Taking some cues from the last time I took a pump vacation (see: white-water rafting) and from some diabetes message boards, I took a look at my total daily dose for basal-only (12.4u) and gave it a bit of a bump (to 15u), then split that dose in accordance with how my basal maps out during the day (6u at 9 am, 9u at 9 pm).  It was some rough math, but oddly enough, it worked perfectly. 

Maybe it was because I was testing constantly to confirm that my doses were decent, or maybe it was because I basically wore the battery down on my Dexcom from checking in with it, but in any event, my numbers were solid.  My overnight Dex graphs were flat-lined for two full nights, and running close to 90 mg/dl throughout.  The daytime bumps were trickier (remembering to shoot up a meal dose kept slipping my mind), but I didn't see anything higher than 200 mg/dl during my vacation.  (Even during the event itself, when there was an open bar and lovely food and chocolate lava cake.  Thankfully, sitting next to skinny celebrity types made me pass on the desserts, which was both a blessing for my hips and my blood sugars.  Sort of yay.)

But after the excitement of the gala and then sludging our way back to the hotel in the blizzard-like conditions, and after the 4 am low blood sugar induced by alcohol and a lack of dinner consumption, and after having to set the alarm to make sure I woke up in time to take the Levemir shot for the third day in a row ... after all that, I missed my pump.  So during our drive back home to Rhode Island, with the snow coating 95 North and bags both in our car trunk and under our eyes, I stuck in a new infusion set and reunited with my insulin pump.

For all its tubing and its beeping, for all its battery needs and weird little plastic pieces ... this device makes my diabetes easier to deal with.  I love that I can take a vacation from it for whatever reason I chose, but I am grateful that when I'm ready, I can just stick it back on and move forward.

January 06, 2011

Disco.

Over the holidays, my husband and I had the opportunity to join his agent (who happened to be in town) for dinner.  Grown-up time, sans BSparl.  (I wore tights.  It was a fancier than our average Tuesday night.)

So we all sat down to dinner and while everyone was talking, I reached into my purse to do a quick blood sugar check and to remote bolus for the bread and olive oil that had been placed on the table.  My hands stirred up the contents of my purse, but didn't score the meter.  

"Damn, I know exactly where it is," I mumbled to myself, picturing my meter case on the front seat of our car, which was down the street and tucked into a parking lot.  

Conveniently, I had this scrappy little One Touch Mini rolling around in my purse, so I was able to test, but I was out of luck in the remote bolusing department.  And with my pump tucked discreetly, but snuggly, into the front of my bra (clip against my sternum, buttons on the pump facing out), it wasn't exactly the most readily available medical device.  Not without some seriously awkward self-groping, that is.

Chris was watching me scramble.  "Just pull your napkin up and grab your pump.  No one will notice," he whispered.

"You don't think I should excuse myself to the ladies' room?"

"Nah, go for it."

So while everyone was talking, I reached down the front of my dress and deftly grabbed my insulin pump.  I programmed in the bolus and then went to tuck it back into my outfit without anyone noticing.

Except.

Once you've begun a bolus on the Animas pump, if you press a button while that bolus is administering, it prompts the pump to cancel the bolus.  It's a great safety feature for when you realize, mid-bolus, that you absolutely do NOT want to take five units of Humalog to cover a spinach salad.  But it's not so awesome when you accidentally hit a button while securing the pump to the front of your bra, and it suddenly starts singing a loud song.  And lighting up, providing a strange glow from your chest, not unlike a medicinal disco ball.

"What's that?"  One of our dinner companions asked, looking in my direction but not knowing the noise was coming from my body.

"Sounds like a cell phone!" One of the other dinner guests said, smiling and reaching for another piece of bread.

During the brief distraction, I snagged the pump again and programmed the bolus a second time, then stuck the pump back where it came from without issue.   Disco boobs.  There.  I said it.

"Oh, it's me.  No big deal - all set now.  So as we were saying ..."  I felt the bolus going in, and the pump was quiet again.  No need for me to get into a big explanation of "Oh, this is my INSULIN PUMP and I'm DIABETIC and YES I CAN EAT THE BREAD."  It wasn't what I wanted to talk about that night.  I just wanted to move on, and swiftly.

No one asked any questions, and the night went on to be a very nice one, with excellent food and great company.

And Chris and I definitely laughed our faces off when we got in the car to go home. 

"So do you think your agent and his family think I have some kind of musical ... disco boobs?"

December 21, 2010

Tangled.

I love my insulin pump (well, as much as you can enjoy anything that's used to manage a chronic disease), and it's a constant part of my daily routine.  It goes with me EVERYWHERE, from the car to the supermarket to the bathroom and to bed at night.  This pump is never more than a few feet away from me, and I keep close tabs on it.

And sometimes it keeps wicked close tabs on me.  See also:  tangled.

Have you ever found yourself wrapped up in a pump tubing hug?

November 30, 2010

Twihard.

Vampires are like in now, right?  Books, movies, TV shows, endless streams of merchandising ... vampires are cool.  (Unless they're staring into your bedroom window from your backyard, in which case, that's creepy and maybe it's best to leave vampires to fictional tales.) 

But what about vampire cannulas?  Like the kind that work just fine for the first 36 hours of an infusion set but then go to complete crap and end up sore and stinging and you pull it out to see the cannula crammed with blood?

Team Edward or Team Jacob?  I don't care so long as the insulin gets in their correctly.  Nerd.

Oh Edward.  Oh Jacob.  What's the deal, kittens?  Why are your vampire people messing with my insulin pump?  Unless I get the glittery skin and the whole "live forever" thing, I'm not excited about these blood-filled cannulas.  They screw with my boluses, they muck up my basals, and they make for very messy post-prandial blood sugars. 

October 19, 2010

Remote Access.

An ode to the remote for my insulin pump.  Sung in the tune of D.  

Remote, O remote, how I'm glad that you're mine.
You make bolusing easy, you beep so devine.
With you at my side, I no longer must fuss
About pushing the buttons to take a bolus.

Because now - O now! - I worry much less. 
I can bolus without fumbling 'round in my chest.
I don't look like I'm sassing, and I must confess:
I don't reach with my hands down the front of my dress
To gain access to buttons on the front of that thing.
Now?  If I bolus? I thump on my Ping.

As much as I don't want to wear a device,I love that the Ping meter acts as a remote for the insuiln pump.  Badass.
(I'd rather my pancreas up and play nice)
I'm thankful that I can remote from my meter.
Makes living with diabetes just a bit sweeter.

 

[Animas disclosure]

September 20, 2010

Guest Post: From Pumping to Pens and Back Again.

Today I'm happy to host a guest post from fellow Clara Barton Camp alum Abby.  Abby helped orchestrate my visit to CBC this past summer, and I'm thrilled that she didn't mind telling some of her overseas travel stories here on SUM.  This post touches on that delicate dance between insulin pumping and pens ... and back again.  (And what the hell is in blood pudding, anyway??)

*   *   *

Abby and an adorable puppy.This past August, I traveled to Scotland with my family, and no matter how hard I tried to leave it behind, my diabetes tagged along. I’ve traveled overseas before, but not since I was 15 and then I was more concerned about which lip gloss to bring than how to best manage my blood sugars.  I had a lot of thinking to do this time. Working at CBC the six weeks before my trip really helped me figure things out.

I finally decided to take a pump break and use Lantus and Humalog pens for a few reasons:

  1. Call me crazy, but it makes me really uncomfortable to be wanded down by random strangers in blue suits because I have a pump in my pocket. 
  2. We decided to only bring carry-ons since we didn’t want to hassle with luggage at the airport (or pay the ridiculous fee to check a bag) and pump supplies take up a lot more space than a few extra pens and some needles. 
  3. I was concerned about re-arranging my basal rates to fit my new wake/sleep cycle and figured Lantus would give me a steady basal, and slightly less tight control; a sacrifice. 
  4. I was getting ready for a pump break anyway (I tend to take one every year or so, it’s nice to have your pants fit the way they should without a plastic lump in your pocket!)

Hurdle #2: For some reason, ever since I was a tiny human, I’ve always taken Lantus in my left leg (big fan of alliteration, I suppose).  This meant revealing my thigh on an airplane full of strangers while flying over a very large ocean. Awesome. Final decisions before boarding the plane: wear yoga pants for easy thigh access, give three other people in my family a bag with insulin pens and glucose tabs, and have the note from my doctor clipped in my passport at all times.  Oh and don’t talk to strangers.  Land of tea and scones here I come!

My blood sugars were high on the plane (sitting around for six hours made me stuck in the 300s for a while (awesome) and then the sleep deprivation caught up to me and decided I should be in the 60s until we ate dinner … or lunch … except it was 9am in Scotland.  (Oh silly time differences.)  Everything was going just swimmingly, until we went out to eat the first time … time to put those years of carb guessing - I mean counting - to work.

The food in Europe is, well, lets just say different than food here in the States. I ordered a ham and cheese toasted sandwich (nope, not a grilled ham and cheese) and hot chocolate, figuring I could fairly accurately carb count the bread and typically hot chocolate is either with or without milk.  Oh boy, was I wrong. The bread had butter on both sides, I’d never tasted cheese like that before, and I’m still not quite sure what was in that mug of steaming brown liquid. Forty-five minutes later, in the 300s again.  Sweet. (At least this gave me a good reason to pass up a sample of blood pudding, especially after the waitress couldn’t tell me what was in it because it was “just a mix of everything” … no thanks).

My family is very into trying the food at different places when we travel, and I’m totally down with that idea, but about three days after these uncountable meals and bouncing from 50-350 every few hours left me feeling like a slug and packing my own PB&J sandwiches whenever we went out to eat (I do have to give some credit to their equivalent of the FDA, because the carbs were counted on packaged food down the the 0.1g … If only my Humalog pen could accommodate!)

After a few days of diabetes interrupting my trip we came to an understanding and my blood sugars leveled out enough for me to enjoy my time in Scotland.  My family was awesome and understood that we couldn’t eat out as much (which saved us a bunch of money too) and we had a fairly routine schedule the whole trip which really helped.  I only forgot my Lantus once, and remembered about three hours later, which worked out alright.  Will I take a pump break when traveling overseas again?  Most likely not.  I rely far too heavily on my active-insulin feature and my CGM sensor. But I don’t regret trying it this way, and things worked out just swell.

So after some minor ups and downs and a big fat fail at carb-counting, the trip was still a success. And even though I rarely use diabetes as an excuse, I sure didn’t mind saying no to the mysterious substance known as blood pudding.

*   *   *

Thanks, Abby!!  If you've taken a pump vacation, how did it fare for you?

August 31, 2010

Something's Missing.

That little cat?  Not a helper.We're packing and hauling and moving this week, and there is so much getting lost in the shuffle.  Like cats.  And epically-important diaper bags.  Car keys.  And iced coffees that I just put down for a second but then disappear into the cardboard ether. 

Yesterday, I had to run a errand on the fly, so I showered off the grime, dressed quickly, and left.  (Thankfully, BSparl was in the care of her aunt for the day, so Chris and I could focus on packing.)  I was gone about two hours, but it wasn't until I got back close to the house that I realized something was missing.

My pump.

I had taken it off before showering and totally spaced on putting it back on.

Realizing my mistake, I felt that warm rush of panic spread over me as I foraged in my purse for my meter. 

Which was also missing.  Left right on the bathroom counter, next to it's pumpy pal.

I pulled into a parking space and called Chris to have him help me bring up the boxes.  

"What's missing from my outfit?"  I asked him, disgusted with myself.  (And also not realizing that a question about a woman's outfit - especially a woman who is dealing with post-pregnancy body image issues - is so loaded that if I were Chris, I would have turned and run.)

"From your outfit?  I don't know ..." He scanned me.  I gestured towards my hip.

"Oh no, your pump?"

"Yup.  On the bathroom counter.  Since my shower.  Awesome."

"Are you high now?"

"Didn't test.  My meter?  Also on the damn counter."

And now I have to check all the boxes we've packed to see what one I mistakenly stuck my mind in. 

August 09, 2010

Invisible Bicycle.

There are very few times when I want to make sure my insulin pump is completely concealed.  I don't have a shred of shame about having diabetes, and I'm proud that I manage my disease using the technology available to me, but I'm not out to advocate at all times.  Sometimes, I want diabetes to be off the discussion table.  Like at my wedding (hid the pump perfectly in a secret pocket in my dress).  While I'm always ready to advocate for diabetes, sometimes I'd rather just hang out.

This past weekend, Chris and I were invited to attend a 40th birthday party for M. Night Shyamalan.  (Chris is working with Night on a project.)  The party was at Night's house, with his family.  And I had never met Night before.  The very last thing I wanted to grapple with was pump tube sticking out of the top of my dress.  I didn't want to be shuffling through the whole, "I have type 1 diabetes and ..." explanation while I'm trying to enjoy a party. So, for the first time in my seven years of pumping, I gave a go at the "bike shorts trick." 

'Tis invisible!
I still love this one the most.

Bit strange, sporting the spandex bicycle-style underwear underneath my dress, but they were perfect for concealing the pump.  I just felt goofy not having a bike.  ("I can haz invisible bike?")    Wearing the shorts, I could tuck the pump into the waistband near my hip, with the face of the pump turned in towards my skin and the clip on the outside.  Because the dress was sort of flowy in the front, the pump wasn't visible at all.  Using the meter as my remote, I was able to bolus during the course of the night without drawing attention to the pump.  (Almost wrote "to the bulge in my pants," but while that's kind of what I meant, it's totally not what I meant.  /digression)  And busting out the Ping meter looked more like I was texting instead of bolusing. 

"You can't see it at all?"  I asked Chris, turning to the side to see if the pump was visible in my profile.

"Not at all.  You look great."

"Not cyborgy?"

"Nope."

The party was awesome and Chris and I didn't get back to our hotel until almost three in the morning (never, ever admit to this party full of people that you haven't really had a drink since the baby was born - all of a sudden, you'll find yourself doing shots of Patron with the Shyamalan family).  Blood sugars were suspiciously well-behaved, holding completely steady in the low 100s, despite drinks and dancing and these really delicious little dessert things that tasted so much like a blend of creme brulee and cheesecake - making it the ultimate taste combination.  We had a blast - the house was amazing, our host was so gracious, and their family made it easy to feel comfortable and have fun. 

And the bike shorts kept me from having to jump rope over tubing while partying.  Thank you, invisible bicycle!

[Animas disclosure]

June 28, 2010

(400) Days of Summer.

Yesterday morning, a new infusion set shunked its way into my life.  It was on the right hand side of my hip, and when it went in, it burned.  When I pulled the needle out to leave the plastic cannula inside, the site burned again.

"Yowza.  That was a frigging stinger," I muttered to myself, trying to get out of the house in time to meet my dad for lunch.  But I didn't pay the pain much mind because a site change isn't always cozy.  Sometimes the sites just sting.  Sometimes they don't.  (Now that "Almond Joys have nuts.  Mounds don't." song is stuck in my head.)

I bolus for a protein bar (still has 17 grams of carbs) and we drive down to meet my dad.  En route to his house, I test and a cocky 423 mg/dl shows up on the meter screen.

"What in tarnation is that all about?"  I asked, substituting something less Yosemite Sam in for "tarnation."  "That protein bar kicked my rear end."

Chalking it up to diabetes being diabetes, I used my pump to correct the blood sugar and we continued to drive.  About an hour later, I tested again and saw the same 400 mg/dl range grin back at me.  Patience tossed, I grabbed my insulin pen and injected a correction dose of insulin.

Forty-five minutes later, I was coming down.

Ninety minutes later, I was back on the upswing.

Hours later, after spending a summer day hanging out in the 400's, with insulin injections and some desperate pump corrections, I was back at home and I ripped out the site.  To see this:

Wicked bent cannula

Wicked bent cannula.

I had no idea the site was crapped out because it didn't hurt after the initial insertion, the pump wasn't sirening with a no delivery alarm, and I kept taking manual injections, so it was hard to tell what was actually bringing my blood sugar down.  Making matters more confusing was that the injections actually made me low at one point, causing me to have renewed faith in the stupid infusion set.  (So no, I wasn't being stubborn, for once.  I actually thought the site was working. Until I treated a low with dinner, and bolused for dinner using the pump, and ended up at 400 again.  And then I threw paper, which was an ineffective way to show anger because paper just sort of floats along happily and doesn't give a satisfying 'thud.')

New site had me from 400 to 90 mg/dl in about two hours. 

I do not like when technical difficulties pop in and make a mess of things.

June 01, 2010

PumpTri: Preggo in a Red Wagon.

Shoving my pregnant arse into a red wagon?  Why sure!BSparl has been many places, mostly before she was born.  She's been to Boston, Las Vegas, Philadelphia, and NYC, to Barcelona and to Sundance.  Kid is a world traveler.  I knew I'd continue to do my thing while pregnant, but there was one thing that I couldn't have anticipated.

That whole "shoved into a little red wagon and wearing a kid's bike helmet" thing. 

All in the name of insulin pumping, right?  Let me explain ...

Animas is doing a very fun (and highly silly) video project - the Pump Triathalon. Here are the details from the PumpTri website:

"The 2010 Online Pump Triathlon is about proving something. It’s about proving there are no limits to what we can do with diabetes. It’s about proving the D community can achieve anything we put our minds (and arms and feet) to when we work together.

Completing a triathlon is difficult. But just like any challenge, it’s more easily approached with friends and smiling faces. That’s why we’re asking for 10 seconds of fun from you in water, on wheels, or by foot. Whether your swimming in your bathtub, rolling on a skateboard, hop-scotching through a playground – it doesn’t matter – because we want show people what happens when the D community approaches something difficult: we finish it together, and we make sure it’s fun."

Aside from giggling at the video submissions, we have a chance to make a huge contribution to a diabetes charity of our choice, you guys.  If we can finish this triathalon by July 31st, Animas will make a $10,000 donation to a non-profit charity that we get to choose.  And that is an amazing opportunity for us to all do something fun and make a difference at the same time.

No worries - you don't have to be an Animas pumper to participate.  And you don't have to have your pump showing in the video, unless you want to.  But if it is showing, more power to you!  (Also, and this is just the "filmmaker's wife" in me talking, but if you avoid wearing or holding anything with a name brand on it, that helps because then there aren't any trademark violation issues to work through.  So, like, don't have a can of Diet Coke in your hand while you skate by.  Scott.)

I've already done my video.  If you go to the PumpTri website, you'll see my pregnant rear stuck in a red wagon and propelled by oar across a parking lot.  (What?  Doesn't sound normal to you?)  Just another example of the list of embarrassing moments that make up my life. 

[Animas disclosure]

May 25, 2010

The Suck.

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

It's The Suck.

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

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

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

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

"36 mg/dl"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

May 10, 2010

A Day in the Life of a New Mom with Diabetes.

For D-Blog Week, Karen challenged the diabetes blogging community with a week's worth of blog prompts. Today is "A Day on the Life," and I've decided to focus on my new life with BSparl.  (Because if I tried to pretend that motherhood isn't affecting my diabetes, I'd be lying my face off.)

DING!!!  Game on.

A day in the life of a mom with diabetes5 am:  Alarms?  We don't need no stinkin' alarms.  Because now we have little baby girl who wakes us up at all hours of the night. 

When BSparl starts to fuss from her bassinet, either Chris or I leans up to check on her to make sure she's okay.  Since Chris usually does the 1 am feeding with a bottle, I try and do the 5 am feeding.  Since I'm breastfeeding, what I need to do first is check my blood sugar.  Anything less than 120 mg/dl and I'm snacking while she's eating.  I start this feeding at 98 mg/dl.

5:15 am:  BSparl is done with one side.  I switch her to the other side to finish eating, and I brush the foil wrapper that the fruit snacks came in to the floor.  

5:45 am:  BSparl is fed, burped, changed, and tucked back in.  I test my blood sugar again - now I'm 74 mg/dl and the Dexcom is showing a bit of a drop.  I wander out to the kitchen for peanut butter and a piece of toast.  (Not froast.) 

7 am:  Up again, only this time because the Dexcom is blaring at me.  49 mg/dl.  WTF?  Breastfeeding has very unpredictable effects on my blood sugars.  Some mornings, it doesn't make me low at all.  And then other mornings, it makes me plummet.

7:30 am:  BSparl and Chris are asleep in the bedroom, so I settle in on the couch with my laptop and a cup of tea.  My goal?  Answer some emails, write a blog post, finish some stuff that always seems to be due and I'm chasing the deadlines of, and use the breast pump to stash some milk for BSparl.  My insulin pump tubing sometimes gets tangled up in the breast pump tubing.  Which makes me think I'm wearing too many freaking pumps.

9 am:  Husband and daughter emerge, both sporting the same furrowed brow of the morning.  BSparl needs to be fed again, so I test my blood sugar to see where I'm at.  145 mg/dl - thank goodness.  Enough with the lows.  Bring on the BSparl!

11 am:  All of a sudden, it's almost noon, and I haven't eaten anything since 7 am.  I also haven't answered a single email.  Or finished the article I needed to finish.  My mornings are usually spent testing my blood sugar, feeding BSparl, changing her diapers (which have baby Sesame Street characters on them, which makes me laugh.  Because what do you call "Baby Big Bird?"  Little Bird?), and doing laundry.  I test my blood sugar - 118 mg/dl - and thank God that it's not pinging all over the damn place today.  Because some days it does. 

High Noon:  Still haven't eaten.  I force myself to stop and devour a Greek yogurt.  Blood sugars are holding steady.  But my pump site is aching a little - when was the last time I changed out the site?

Noon-thirty:  BSparl and I investigate the site.  Well, she hangs out in her bouncy chair on the bathroom floor while I take a look at the infusion set.  Looks fine - edges are peeling a bit - but it's only been four days.  Even though the reservoir isn't anywhere near empty, I opt to change the site because it's achy.  And because if I don't do it now, while I'm thinking about it, it will be another full day before I remember.  With all of my focus on BSparl and adjusting to life as her mommy, sometimes diabetes takes a wicked back seat.

1 pm:  New infusion set is in, baby girl is getting a bottle of breast milk because my own breasts need a break sometimes, and I still haven't answered one single email.  Is this why people take maternity leave?  I need some coffee.

2:15 pm:  Thirsty as all hell.  Test again - oh, that's nice.  233 mg/dl.  Frigging pump site change ... did I forget to take a little 0.3u bolus before pulling the site?  That seems to be the only way for me to avoid post-site change highs.  But of course, I had forgotten to do that.  And now I'm basking in the warm warming glow of a high blood sugar.  FanTAStic.  Still haven't eaten lunch, and now lunch is on a further delay due to the high.  I bolus down the high.

2:45 pm:  Dexcom shows that I'm dropping.  Meter confirms the same - 177 mg/dl.  Thing is, with the baby now out of me, I'm trying to figure out what my body's insulin needs are.  And that's tricky, because with breast feeding, I am never able to do an accurate basal test.  I have an appointment with Joslin in two weeks (for my 6 week follow up after surgery/birth), so I'm trying to log blood sugars to give my endo something to go on.

2:46 pm:  CRAP!  I haven't logged any blood sugars in three days!  With BSparl in my arms, I open up my laptop and try to find the spreadsheet.  I locate it, and then try to scroll through my meter memory and type the blood sugars into the spreadsheet using one hand.  BSparl decides this isn't a good time for her, and she makes a sound not unlike a can of shaving cream being deployed.  (She is a delicate, fragile, pooping flower, this child of mine.)  Diaper change time!

3:30 pm:  Lunch.  Finally.  Blood sugar is 109 mg/dl.  Lunch is a turkey and cheese sandwich, even though I'd much rather go low-carb these days to help lose the pregnancy weight.  But without carbs, I'm low all the time after feeding BSparl, so carbs it is. 

4 pm:  Time to head out to the grocery store and then to the post office.  BSparl hangs at the house with her dad while he works, and I test once more before getting into my car.  167 mg/dl.  How is the post-prandial that high?  I counted those stupid carbs.  My insuiln:carb ratio, I thought, was settled back into 1:12.  I need to test that ratio again, but no time today.  Must run errands.

4:04 pm:  As much as I love my daughter, I felt guilty blasting the Beastie Boys while she was inside of me.  Without her in the car, I can crank up the volume of the music again.  So i do.  As I head to the grocery store.  Damn, my life is a thrill a minute.

5 pm:  Walking out of the store, I realize that my Blackberry has been pinging for three hours and I haven't looked at it yet.  Checking the emails, I see that 75 emails have come in since 7 am.  And I STILL haven't answered a single one.  Whoops.

6:30 pm:  It's time for BSparl's dinner.  And then we read a book together - I like Dr. Seuss, but sometimes we read other books because I can only make my mouth navigate words like "Th'need" so many times before I start to either giggle or accidentally spit on my daughter while reading.  

7:45 pm:  Chris heads down to the gym and I prepare to go when he gets back.  (No, I'm not really "exercising."  Can't for another two weeks, due to the c-section.  But I can go for walks on the treadmill, so that's what I do.)  I test my blood sugar (139 mg/dl) and get all my crap together for the gym:  Dexcom receiver, meter, cell phone, reaction treaters, and that ever-elusive pair of workout pants that actually FIT. 

9 pm:  Back from the gym, blood sugars are steady for once, and BSparl is napping.  FINALLY, I answer some emails and finish up that article.  Oh crap - dinner!  I find something in the kitchen that doesn't require much assembly.

11 pm:  I realize that, since 5 pm, I've either fed BSparl or pumped six times.  How is that even possible?  Sure does account for the unpredictable blood sugars, though.  My body is in a constant state of "feed," making trends nothing short of chaotic.  And I have to be honest - I'm not sure I have the mental bandwidth to wrangle in diabetes and motherhood with any kind of precision these days.  Working off of very little sleep, and trying to understand the new swell of hormone changes in my body, is frustrating as hell.  Diabetes fine-tuning isn't my top priority these days.  I just want to coast as safely as I can at the moment.  (Note to people who may want to lecture me about my own health: Back off for a few weeks before you run cryptic commentary.)

Midnight:  What am I thinking, still awake??  BSparl will be up in two hours for her 2 am snack.  I'd better restock the bedside table with low blood sugar snacks and call it a day.  

Midnight-thirty:  Whoops, forgot to test.  94 mg/dl.  Dexcom confirms it's a steady number.  Off to bed!

Game Over ... until 5 am.  :)

April 13, 2010

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

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

Here's what I know so far:

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

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

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

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

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

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

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

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

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

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

February 25, 2010

Free Shower.

I love "free shower" - which, if you're diabetic and using an insulin pump or a CGM, you know that means "the shower when you're changing sites and you don't have any hubs connected to you."

It's nice to lather up and not worry about catching on an infusion set or a sensor edge.  Thing is, this is what's waiting for me when I'm done getting all cleaned up:

Oh I love me some free shower.
The potlock o' diabetes crap

Yesterday was "free shower" day for me, which is a rarity now that I'm wearing two devices.  The chances of an insulin pump change synching up with a Dexcom sensor change are pretty low, so when I'm swapping both, it's particularly nice.  And this scene on the bathroom counter is what needs to be reapplied after the fact.

That's the potluck of diabetes devices:  the Dexcom sensor, transmitter, and receiver, and then the insulin pump, infusion set, cartridge, and little bits associated with pump site changes (like that all-important insulin).   If you look fast, you can almost fool yourself into thinking it's a photo of make-up stuff, like any lady would have on her bathroom counter.  But the Sparlings don't have a "powder room," - we have a "site change room." 

I'm adjusting, though.  Don't we all?  Back when I first started pumping, I was freaked out about the whole "external symptom" because I'd existed 17 years without one.  Popping in those first infusion sets and clipping on the pump was a very surreal experience, and one that it took me some time to get used to.  ("Do I look like a robot?  Not really, but sort of.  Am I okay with looking a little like a robot?  Do I get special powers?  No?  That's only super heroes?  Okay, well what do robots get?  They're maids on the Jetsons?  WTF?"  The internal monologue was constant back in those days.)  Adding in the Dexcom sensor and receiver sent me back into that "Wait a minute ... I'm now like a SuperRobot!" mode. 

But now, it's been six years with a pump.  And almost two and a half years with the Dexcom.  So while free showers are nice and I like that feeling of not having anything attached, once I put on the new sensor and the fresh infusion set, I still felt fine.  The sites don't look so scary anymore. 

They look ... almost right.

(Note:  But it may be the ever-growing belly that's making things look more proportionate lately.  Ask me in eight weeks. :) )

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 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.

November 05, 2009

Cracked Insulin Pump.

A few days ago, I noticed a hairline fracture in my insulin pump, starting right underneath the "Esc" button and stemming down into the insulin reservoir window.

Cracked insulin pump

And the day after I noticed it, the crack spidered out just a teeny bit more.  It's weird - I am actually able to look at this crack and think, "Wow, how did that happen," forgetting that the insulin pump is attached to me, literally, twenty-four hours a day.  I could have banged into a door jam (not that I ever do that - nope, not me), dropped the pump on the floor, jostled it against a bag or a package, or, for all I know, Siah could have gone at the thing with a hammer.  No telling how this little pump ended up wounded.

I called the Minimed customer service line and pleaded my case.  Thankfully, since my pump is under warranty until 2011, they said they'd overnight a new pump my way.  

"It's a refurbished model," the slightly sleepy-sounding service rep told me, and I could hear her fingers tapping against her computer keyboard as she typed up our discussion.

"Not a problem.  I've had one once before."  

I'm all for recycling, and I also believe in the value of "certified, pre-owned" merchandise.  But I thought about the places that this pump has been with me.  This one insulin pump was built into my wedding dress, traveled to Spain and visited a movie set with me, and has been a part of my first pregnancy.  It comes to bed with me every night and it has been tucked close against my body for countless hours at a time.  

Kind of intimate for a machine, eh?

DRI's Diabetes 2.0 conference

I can't help but wonder where this refurbished pump has been.  Is it from across the country, maybe a California pump?  Has it ever experienced a freezing cold New England winter?  Has it ever been with a woman before?   Can it tolerate my stupid cats?  (Can it survive awkward me?) 

The new pump is scheduled to arrive in about an hour, just in time for me to swap out my old pump before heading to Florida for the DRI's Diabetes 2.0 conference.  And I'll send the old one back to be refurbished and distributed to another clumsy PWD. 

Thanks for the quick turnaround, Minimed!  I'm off to Florida!

UPDATE:  Just kidding.  Minimed missed the overnight and now the pump is arriving tomorrow.  But I won't be able to access it until I return on Sunday afternoon.  Here's hoping this cracked pump can make it until then.  Minimed - FAIL.

October 08, 2009

Needed More Diabetes Real Estate.

Wearing two diabetes devices has its mental hurdles, but sometimes the physical hurdles are the most irritating.  For the last two weeks, my husband and I have been packing up our old apartment and I've been closing out my office at dLife, so there's been a lot of physical lifting and moving of stuff.

Which means there's been a lot of Dexcom and insulin pump site set jostling.  Wearing the Dex and the pump full-time means plenty of little red dots on my thighs and lower back, and the physical movement of moving has made these areas even more irritating and inflamed.  

What's my point?  

My point is that my regular sites are sore.  And I need to switch things up a bit.  Again.  So last night, I opted for an arm site for my infusion set, instead of my standard thigh or hips.  I've worn the site here before, and it was comfortable, but it can be a hassle wrangling the tubing and shirts/bras. 

Needed some new diabetes real estate, you know?

So this round, I opted to use the longer tubing (43 inches) and I'm snaking that up my arm, down under the back of my bra, and then down to my hips where the pump clips to my pants.  The longer tubing gives me just enough room to accidentally pull on the tubing without jerking the site out.

It is a very different place for me to wear it, though.  So I reminded Chris to remind me.

"Dude, I'm showing you in case I forget.  The site is on my arm, okay?"

"Got it."

Now, as I sit here and write this, I can't feel the wire and it's undetectable underneath my long-sleeved shirt.  Hopefully wearing the site on my arm for a few days will help my other sites heal and give me a little breathing room on the ol' real estate front!

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.    

August 27, 2009

Pink is the New Quickset?

Even though I've been pumping for several years, I've only used one kind of infusion set in that whole span of time.  So last night was a diabetes first for me - my first Inset infusion set.  

My first thought was, "Um, big needle?  What's that about?"  But it's just a mega needle for filling the pump reservoir.  The infusion sets are luer lock (which I'm not sure is one word or two or what it means other than some version of "it's like a bottle cap"), which means that using the new sets means using new reservoirs.  I'm not sure how I feel about this, but I think I could adjust.

Mega needle?  No big deal.  It's not going in me. :)

In addition to the funky reservoirs, the Insets come with their own built-in insertion device.  This is a big score for someone like me, who travels a lot and is always having that mid-drive home to RI panic attack of "OMG IS THE QUICKSERTER IN MY BAG?!"  With the tubing coiled around the infusion set there, it's a little complicated (or at least it was for me, this first time) to prime the pump and pull away the adhesive cover.

Pink.  I can't believe I'm using a pink set and am OKAY with that.

But the fact that it cocks back and becomes its own insertion device?  I'm sorry - that's just downright badass to me.  (It also slightly resembles a birthday cake, but that's neither here nor there.) 

Birthday cake, anyone?

One thing I didn't realize until I had attached the site was that it was pink.  Pink, pink, girly pink.  "Chris, it's pink!"  And he took a peek.  "It's cute.  I like it." 

Another change for me to get used to was the fact that this set doesn't connect to the tubing by swiveling in place.  It snaps together like a seatbelt.  It isn't as low-profile as the Quickset hub, but it's pretty close.  But I was weirded out by one thing:

"Where is the pump cap?"

I'm used to that little plastic disc that covers my set when I'm showering or in the ocean or during intimacy.  How does this new infusion set stay "closed" even when I'm disconnected?  Does anyone know?  Or it is just supposed to be open like that? 

All hooked up on the left thigh.

One thing is for certain:  this kind of infusion set does produce less garbage.  Here's the aftermath from a site change with the new infusion set: 

More diabetes carnage.

I like that the set can close all on it's own and be chucked into the sharps container.  And I also kind of like the spaceship look of the infusion "pod."  Actually, I just like trying something new for a change. 

The disease doesn't change.  Diabetes is every day and it's the same kind of crap every day.  But a little technology swap or a different flavor of juice to treat a low or a new kind of workout at the gym to mix up my routine?  Sometimes you just have to appreciate these little bits of change. 

(Also:  You guys are great.  GREAT.  You had so much great feedback on yesterday's post that I really feel like I have the right questions to ask my endo this week.  THANK YOU for all of your informative comments!!) 

August 26, 2009

Choosing an Insulin Pump.

I wrote a quick status update on Facebook, after receiving the Solo demo in the mail and then meeting with the local Animas rep for lunch to discuss pump options. My brain was buzzing with questions.

Just a quick Facebook musing that opened up the damn flood gates for me.
 
And the flood gates were opened.  Lots of comments, lots of perspectives, and lots of people who had great information to share.  Turns out I'm not the only one who has been thinking about this.  :)

I've been a Minimed pumper for almost six years now, and have never had an issue with Minimed customer service or the pump itself.  When my pump broke two years ago, their customer service department took my call at a few minutes before midnight and a new pump was overnighted to me.  I have no problems with the color, the size, or the functionality of my Minimed 522.

But two things happened that made me think about switching.  One was the CGM upgrade, which I tried for ten weeks and still didn't have any semblance of success and/or comfort with.  (Thankfully, the Minimed CGM works fine for some diabetics, so it's not just me.  Appears to be personal preference.) And the second was that I haven't seen many changes at all in the six years I've been pumping with Minimed (starting with a 512 and now a 522).  The CGM component was a big one, but for people who aren't using that feature, there isn't much going on as far as upgrades that mattered to me.

So even though Minimed has been good to me, I'm on the prowl.  

With Cozmo off the market, my options are limited.  I've given a lot of thought to Omnipod, and while I love the idea of no tubing, I don't like the idea of a larger device stuck to me for the duration.  I also don't like the idea that if I lose the PDM, I'm screwed as far as dosing my insulin.  It's important to note that I've never worn an Omnipod, so I'm purely speculating.  And Omnipod works great for lots of diabetics that I know, and even some cute kiddo ones.  But it's not about the product - more about my personal preferences.

The Solo pump demo arrived in the mail yesterday and that thing appears to have both the tubeless delivery that I'd prefer and also the ability to disconnect the bulk of the pump, but it's not a working model and with pregnancy goals on the horizon, I'd like to make a change sooner rather than later, if possible.  Still, Solo has a lot of promise and coulda been a contenda.   Could still be one, depending on their timeframe.

I've looked at Animas, too.  The Ping seems to be my top contender for several reasons, but the main one is the meter doubling as a remote control for the pump.  I've written countless times about my desires to have the pump reasonably concealed, and when my 522 is stashed in my bra at a dressy event, reaching for it to access the buttons turns me into a female, diabetic version of Mr. Bean.  I like that the Calorie King info is stored in there.  (The Dexcom/Animas integration, whenever that happens, is also a nice future-state.)  I also like the option to take a hundredth of a unit.  Precision is a nice option.  I'm not sure how I feel about the infusion sets they use (sampling some this week) or what it might be like to use their user interface, but I want to see for myself.  Thankfully, pump reps are all about hooking us up with samples so we can see if we want to make a full transition. 

But then there's the whole money thing.  And the insurance thing.  And the "closet full of supplies" thing that will be rendered sort of useless if I switch.   And the "do I want to wrangle with a new device" thing.  There's also the "you can always go back" thing.  And the "pumping isn't permanent" thing.  And the "if you continue to put weird phrases in quotes, people will get annoyed" thing. 

There's a lot to consider.  And I'm excited to see what options are available to me.  But there's only so much information I can get from "official company representatives" and websites.  If you're a pumper, what are you using and why?  If you're thinking about going on a pump, what factors are playing into your decision?  And if you're like me - currently pumping but thinking about changing pump providers - what would you do?

Your feedback is, without fail, among the top resources I'll be using to make my decision.  So thanks in advance, and power to the pumpers!!

June 24, 2009

Why I Wanted a CGM.

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

And then fighting for insurance:

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

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

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

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

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

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

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

And that's why I wanted a CGM.

June 16, 2009

Do I Have the Right?

Over the weekend, Chris and I (and his sister and dad) ended up in a harborside restaurant in South County, RI.  We stood in line and read the chalkboard menu until it was our turn to order from the girl behind the counter.

"What can I get for you?"

"Can I have an iced coffee?  Do you have iced hazelnut?"

"I'm sorry - we don't have hazelnut.  But we have snickerdoodle or french vanilla.  Either of those work for you?"

"Snickerdoodle sounds awesome.  Is that a syrup?  Is it sugar-free?"

She gave me just a quick look.  Not judging, just looking.  "It's definitely sugar-free.  Medium or large?"

"Large," I said, and she turned away to make my coffee and I saw the pink Animas pump clipped to the side of her black pants, the tubing sticking up all crazy. 

And instantly, I want to ask her a million questions. 

With the Dexcom and the Animas being integrated sometime "soon" and with my only pumping experience being with Minimed, I wanted to ask her how she liked the Animas.  I wanted to see how long she'd been diabetic and did she go to Joslin, too?  Did she know any other diabetics?  How long had she been pumping? 

I wanted to tell her that the tubing gets all crazy on my pump, too, sometimes. 

But do I have the right to make her diabetes my business?  Just because I write about it doesn't mean I have the right to grill her about her diabetes.  She wasn't asking me why I wanted to make sure the coffee was sugar-free.  She was just going about her business.  Did I have the right to poke into hers?  Just because she wears an "external symptom" of her diabetes in the form of that pink pump, did I have the right to ask her about it?

There have been a few times when a diabetes discussion was thrust on me without my invitation.  "Hey, what's that thing on your hip?" becomes this moment of advocacy that, while effective, wasn't what I wanted to do that day.  Sometimes I just want to order my coffee without being grilled about why I need to make sure the syrup is sugar-free.  Other times I'm blogging about the teeniest minutiae of life with diabetes.  I oscillate between wanting to be a diabetes advocate and someone who lives a quieter diabetes life.  Sometimes I don't want to talk about it at all.  That day, I didn't want to be an advocate.  (Or a pain in the ass.)  I just wanted to get some coffee and enjoy the day.

Maybe she doesn't want to talk about it, either. 

She made my coffee and added some cream.  I handed her my money. 

And I left without saying anything.

Do I have the right?

It's not always what we have to talk about.  There's way more to us than this. 

June 03, 2009

Pump Battery FAIL.

A funny thing happened on the cruise ship two weeks ago.

My pump refused to accept shiny new Energizer batteries.

About two days into our vacation, my pump threw out the familiar boop beep boop, and a quick glimpse at the screen confirmed what had been looming for a few days - low battery.  Since the low battery alarm goes off every few weeks, I keep a spare AAA battery at the ready in my testing kit.

Using a quarter, I unscrewed the battery cap, pulled out the dead battery, and slid in a brand new Energizer AAA.

Boop beep boop!

FAILED BATT TEST.

Oh come on.  I took the battery in and out again, trying the insulin pump version of "roll the batteries in the remote to get it to work" theory.  

Boop beep boop!

FAILED BATT TEST.

Battery FAIL!

Bullshit!  I went over to my suitcase and snagged another battery from the back-up stash.  The package of batteries was about a month old - Energizer, like the Medtronic manual recommends - and tried two new batteries.

FAILED BATT TEST.

"Arghhhhhh!"

Half expecting Chris to ask me if Lucy moved the football, I asked if he would run to the onboard cruise shop and purchase a package of batteries.  "I don't know what's up with the pump, but it refuses to acknowledge my new batteries.  It's being a prick."

Chris nodded and took off.  I proceeded to try each of the four batteries in the pack I had in my suitcase, and they all refused to work.  OMGWTFBBQ, what is up with this pump?  Why isn't it accepting new batteries?  This happened once before, of course when I was traveling, and it caused panic on my end.  Even though I had a tattered box in my medical bag with an almost-expired bottle of Lantus in it, and even though I had enough syringes to finish the trip without the pump, coming off the pump isn't easy.  I did it once before and it was a hassle of highs and lows - not what I wanted to wrangle with while I was on vacation.

Chris quickly returned with new, nine dollar batteries.

"Nine bucks?"

We both shrugged.

Of course these pricey batteries worked.

I believe my pump and the cruise ship were in financial cahoots on this one.  And Medtronic, what's the deal with this battery issue?  Has anyone else had this happen before?  Should I contact Medtronic?

March 27, 2009

Diabetes Carnage.

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

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

Exhibit C (for crap, holy):

So.  Much.  Stuff!

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

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

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

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

March 18, 2009

Knot What I Expected.

I have to admit - I'm pretty satisfied with this longer tubing option.  Maybe I'll be more annoyed in the summer when I'm sporting fitted clothes and no trouser socks, but for those freaking freezing months with bundly sweaters and long pants, I'm content to have an extra 20" of tubing. 

Thing is, I tend to get tangled in it when I take off the pump.  I guess I bunch the tubing together and just shove it in the waistband of my pants or, if I'm rocking the sock, it stays smooth as it travels down from my hip to my ankle.  But when I disconnect to shower or go to the gym, the tubing becomes a knot of chaos.

Exhibit A:

Knot a clever caption, either.

How did this happen?  It was on the bureau for exactly 20 minutes - just for a shower! - and when I went to snap it back into place, the whole damn thing was knitted into this insuiln pretzel.

(Should I mention that it also was wrapped around me, and Prussia the Cat, this morning?  I woke up to find the cat pressed against my side and the pump tubing casually looped around her paws.  Thank goodness she didn't pull a Sausage and bite through the thing.) 

It's weird to look into my diabetes supply closet and mentally map out my tubing options.  Now that the weather is starting to warm up a smidge, I'm thinking about packing up my winter coats and my wool skirts in exchange for my spring sweaters and dresses.  Long tubing works well for using the sock trick with a lower back infusion set, but it could be a pain in the everything when it comes to tucking tubing in a springy warp dress.  I'm planning to switch back to the 23" tubing in a few weeks.

I can't wait until the weather is warm again.  I've had a freaking-nuff of the snowy stuff.

March 06, 2009

Kerri's Diabetes Technology FAIL.

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

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

Kerri + Diabetes Technology = FAIL.

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

February 19, 2009

Length Matters.

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

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

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

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

A little tubing goes a long way.

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

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

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

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

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

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

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

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 20, 2009

New Thigh Thing?

At the JDRF Walk in Connecticut this year, I met with a woman named Joan Benz.  She was tending a table of her homemade wares:  specialty pump pouches and concealment cases.  Joan is the founder of T&J Design.

Joan is the creator of a fantastic little product called "the leg cuff," and it's the Thigh Thing 2.0, as far as I'm concerned.  I absolutely cannot STAND when I'm wearing my pump on some kind of strap around my thigh and it starts to FAIL.  Nothing is more embarrassing than walking down the sidewalk towards my office and feeling that thigh strap start to slip, then slide down towards my knee, then tumble out from under my hemline - making me look like my undergarments are falling off me as I walk. 

The leg cuff is different because it's a thicker piece of fabric and there's a lining that adds some extra grip to the whole thing.  Because it is a wider structure, it isn't as apt to slide down while you walk.  And because Joan makes these herself, specific to your measurements, the fit is precise and snug. You can get the leg cuff in black or white, which makes it pretty darn versatile.  And you know what a fan I am of keeping the pump concealed and quasi-fashionable!

And while this whole leg cuff thing is a wicked cool product, there is something else that Joan makes that really tugged at my heartstrings.  Joan creates these pump concealment pieces, ranging from the leg cuff to a more standard "pump pack."  But she also makes pump packs that are doll-sized, helping a little kid with diabetes to feel more accepted and less alone with their disease.  Each pack comes with a little cardboard, doll-sized pump.  It's just about perfect.

I think having a "diabetic doll" is crucial to that acceptance stage, growing up with diabetes.  I remember I had a Cabbage Patch Kid with blond yarn hair that I named "Carolyn," and she was diabetic.  Just like me.  Carolyn had to test before she ate.  She took "injections," and she accompanied me to many pediatric endocrinologist appointments at Joslin.  Even now, years later, I remember how Carolyn the Cabbage Patch Kid made me feel  like I was normal.  Or at least a new kind of normal.  So, to me, Joan's idea is fantastic.

If you are looking for a good "thigh thing," check out T&J Design and tell Joan I said hello!

Kerri Sparling's insulin pump ... and hands.

(Also, Joan was recently named the Outreach Coordinator for the Fairfield County JDRF Chapter - my local CT chapter - so hopefully she'll have a bigger outlet for her terrific product!  Congrats on your new position, Joan!)

December 18, 2008

Minimed Trick I Didn't Know About.

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

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

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

Minimed pump features I had no clue about.

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

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

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

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

December 16, 2008

Diabetes Fashion Trends.

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

No, no, and NOPE.

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

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

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

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

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

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

December 08, 2008

Robot Warrior.

Diabetes hardware is FUN!  ;)I love a good bargain.  So when I saw the BCBG Max Azria gray sweater dress on the rack at Marshall's for $30, I had to grab it.  (Consider it my economic stimulation effort.)  The dress is a soft gray with a flattering A line cut and a nice V neck.  Clingy fabric.  Fun.

But.

This dress doesn't hide much.  And it definitely didn't hide anything diabetes-related.

Normally, I'm able to hide my diabetes hardware to the point where I feel comfortable - the sock trick lets me wear the pants I like and not have to worry about pockets, the bra trick works with most dresses, and when it's a big event, pockets can be created

But this gray dress wasn't having it.  The pump set on my outer thigh stuck out.  The tubing snaking up the side of my body and into my bra (where the pump was clipped) was completely obvious.  And the pump itself looked like a cell phone shoved in my shirt.  Not okay.  Nevermind the Dexcom sensor on my right arm that the clingy dress fabric was gathering around. 

"For crying.  Out.  Loud."  I shifted things around to see if I could get the dress to settle smoothly, but every piece of diabetes hardware was on display.  

I don't care if anyone knows I have diabetes.  I don't care at all because it's not this big deal that I want to hide from people.  I am very open about diabetes and I don't mind explaining things to strangers and friends alike.  This is evidenced by my blog, my job, my decision to network with others like me.

What bothers me is when I want to look "normal."  I want to put on a dress and not grapple with wires.  I want to grab a small clutch purse that doesn't howl with a "BEEEEEEEEEP!" when my blood sugar drops or rises.  I want to be able to have a beer at the bar without fumbling to bolus.  I felt frustrated and furious and like a diabetes robot warrior.

"But isn't the pump best for you?  And the CGM?  Isn't that best?"

I know what's best for me.  I completely understand that using a pump with the help of a CGM and all the other technology I have access to is best for me, but in that moment, I wanted it to all be invisible.  I wanted to be living with that version of diabetes that everyone on the outside thinks is so manageable.  "Oh,  you do so well with it!  You seem so well-adjusted!"  But inside I'm screaming. 

Frustration got the better of me and I replaced the pretty dress with jeans and a black shirt.  (This is the abridged version - the full version included me creating some unique curse word combinations and throwing the dress into my bag in a satisfying tangle.)  Shoved the pump into my sock and hide the CGM receiver in my purse.  Tried to forget that the pump on my thigh and on my arm wasn't natural.  Tried to remind myself that this is part of diabetes and part of trying and part of my life.  Tried to remind myself that tomorrow is another day, and it will be another day with diabetes, so rebelling against it won't do me any good.  Acknowledge, accept, and move on.

The dress is balled up in my weekend travel bag, and I think I'll leave it there for a few weeks.  Maybe I'll make another attempt.  It could look different on a different day.  I could feel differently about it.  The emotional ebb and flow of chronic disease management is ongoing.

Some days, diabetes is a better fit than on other days. 

November 24, 2008

Old School Insulin Storage.

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

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

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

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

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

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

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

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

Jim Turner's "insulin bullet" 

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

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

November 21, 2008

Insulin Pumps In Wedding Dresses!

Six months ago, Chris and I got married.  (Holy crap, six months already?  I can't believe it's been that long!)  When I picked my gown, I spoke with the seamstress about creating a pocket for my insulin pump to hide in all day long.  And on my big day, my pump was safe and secure, and so was I.

Over the past few weeks, I received emails from other women who had just tied the knot.  These two different, wonderful, recently-married women also had their insulin pumps worked into their wedding day, like I did.  And they agreed to let me share their stories - and their gorgeous photos - here on SUM! 

Here is Lindsay:

Lindsay
Lindsay on her wedding day.

"I've been a reader of your blog since this spring when I Googled 'insulin pump' and 'wedding dress' in the same thread.  Your site popped up and I was hooked.
 
I wanted to thank you for showing your readers pictures of the insulin pump pocket that your seamstress made for your wedding dress.  I, too, was wondering how I'd manage a pump in that corset-back dress with a very full skirt (and no way to access a thigh holster!)  Attached is what my seamstress came up with.
 
I was able to have my cake (and champagne) and eat it too, all while maintaining a 121 mg/dl throughout the wedding."

(The best part of this is that her best friend, Jenn, emailed me months ago about how her best friend is diabetic and is getting married.  She and I corresponded for a bit ... then Lindsay emailed me a few months later!  Small online world!)

And this Suzanne: 

Suzanne
Suzanne on her big day - with her big smile!

"I only bolused once during the whole reception.  It was one of those rare 'perfect diabetes days' - hovered between 85-110 mgdL all day!  I didn't have the cake & danced like crazy, so that probably had something to do with it.  :) 

Anyway, it was a grand day, but my husband and I marvel at how great every day since then has been.  We love being married!"

I love their pictures.  I love the look on their faces - gives me goosebumps!  Thank you so much, Linsday and Suzanne (and hi, Jenn!) for letting me share your stories and photos here.  There's no better way to end the week than by celebrating love and showing that diabetes doesn't stop anything - not even a beautiful bride on her big day.

November 20, 2008

Just Another Morning.

Wake up with a start as the alarm begins to blare,
Groggily come to and push aside my mussed-up hair.
Reach out to the nightstand and retrieve the zipper case,
Fumble with a strip and finally get the thing in place.
Lance my finger, squeeze a bit, and for five seconds wait,
Hear the beep, watch the screen, and see the "108."

Disconnect the pump with a quick and easy snap,
Grab that little plastic thing that I call a "pump cap."
Bring the Dexcom with me and connect it to the door
So I can shower, get all clean, and data will still store.

Towel dry - so careful, watching for the set and sensor,
Grab my robe and reconnect to the insulin dispenser.
Blow dry hair, drag a comb, and make attempts to dress,
Aim for outfits that conceal my pump with learned finesse.

Make my lunch and grab some snacks, minding carb-y grams -
Greek yogurt, green beans, protein bars - my morning snack grand slam.
Throw it all into my bag - I just have one more thing to add!
Toss in a tube of glucose tabs for all the lows this week I've had.

Snake the pump tube down my leg, tuck the pump inside
The trouser socks I love to wear - perfect for pump to hide.
Check the Dexcom to see for sure that I'm okay to drive,
Pet the cats, throw on my coat, and I'm out the door in five.

So much is diabetes, but it isn't my whole life.
I'm a daughter with type 1; I'm a diabetic wife.
It's in the fabric of my day, in the subconcious of my mind.
It explains so much of what I do, but I am not defined.

October 27, 2008

Diabetes Radar Blips.

We made it to the church just before the wedding started on Saturday afternoon, and the bride looked beautiful.  It was like a mini-roommate reunion, with all of my roommates in attendence and ready to celebrate.  But as we sat in pew and watched her say "I do," I noticed a run in my stocking. 

"Oh man!  A run.  In my stocking."  (I kept thinking about that lady in Lost In Translation, who encourages Bill Murray to "lip her stocking, Mr. Bob Harris.")

We had some time to kill between the service and the reception, so we stopped by CVS to grab another pair of stockings.  Being the awkward human being that I am, I managed to remove the torn stockings most ungracefully, ripping loose the infusion set that was (at one time) adhered to my left thigh.

"Damn it!"  Blood spurted out from the manged site, which was now fully torn out.  "Shit - I tore out the site."

"Do you have an extra one?"

"Yeah, back here somewhere." 

Thankfully, on our weekends in RI, we live out of our car.  My travel bag was in the backseat, where I had a backup infusion set and the Quick-Serter handy.  I prepped the site with an IV wipe and mutted to myself as I reprimed the pump.

"Thank God we had the travel bag with us, or I'd be screwed." 

"You have syringes with you, though, right?"  Chris asked.

"Yeah, but no Lantus.  I'd be dosing little weeny bits of Humalog every hour or so just to keep up.  Forget sleep - it would be a nightmare.  And even if we got a bottle of Lantus, things would be all mucked up on Sunday and Monday."

I popped the new infusion set in my leg and pulled on a pair of nylons.  New stockings, new infusion set - both "rips" were just blips on my radar. 

But it struck me how much I take this technology for granted sometimes.  I'm used to the pump being attached and everything just plain working.  A tugged out infusion set can throw my whole weekend into a tailspin.  I try and plan for unforeseen issues, but you can't plan for everything.  There's a lot of crap to remember!  Extra infusion sets, enough test strips, glucose tabs for a low, an insulin pen in case of a high ... and back ups of these back ups.  Diabetes pack-muling.

People have asked me why I bring so much stuff everywhere.  Why I'm always toting a bag that makes me shoulders ache after a few hours of carrying it on my shoulder.  Why when someone says, "Oh, do you have a pen?" or "Anyone have some gum?" or "Hey, would anyone happen to have grape flavored glucose tabs?" - I'm their go-to girl.  It's tough to pack light when you're trying to prepare for all the diabetes variables.

"Okay, so you're set now?"

"Set.  Literally."  (Oh, diabetes humor.)  "Want to stop by Second Beach before the reception?"

Second beach in Newport, RI

Diabetes can be a huge pain in the arse.  And sometimes it can just be a blip on the radar.  I'm thankful for the blippers.  :)

September 10, 2008

Diabetes For The Day: Third Edition.

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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


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

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


CW:  I think everyone should.

Kerri:  Anything else you want to add?


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

September 09, 2008

Lunch Hour Education.

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

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

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

"Yes, I work at dLife."

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

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

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

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

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

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

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

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

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

"Oh my.  How long do you have?"

"Excuse me?"

"How many years?"

(Is she seriously asking me this?) 

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

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

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

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

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

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

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 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 11, 2008

Beach Blanket ... Pumping.

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

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

Pumping can be a day at the beach.  Holla.

Top Five Beach Pumping Tips:

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

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

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

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

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

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

June 04, 2008

Where's Waldo?

Holy crap - this made me laugh out loud.  Part of yesterday's post involved Nick naming my new insulin pump "Waldo," since it's always hiding and people are trying to find out where it's stashed.  I liked the name and thought it was pretty damn funny.

So this morning, I received an email from Michelle.  She attached this:

Where's Waldo?  Oh wait, he's right here.

Which made me almost lose it.  I had to share.  Where's Waldo?  Oh wait, he's right here.  Waldo the Insulin Pump.  I love it. 

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 08, 2008

Pumps Are Good, M'Kay?

Pumps are good, m'kay?The Associated Press has issued an article about the safety of insulin pumps, claiming that deaths have been linked to insulin pump use.  What's that phrase again?  If it bleeds, it leads?  Our own Scott Strumello, research blogger extraordinaire, has provided a very fine synopsis of the article - you should definitely take a read.  I was contacted by Steve Sabicer, a representative at MiniMed, and had the opportunity to get a little feedback from their camp. 

How does Medtronic respond to the claim that "insulin pumps can be risky and have been linked to injuries and even deaths"?

Medtronic stands behind the many years of clinical evidence that support the benefits of insulin pump therapy in patients of all ages

  • Insulin pump therapy is proven to improve patient outcomes versus multiple daily injections (MDI) with long-acting insulin (glargine).
  • Insulin pump therapy has shown strong results in pediatric patients as young as one year old.
  • Insulin pump use in children and adolescents may be associated with improved glycemic control and improved quality of life, and poses no greater, and possibly less, risk than MDI.
Do you feel that this article could keep doctors and insurance companies from approving the use of insulin pump?

We don't think this will significantly impact physician or insurance company practices moving forward.  The clinical data in support of insulin pumps is very strong.  In fact, Medtronic has noticed that many physicians have proactively come out in support of the therapy in response to this article. That said, we anticipate patients may be concerned because of the lack of context provided by the AP story. Medtronic encourages every patient to speak with their physician before making any decision about insulin pump therapy.

It's important to note that the article conceded that insulin pump therapy is beneficial for adolescents. They only suggested vigilant training and attention by parents and physicians. Medtronic encourages significant parental/physician involvement and we have designed a robust product training protocol to ensure our patients receive optimal instruction on the use and functionality of their insulin pump therapy.

  • We have more than 3,000 certified product trainers
  • Comprehensive online tools (Pump School Online, web-based training modules) for general diabetes information and product specific training
  • Paradigm REAL-Time CD-Rom product training
  • Code and PIE classes

How is Medtronic planning to address this issue with the media?

Medtronic is available for comment and interview to any journalist, and we also encourage them to contact pediatric endocrinologists and patients who have experience with insulin pump therapy.

What can pump users do to show insurance companies and doctors alike that insulin pump therapy should be available to any insulin-dependant diabetic?

As I said before, we don't believe this story will significantly impact physicians or insurers regarding insulin pump therapy. The clinical data in support of insulin pumps is strong.  That said, if patients are having difficulty getting coverage for their insulin pump, they can visit our website for claims information and helpful tools to demonstrate the case of their therapy.

(End of interview)

I've made no secret that I'm a fan of Medtronic's insulin pump line and that I believe pumping insulin has been one of the best decisions I've made for my diabetes management. What makes me craziest about this article is this line:  "There were two possible suicide attempts by teens who gave themselves too much insulin, according to the analysis."  This statement makes it seem like an insulin pump holds a substance far more dangerous than what I injected for over 17 years.  Point is, pumps are not for everyone, but that decision should be made by the diabetic and their caregiver.  I'd hate to see an article like the one from the Associated Press be something that keeps an insurance company from approving use of an insulin pump.

Scott summed it up nicely by saying, "But blaming the pump itself for problems that are not clearly tied to these Adverse Events seems to be irresponsible reporting at its worst."  Hear, hear!

May 01, 2008

Empty or Full?

I am not the one who just lives in the moment - I'm the one preparing for the moments to come, as well.  I live it up and have a great time doing whatever it is I'm doing, but as I'm hanging with my friends or having dinner with my fiance, my brain skips ahead a few hours.

"Do I have juice in my purse for the drive home?"
"Is there enough insulin in my pump to get me through dessert and coffee?"
"How many test strips are left in that bottle?"
"I called in the prescription, didn't I?"
"If this train ends up being delayed, do I have enough snacks on me to get through?"
"Don't forget to bring home the charger for the Dexcom."
"Shoot, did I send out that article?"  (Whoops, not diabetes-related.)
"I need to buff out that scratch on my car."  (Okay, not diabetes-related either, but it looks terrible.)

It's hard for me to tell if I am this way because I'm diabetic, or if I would be this way regardless.  Would I be so prepared and fastidious if I didn't have to worry about the minutiae of diabetes?  Whatever the case, I'm always noticing how much juice is left in the fridge.  I know exactly how many bottles of insulin are in that styrofoam container.  I keep track of the co-payments, the medical insurance, and when it's time to make a doctor's appointment.  (Yet I can't keep track of my email inbox to save my life, but I've digressed yet again.)

I notice how many AAA batteries are stashed in the bathroom cabinet.  I think about when my next site change is.  And when both the insulin and battery life indicators on my insulin pump start pinging, those facts burrow themselves in my brain and stay there, gnawing until I fix the problem.

Empty and empty.

Diabetes causes me to keep a constant tally of moments, a ticker tape of tasks that run through my mind and has me always thinking ahead to the next possible scenario.  Diabetes requires so much preparation in efforts to enjoy even the smallest moments.  This is not a depressing fact - just an honest one.  But after more than two decades of doing this, it becomes autopilot.  And not just for me.

Friends:  "Ready to go ... and do you have your meter?"
My Mother:  "Do you need the carb count on that?"
Chris:  "Is there juice on the nightstand?"
Me:  (smiling because I know they love me and I know they care)  Yes. 

It's good to be prepared.  Thinking ahead keeps me safe.  (But after I refill my pump, I'm going to buff that damn scratch out of my car and send out that article.  And move closer to my wedding - 17 days!)

April 22, 2008

Beeeeeeeeep!

Image credit to Maplenet.netWell hello - I'm rather grumpy today.

I had a moment of cyborgy-ness yesterday, when I was dressed for bed at the end of the evening, yoga pants and a sports bra, and I realized that my pants were sort of falling down, thanks to all of the gadgets hooked to my waistband.  The pump and the Dexcom, separately, are not heavy items, but together they are a bit weighty.  Even though I welcome the protection from lows and highs that Dex is offering, I felt a bit unattractive and robotic.  And my blood sugars have been troubling for the past few days, causing the Dex to sing at me with that loud, loud, loud BEEEEEEEEP!

(Note to readers:  If this post is making you feel like you want to chime in about how being sexy/attractive is far less important than good diabetes control, now is not the time.  I understand how important diabetes control is, and I work hard to achieve a relatively respectable rein on things.  But for that moment last night, I wanted to feel like a girl, not a robot.  I am entitled to these desires.  I am a real human being, not a spokesperson of any kind.  :: steps off soapbox, though laughing at the literal illustration of the bar of soap on the box over there on the right.  Hee hee. ::)

Dex and I are linked back up again this week, only this time the sensor is on my right thigh.  (My pump infusion set is on my left.  I'm sporting diabetes saddlebags this week.)  I'm hoping that having the sensor in a place that doesn't bend, flex, and deal with waistbands will help keep in place more than four days.  The numbers have been pretty precise all day long, except I've seen my first "???" indicators popping up.  According to the user manual, this means that the sensor may be disrupted by my clothes rubbing against the sensor face.  With the site on my thigh and sporting jeans today, that may be the case.  It seems to help if I keep the Dexcom clipped to my pocket, closer to the sensor itself.  However, numbers are still relatively accurate.  My faith is still strong in this product.

But the annoying bit I'm noticing the most, and which is sending me into a bit of grumpiness, is the beeeeeeping.  The "Above 180 mg/dl BEEEEEEEEP" that permeates my office.  It's not the fault of the product but more of an alarm that announces my body's failures.  It bounces off the wall, ricochets into my ears, and shaves off a bit of my ego.   "BEEEEEEP - Kerri, you're high.  Your diabetes is uncontrolled at the moment - HEY EVERYBODY!  She's high!"

Over the past two weeks, stress levels have once again crept up, and I'm finding myself a bit looped out at times.  The wedding is closer, finances are spoken for before they arrive, work is extremely busy, and personal projects are ramping up, thus grabbing and needing more of my attention. 

Most often, I'm very upbeat, quick-witted, and pretty damn smiley.  But today - meh.  I'm grumpy and frustrated with stress, the snowglobe of ideas in my mind, and that damn BEEEEEEEEEP.  I become disheartened when my efforts at good diabetes control - hell, good LIFE control - are thwarted by these unseen little factors, like stress, or maybe weak insulin, or the pile of wedding things that still need to be wrangled ... it's a bit much today. 

I would love a personal assistant.  Or, better still, a vacation.  Instead, I have a headache.  And BEEEEEEEEEP

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 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 27, 2008

Precision Carb Counting.

Diagnosed in 1986 with type 1 diabetes (Kerri, you're diabetic?  I had no idea...), my first diabetes meal plan involved that dreaded exchange system.  Two starches, a protein, a fat, a fruit ... a headache with each meal.  Since my insulin at the time was Regular and NPH, I was matching food to insulin and constantly chasing that bell curve.  Meal times were a constant hassle, with my poor mother whipping out measuring cups and teeny food scales at restaurants, referring to the Big Red Joslin Handbook for exchange values, and swearing under her breath with savvy and discretion.

As a result of this willy-nilly (ooh, fun phrase) mash-up of insulin and food, it was tough to hold my numbers steady.  We could only predict somewhat how my numbers would react to my mealplan.  It wasn't until fast-acting insulin, the precision of insulin pumping, and the frustrating miracle of carbohydrate counting that I was able to eat with more pleasure and better predict the blood sugar outcome.

However.

I am not good at "eye-balling" food portions.  Without second-guessing, I can convince myself that a cup and a half of pasta is only a cup.  What looks like fifteen green grapes captured in a plastic bag ends up actually being 26.  And please don't even ask me what a tablespoon of ketchup is, because I have no clue. 

Which is why, when the guy at Eat Smart contacted me about his nutrition scale, I was all about giving it a go.  He offered to send me a sample scale to review, at no cost and no payment to me.  So FYI - this is not a paid review. 

The Eat Smart scale

The scale arrived in the mail yesterday and it has a jazzy, streamlined look to it, which I like. Figuring out  how to turn the thing on and make sense of all the buttons was not intimidating to me (as I've mentioned before, I have serious techno-joy) but I could see it being a little overwhelming for someone not as tech-savvy.  However, the instruction manual was very straight-forward and within a few seconds, I was weighing in my mid-morning apple. 

According to the Calorie King website, my apple should have contained roughly 19.1 grams of carbohydrate.  This is an estimation based on the size of the apple and my perception of that size.  According to the nutrition scale, my apple contained 15.3 grams of carbohydrate.  At first glance, it looks like a "tomato, to-mah-toe" issue, but when I'm aiming to keep my numbers as steady and eliminate as many variables as possible, even 5 grams makes a difference. 

In addition to weighing random items with precision, the scale also offered up plenty o' nutritional info like calories, carbohydrates, fiber, fat content, sodium ... and on and on and on.  At this stage in my life, I'm mostly focused on carbohydrate content and occasionally sodium or fat values, but I can see how this data would be really helpful for other health conditions.  There's a list of 999 foods that are pre-programmed into the device, with an option to manually calculate using the food label on an item - like a dollop of cottage cheese or similar.  This feature was very helpful for me because I tend to eat a lot of fruits, fresh vegetables, and protein, so I don't have the benefit of an FDA nutrition label on everything I'm chowing.

So the data is helpful.  The scale is a little on the bulky side (see the picture for comparison against your average, garden variety office pen - grown fresh here in the dLife garden) and it's also on the pricey side ($75 bucks for this sucker!) but the return on this investment could be worth it.  I haven't tooled around with it enough to make a long-term assessment, but my initial feel is "Hey Scale, You're damn useful!"

Do you guys use scales to measure the "unpackaged" food?  Or are you more apt to wing it?  I'll admit - I wing it more often than I'd like, even though I'm eating a very healthy diet for the most part.  Hopefully a scale like this, a more focused determination to carefully account for my carb intake, and more coffee (yay!) will help me fine-tune this chaos.

Now let's see if this booklet has a value for "cheesecake" ... yum...

(Also, Hannah wrote a great post on the old exchange system from ADA - check it out!) 

UPDATE:  If you want to order your own scale, enter "KerriSentMe" into the coupon field during checkout on the EatSmart website and receive 10% off your order.  How's that for cool?

March 19, 2008

Dear Medtronic.

These are the sneakers I have.  Just as a sidenote.Dear Medtronic,

How are you?  It's been a few weeks since we've touched base, but I wanted to let you know that my new insulin pump is chugging along just fine at the moment.  It's finally a bit scuffed and I have all my new carb ratios and basal patterns plugged in there - just like the old one.  So thanks for making such a great pump and for having a commendable level of customer service.

Why am I sucking up a bit?  Well, this is a little awkward.  I'm really disappointed in something I've read today.  I've always liked you as a company and I've always been proud to be a part of your user base.  But I received an email from Marcus last night that upset me. 

He sent me a link to the Medtronic Global Heroes campaign, aimed at highlighting the achievements of runners with diabetes.  According to your website:  "A Global Hero is a runner. An inspiration. A person whose life has been improved by medical technology."  Aside from earning some recognition and plenty of product benefits, the Global Heroes will also have this option:  "Medtronic Foundation will donate $1,000 on behalf of each Global Hero to a non-profit patient organization that educates and supports individuals who live with the runner’s condition."

What an awesome opportunity!  I know plenty of strong, talented runners from the blogosphere.  Like Marcus Grimm.  And Anne.  And Ed.  People who are conquering their condition and pushing themselves to higher levels of physical fitness and health.  But only if they fit the specific criteria.

Because you have added a stipulation this year that states: "Runners 40 years or older with insulin pumps and who have had diabetes for more than 15 years are ineligible."

Medtronic, would you care to explain to us how you justify leaving them behind?  Your Global Heroes program is inspiring and can really show people with diabetes how limitless their lives can be.  I understand the need for a CYA caveat, but to forbid them to even participate?  Taking away their option to earn funding for their chosen charity?  That's shameful.

Medtronic, you make a great pump.  But you've made better impressions. 

-- Kerri. 

March 12, 2008

Infusion Sets.

I've made it pretty clear that I'm an advocate for using my thigh to host my insulin pump infusion sets.  I like having it placed lower on my body, keeping it a bit incognito, even from me.  It doesn't rub against the waistband of my pants, it doesn't press against Chris when I hug him, and it doesn't get in the way when I'm at the gym.  Overall, the thigh placement keeps my blood sugars stable and my pump tucked away most easily. 

I'm a fan. 

But there are times when it's a little tricky, too.  Take this weekend:  I spent the majority of the day lolling around the house and traipsing around town in jeans, vs. the dress pants or skirts I wear at work.  The jeans aren't baggy or loose, so the denim fabric is pressed pretty snugly against my legs.  Over the course of the last few months, I've noticed that wearing jeans while wearing a thigh site leaves my infusion sets a little battered.  The white edging gets frayed and stained with blue fibers.  Eventually, if I wear jeans for a few days in a row, the site gauze starts to peel back a little, threatening to dislocate the site entirely.  

Insulin pump infusion set, post-jeans.
The infusion set, hanging out on my right thigh. 

Aside from the times I've almost ripped the site out while getting dressed, this jeans thing is the biggest problem.  To help keep the site from bailing before its time, I will stick a few pieces of medical tape around the edge of the gauze.  The tape ends up frayed and blue, but the site remains intact.

I've been thinking about doing some site rotations again - maybe trying out the arm site again or perhaps making an attempt at the (gasp) rear end location.  I'm such a creature of habit, though, a little shy to try something away from my regular routine.  Are you guys using some creative locations for your infusion sets?  (Aside from the breasts - I cannot bring myself to try that one.) 

(Also, THANK YOU for all of the great music selections yesterday.  I have been at Amazon all morning long, picking out CDs and previewing stuff on Seeqpod.  I feel like I've been completely revitalized.)

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 22, 2008

Prospectin'.

Two minature grizzled old prospectors sit on the corner of my desk at work, chewing tobacco and watching me work. 

"Blizzard's a-ragin' outside." 

"Yep, reckon 'tis."  

Leans towards spittoon - clang.

"Pilin' on up yonder.  I think she's fixin' to go home early and work from the confines of that there apartment."

"Seems that way.  With all them vermins."

"Cats.  They're cats, not rodents."

Clang.

"Makes no matter to me.  So should we give her a good scare before she leaves?  Rustle'er up a bit?"

"Yessir.  Let's wrangle up that pump site and shift it off course like a tumbleweed makin' its way through the desert."

Blank stare.

"She's wearin' jeans, Old Timer.  Let's rub the seam of the jeans against her infusion set until it spins a bit and comes loose from the site."

The piano stops playing abruptly. 

"You mean you want to stop that there insulin from gettin' in her?"

"A'yup."

"Okay, but just for a few minutes.  Just so she gets all riled up and has a little This here is a tumbleweed.  :: clang ::ol' fit.  A-hee hee hee!"

Kerri:  So I uncross my legs while sitting at my desk and notice that I could feel the cap of my site scraping against my jeans.  How the heck did that happen?  After a quick consultation with my thigh in the ladies' room, I noticed that the tubing had come loose from the hub of the set, leaving me without insulin.  I checked my blood sugar and saw a harmless 87 mg/dl, so there was no need to freak out. 

Then I noticed the two minature grizzled old prospectors with their spittoon, sitting on the corner of my desk.  I'd been done hornswoggled.

It was as this point that I decided I was burnt out and needed the weekend. 

January 22, 2008

An Open Letter to The Edges.

Dear Edges,An Open Letter to the Edges.

You've been a part of my life for as long as I can remember.  When I was a baby, I used to lean on you in my crib.  Then there was that day when I was two years old and broke my nose against you on the fireplace.  My mother used to keep my baby bottles on you in the kitchen.

Oh Edges, you've been around forever!  From resting my elbows against you on the table in anatomy class senior year to the you above my bed where I had a library of books, you have always been there.  And we've lived in relative harmony, until the last few years.

Edges, I know you know what I'm talking about.  Listen, I understand that I've added these shifting bits of technology to my body - a pump infusion set on the outside of my thigh or on my abdomen, or the CGM transmitter on the back of my arm or on my hip.  I realize this adds an additional inch, maybe three inches at best, to my overall surface area.  But must you grab at these bits so much?

Was it really necessary for you to snag my pump site over the weekend?  I was undressing for my wedding gown fitting and the edges of my pants caught a small bit on the infusion set.  Granted, I moved slowly enough to thwart a complete site removal, but still. 

And did you really have to reach out for me when I was picking through my jewelry box this morning in search of the stupid matching earring?  I leaned against the edge of my dresser and didn't realize I was pressing up against the infusion set until I stood up straight and felt that ping of pain when the feeling came back to my thigh. 

But the last straw was this afternoon at work.  You know exactly what I mean, when I was talking with H about something and then I turned around quickly.  It was like you came darting out at me, snagging my shoulder on you and pulling the CGM transmitter almost cleanly from my arm, but not cleanly enough that I was sure it came out.  Just enough so that it stung in that oddly warm and slightly painful way, enough to make me wince but not enough to make me grimace.  I had to go into the bathroom at work, push up my sleeve almost to my shoulder, and see the sensor needle dangling from the back of my arm like a tooth that just needed a quick tug to come free.

Edges, I had just put that sensor in this morning and it was calibrated perfectly.  The results were working and I was watching my afternoon trend happily away.  But you had to reach out and say hello, didn't you?  Couldn't just sit back and let me sport this sensor for at least 24 hours before you grabbed it and yanked it out?

I am putting another one in today.  I am going to use my leg, I will tape it down to eliminate any variables, and I expect you to keep your grabby little edgy hands off of it for at least three days.  Three days, damnit. 

If I have to walk around with a giant nail file and round you all out, I will.

Best,

Kerri.

SUM Tags: , , , ,

January 21, 2008

Every Bit the Bride.

Not my wedding gown, but sort of close.The dress gathered in beaded ivory folds at my feet.  I stood on the fitting pedestal while the seamstress sat, pinning up the edge of the dress and adjusting the seam of the beading so she would be able to hem my wedding gown

"Hemming this gown is tricky because of all these pretty edges," she said through clenched teeth, her hands busy folding and pinning with precision.

"It's going to be beautiful."  I looked in the mirror and felt every bit a bride, despite my smudged make-up and my rumpled hair.

"It already is beautiful.  That dress fits you perfectly, Kerri."  My mother grinned as she watched from her chair. 

"It's going to fit perfectly after I take it up a few inches, my friend."  The seamstress laughed a bit and stood up, admiring her pinning job.  "This will work fine.  Just a lot of work to move those beads!  Okay, now tell me about the pocket."

"It's for that insulin pump.  It will need to be off the seam and big enough to fit this,"  I reached down and lifted the edge of the dress so she could see the insulin pump, hiding out in my trouser sock.

"That?  Okay.  Do you need to keep that on or can you take it off?"

"It's for diabetes.  For her insulin?  It stays on all the time."  My mom asserted from her seat, shifting around a bit.

"Yes.  It can't come off.  And the pocket needs to have a hole in it for this tubing, so it can be fitted through all the layers and reach my thigh.

"Show me this tubing."  The seamstress put her hands on her waist and furrowed her brow.

I lifted the dress and removed the pump from my sock, following the tubing up to the infusion set on my outer right thigh.  "Here.  This is the pump itself, and this plastic tubing needs to be fed through the layers of the dress so that it can reach this, "  I tapped the plastic cap of the infusion site with my finger.  "It delivers my medicine this way and needs to be connected, but hidden at the same time."

"Okay."  She reached into her sewing kit and removed a seam opener.  "So we'll just open this here and," She opened up the seam of my wedding dress and placed pins on either side, pushing the pump through the hole.  "We'll sew in the little pocket.  Maybe add some edging to it so you don't notice it.  A bit of velcro to keep it closed.  Very small.  Very pretty."

I watched her in the mirror as she took her seam opener through the different layers of my dress - from the gown itself to the petticoat layers underneath and then to the slip.  I knew once she was done with the alterations that the dress would fit me perfectly, and would have the perfect hidden pocket for my insulin pump.  A little makeup would cover up the small red marks on my arm from the CGM transmitter.  I raised my chin proudly.  I have had type 1 diabetes for over 21 years, and I have found good health and strong love and support in those decades. 

I caught a glimpse of my mother in the mirror's reflection.  Her eyes were a little red and her smile was a little softer as she watched her oldest daughter fitted for her wedding gown, the seamstress holding my insulin pump in her hand.

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 11, 2008

What's Best.

Last night, Chris and I wrapped up on the couch and watched Signs.  As we watched the movie, I felt Chris absently start rubbing my shoulder.  His hand started at the top of my shoulder and went down towards my elbow.  I felt his fingers skip up against the CGM transmitter.  It made my eyes fill up, and I’m not exactly sure why.

I have been receiving some good data from the MiniLink so far.  It has confirmed that my overnight basals are pretty much spot-on, with a small bit of tweaking to be done for the weekends, when I sleep past 7:15 am.  It has shown me that my run at the gym makes my blood sugar plummet after about 15 minutes.  I like being alerted when my blood sugar is over 180 mg/dl because I want to spend as much time away from that high end as possible.  I feel somehow safer wearing this device; a watchdog while I am otherwise indisposed.

All of this information can help me better manage my diabetes.  Tight control can help me reach my goals of good overall health.  I’m being proactive.  I am testing and bolusing and making use of the latest diabetes technology in efforts to live a long and healthy life

That is what’s best.

It’s just hard to be so focused at all times.  I've been emotional lately.  I lost my edge.

Today, the alarm sounded on the CGM all morning long.  “Bad sensor.”  “Cal error.”  “Bad sensor.”  “BG Now.”  This rotation went on for three hours.  I had resolved to leave the sensor in and go home at lunch to change it out, but after a series of seven errors in a row, I stormed into the bathroom at work and ripped out the sensor early.

I went home at lunch and inserted another sensor into my arm, with Chris’s help.  It was the first sensor we had done on our own, so I had some trouble figuring out how to pull the needle out.  I tried.  Chris tried.  Unfortunately, we were tugging at the wrong angle and my arm became a bit mangled in the process.  The long needle remained stuck in my arm as I tried to wiggle it back, with Chris holding onto the side of the sensors.  Feeling under the weather both physically and emotionally, with the bruise already visible on my arm and a sharp pain edging down towards my elbow, I burst into tears. 

“I can’t get this out.  It hurts a lot right now.”  Tears, without asking my permission, fell into my mouth.  “I can’t do this.”

“We’ll figure this out.  It’s okay.”  Chris grabbed the CGM manual and started flipping through the pages, looking as quickly as he could for the page about removing the needle.  Frustration mounted, along with the soreness from the lodged needle, and I pulled the set from my skin.  Blood poured from the site.  Tears streamed from my eyes.  I felt defeated and frustrated and foolish.

It took several minutes to calm down.  It wasn’t about the sensor mishap.  It wasn’t about the infusion set two nights ago that stung all the way down to my toes.  It wasn’t about the low that had me sweating as I slumbered last week.  It wasn’t about the counted carbohydrates or the glucose tabs in my car or the press releases that I read every day, outlining diabetic complications.  It was simply an overwhelming sense of everything.

What’s best for me?  Is it all this concentration on diabetes?  Is it taking advantage of the technology that this decade, this job, and this blog have given me access to?  My physical health is of the utmost importance, but I value my emotional health just as much - maybe more - than I value my A1c.  Lately, my emotions have been capped up to keep me focused on my numbers.  Today, the bottle uncorked and they flooded me, leaving me bleeding and vulnerable and crying.

I dried my tears.  Chris gave me a hug.  I asked him what I should do.

“Do what you think is best.  I support whatever you decide, baby.”

Sometimes it just takes a good cry and knowing that you’re loved to make it easier to realign your heart and your head with "what’s best."

He helped me insert another sensor into my arm.  We were calm and focused.  It didn’t hurt at all.  It only bled a little, and he grabbed a tissue and blotted the blood with careful hands. 

“See?  Much better that time.”

“I was afraid if I didn’t do it again, right away, I would have given up for a while.”

He nodded.  I rubbed the sensor on my arm, telling myself that it was worth trying, that my moodiness would pass.  The pump was hard to adjust to at first, too.  Everything has an adjustment period, even what’s best.

I opened my mouth to tell him I loved him, but the sounds of the cats fighting over a cardboard box in the living room distracted us both.  Siah was leaping in and out of the box like a little gray gazelle.  It made us laugh.  And the laughter felt right.  I felt lighter.

Siah Sausage looks like she doesn't have a thought in her damn head.

Laughter, for me, is what's best.  It helps make sense of the rest of it.

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 03, 2008

Vampire Cannula.

It ached a small bit. 

I noticed the ache when I leaned up against the kitchen counter to grab a mug from the top shelf for my tea.  Not a holy-crap-that-hurts sort of feeling, but more of a latent bee sting.  It didn't feel right and I knew it would be painful once I focused on it, so I pushed the pain out of my mind and instead reverted my attention to the tea.

I tested:  180 mg/dl.  Bolused half a unit to bring me down.

An hour later, I tested again:  186 mg/dl.  That bolus did nothing?  Didn't seem right.

Waiting for the shower to heat up and planning to change my infusion set afterwards, I pulled out my site.  Immediately after I pulled the plastic away, a drop of blood seeped up and scurried down my thigh.  The cannula revealed its vampiristic tendencies:

Vampire cannula.

This explained the dull ache at my site location.  It also explained the fact that a 1/2 u of Humalog fell into some kind of useless void. 

No problem.  Changed the infusion set, laced in another half unit to correct the high, and slid a garter of garlic around my thigh. 

When it comes to these vampire cannulas, you can't be too careful.

SUM Tags: , ,

January 02, 2008

Pump Reservoir Revisited.

A few weeks ago, I was out to dinner with Chris and rang in at an excessively high blood sugar after taking part of my meal bolus.  Wondering if my site was conking out, I rummaged through my bag to find my always-on-hand insulin pen.

Well, almost always-on-hand.  This time, I had left it at home. 

Never fear - Old School Syringe is here! 

That experience pretty much encapsulates why I carry a syringe in my meter bag at all times.  Here's how I bolused in a bind:

A blast from the past.

In the side zipper part of my OneTouch Ultra2 meter, I keep an unused syringe, orange cap and all.

Reservoir in the pump.

Wearing my pump is like carrying a teeny little bottle of insulin at all times. 

Reservoir, loose from pump.

I unscrew the reservoir from the main housing of my pump.

Reservoir disconnected from tubing.

Then I disconnect the reservoir from the pump tubing.

Inserting the needle into the reservoir.

Using the syringe, I poke the needle into the spongy access point in the top of the reservoir.

Drawing back a dose.

And as though it were a bottle of insulin, I pull back a few units.  After I inject with the syringe, I reprime the insulin pump to make sure there are no air bubbles stuck in the reservoir or the tubing, and I reconnect to my infusion set.

This little trick has bailed me out a few times and can also be used in a pinch if my insulin pump ever fails on me (or if my brain fails on me and I forget my trusty old insulin pen).

Over the last twenty-one years, I have seen plenty tricks of the trade.  What have you come across?

SUM Tags: , , ,

December 19, 2007

Paradigm Shift.

UPS arrived this morning, dropping off an early Christmas present from Medtronic. (Okay, it was from my insurance company, too.) 

Inside?

Pump and link!

My new Paradigm 522 and accompanying Paradigm Link meter.

My new pump pal.

In a festive "smoke" color.

Working on getting those sensors sent out just after the New Year.  Oh how I love new diabetes gadgets.

December 18, 2007

Armed.

When I got home from the gym last night, I ripped out that belly site with relish.  (And a small bit of ketchup, as it bled a teeny bit and that makes me wonder if I had nicked something and if that had contributed to excess pain.  But I've digressed.  Again.) 

After showering, I slid a little IV prep on the back of my left arm, where I took daily injections for so long, and held the circular, blue Quick-Serter against my arm.  Leaving no time for anticipation, I hit the buttons on the side and plunged the needle into my skin.  No real pain, not much impact, and when I pulled the Quick-Serter back, I exposed a neatly nested circle of white on the back of my arm, with the blue needle sticking out of it. 

"Gotcha now," I muttered. 

Pulled out the blue needle and fixed primed the set with 0.3u of Humalog.  No burn.  I clipped the pump to my yoga pants.  It felt weird to have the tubing all "up north" instead of the southern hemisphere of my body.  I laced the tubing underneath the side of my sports bra and kept it along the side of my body.  This worked for the most part, aside from the fact that it tickled a bit on the underside of my arm.

I pulled on a black t-shirt and surveyed the scene.  I could see the set bulging out a little bit underneath my arm, but since it was on the back, it seemed barely noticeable.  I fell asleep more aware of the fact that the pump wasn't on my leg, instead of hyper-aware of the set on my arm.

This morning, not much different.  Showering proved to be no issue, as the shower poof didn't come into direct contact with the site (it does when I'm using my leg -- I'm obsessive about shaving).  I got dressed in a pink sweater and black skirt and snaked the pump tubing underneath the side panel of my bra and along the side of my body again, coming to a rest tucked into the top of my skirt.

Pros to wearing it on my arm are that the area has been virtually untouched for the last four years, save for the rare injection.  It's up and out of the way, so using the bathroom isn't a tricky "hey, did I just skim the site with my pants?" excursion.  It's not creating a bulge that I can see without lifting my arm a little bit, and once the tubing is secured under my bra, it doesn't budge.

Cons to this site are that dressing/undressing is a bit tricky, as there's plenty of braided tubing to contend with.  It aches a teeny bit, but nothing too dissimilar from a thigh site and nothing even close to the ache of an abdomen site.  It's a bit tricky to connect/disconnect because I can't really see it, but since I don't usually look when I reconnect, I can do it by feel.  The main con is that I can't extend the tubing to my sock and hide my pump there, so I'm experimenting with different "above-the-belt" hiding spots.  Today it's tucked inside my tights, against my hipbone.

So, thanks to your encouragement, I think I have a new spot to rotate my infusion sets to.  And it wasn't too scary!  Now it's your turn to try something new.  :)

December 17, 2007

Site Unseen.

About 90% of the time, I do not mind wearing an insulin pump.

Yes, of course, I would much prefer to be cured of this disease and I don't enjoy the day-to-day maintenance of a chronic condition, but for me, pumping these past four years has been far superior to multiple injections.   I can hide it in the folds of my clothes.  I can disconnect for exercise, intimacy, and beachin' it.  And it delivers my insulin with a precision and stealth unrivaled by my orange-capped syringes.

However, the past few days have been holy hell.

Instead of sticking the infusion set on my thigh, like I usually do, I opted to give my legs a rest and revert back to my abdomen.  I originally started using my thighs because I thought stomach sites burned and felt like fire in my sensitive, nerve-riddled skin.  I liked having the tubing snaking down my leg instead of jutting out from underneath my shirts, and I preferred to have my infusion set nested on my out-of-the-way leg instead of my front-and-center abdomen.

But, in the interests of site rotation and absorption tests, I stuck the site in my stomach and went about my merry way.  Unfortunately, it was far less merry than usual.

The site is currently about three inches to the right of my naval, about two inches down.  While wearing sweat pants, this site location is not an issue because the waistband of the pants rests about two inches below the site.  HOWEVER.  The waistband of my jeans rest, with precision, where the infusion set sits, rubbing and pressing and making the site incredibly sore.  Every time my arm brushes against it, here on its third day, it's as though the cannula has made its home in a pile of ultra-sensitive nerves.

We're out at dinner the other night, and one big laugh had me squirming because the site had caught against the edge of my pants.  Driving home to RI was entirely uncomfortable because my seatbelt was snug against the bulge of the site.  Every bolus has a bit of a burn to it.  The sweater I wore to work today shows the faint outline of the infusion hub orbiting near my naval.  Even sleeping has me rolling over, folding my arm underneath myself, and mashing up against the site. 

For the last three days, that infusion set has gone from "something I barely notice" to "alien in my belly."  An alien in my belly has been a bit of a startling enterprise, to say theNow he's wearing an infusion set.  Gotcha. least.

I admire people who can do a full site rotation, hitting places like their rear ends, their arms, and even their breasts.  (Note:  I will never, ever use my breast as an infusion set site.  I cannot imagine that kind of ouch.)   But I officially hate the belly sites.  I can't stand them.  I feel like a stubborn kid, crossing my arms over my chest and pouting, "No more belly sites.  I'm going home."

So, in efforts to be more of a grown-up, I'm going to give an arm site a pass.  Once I'm home from the gym and neat and clean from the shower, I'll be trying out the back of my left arm as a home for my infusion set.  You guys have given me the confidence I needed to at least give it a whirl.

If an alien takes up residence in my arm, I'll be back to legs by Friday.   

October 09, 2007

Found.

"Just lift your arms up and ... okay, dive in!"I can't wait to post a real picture here!  (Only not for 7 more months.)

She held the seemingly endless yards of flowing fabric above my head, with her arms through the middle to guide me to the top.  The rustle and shuffle of silk and taffeta undulated by my ears until I had shimmied into the dress.

And I walked out to where my mother was waiting, the train of the dress following patiently. 

"Oh, that's the one.  That's it."  My mother started clapping softly, then realized it was an odd thing to do, so she just folded her hands in her lap and grinned.

I turned to face the mirror and, despite the exhaustion from the whirlwind weekend and the day of working remotely and the strong scent of Starbucks coffee, I felt pretty.  All in an instant, I didn't want to wait another seven months to be his bride. 

"Oh, that's the one."  My bridal consultant had patiently helped me try on over two dozen dresses and she showed no signs of slowing down.  But this one was it.  Hands on her hips, she followed the lines of my body with her eyes and nodded her approval.  "It fits you perfectly."

I nodded in agreement.  She leaned in to my mother.

"Let's get the pump and I'll get the seamstress, so we can see how we'll work with this."

My mother unearthed the pump from the depths of my purse, where it had been stashed during this dress-session, and handed it to me. 

The seamstress came out and gave me a coo of approval.  "Oh honey, you look beautiful.  Now what are we looking at here?"

"This is my insulin pump.  I need to have a pocket or something created in the dress so I can access the buttons here," I gestured to the front face of my pump, "and then the tubing needs to funnel through the dress layers to a port on my outer thigh."

"No problem, honey.  No problem at all.  Let's see this."  She reached out her hand and I placed the pump on her palm.  "Not too heavy at all.  We make a little pocket along the seam here," she pointed to the side of the dress, "and then we'll just tunnel through the layers to meet up with your leg.  A small bit of velcro to keep the pocket shut and viola!  You're a bride with a beeper."

"A pump."

"Pump."

The seamstress patted me on the arm.  My bridal consultant helped me slip out of the dress and I put my own skirt and shirt back on.  I looked at some options for my bridesmaids and ooohed over dresses for my flower girl (little MP).  We talked about when the dress would be ordered and how long it would take to come in.

And if I closed my eyes, I could still feel the weight of the train and the way the beading felt underneath my fingertips.

I can't wait until May.

September 25, 2007

Pump Grump.

Where does the pump go?For my own diabetes management, I'm pro-pump.  Pumping has helped me keep my A1c on a steady decline.  The pump has helped me control those insane morning for-no-reason spikes and has helped protect me from frightening lows.  I lived seventeen years without my pump and I'm happy to not be sticking myself with syringes every few hours.  I appreciate the convenience and fluidity of pumping.

Except.  For.  This morning.

I woke up early to a comfortably cool bedroom temperature.  Long, hot shower.  Running right on time - early, even! - and I even knew where my keys were.  I found a nice (ironed - imagine that!) outfit in the closet - red floral skirt, off-white sweater, fancy Monsoon Artisans necklace.  Perfect for the warm beginning of fall.   

All dressed.  Just about ready to walk out the door.  Oh, one more thing! 

The pump.

I reattached the pump to the site, snaked the tubing up from my thigh, and clipped the pump to my waistband.  The light fabric of the skirt buckled under the weight and the skirt lurched to one side.  No problem, I'll just slip on the "thigh thing."  Okay, so that's all mangled and stretched and doesn't stay up right today.  How about tucking the pump into my bra?  Nope, the v-neck shirtline doesn't leave room for a medical device.  Maybe in the side of my bra, underneath my arm?  I did that on Saturday night in the black dress and no one was the wiser.  

Unfortunately, this light shirt made the pump look like a budding appendage. 

"Fricka-fracka dag nab it..." I muttered.  (Yosemite Sam's got nothin' on me.)  No matter how I wore the pump, it was the most blantant accessory.  Not even McGyver Morrone could figure out a quick way to solve this one.

So ... I plugged in the iron, grabbed my khaki skirt (with pockets) from the clean laundry pile, and gave it a quick steam.  Tossed the red skirt aside, determined to wear it someday but apparently not today.  I scurried off to work and made it just in time.

I was a bit of a Pump Grump.  In somewhat of a Pump Slump.  Until I tested at around 9:30 and saw that the 157 mg/dl I had woken up with had settled back down to 97 mg/dl.  It is worth it, even if it steams me up now and again.

September 13, 2007

No Chocolate to Blame

Here's a snapshot of the last 24 hours:

Wednesday, 8 am:  Stupid pump.  Still not working.  Can't even tell how much is left.  Grrrr. 

11 am:  YAY!  FedEx has arrived!  New pump is here!  I'm healed!

2 pm:  All hooked up with new pump, cruising around with a nice blood sugar of 112 mg/dl.  Feeling good.  Hey, the phone is ringing. 

"Hello, Dr. CT!  Nice to hear from you, too!  What's that?  The Protein C test came back negative?  That's great news!  And my A1c is lower?  Excuse me?  Under 7%?  AWESOME!  I haven't had an A1c under 7% in several years.  Yes, I will.  Okay, thanks for the good news."

7:30 pm:  Home.  Skipping the gym tonight.  Going to Chocopologie for nice, romantic dinner with my handsome fiance.  Pulled out the old infusion set, took a nice, hot shower, and then primed my new pump for the first time.  Ah, new pump.

7:45 pm:  Hmmm.  The Quick-Serter didn't have that same solid *thump* that it usually does.  But the infusion set appears to be in there okay.  Hope all is well.  Blood sugar is 142 mg/dl, so I'm ready to roll!

10:30 pm:  Back from a delicious dinner of portabella mushroom Paninis and a hot cappuccino from Chocopologie.  No chocolate this time - trying to be fit for that white dress!  But I did have a good amount of carbs and my mouth is pretty fuzzy.  Come to think of it, the words are swimming around on the computer screen.  Can't focus correctly.  I'll test just to make sure I'm not close to 200 mg/dl.

10:31 pm:  What.  The.  Fuck.  483 mg/dl?  Fantastic.  Lace in 6.5u of Humalog.

11:40 pm:  Oh nice.  418 mg/dl.  Nice.  Way to scream in the face of my finally-solid A1c. 

11:41 pm:  Drinking bottles of water by the minute.  Pull the set out from my leg and replace it.  Rage bolus in a few more units.  This had better work.  I feel like garbage.

12:45 am:  298 mg/dl.  Ah.  Even that feels better.  At least the set is working now.  Let's see how fast I fall.  Will work on assorted bits for a little longer.

1:40 am:  189 mg/dl.  Damn straight. 

"How are you feeling, baby?"  Chris asks as we climb into bed.Alarm clock.  Couldn't you tell?

"Much better.  I could go south in the middle of the night, so if you wake up, wake me up and make me test."

He smiles.

"It's the middle of the night now."

4:49 am:  He's shaking my shoulders.  "Wake up, Kerri.  Kerri.  Baby, you're really sweaty.  Drink the juice."

I reach over to the bedside table and click on the lamp.  Grab my meter. (Why, oh why, can't I just drink the damn juice?  Must I test every time?  Am I on autopilot to that degree?) 

36 mg/dl.

In one movement, I uncap the juice that was next to the lamp and drain it in a few shaky sips.  Sweat on my forehead.  My pillow is damp.  Abby the Cat is meowing up at me pitifully from the floor.  I lay back and fall asleep almost instantly.

7:30 am:  The alarm goes off.  Unzip ... 98 mg/dl.  After falling fast and furiously from almost 500 mg/dl and crashlanding at close to 30 mg/dl, my mouth is a confused tangle of dryer lint and fruit punch.  My body is aching from the wide blood sugar swings.

And I didn't even eat any damn chocolate.

September 12, 2007

Yay for FedEx!

FedEx has arrived!!

For about fifteen minutes, I had two insulin pumps on my desk at work.  I felt like I was on a diabetes version of MTV's Cribs, all pimped out with two pumps.  (All pumped out?)  Approximately $12,000 worth of medical equipment in my hands.  Whoa.

I hadn't programmed a new pump in four years.  After setting the time, date, programming in my sensitivity factors and insulin-to-carb ratios, I was ready to set the new one up with my basal rates and start the transition.Enclosed please find my wonderful new pump.

Only ... I couldn't press the 'down' button on Old Pump to access the basal review.  And I had NO CLUE what my rates were.  They were written down somewhere at home, but I was at work.  Damn it!!

After talking to myself, to the Old Pump, and to God, the 'down' button finally gave in and allowed me to scroll through the basal review menu.  (Coercing the button to work took almost fifteen minutes.)  I quickly wrote my basal rates on a post-it note and entered them into the New Pump.  Snagged the reservoir from the Old Pump, inserted it into the New Pump, primed it up and reconnected to my infusion set.  Ahh, insulin bliss.

In accordance with the letter I received from Minimed, I bade Old Pump a fond farewell and tucked it into the return envelope. 

New Pump is shiny and blemish-free, completely devoid of the dings from doorknobs and scuffed with paint from the doorjambs in every apartment I've lived in over the last four years.  It was strange, placing my Old Pump into the envelope to mail back to Minimed.  I've worn that pump for years.  I've had it in bed with me.  It's gone on planes.  It was there the night I got engaged.  It has almost fallen in the toilet and has been stashed in my bra and has ended up wrapped around my thigh while I sleep.  Strange attachment to this inanimate object. 

Holding New Pump and knowing full-well it had previously been a part of someone else's life was strange.  But now it's part of mine.  It may have missed the engagement, but it will be there at the wedding.  (Unless I upgrade in January.  Hmmm.  Maybe I need to stop forming attachments to inanimate objects entirely, as their turnover is inevitable.)  

So for now, I'm 179 mg/dl (too much pump excitement, I think).  New Pump and I are bonding.  He knows I like iced coffee and I don't like using the bolus wizard unless I'm over 240 mg/dl.  I know he likes long boluses, being tucked into my pocket, and boop beep boop-ing. 

I didn't tell him that Old Pump liked boop beep boop-ing, too.  I want him to think he's the only one.  ;-)

Midnight Calls to California

Click.  Click.

"No backlight?  That's odd."

Click.  Hit the button with the arrow.  Try and scroll down.

Click.  Click.  Clickity-clickity-damnit-whatthehellisgoingon-click-click.

Sigh.

Before I went to bed last night, I clicked on the "arrow" button to show me the pump stats - the time, my last bolus, and most importantly, the insulin left in my reservoir.  I usually check my reservoir supply every night before bed, to keep myself from running out on the overnights.  I knew I had changed the infusion set on Saturday morning, so I had to be close to running out.

The "arrow" button clicked fine.  But the "down" button was not having it.

"What.  The.  Hell.  Is.  Wrong.  With.  You?"  I punctuated every word with the click of the button, hoping it would catch and everything would be fine again.

No luck.

I tested my blood sugar.  214 mg/dl.  I pressed the "up" button in hopes of being able to manually click my way through a bolus, then hoping the insulin would still be delivered.  As my wounded pump boop beep boop'ed its way to a correction, I called my customer service pals at Medtronic.

"Hello, this is Damien."Thank goodness for Minimed.

"Hi, Damien.  My name is Kerri.  I have a Paradigm 512 and it's still under warranty.  The 'down' button is toast and I can't access the prime function, my insulin totals, or the bolus screen.  Or a self-test." 

"Hi, Kerri.  I can help you out with that.  Let's try a few things first."

We changed the battery.  No luck.  We talked about the most recent alarms that had been thrown and how they may have impacted.  No solution there, either.

"Okay, Kerri.  I'm going to recommend that you stop using the pump now.  Do you have back-up insulin and syringes?"

I thought about the bottle of Lantus in my fridge from the rafting trip and the boxes of syringes I've been stashing for the last few years.

"I have plenty of back-up."

"What was your blood sugar when you checked last?"

"214."

"Were you able to correct for that?"

Nice question.  I didn't think they cared what my blood sugar was. 

"I was.  I could manually bolus using the 'up' button."  I answered, affixing a gold star for Medtronic in my mental chart.

"Great.  Okay, Kerri.  I'm going to see if I can get this overnighted to you for delivered tomorrow morning.  Where can this package be delivered?"

"My office."  I gave him the address.  "Yes, that's 'd' as in 'diabetes.'  It's a diabetes-media company." 

"Wow.  You work in diabetes, too?"  I heard him clicking on his computer keyboard.  "And what email can we send an update to?"

"Kerri at sixuntilme dot com.  Six is spelled out."

"Nice.  Got it.  Six until me?"

"It's my blog.  It's a diabetes blog, actually."  It was one in the morning, my insulin pump was busted, and it was my 21st anniversary with this disease.  I was burnt out.  "I know.  I'm surrounded by this stuff."

Damien shook off his professional demeanor and laughed freely.  "No kidding?  That's pretty cool, I think."

"I have a good time.  So this pump should arrive tomorrow morning?"

"It should.  You'll have a FedEx confirmation email in a few hours."

"Great.  Well, I'll be sure to write about you tomorrow.  You've been very helpful."

He laughed again.  "Make me sound nice, okay?"

"It'll be easy."

And now I wait for my "certified pre-owned insulin pump" to arrive at my office.  I have a bag filled with pump supplies, syringes, a bottle of Lantus, and some back-up Humalog pens, in case FedEx doesn't make it in time.  I have no idea how much is left in my pump, or if it's working properly, but I woke up at 84 mg/dl and I'm sitting currently at 126 mg/dl.  It appears to still be able to administer insulin, I just can't access anything or prime the damn thing.  Even though I'm going against the recommendation of Minimed to remove the pump and revert to injections again, I'm holding out for the new insulin pump and closely monitoring my blood sugars in the meantime. 

Here's hoping FedEx arrives soon. 

September 07, 2007

Sex - with a Side of Diabetes.

(Cue sleezy saxaphone music, dimmed lights, and the extremely uncomfortable mental image of my mother reading this post.)

Even though I've been thinking about writing this post for a few weeks now, I can't keep the blush from creeping up my face.  But I'm a twenty something, engaged woman, for crying out loud.  There is a sexual element to my relationship.  There is also a diabetes element to my sex.

I can't compare sex with diabetes to sex Sex and Diabeteswithout diabetes.  On the cusp of my twenty-first year with type 1, there's not much of my life that I've lived without diabetes.  Sex and intimacy dredges up a whole host of issues, diabetes notwithstanding.  Is my body appealing?  Am I feeling pretty?  Do I think my arms /ass /ears look fat in this shirt /skirt / hat?  Will the cat just freaking stop pawing at our ankles?

Now add diabetes to the mix.  Is my blood sugar at a stable level?  Is there juice within reaching distance, in case of a low?  Where is my pump infusion set these days?  Can I disconnect easily or do I have to go foraging around for it?  Whoops, watch those underwear on that infusion set ... don’t want to tear it out by accident.  Are the blinds closed?  (Okay, so the last bit has nothing to do with diabetes, but it’s crucial to make sure the blinds are drawn.)

Wearing an insulin pump adds a whole new level to sexual relationships.  It’s a machine.  And yes, being healthy is sexy and there’s nothing sexier than someone who is taking care of themselves, but once you have adjusted to that comfort level, it’s still a machine.  And it’s attached to you at all times, even when you’re feeling amorous.  I’ve received a number of emails about sex and an insulin pump.  Do I feel self-conscious?  Is it awkward during moments of intimacy?  Does it get in the way?  Does he notice it?  Are the blinds drawn? 

I wear my infusion set on my thigh specifically to keep it out of my way – away from the waistbands of pants and skirts, away from the abdominal muscles I am working furiously to uncover, and away from my fiancé’s hugging arms.  For me (I only speak for myself here), I feel sexier when my infusion set is safely adhered, working flawlessly, and out of my sight.  Diabetes incognito – still well-managed, but not the focus.

Since I have been pumping – almost four years now – I have always disconnected my pump during sex.  Whether it’s off before anything starts in earnest, or whether I’m discreetly disconnecting it and tossing it underneath my pillow or on the bedside table, I am not wearing it during sex.  (FYI - I also don’t wear my pump while I exercise.  And this is a form of exercise, no?)  I also make sure I keep a pump cap on the site during intimate moments, to keep the sharp edges of the infusion set from scraping up against skin, blankets, etc.  Occasionally, I’ve had the site get tangled up in the undressing moments, but it’s never been an issue.

There have been a few occasions over the last few years when a low blood sugar has entered into my intimate moments.  Instant mood ruiner, as my low symptoms are crying, sweating, confusion, and irritability.  (Not a sexy scene, trust me.)  Once or twice, I’ve had to stop everything completely and treat a hypoglycemic moment.  This is a part of my diabetic sex life.  I can’t lie and pretend it hasn’t happened, but I will say that it hasn’t made a difference in my relationships. 

Sure, there have been awkward moments where I’ve felt self-conscious about my “hardware.”  I’ve also felt self-conscious about my fingernails – it all depends on how the proverbial wind is blowing.  Sex is a normal part of my life.  So is diabetes.      

I’ve asked Chris a few times if he ever notices the infusion set or the pump or any of the diabetes paraphernalia in our sex life and he has honestly answered, “No.”  I’ve also asked him if he’s lying about that.  Again, and this time with a bit of a smile, “No, Kerri.”  I’m not sure if it’s the way I handle my disease or if it’s the way Chris handles it or if it’s a combination of how we manage diabetes as a family, but it doesn’t affect our physical relationship.

So long as the blinds are closed.  ;)

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!

July 24, 2007

The Wedding Crashers.

We started at Narragansett Beach on Saturday morning - early.  Armed with bathing suits, trashy magazines (oh how I love trashy magazines), and the company of some of my college roommates, we were on the beach and relaxing in the sun by early morning. 

"Kerri, only you would have that little pouch that matches your bathing suit."  My roommate said, gesturing towards the flowered blue case my pump was nested in.

"What?  I need to keep it fashionable!"  (Thanks, Donna, for the insulin pump pack!  It was a hit at the beach!)

Wearing the pump at the beach usually isn't an issue at all.  Infusion set on my thigh, pump tucked underneath a shirt to keep it shaded, and a spare pump cap for going in the water and I'm all set.  No one notices.  I've only caught people looking at those moments when I'm first arriving at the beach and the pump is clipped to my bathing suit bottom.  (Wires are essentially untuckable in those situations, so they are a bit exposed for a few minutes.) 

However -

The sand/ocean/stickiness from sunscreen presents a unique problem:  reattaching the tubing.  When I disconnect and put on a spare pump cap to go in the ocean, the salt water cakes up around the infusion set, making it sticky and tricky to reconnect once I get out.  I have to rinse the site profusely with clean water to unstickify it and even then the site clips back in place with a chalky groan.  (I use the Minimed Quick-Sets.)  At one point, I couldn't get the site clipped back on until I rinsed the site off in the bathroom sink.

Aside from those pumping glitches, blood sugars held steady in the sun, ranging from 80 - 212 mg/dl (forgot to bolus for that iced coffee - dang!). 

Lindsey, Kate, Heidi, and me - we couldn't decide which camera to look at, apparently.

After dinner at Crazy Burger (where something that looked like spinach with chocolate sauce was served, but it was actually spinach with a balsamic reduction) and some sangria at Turtle Soup, we hit the Coast Guard House. 

Standing out on the upper deck, a woman in a black dress came stumbling towards us.

"You girls need to come inside."  Her shoulder strap slid down a bit but she was too drunk to notice.  "Seriously.  You need to come inside and dance.  This wedding is so fun and you need to come inside."

We shot her a collective confused look.  She shook her blond head and smiled sloppily.

"I know.  I would be like, 'Who is this lady?'  But you should come inside and dance.  Come on!"

I think we were too taken aback to argue with the lady.  We filed in, watched as assorted bridal attendants danced like fools, and laughed our asses off watching the drunk blond lady girate all over the place. 

Is it possible to be invited to crash a wedding?

July 11, 2007

The Disconnect.

I do not like needles.

The feeling of the tip of a needle against my skin makes me cringe a little bit.  Having blood drawn makes me sick to my stomach and very light-headed.  Even watching shots being administered on TV causes my fear to prickle. 

I'm a big baby.

When I was first diagnosed with diabetes, injections were our weapon of choice.  I started out with one injection of Regular and NPH in the morning.  Time progressed and I tried out all kinds of insulins:  Regular, NPH, Lente, UltraLente, Lantus, Humalog, synthetic and animal varieties ... you name it, I shot it up.  I went from one shot a day to two, then to three, and so on.I don't miss filling these every week.  Blech. 

When I was 24 years old and using a Lantus/Humalog regimen, I realized I had hit an average of 11 shots per day.  It wasn't that I was taking a ton of insulin, but I was taking eensy doses all day long.  My arms were peppered with bruises.  The scartissue in my thighs causes my little doses to leak.  I had dozens of coffee cans with used syringes stashed in them underneath my kitchen sink, taped tight with duct tape and regularly disposed of at the local CVS sharps drop-off.

There was one night when something inside of me broke in two piece and I felt my fear and my strength mix together like sands in a timer.  I had taken my ninth injection of the day.  The needle caught slightly in my arm and a hot, red drop of blood spilled out immediately after I pulled back the needle.  I wiped the blood with my finger - it smelled like the dentist's office, letting me know that some of what I just injected had leaked out.

"I'm done."  I announced to no one in particular.  Abby strolled by and gave my hand a lick in acknowledgement.  This hot rage built up inside of me and I threw the syringe against the television screen. 

"I am DONE!"  I screamed with all the power in my lungs.  Cell phone in hand, I dialed my doctor's number, leaving her a crazy message at ten-thirty on a Sunday night.

"I am tired of shots.  I am sick and tired of them.  I want to start on an insulin pump.  I can't deal with this anymore."  Hearing the frantic pitch in my voice, I caught hold of my composure.  "Um, this is Kerri Morrone.  If you could return my call at your earliest convenience, that would be nice." 

Click.

That was almost four years ago.  And over the last four years, I've had pinched cannulas, kinked tubing, and air bubbles.  I've felt frustrated by being tethered to a machine.  The damn cat has chewed through the tubing and tossed me up high.  Sometimes I have no idea how to wear it.  Sometimes I'm tangled in every possible way.

But after last week's pump vacation, I realized that choosing pump therapy was one of the best decisions I've made in my diabetes management.   Despite all the frustrations, shots just don't cut it for me.  After disconnecting and reverting back to Lantus, my skin immediately remembered how to recoil from a needle and how to bruise up with a vengance.  I realized how easy it is to forget that Lantus shot.  I recalled how frustrating it is for me to take a dozen shots a day, totalling no more than 30 units.  Toting around insulin pens, making sure my bottles of insulin stay cool, and seeing those orange syringe caps making appearances on my kitchen counter - these are not things I missed.

I'm not of the mentality that pumping is better than injections.  Different therapies work for different people, so I'm all for whatever keeps you healthiest.  But for me, pumping is the way I need to roll.  My sugars stay steadier, I'm able to administer precise eensy doses, and I don't have to whip out a needle every few hours.

One needle every four days versus eleven times per day is the kind of ratio I can handle.

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