Main

January 09, 2013

:: Head Explodes ::

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

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

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

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

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

"What are you doing?"  

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

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

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

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

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

He laughed.  "Whatever it takes."

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

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

Hot damn.

January 31, 2012

What We Document.: Solving for "Why."

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

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


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

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

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

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

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

March 09, 2011

Advanced Avoidance Technique.

I received the reminder call.  I discussed my schedule that week with my husband and didn't bring it up.  And the letter from their office still remains stuck to the calendar page.  (Not to mention, the missed appointment cost me $25, to boot.)  But I never made it to Joslin to have my eyes checked again.

And I don't want to go.

If it seems like I've had an eye dilation like every three months, it's because I have.  My eyes were dilated several times during my pregnancy to track the progression of my then-mild and now-moderate non-proliferative retinopathy, and this eyeball issue was the main reason I ended up delivering my bird via c-section.  (The pre-eclampsia didn't help matters much, either.  Yay for ... stuff?)  

I fully realize that what I need to do is pick up the phone, call the eye clinic, and make an appointment for a dilated eye exam.  I know this.  And later this afternoon, I will make that phone call. 

It's just sometimes I find all this crap really tedious.  Not so much the little things, like testing my blood sugar throughout the day, changing out the insulin pump ever few days, and popping that blood pressure pill every night before bed.  That stuff doesn't make me bonkers. 

It's more the Big Stuff.  The eye exams.  The endocrinologist appointments.  The hours spend combing through insurance EOBs and spending even more time discussing this paperwork and battling with insurance claim specialists who think 10 test strips a day is "excessive."  It's making log books and calling the mail order pharmacy.  It's moving the fax machine from the office into the living room (because we neglected to hook up the office phone jack) so that I can fax documents to our insurance company.  It's going online to the insurance website and jumping through all the search hoops to find a doctor within a 30 mile radius who takes both my insurance AND new patients.  Taking a whole day to trek up to Boston to sit with my endocrinologist for an hour; another day to have the dilation drops plunked in and to have to wrangle someone to drive me home afterward.  It's a day away from my baby.  And from the work I enjoy doing.  And a day that someone else has to either watch BSparl or drive me or whatever.  It's a day that makes me resent diabetes just enough.  And it makes me admittedly grumpy because I really don't want to spend the day doing crap I don't enjoy.

Every time I re-find this picture, it reminds me how far we've come with diabetes, but also how much HASN'T changed.
An image from an older post about guilt, but the words I chose are blunt,
and I think if I made this same list today, it would read the same.


(And before you say it, I know I could see someone closer to home, but it's hard to be so close, yet so far from the doctors I know and trust and who are best suited to care for any complications that may arise.  And before you say it, I know it's pointless to have access when I don't actually go to the appointment.  And before you say that you weren't thinking that, let's get some iced coffee and talk about Spring Training, instead.  And before you say you like the Yankees, I'll kindly refer you to my husband and my editorial assistant, who share your bad taste.) 

The time it takes to manage diabetes on a day-to-day basis isn't tremendous.  Constant, yes, but not overwhelming most of the time.  But taking time and sitting in the car and in waiting rooms and hoping they'll call my name first so I can let them stick a needle in my arm and then pay the garage attendant and then drive home for two hours?  (Sometimes with dilated eyes?)  It is so worth it for my health to make these appointments and stick with them.  But sometimes it feels like such a pain in the ass that I'd rather skip the appointment entirely and spend a few hours playing blocks with BSparl. 

And then I realize that in order to play blocks, or to travel for work, or to be able to make the bed and run the laundry and enjoy dinner out with my friends, I need to stay healthy. 

... sigh.  Fine.  I'll make the appointment.

September 17, 2010

Diabetes Control = Hot Mess.

I want to stop picturing these every time I test my blood sugar.Exhausted doesn't even begin to explain how I'm feeling at the moment.  Over the last few days, we've moved into a new house, worked and lived through some construction efforts in our home, traveled to the Toronto International Film Festival for the Buried Canadian premiere (by propeller plane, but more on that panic attack later), and then hoofed it to NYC for a screening (more on that later, too).  Our house is chaos, our schedules are all over the place, and my health management is under duress.

Even though all of this stuff is exciting and the journey to get here has been incredible, it's a lot to manage all at once.  I love to travel, but I hate the actual process of "getting somewhere."  I don't travel light, I have some physical limitations that make travel difficult (read:  tendinitis so bad that I can't lift a bag without wussing out), and I'm still not a fan of flying.  That, combined with the lack of sleep and a wildly varying schedule (including nights that push the 3 am envelope - hey, college throwback!), is a recipe for disaster with all the diabetes stuff.

Blood sugars have had pockets of success, like last night at the Tribeca screening, where I held rock solid between 100 - 150 mg/dl all evening long.  But there have been some disastrous runs, like the night of the Toronto screening, where I was over 280 mg/dl for four hours, despite boluses.  (I eventually took an injection and pulled the site, but the site seemed fine.  I hate when the cause of highs can't be nailed down.)  I'm testing a lot, but my body isn't responding to things normally.  Foods that I'm usually able to tolerate, numbers-wise, are now throwing me into the stratosphere  or tossing me into the trenches.  I'm living on a steady diet of coffee and lip gloss.  Infusion sets are staying in for four days at a time (instead of the three days I had committed to while pregnant - absorption is so much better when you follow the damn rules) and I think the last time I changed my lancet was when BSparl was born.  

I'm a hot mess.  And not in that cool way.  More in that "Geez, Kerri, you think you're cured or something, the way you've been acting lately" way.  (Note:  Haven't been cured.  Just a very scattered diabetic these days.)

I'm not sure if these hiccups seem more dramatic because they're in contrast to the very tight, very obsessive control I had while pregnant, but in any event, I'm not pleased with my lack of commitment to sparkle motion.  (see also:  hot mess)  But I have to get things back under control.  Events for Chris seem to be coming up every week, and I want to be physically ready to attend with him.  (As in, I don't want to be 39 mg/dl.  Or 399 mg/dl.)  And this is all without mentioning my smiley little daughter, who would do well to have a mom who isn't bouncing all over the blood sugar map.  

The next six weeks will be challenging for me, as both a diabetic and a new mom, because it's sort of non-stop until the holidays.  And even though the events are coming and going, the diabetes isn't.  I can't spend the next six weeks winging it.  I need to find a way to do these things without sacrificing all of my diabetes control.

I can do this.  If I was able to get my terrified arse on a propeller plane, I can wrangle in a blood sugar or two. 

September 02, 2010

Diabetes and Moving: Fun.

Every time I look at this bit of clip art, I picture the cats driving it.You know you're a diabetic moving into a new place when:

  • You pack extra glucose meter test strips, baby diapers, and toilet paper into the same box because you know you will need both on the first day.
  • You're watching at the window for the cable guy so you can get yourself back online and immersed in the diabetes blogosphere.
  • You don't care that there's an ice maker in the new fridge, but more than there's a handy compartment that's PERFECT for insulin storage.
  • There's a whole box labeled "Diabetes Supplies."
  • You're grateful that the hardwoods are being installed because it will be easier to find rogue test strips.
  • The washer dryer combo looks like a spaceship command unit and you have no idea how to work it.  (Wait, that's just me?  Domestic goddess I am not.)
  • Even though the fridge is almost entirely empty, there's still a bottle of grape juice at the ready.  (And a pitcher of iced coffee.  Priorities!!)
  • You buy a smaller garbage can for the kitchen to leave room under the sink for a massive, red sharps container.
  • There's a space in the walk-in closet that's dedicated solely to stacking insets, insulin reservoirs, and test strip bottles.  Not to mention lancets, which I've had the same seven boxes for the last four years and I never manage to use them up.  (Something tells me I should change my lancet today.) 
  • And: You test the wall outlets by plugging the Dexcom receiver in to charge.
Diabetes plus moving totally equals fun.  :p

June 23, 2010

"When can she fly?"

"Um,   doctor?  When can she fly?"Summer tends to be a busy travel time for my family, so once Chris and I knew when BSparl was arriving, we started researching "traveling with babies."  We consulted different books, some websites, and asked around our collection of family members.  We also spoke with our pediatrician at her first appointment - and we asked her a ton of questions of all kinds.

"When should we expect her to start sleeping through the night?"
"Does she like us?"
"Should she be taking some sort of vitamin supplement?"
"Why is her poop, like, electric yellow?"
"When will she start crawling?"
"How do we get her to stop smiling when she eats, because it makes it hard for her to latch on?"
"Does she know we don't have a clue what we're doing?"

But the question that always made me laugh was this one:  "When can she fly?"

As though she was going to sprout wings and start flapping.

But apparently BSparl gets her wings next Monday, as the full Team Sparling travels to Florida for the Roche Summit and a few days of the CWD conference.  

And I have no clue how to truly travel with a little baby.  

As far as BSparl's safety and immunity goes, her pediatrician is completely fine with us traveling so soon.  BSparl has had her first round of vaccinations and we're breastfeeding, so her immune system is ready for travel.  But am I?  I'm a nervous traveling as it is, and the idea of planning for all my diabetes stuff and now BSparl's needs makes me feel like I'm certain to forget something.

So I would love some advice, if you have any.  What are some tricks for keeping a two and a half month old baby happy and content on a plane ride?  How do you pack for four days with an infant in tow?  What toys might keep her happy and quiet?  How can we keep the rest of the passengers from hating us?  Do airlines have special arrangements for teeny kids?  Is it true that breastfeeding is a good way to keep her content and to protect her ears from popping?  Do they have baby changing tables in the airplane bathrooms?  (Is there even room in there for one of those??)  Do you check the carseat as baggage or do you bring it on as a carry-on?  I HAVE NO CLUE!!!  (And please don't make your advice, "Don't bring the baby.")

If you have traveled with a little kid before and you have some sage advice, please, pass it along.  I'm still figuring this mommy stuff out and I can use all the help I can get!!

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."  

March 02, 2010

Questions About Growing Up with Diabetes.

Rockin' it old school.  Where's my gel pen?No WAY could I ever claim to "counsel" parents of kids with diabetes.  I'm not an expert, I'm not a doctor of any kind, and I don't have the first clue as to what I'm doing 90% of the time.  

So.  That being said, I will admit that I've emailed with lots of parents of kids with diabetes, and I've gotten so much out of that glimpse into what it's like to be the parent of a CWD.  Not counseling, but listening.  And learning.  Talking with these different parents has given me a whole new level of respect for what my mother and father did for me, growing up, and how I view my diabetes as a result of their care.

Over the weekend, I received a few questions from a parent that I couldn't quite wrap my head around.  They were big questions, the kinds that require coffee and one of those old school composition notebooks (and a phone call to my mom) to sort out in my head.  Here's my take on this mom's questions about growing up with diabetes:

How well did your parents do in managing your diabetes until you were able and independent?

I can't say my parents did anything short of remarkable work when it came to my diabetes.  And that goes for every parents of a CWD that I've met in the last few years.  I was diagnosed just before second grade, and my family didn't know anything about type 1 diabetes, let alone that it could ever effect their daughter.  They brought me to the hospital and stayed there with me for 12 days, learning how to inject insulin into oranges using syringes that they would eventually plunge into my own skin. 

My mother, in particular, took her role as "my pancreas" very seriously, and worked tirelessly to control my difficult blood sugars.  She tested me every morning when she first woke up, the sound of the ziiiiip on the black meter case stirring me just enough to poke my hand out from underneath the covers so that she could lance my fingertip.  She carried measuring cups in her purse and had a food scale in our kitchen.  My pancreas wasn't working hard enough, but my mother was.

This isn't to say that we were "perfect" in managing diabetes, or our emotions, or that we had one of those "unicorns and rainbows" types of relationships.  My parents and I battled endlessly about all kinds of stuff, from cleaning my bombsite of a room to my propensity to drive too fast to fighting over the boys I wanted to date to the diabetes I didn't want to control all the time.  Fights were part of the routine, but it wasn't because of diabetes.  It wasn't despite diabetes.  Diabetes was just part of the stuff we fought about. 

(And on the whole "able and independent" part, I'm still not fully either of those things.  I'm able to take care of myself, but I still lean on my parents, and my husband, and my friends for support.   And while I'm fiercely independent, I still need, and want, their help.)

Did you resent them?

No.  I never resented my parents for any of this diabetes stuff.  Not even when I wanted to convince myself that it was hard because they made it hard.  Diabetes is hard because it's diabetes.  Sure, my mom and I had blow outs about when she would say "We have to test our blood sugar," instead of "You have to test," but I grew to understand how much she was truly involved, even though I wasn't aware enough at the time

I've resented diabetes, though, which I know is hard for my parents to hear (and to read on this blog).  I do not like it, I didn't invite it, and I'd sell it to the lowest bidder without thinking twice.  I resent it for making me write To Do lists that a child has no right even worrying about, and I resent it now for making me feel for a kick from BSparl every time I have a blood sugar spike during the course of my pregnancy.  But my parents - my whole family and friends support team, honestly - have tempered that resentment for me by supporting me.  They don't coddle me, or tell me that "Things will be fine" or "Sure, you can go ahead and not care about diabetes."   They understand that this disease is serious.  And unfair.  And only sort of manageable.  But also that it doesn't have to own me.  It never has.  And it never, ever will.

What is one thing you could tell me to do that will make make this easier on [daughter's name]?

Blame the diabetes, not yourself.  Or your child.  Let her know that it's you and her against this monster, and you'll always fight beside her, not against her.  You're in this together, and she'll never be alone.

But Reader, you'll never be alone, either.  You've got all of us.   For the long haul.  :)

I wanted to give my answers to this mom of a little girl with newly diagnosed type 1 diabetes, but I also wanted to offer these questions up to you guys.  To get more than just my perspective, because so many of us have grown up with type 1 diabetes and might answer these questions in completely different, completely honest ways.  If you have insight to offer, please do! 

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. 

August 21, 2009

Staying Accountable.

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

Yet.

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

But DUDE.  I'm still doing it.  

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

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

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

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

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

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

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

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

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

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

August 04, 2009

Biking Block Island.

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

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

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

Oh how stupid I was. 

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

Exhibit A:

Tabs by the lighthouse.  Of course.

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

Exhibit B:

Tabs on the bluffs, yo.

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

Water Street in the background.

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

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

Or maybe just my meter would be more realistic. 

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

August 03, 2009

A Diabetes To-Do List.

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

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

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

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

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

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

"I need help being held accountable."  

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

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

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

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

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

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

I have to do that. 

I will do that. 

It's a long way down from here.

May 29, 2009

Old School Diabetes: Meters.

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

Like this brick from Accu-Chek:

Old meter from the dark ages of diabetes.

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

Another oldie.

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

Like this morning.

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

The Dexcom said I was 39 mg/dl.

I tested again and saw 101 mg/dl.

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

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

Today, I'm spent.   

April 30, 2009

I'm in the Zone: Cortisone.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I was all, "Ow."

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

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

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

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

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

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

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

And I was all, "This sucks."

April 15, 2009

Deflated.

Yesterday didn't go as well as I had hoped.

The nurse came in first and took my blood pressure (fine), weight (slightly higher than last time but I can deal), and my A1C.

(Yes - Joslin is finally giving their adult patients A1C results day-of!  I was abnormally excited.  "You mean I'll know in 15 minutes?  Really?"  The nurse looked at me like I was new to the planet.  But for a minute, I was ecstatic.  I hate waiting.)

While the results were being spun, my endocrinologist came into the office and she and I spent almost two hours together going over numbers, plans for improvement, and the specifics of pre-pregnancy appointments.  While we were talking, the A1C result came through.

"Okay, so you're just where you were four months ago."  

And I felt like crying.  It's overly-dramatic and pretty sad to feel so affected by this number, but it has always been the standard I judged everything against.  It was the number that defined my health. It was the only number in my diabetes world that mattered, and a result that was too high tarnished my spirit.

It spoke to my success, or failure, as a person.  

Or at least that's how it's always felt to me.  

So I felt very teary and felt totally deflated.  And my endo kept talking, moving on past this number and instead trying to isolate patterns in my blood sugars that could be contributing to this result.  We went over my January lab results, and she was very happy with my cholesterol and my heart health.

"You're exercising how often?  Five days a week?  That's great.  I wish more of my patients were into their cardio that way.  Your resting pulse is very low.  That's good."

I couldn't stop thinking about the A1C.  Even though we're not actively trying for a baby, I wanted to get the green light, at least diabetes-wise.  I want to be a mom, and I don't want diabetes being anything that makes me decide to wait.

"Yeah, but the A1C.  I mean, that's the same as last time.  I felt so sure that I was doing better."

She looked at me.  "7.5% is not where we want you. Under 7, if we can, and even closer to 6, if possible.  But it's time, isn't it?  You feel ready?"

I nodded.  A little afraid to speak because this is something I've always wanted.  To be a mom.

"Okay, so it's time to schedule the pregnancy clinic.  Let's get this in motion and we can make everything fall into place.  And I want you to meet with Doctor Boston because she's the leading high-risk maternal fetal medicine ob/gyn out there, and she'll be able to handle your type 1 diabetes, Factor V, and hypertension.  You have more than two decades of diabetes under your belt, so I know you're feeling vulnerable.  We'll schedule this for June?  Does that sound okay to you?  Between now and June, you and I will work together to make this A1C happen."

"So the three of us will be together on this appointment?  And she'll see me through my pregnancy?"

"She'll actually be delivering your baby.  She's the best.  You'll be in very good hands, Kerri."

I had this moment where I clearly pictured this moment of delivery, when I will go from Kerri to "mom" and Chris becomes "dad" and in that instant, diabetes won't count.  It will be about me, and my husband, and my baby.  I felt hopeful that maybe, with enough help, I could really do this. 

"June.  And if I'm good in June, we can actually decide if Chris and I are ready to get pregnant?"

"Some mommies, I worry about.  I worry that they won't be willing to give it the best try they have in them.  But you, I don't worry about.  We can get you there.  You aren't going to do this alone."

"Okay.  I can do better.  I really need to do better.  I'm ready." 

She printed my prescriptions.  They took photos of my retinas to send to the pregnancy clinic.  I paid my co-pay.  I asked Chris to wait for a minute while I ducked into the bathroom.

I closed the door behind me and cried.  I'm so afraid that I can't do this.  I'm so afraid to do this wrong.  I'm almost afraid to try.  I'm afraid to hope.  But I'm so sure that I can overcome these obstacles, just like other women with diabetes have done before me, and become a mom. 

Cried so hard I thought my heart would break because I think this can really happen. 

Hopeful.  Damn it.
 

April 14, 2009

Joslin: I'm So There.

Thumbs up for, um, blood!I'm driving my little Honda up to Boston today for my endocrinologist appointment.  I spent part of last night printing my blood sugar logs from the end of March and the bulk of April (I have been keeping up with The Log Book, as promised - many blue stars on my chart).  I noticed that while I've been feeling like my control has been relatively good, I've had some zinger highs and a few trenches in the last 90 days. 

For whatever reason, I'm not dreading this appointment.  Oddly enough, I'm looking forward to spending the day in Boston, even if I will be at a hospital for much of the day.  Going to Joslin forces my brain to realign, and it always makes me feel hopeful.  I've been a patient there for over twenty two years, and it feels oddly like home.

They'll take an A1C, and I hope it's finally ringing in at NHB Range.  But my doctor has expressed more interest in having my numbers stable, instead of "good" as a result of averaged highs and lows.  She'd rather see me holding strong at a 140 mg/d as opposed to pinging from 300 mg/dl to 40 mg/dl. 

I'm not sure how I feel about an A1C result being the definitive measure of my diabetes control.  (Apparently Lindsey at Blogabetes has had the same thoughts.)  Is this a state of mind I've decided upon as a result of a result over 7%?  People talk about the estimated average glucose (here is a dizzying article including lots of math and here is an online calculator that keeps the math hidden where it belongs), but is it a true indicator of how I'm running?  And what is this fructosamine test I keep reading about?  What is the best way to tell if my body is healthy?

I'll have these tests today and I'll run through my list of questions (including, but not limited to, what can I do about this relentless tendonitis, is my blood pressure well-controlled enough for pregnancy, and do I really need to cut out ALL the coffee from my diet as I move forward here?)  I feel like I'm in excellent hands at Joslin, and I'm ready for whatever today has to throw at me.

(In the meantime, this had me mesmerized for quite some time yesterday.  I wanted to dive into the middle of that couch and snuggle every last one of those furry messes.)

March 16, 2009

The "Ellipmachine."

The Ellipmachine ... by Mennen.When I was preparing for our wedding last year, I spent a lot of time at the gym.  A.  Lot.  As in, too much.  If I wasn't at work at dLife or doing wedding-esque things like cake tastings, dress fittings, and bridal shower fun, I was working out and doing my best to keep the stress from fattening me up.

Fitness was my priority.  

But after the wedding, other stuff started to crop up.  Weekends home in RI.  Travel for work.  Writing projects that required lots of attention.  New focuses at dLife.  Every day was this whirlwind of chaos and while I've been having fun and being very productive, my days at the gym were harder to come by.  Before, I was working out faithfully Monday - Friday after work.  But "life stuff" kept cropping up, and suddenly I found myself at the gym only four days a week.

Then it all became a perfect storm of distraction.  I was working late on dLife initiatives.  I was answering emails from my Blackberry into the wee hours of the night and sleeping less.  My wrist exploded in a fit of tendinitis and low blood sugars returned to my life with a renewed sense of determination.  Piles of snow kept falling and the gym kept closing, and on other days, I worked too late to get to the gym before it closed.

My time at the gym went from frequent and intense to only four days a week and pretty remedial.

Not okay, because my body wants to be fluffy.  It may be a family gene pool thing and it might also be exacerbated by diabetes factors, but if I sit still and let nature take its course, my body wants to be a happy 15 lbs heavier.

I, however, do not agree.

But I was frustrated because between feeling stressed and having lows again, my caloric intake far exceeded my burn off.  Thus, I lost any semblance of abs.  (Shame, too, because I liked them while they were there.)  So, in effort to reclaim my abs before I get pregnant and become a happy beach ball swallower, I did my part to stimulate the economy:  I bought an elliptical machine.

Or, as I keep calling it by mistake, an "ellipmachine."

It was delivered and assembled last Monday morning, and I called Chris (who was on business in California last week) to tell him it had arrived safely.  

"It's here!  The ellipmachine!"

"The what?"  

"I mean the elliptical."

It's a nice machine - very smooth and not clunky as to annoy our downstairs neighbors (I do not want to become Shoes) - and I used it every day last week for an hour.  Now I'm able to go out with my coworkers after work for an hour or two and still manage to slide a workout in.  I am also hoping to use it in the mornings (provided I'm able to get to bed at a reasonable time and eek out a 20 minute workout in the am).  My main hope is to reclaim the level of fitness I worked so hard to achieve before the wedding but lost a bit due to that pesky "life stuff."  

Last week, while Chris was out of town, he called one night and I answered, panting.  

"Hey baby ... what are you doing?"

"Dude, I'm on the ellipmachine."

I could hear him laughing.  "The ellipmachine, eh?"

"Oh you know what I mean."

Here's hoping that the ellipmachine can help me get a workout in even when my schedule wants to thwart my good intentions.  I'm ready to battle.

(Take that, early gym closings!  En garde, late nights at work!  Pffffft, snow days!  Come back, sort-of-abs!) 

February 03, 2009

Frustrated.

I am absolutely furious.

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

Nice.

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

But I'm already starting to climb.   

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

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

BEEEEEEEEP!  Still climbing.

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

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

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

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

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

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

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

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

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

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

January 16, 2009

Appointment'd Out.

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

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

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

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

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

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

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

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

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

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

"Twenty-two years."  I smiled.

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

"What is that?"

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

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

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

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

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

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

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

December 10, 2008

Stupid Diabetes Move.

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

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

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

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

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

"Do you need more than one?"  

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

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

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

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

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

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

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

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

November 06, 2008

Petal By Petal.

I'm picking my priorities, petal by petal.

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

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

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

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

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

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

Diabetes management, petal by petal.

October 01, 2008

Who Can Ignore The Economy?

Photo credit:  Fiction, apparently.Anyone who hasn't been storing their brain in a shoebox underneath the bed has probably realized that the economy is tanking.  People are being laid off and positions are being eliminated at companies.  Grocery money doesn't seem to buy as much now as it did even six months ago.  Gas prices, despite the fact that they've fallen a bit in the past few weeks, are still just under $4.00 a gallon. 

But these are issues that are affecting all families across the nation.  For us, diabetes care can also be affected by the crumbling economy.  My brain tends to go into panicked little pockets when I think about the economic situation.  For me, a job means more than just money - it's medical insurance.  Even now, in good health and without any outstanding medical bills, my monthly medical expenses add up.  From co-pays on items like blood pressure medication and birth control pills to the non-prescription items like prenatal vitamins and healthy food, it can get expensive. 

I was thinking about money in my budget that I consider well-spent, like my monthly membership to the gym and our grocery bill.  For some, spending $30 a month to workout and spending an inordinate amount of money on foods like fresh produce, organic products, and other fancy crap that they sell at Whole Foods and Trader Joes may seem like money that could be saved.  But when it comes to diabetes management, "control" is more than just the pump I'm using and the insulin I'm taking - it's about all these other variables, too. 

I remember (let's step into the Wayback Machine again, shall we?) test strips that could be cut in half, or into thirds, and at least the gist of a blood sugar level could be grabbed by comparing the color of the strip pad against the guide on the side of the bottle.  Granted, today's strips are more accurate, but are they really costing manufacturers $0.85 apiece to make?  (Because that's about what they charge us, as consumers.)  Diabetes supplies used to be able to go further.  Now they are indeed more accurate, but they don't go very far at all.  And keeping up with the costs of this maintenance, in addition to making attempts at important, preventative care like a CGM, is starting to make me a little nervous.  I'm finding my mind going back to the desire to wear infusion sets past their three-day shelf life and refilling reservoirs, to help extend the life of my supplies.  Ridiculous?  Yes.  But when I'm thinking about other life expenses - car payment, rent, utility bills, gas prices, and the occasional movie or night out - I find myself cutting corners where I can.

What are you guys doing to get the most bang from your diabetes buck?  Are you streeeeeetching out the life of insulin pump supplies?  Are you trying to gain insurance approval for a CGM as a way of conserving test strips?  Do you find yourself debating between paying for gas or renewing your gym membership?  The decisions are tough now, and I fear that they may be getting tougher in the future.  (And have you seen the Twitter election feed?  Regardless of who you're supporting in this election, this constant streaming commentary is pretty fascinating.)

The price of good diabetes control is high, and the cost of not trying to stay healthy is even higher.  How are you managing the cost of care?

September 25, 2008

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

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

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

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

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

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

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

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

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

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

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

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

(I hope.) 

August 18, 2008

Diabetes Real Estate.

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

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

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

Infusion set on the back of my arm.

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

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

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

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

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

And how was your weekend?  :)

August 14, 2008

CGM Denial - Yes, Another One.

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

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

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

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

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

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

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

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

I look forward to your response.  

Best,

Kerri Morrone Sparling

July 21, 2008

Blue Bird of Happiness.

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

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

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

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

Bluebird of Good Health 

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

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

"I see that."

"Well?  Doesn't it make you happy?"

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

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

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

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 13, 2008

Brain Skippies.

Monkeys are very talented writers.It's been a day of 'brain skippies' for me, where I have every good intention to accomplish something in full, only to be thwarted by my own rambling mind.  I'm remembering only most of what I'm intending to remember. Case in point:

Exhibit A:
"Did you call the church and check on the payment for the officiant?"

"I called the church.  I forgot to ask that part."

(Now that's not a big deal - forgetting to ask one part of a multiple-parted question.  However, my brain is skipping some steps on more autonomic things.)

Exhibit B:
I remove my meter from the case, lance my fingertip, apply blood to the strip, wait for result, remove strip, rezip case, put meter away.

Then I realize, about five minutes later, that I did not look at the result.  So I have to bust out the meter again and scroll back through the memory.

Exhibit C:
I've been sitting here, at my desk, with headphones on for the last 20 minutes.  Yet I forgot to put the music on.  So I'm just hanging out with the earbuds in, like teeny decorative earmuffs.  I do this all the damn time.  I'm starting to wonder what's wrong with me.

Bit silly there, eh?  I can't imagine what the inside of my brain looks like right now.  Monkeys wearing wedding gowns, typing furiously on ancient Smith Coronas?  With the wedding only five days away and the to-do lists not short enough these days, I'm starting to get a little mixed up and tangled in my tasks.

However, we did settle on a first dance song - The Luckiest, by Ben Folds.  It's pretty, it's plain, and it means something to both of us.  My dress is completely pressed and lovely and waiting at my mother's house for me, complete with perfected pump pocket.  And we've just finished up all the bridal party gifts (I'll disclose those after the wedding - don't want to spoil the surprise!).  We're almost ready for this big day.  I can't believe it!!

April 25, 2008

Friday Six: The Short List.

The Friday Six:  April 25, 2008 editionNo intro.

1.  Last night I attended the premiere screening of Life For A Child in NYC, a moving documentary profiling children with type 1 diabetes who are living in developing countries.  I'll have a write-up for this next week, but suffice to say that there is so much work that needs to be done, both around the world and here at home.  I ended my evening with a low blood sugar as I left the screening and with mounting frustration on how much worldwide attention diabetes needs, yet doesn't receive.  More on this next week.

2.  The dTOEs that were sent in are AWESOME!  I'll be posting the dTOEs, Second Edition on Monday.  :)  If you have any others you want to add, pop them in the comments section for yesterday's post, or email them to me at kerri [at] sixuntilme [dot] com.   

3.  I spent at least a few minutes siphoning through this list of Smurfs to figure out which one I would be.  I think I'm Jokey Smurf (or Schtroumpf Farceur ... are they French or something?) - I love the idea of his alter-ego, the Masked Pie Smurfer, "a cloaked figure known for sneaking up on other Smurfs and throwing pies at them."  Which Smurf would you be?

4.  Speaking of blasts from the past, one of my favorite books growing up was The Monster at the End of This Book, Starring Lovable, Furry Old Grover.  Come on ... you remember this, don't you?  If not, here's a slide show of all the pages in this book.  I remember being terrified of turning the pages when I was little, entirely unsure of what the monster was going to look like.  I read it to my nephew a few years ago - as we turned the pages, he looked up at me with his big, blue eyes, put his hand on my wrist, and whispered, "Auntie, please don't turn the page, okay?"  The world keeps spitting out all this garbage but at least children's books are still wonderful.

5.  Want to be on dLifeTV?  We're looking for people in good health who have lived with type 2 diabetes for 25 years or more. Send our production team an e-mail and tell us about yourself, including your name, age, contact information, number of years living with type 2 diabetes, plus your thoughts on how you have handled your diabetes, especially what you have done to maintain good control.  Thanks in advance!

6.  It's going to be a long weekend, but not exactly a relaxing one.  Tomorrow night we have the pleasure of attending the wedding of two friends in Brooklyn, then a Cirque du Solelil show on Sunday night, then we're spending Monday in RI to finish up last-minute wedding stuff like finalizing the floral arrangements, the marriage license, our marriage classes, and my final wedding gown fitting.  May is right around the corner, and I couldn't be more excited.  :)

Have a stellar weekend, and look for the dTOEs on Monday!   

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 08, 2008

Dexcom Seven: The Warrior Returns.

I made the mistake of saying the following to Chris the other morning:

"You know, I haven't had a low in like two weeks!"

The next morning, the alarm went off and my eyes slowly opened, as though there were weights attached to each lash.  Brushing my hand against my forehead to wipe off the sweat, I reached for my meter and loaded in a strip.  For some reason, the lancet wasn't pricking my finger.  Shunk.  Shunk.  Shunk.  Chris stirred beside me. 

"It won't bleed."  Said as though the blood wasn't mine, the finger someone else's.

Finally, a ruby red spot leapt up from my fingertip.  Five seconds later, 48 mg/dl winked at me from the meter.  I drained the small bottle of juice on my bedside table and snuggled back underneath the comforter, waiting for my body to catch up.

I had two more lows that day, one that left me shaking at my desk at work and another that had me stumbling on the treadmill at the gym.  The next day, I hit a sticky high of 409 mg/dl after a site change, the sweaters knitting up in my mouth and lethargy wrapped around every movement.

The DexSignal

So when the Dexcom Seven arrived at my office, courtesy of the reps out in California, I didn't think twice about suiting up for another round as the Dexcom Warrior.  I installed my first Seven sensor on Sunday night.

I know what you're thinking:  "You had a rough experience with the MiniLink - why are you doing this again?"  

Why?  Because I found the Dexcom to be a superior CGM product.  Minimed makes my pump and therefore has my appreciation, but their CGM unit is sub-par.  Aside from the flopping sensors and the painful insertions, the darn thing just wasn't right.  I know CGMs aren't supposed to be a substitution for manual blood glucose testing, but I had little confidence in even the trends offered by the MiniLink - and I was very frustrated by the errors that were cropping up.

The Dexcom, however, had a more reliable trending ratio and the actual results correlated tighter with my meter.  I'm not thrilled about using a second device (the receiver being its own entire hub device), but if I'm going to make use of a CGM on occasion, I want things to be as "right" as possible.  Like right now:  Dex says I'm 146 mg/dl.  Meter says I'm 137 mg/dl.  It also says I'm on the rise, which is true - I was 92 mg/dl an hour ago.  

So I'm spending this week with the Dexcom Seven, making it part of my work day, my workouts, and my wedding stress.  With wedding planning coming to a wild and all-consuming crescendo, I'm hoping Dex can help me stay more tightly controlled.  Because, between you and I (and the entire internet), I'm having trouble keeping my numbers steady these days.  Diabetes is rearing its head and I, for one, am not feeling very armed for battle.  Hopefully I can sharpen my Dexcom skills and have it as my secret weapon. 

March 28, 2008

The Friday Six: Weekend Prep.

The Friday Six:  March 28, 2008 editionShannon tells me it's snowing like 8 inches up in her neck of the woods.  My mother reports rain in Providence.  And it's chilly with a side of potential frogs raining down here in Connecticut - what the heck is up with this weather?  Here's the Friday Six for this bizarre-weathered Friday.

As I stated in my earlier post today, Children With Diabetes is now a part of the Johnson & Johnson family of companies.  See it ... look closer - it's diabetes, right there on the map.  Nice.  I'm excited to see how this will affect the diabetes community on the whole.  Big news!

In other diabetes-related news, April 14th is Raise Your Voice: Type 1 Diabetes Awareness Day!  There's a Facebook event if you haven't seen it already (and it's not hard to "attend," seeing as how this is a virtual event.)  Now that the troops are rallied, all we need is a logo ... and here's where you come in.  Bill over at EatSmart has offered one of his nutrition scales as a prize for our logo contest - that's a $75 value!   Here are the rules:

  1. Design a logo (the size cap is 200 x 300 pixels). 
  2. Include the event name:  "Raise Your Voice!" 
  3. Have fun designing it.
  4. Maybe have a snack while you're designing - apples are tasty.   
  5. Email it to me as an attachment to kerri [at] sixuntilme [dot] com with the subject line "LOGO CONTEST" no later than 3 pm on Thursday, April 3rd
  6. Grin because it's done and submitted.

That's it.  The winner will be decided on Friday morning and Bill (thank you, Bill!) will send you an EatSmart nutrition scale of your very own.

And one last thing on the scale:  After I posted my review of the EatSmart nutrition scale yesterday, Bill over at EatSmart gave me a call and told me that if you guys want to order your own scale, enter "KerriSentMe" into the coupon field during checkout on the EatSmart site and receive 10% off your order.  I thought that was right-kind of him - so if you're thinking about ordering a scale, score your 10% off, damnit!

I know many of you have seen the Gaping Void cartoons (this one is my favorite today), but did you know you can get business cards with these quippy little suckers on them?  I was unaware.  Now I am intrigued.  I like my business cards, but it would be kicking to have something so bizarre.  Food for thought.  And just as a sidenote:  I love these cartoons. 

Tomorrow is my wedding shower.  (Yes, I know I'm not supposed to know, but since I live out of state, I needed to know what day to come home.  So I know it's tomorrow.)  I know I need to be there at noon-thirty.  And I know it will be fun, because with my mother and my terrific bridesmaids at the helm, it's sure to be an awesome time.  Everything is happening very quickly now:  the bridal shower, then bachelorette party, then the last meetings with our vendors, then the rehearsal dinner, then the wedding ... I'm afraid if I blink, I'll find myself on the plane bound for our honeymoon.  I wish I could slow this time down so I could actually enjoy it!  Instead, I will blog it.  (This may be the mark of a blogging addiction.)

And six.  Ahhh, the final moment for me today before the weekend cracks wide open and swallows me.  This morning, at about 3 am, I woke to the sound of scritch scritching, coming from the bedroom floor.  I ignored it at first, thinking that it was just one of the cats lolling around.  But it came again, louder this time:  scritch scritch.  So I leaned up, looked to the floor, and saw Siah completely wrapped up in toilet paper.  She had completely unraveled the roll from the master bathroom, dragged the bulk to the middle of my bedroom, and made a nest in it.  Like an enormous hamster. 

I do not need a dog.  I have a Sausage cat who laughs at me.

March 05, 2008

Like the Weather.

Last week, I was scraping snow off my car.  The heat was on in the apartment and we were huddled underneath piles of down comforters, often accompanied by a small and irritating gray mess.  This week, I've been carrying my wool coat into work instead of wearing it, and I'm window-shopping for kicky little skirts at Ann Taylor. 

The weather here in New England is about as predictable as my blood sugars some days.  And my moods.

As the wedding draws even closer (it's 75 days away as of today - holy crap), everything has started to seem like it's taking on some fast-forward zoom.  I blink and it's Friday again.  I fall asleep for what feels like an instant at night, only to realize it's been six hours.  It's not stress (I'm trying to leave that behind) and it's not the tasks that need to be completed, but more how quickly time is passing.  In a few weeks, it will be a full year since Chris asked me to marry him.  A week later is my wedding shower.  And barely six weeks after that is my wedding day. 

Life is a patchwork of loosely threaded fabrics with incongruous patterns and unanticipated frays.  I find my mind clutching to the most random thoughts - my imagination is on excessive overload.  I'm collapsing into fits of giggles constantly. I wonder if the people at work think I'm losing it a little bit.  Someone made a comment about how I must keep my cats in cages at home because they are so meddlesome.  I retorted with, "No, I usually peel a banana, remove the banana part, and stuff the cat inside the peel, then reseal it."  My co-worker laughed.  "The ol' cat-in-the-banana trick again."  (Oh how I'd love - LOVE - to see a Photoshop representation of this mental image.  Siah, all tucked into a banana.  I'm laughing all over again.)

They're humoring me, but I don't think they have any idea how oddly wired I've felt lately.  I'm having a hard time writing non-fiction bits at the moment but have been penning so much fiction that it's making my fingers cramp.  My imagination is roaming around unsupervised, waking me up in the middle of the night so I can scribble down the thoughts I'm hosting.  Blogging lately has been a little difficult - maybe because my brain is taking all these unapproved vacations?  Diabetes, for the most part, has been giving me little to worry about, other than the daily maintenance routine, and IBanana - courtesy of www.chidiet.com  :) like it in the background vs. in the foreground clammoring for attention.  Yes, I'll test.  And eat healthy foods.  And sport the ol' insulin pump.  And exercise.  But I'm feeling highly creative, pretty damn moody, and a bouncing blend of extroverted and introverted.  At any given moment, I could either blurt out a poem or burst into tears.

Are these the chaotic emotions of a woman on the verge of getting married?  Is this part of a woman's monthly emotional ritual?  All three?  None of the above?  Is this normal?

Oh shoot, the banana's meowing again.    

February 15, 2008

The Stress Management Six.

The Friday Six:  February 15, 2008 editionStress management has been on the top of my list for the last few months, and I've finally made it the priority it deserves.  I know that all of this cortisol coursing around in my body isn't good on several levels (contributing to higher blood pressure, hyperglycemia, impaired cognitive function ... wait, what was I saying?) and I can't let this go on any longer without making considerable efforts to change.

So, I'm taking on the Stress Management Six.  My ways of dealing with the chaos that comes along with ... life, it seems.  

1.  Better Manage My Time.  Between work, personal projects, and the wedding, I often feel overwhelmed by the tasks that need to be done and instead of tackling the "to do" list, I end up intimidating and spinning my wheels.  I need to really isolate the things that need to be done and prioritize them appropriately.  Do I really need to update my Twitter status every day?  No.  But do I need to make sure that the wedding invite list is completed by next week?  Yes.  Knowing what truly takes priority and not assigning myself too many tasks can help make better use of my time.

2.  Sleep.  Oh blessed sleep.  I have a tendency to stay up too late, throwing off my whole mindset for the next day.  More sleep is pivotal to achieving a lowered stress level.  So I'm buying new pillows.  And mushing my face into them for at least 7 hours a night for starters, aiming for 8 once I get closer to the wedding.  Part of getting more sleep also means cutting waaaaaay back on the caffeine.  I'm used to be a four-cup-a-dayer, but I'm trying to cut back.  Over the last month, I've worked my way down to two cups, and this week it has only been one cup of tea a day.  I'll eventually switch to decaf tea, I think.  Weaning off the caffeine will help lower stress, help me sleep, and keep my brain from imploding due to the jitters.  (I'm like Tweek from South Park when I have too much coffee.)   

3.  Meditation.  After speaking with my doctor this week and describing the anxiety and stress issues I've been wrangling with for a few months, she strongly suggested a meditation class to help keep me centered and help me let go of the things in my life that are tossing me into the spin cycle.  So I'm currently looking for a meditation class near my office or house.  (Which, here in Western CT - aka Soccer Mom Central - shouldn't be that hard.  It's all the rage to sit on a yoga mat and breath deeply these days.) 

4.  Breathing Exercises.  Even if I'm trying my best to avoid stressors, they will still find me.  (They have some kind of honing device, I think.) I need to find ways to deal in the heat of the moment.  I've found some breathing techniques that I can use while I'm, oh, say sitting in traffic, watching the email inbox total climb into the stratosphere, or for those moments when I mash my hand in the bathroom cabinet by accident. 

5.  Disconnect From The Internet.  I spend entirely way too much time on the computer, especially for someone who is completely social and chatty.  It's unnatural for me!  When I am at work, almost all of my day involves the monstrous computer screen (I do so enjoy the WorkMac, though), but I need to make more of a habit of disconnecting when I go home at night.  Usually, my evening includes the gym, dinner, and then more computer work.  Chris and I are resolving to spend less time online in the evening and more time hanging out.  Work can't suffer and tasks need to be completed, but being online all day and all night doesn't do much for my stress levels.  I need a freaking break. 

6.  Take A Freaking Break.  Lately, I've been mostly work and not enough play.  ENOUGH OF THAT.  I am young, healthy, and part of a wonderful network of friends and family.  I'm resolving to spend more time with my friends and less time mucking around on work-related items.  Last weekend was nice, spending it exploring a new city.  This weekend, Chris and I are tucking ourselves away into a bed and breakfast - no cell phones, no internet, and no tasks.  And next weekend, I have some fun plans with friends on tap.  Life is going by so quickly these days - I need to take some time to actually enjoy it and make some memories. 

So the plan is way less stress, which should have a positive impact on my diabetes and my overall health in general.  And if that doesn't work, I may have to move permanently into a hut on the side of a mountain.  Only it will have running water.  And a wireless connection.  ;)

Have a stress-free weekend and I'll catch you, all mellow and whatnot, on the flip side.  Yo. 

Visitors since November 7, 2005