• 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.

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

My pump.

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

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

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

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

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

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

"Oh no, your pump?"

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

"Are you high now?"

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

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

This morning's post comes from Jacquie of Typical Type 1, and I'm very honored to be sharing her writing talent here on SUM!

I swear I wasn't trying to get out of jury duty.

See, I was in the juror pool, answering questions about my job, my home ownership status and the last parking ticket I'd received, when the judge asked one question of all of us: "Is there anything we should know about that may impede your ability to serve as a juror in this trial?"

Sheepishly, I raised my hand. "I have Type 1 diabetes," I admitted. "It's not a huge deal, but there may be a few minutes when I'm not able to pay complete attention. I may have to eat something in the middle of the trial."

For a second, no one said anything. Then the judge spoke up: "Hundreds of thousands of Americans have diabetes, and they're able to perform everyday tasks like jury duty. If you need to eat, just let us know, and we'll take a recess."

I nodded, and accepted my fate as a diabetic juror. (Also, I felt like kind of a dumb ass for even saying anything.) While I sat there and listened to the details of the trial and the life stories of my fellow jurors, the weird familiarity of the situation started to sink in. Of course I know that hundreds of thousands of Americans live with diabetes, Your Honor. Of course we're all able to perform everyday tasks with relative ease. Of course I'm a normal person – except for the times when I'm not. Sometimes I have to excuse myself from a meeting or a bridal shower to shotgun a juice box. Sometimes I wear a mechanical pancreas in my cleavage. Sometimes I say things on the phone with insurance company customer service representatives that I would never say to a person in real life. But I'd be darned if some innocent citizen was going to go to jail because I'd miscalculated my breakfast bolus and spaced out on the defense's arguments.

This was a perfect example of the proverbial tightrope we all walk as people with diabetes. Lean too far to one side, and you're Sick. Fragile. Old before your time. Wilford Brimley's biggest fan, with a collection of pill organizers and sad story to tell anyone who asks you how your day is going. Teeter too far to the other side, and your friends, family members and co-workers begin to believe that your diabetes is no big deal, after all. They'll become convinced that your insulin pump does all the work for you, that diabetes is no more of an inconvenience than the task of flossing, that maybe if you just exercised more or laid off the Cinnamon Toast Crunch, your health problems would effectively disappear.

Before I started wearing my pump – and way before I started connecting with others in the diabetes online community – I treated my disease as an accessory. I wasn't embarrassed about it, but I wasn't exactly forthcoming, either. I gave myself injections in cars and at dinner tables the way other people apply lipstick. I kept up with everything, but I didn't obsess over it. Every once in a while, a roommate would complain about my trail of test strips, or someone would shoot me a look while I tested in public, and I would retreat into a more secretive or jocular mode, shrugging off diabetes like it was a case of the sniffles or pesky rash.
Now that I'm in my thirties, I feel like it's a tougher performance than ever. I don't want anyone to assume that I need to eat lunch just because it's noon, but I also want people to know that when I need to take a break from normal life to treat a low, I'm not screwing around. I really do feel like crap, and I really am in a potentially scary situation. Forty-five minutes later, however, I feel as average as they come. (Assuming I haven't overtreated, of course, but that's an entirely different kettle of Swedish Fish.)

I suppose the balance between "sick” and "normal" is just as difficult to achieve as a consistent blood sugar level that's not too high or too low. The story of Type 1 diabetes – and how any person lives with a chronic illness – is a complicated and nuanced one, and it takes decades to tell.

Am I a healthy person who happens to have diabetes, or a diabetic person who happens to have a pretty healthy life? For this girl, the jury's still out.

*   *   *

Thanks, Jacquie!  And for you guys, what's your take on that last bit?  Are you a healthy person who has diabetes, or a diabetic person who has their health?  

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

BEEEEEEEEEEEEEP!

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

Shunk.

Another blood sugar test confirmed yet another low.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Click here to vote for Jenni's panel!

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

Fear has never been a good motivator for me.  When I'm scared, I have a tendency to hole up and hide.  When I think about the future of my diabetes, I know there is a good chance I will have some kind of complication. I have sat in the endocrinologist's office far too many times to tune out the threat of "what might happen."  I know what could be brewing.  Like it or not, I understand the effects of unmanaged diabetes.  I work hard to manage diabetes.  But I'm not so hot with managing the fear.

And if, for even a second, I forgot what diabetes complications may be waiting in the wings, I have many things to remind me.  Like the pamphlets at doctor's offices.  And the commercials on TV.  And videos about how diabetes can cost you a leg.  

That video makes me so frustrated because if I had seen it before the diabetes online community had bloomed, I would have been so distressed.  The images in that video would have haunted me, but not in a way that would impact my diabetes favorably.  That kind of video makes me want to stick my head in the sand and pretend it's not happening, instead of taking charge and control of my own disease and realizing I have the ability to impact my future health TODAY.

I think it's more important to remember that there is a good chance I WON'T have some kind of diabetes-related complication. That some combination of good care and good support and good luck (yes, I think some of it is just plain luck) will usher me into my later years without a scary complication. Fear is not the best motivator for me - hope is far more effective.  I hope to be healthy for a long time.  And it's hope that keeps me testing my blood sugar every morning, working with my doctor to best-manage diabetes, and monitoring this monster closely. I don't want images of amputation flashing in front of my eyes every time I go to grab my meter.  I'd rather think about blowing out the candles on my 75th birthday party, a strong and healthy old bird.

Fear?  No thanks.  Give me hope any day.

(Favorite line:  "Toenails from a man.")

(The previous paragraph is filled with lies.  Big, fat ones.)

I wish I was a precision carb counter.  I wish I had the patience for it, always either eating pre-packaged and factory-analyzed foods or spending my time carefully measuring and weighing any home cooked adventures.  But I am not a precision carb counter.  

I'm a precision carb ... guesser.

During the nine months of baby-building, I became pretty good at guesstimating carb content based on the size of the food serving.  You know, like a "deck of cards" is the size of a meat serving, or an oatmeal serving the size of my fist.  (When I was at dLife, the food and nutrition editor did this article on serving size visualizations, which I thought was really good.)  But while pregnant, I tested a LOT and wore the Dexcom every damn day, so there wasn't much of a chance for my blood sugars to dance around due to controllable variables.  (Hormones?  That was a whole different story - they made my numbers nutty.)

But now, with baby out and my level of diabetes management slacking a good amount, I'm losing my attention to those foodie details.  I'm back to eyeballing things without a reference point ("That bathtub of pasta?  That's about 25 grams of carbs.") and doing some seriously wild guessing.

I'm okay with being a guesser.  It fits with my lifestyle (my purse isn't big enough for a scale, thank you very much) and I'm reasonably good at it.  For me, the key to keeping meals from spiking me all over the place is to do the following:

1. Bolus well in advance for meals.  Not the 15 minutes I was told when I first started on Humalog.  I'm talking like 35 minutes before I take a bite.
2. Asking about rogue sauces in meals.  When we're dining out, I always ask if the meat comes with a sauce or if the salad comes drenched in dressing.  I've found that "on the side" helps me keep from devouring hidden carbs.
3. Refresh my visual memory.  I need to remind myself, at least once a month, what "one serving of pasta" looks like.  I need to measure it out at home and actually look at it before I chow on it.  Because without that reminder, portion sizes get all distorted in my head and suddenly I think one "small apple" is akin to this. 

There's something so therapeutic about art, whether you color in the lines or all over the place.  It feels good to express yourself artistically.  I have some friends whose paintings look like photographs, and ones whose photos look like beautiful watercolors.  Their talent amazes me, and I envy it.

Because I am not artsy fartsy.  I wish I was.  I can't draw or paint of sculpt up anything remotely recognizable.  But thankfully, being "artsy fartsy" isn't limited to the classically talented.  You can let you art out by means of crayons, or sticking googly eyes on mustard jars, or creating a log cabin out of old glucose vials.

Which brings me to the point of this post:  Diabetes Art Day.  September 1st has been deemed Diabetes Art Day by the diabetes online community's resident art therapist, Lee Ann Thill.  Here are the details, courtesy of Lee Ann's blog post:

"I’m asking you to break out of your linguistic comfort zone, bust out some art materials, and make a piece of artwork – painting, drawing, collage, sculpture, an installation piece, a mixed media something or other, or whatever you can imagine. I’m sure most of you don’t consider yourselves artists, but I think that you are, and just haven’t discovered it yet. Then, once your masterpiece is complete, post it on September 1st. If you want to get your family involved, maybe each of you can create something, or you can even do a group art project. The possibilities are endless if you use your imagination!"

Even though my talent is limited, I'm very excited to participate in this advocacy effort.  And I can't wait to see what everyone submits for September 1st!

(For more details, please visit Lee Ann's post on Diabetes Art Day.)

But the kidlet is four months old, and I've begun the weaning process from breast to bottle.  I'm still feeding her in the morning and once or twice throughout the day, but my days of full-time breastfeeding are in the past.  Within the next two or three months or so, she'll be fully weaned and my body will be mine to mess around with again.  (Thinking about adding an extra set of hands - would be useful additions when it comes to changing a diaper while shooing the cat away.)

More realistically, I'm thinking about Symlin.  Once BSparl isn't directly receiving the drugs I am taking, there will be some medical changes to my regimen.  My endocrinologist has already told me that once the baby is weaned, I'll be moving from my blood pressure medication Labetalol to the previous drug I was taking - Altace 2.5 mg.  And I'm already wondering what tools might be at my disposal for blood sugar management, other than insulin.  Like maybe that Symlin character.

I have mixed feelings on the whole "additional drug" thing.  Over the last year or so, I've become sort of hyper-aware of what's safe for a pregnant woman, from deli meat to drugs.   "If it's bad for a growing baby, how can it be good for me?" is the question rolling around in my head almost at all times.  I understand that sometimes it's a risk/benefit situation, like with deli meats (the nitrates aren't great for me, but they could be really crummy for a budding fetus).  Or the Labetalol, which isn't a drug you want to be on during pregnancy, but if I had ditched blood pressure meds entirely, my experience with pre-eclampsia could have started in the second trimester, instead of the third.  Symlin is something that can help tremendously with post-prandial spiking (and additionally, with weight management), according to the claims on their website.  And I like the idea of that extra assistance all the way around.

But I'm a little sketchy on the idea of taking a drug that has some known nausea side-effects.  (I HATE puking.  Hate.)  And then there's the "Hey, you're on an insulin pump so you don't have to worry about injections ... oh wait, here's another injection."  I feel all uppity and self-righteous about adding in another drug, because in my opinion, less is truly more.  One thing about Symlin, though, is that the decision to try it doesn't mean I have to stay on it.  I could opt in for a few weeks and then return to life without it.

So much to think about in anticipation of my November visit to Joslin.  Has anyone used Symlin and survived the icky first few adjustment weeks?  Could Symlin, in addition to exercise, help me toss the last ten pounds of baby weight?  Is this drug worth shooting up?

Inquiring minds:  I haz one.

Which is why, when Chris told me he was making a batch of egg white ice cream, I was all "Whaaat?" and then "Bring it on."

Chris stumbled upon this recipe in a fitness magazine (can't remember which one) and he busted out the mixer the other night in efforts to give it a go.  I scoffed, because I thought it was a little nasty making ice cream out of egg whites, but then he explained that the egg whites are pasteurized, so they're safe to eat uncooked.  And then he explained that the whey protein makes the egg whites taste like chocolate.  And then he handed me a spoonful, and by golly, he was correct on all counts.  

So I wanted to share this tricky little recipe with you guys, because I was impressed that something so "Rocky" could taste so "Rocky Road."

Pour approximately 1 1/2 cups of egg whites into a glass or metal bowl (plastic bowls keep the eggs from whipping themselves into a frenzy properly) and beat them senseless for several minutes, until the egg whites are forming soft peaks.  

Once you have those peaks going on, add approximately 2 1/2 scoops of whey protein (preferably chocolate).  The egg white will deflate considerably, so don't worry.  Just be sure to have the eggs beaten to a texture of your preference.  After the protein is thoroughly mixed with the egg whites, add your sweetener of choice.  (We used two packets of Splenda in ours.)  Put the bowl into the freezer and watch Stephen Colbert (NATION!) while you wait for the "ice cream" to freeze. 

Amazingly enough, this crazy concoction DOES become something resembling ice cream.  And it tastes good, too.  (Point: Chris.  Turns out these weigh lifting magazines have useful information in them, and not just photo shoots of this guy.)

Dude, you are four months old.  (And yes, I'm calling you dude now, too.  Daddy is 'dude' and you are 'little dude.'  I sound like I'm about one President short of Point Break.)  Four months!!  

When I look at pictures of you from your birthday week and then ones from this past week, the differences are astounding.  You are developing a little personality now, and it's amazing to watch you come into your own.  You love being toted around in the Baby Bjorn.  You like to chow on the edges of your bibs and dresses and the little linky things that hang from your play mat.  Basically, you'll chew on anything that sits near you long enough.  (Watch out, Siah.)

In the last few weeks, you've made some big advancements.  I'm convinced that you say "Hi" now, because every morning we lean into your crib and greet you for about ten minutes straight.  "Hi!  Hi!  Hi!"  We sound like lunatics, but you laugh and kick your legs like you're Mini Pele, so it's worth every moment.  You also rolled over for the first time yesterday while we were at your Mema's house, rolling your chubby legs over and shifting your hips until you went from your back to your front.  And then, at home that night, you did the same thing, and then went from front to back.  Was this an epic moment in the span of humanity?  Nah, but it was a big moment in the life o' BSparl, because now you're on your way to becoming a mobile little biscuit.  (And NBF is excited, because once BSparl is crawling, we can race our kids.)  

Also, you've discovered your thumb.  First, you found your hands and spent many minutes staring at them as though you were tripping.  (Hey maaaaan ... fingers!)  But once the shock of realizing these little starfish were attached to your arms was past, you set upon eating them.  Entirely.  We'd find you trying to shove your whole hand into your mouth at any given moment, chomping on your little fingers with your tiny, toothless mouth.  After a week or so of trying to consume your hands whole, you gave up and decided to focus on that delicious little stem at the end.  And just like that, you became a little thumbsucker.  Daddy and I are already saving for the orthodontic work you may need in the future, but for now, we just get a kick out of watching you learn and grow.

Chompies on the thumb.

Your eyes are beginning to change a little, and they appear gray one day, hazel the next.  Will you be a brown eyed girl?  Only time will tell.  But your red hair is giving way to light brown, and it's falling out and growing back at such a rapid rate that I can't keep up.  (For the record, you looked adorable with male pattern baldness.)

This past month, you had your first overnight at Grampa's house, your first trip to the beach, and your first side-by-side car ride with your best friend (NBF's daughter).  You had your first run-in with my insulin pump (kicked it when you were flailing while burping - didn't like it very much, did you?) and your first wide-eyed response to the Dexcom wail. 

You are growing up so fast, little dude.  When I send photos off to be printed, you don't look like that anymore when they return.  As much as I'm excited to walk hand-in-hand with you and watch you run and hear your first words, sometimes I snuggle you close when no one is looking and whisper "Please, slow down."

Love you so much, pancake,
Mommy.

*   *   *

The wheels on the grocery cart clatter against the store's tile floor as my Internal Motivational Speaker and My Stomach wage war inside my head.

Internal Motivational Speaker:  Oh Kerri, don't those organic cucumbers look delicious!  You can slice them up and eat them as a snack in the morning.  Grab two of those.

My hands extend out and grab two cucumbers.

Stomach:  Seriously, dude, if you don't get me something to eat I am going to make that noise you hate.  You know the one.

Internal Motivational Speaker:  And raspberries!  They are filled with flavonoids.  Get those, too.

The raspberries make their way into my cart.  I shuffle through the grocery store on autopilot.

Internal Motivational Speaker:  Yes, yes.  Baby spinach.  Some sliced turkey and cheese for sandwiches for lunch.  Good idea.  Baby carrots ...

Stomach:  Baby spinach, baby carrots.  You eat babies.  Heh heh.  FEED ME.  I'm running out of patience. 

I turn right and make my way down the granola bar and cereal aisle.

Internal Motivational Speaker:  You liked those organic granola bars we bought last week.  Grab another box of those.  Keep walking past that cereal, too high in carbs for you.  You know if makes you spike.  How about some banana bread oatmeal?  That worked out nicely.

The area just below my belly button lets loose with a low growl, like I'm hiding a ravenous bear underneath my workout shirt.

Stomach:  See?  Told you.  You can't go to the gym and then come straight here without feeding me.  I've let the bear loose now.  That guy over there just looked at you because it sounds like you are about to throw up.  Ha ha ha.  Because you eat babies.

Internal Motivational Speaker:  Stomach, stop being so crude!  We'll be home soon.  Just be patient.

Stomach:  I am being patient.  You don't know what I've been through, lady.  She did abs tonight.  Do you know what that means?  She spent way too much time crunching and now I'm all tense.  Hey Kerri, grab those frosted mini-wheats.  I've earned them.

Internal Motivational Speaker:  No no!  Frosting on the outside means high blood sugars on the inside, you silly prat! 

Stomach:  They say whole-grain.  Do you see that, Kerri?  Whole-grain.  Grab 'em.

Whispering "Whole-grains are in these," to myself, I add the mini-wheats to my cart.

Internal Motivational Speaker:  I can't believe this!  You just went to the gym and now you're adding "frosted mini-wheats" to the cart?  I mean really, Kerri, you need to get your priorities straight.  Now come on and put them back.

Stomach:  Kerri, you have your priorities in fine order.  You are eating well and exercising and torturing the hell out of me.  Add those mini-wheats to your rabbit food carriage and let's get on with this.  I need a snack. 

The bear growls again.

Stomach:  Rocco's getting upset.  Better move on.

I move the mini-wheats underneath the bags of fresh vegetables.  My Internal Motivational Speaker sighs deeply.

Internal Motivational Speaker:  I can still see them, you know. 

Stomach:  Oh would you just shut up?

Internal Motivational Speaker:  I will not.  And another thing ...

I hear the sound of a heavy chain snapping and the ravenous roar of a hungry bear. 

Stomach:  Sick 'em, Rocco!

Internal Motivational Speaker:  Noooo!!  Oh God, I can feel his breath on my motivational neck!  Help! 

Her voice trails off.  And the mini-wheats stay in the cart.