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Posts from the ‘Pumping Insulin’ Category

Prebolusing the Sh*t Out of Things.

Now, at the halfway mark of my pregnancy, insulin resistance is becoming a bit of a thing, and is going to progress into an Actual Thing as the weeks go on, which happened last time and I’m prepared for but it still a bit whoa and this sentence is a run-on.

Which means that basal rates are creeping up ever-so-slightly (my pre-pregnancy basal total was around 13u and I’m now up to 16.2u) and my insulin:carb ratios starting to dance (pre-pregnacy was 1:10, am now 1:9 … except lunch is 1:12 because why would things be consistent?).  When I first found out I was pregnant, my endocrinologist told me that post-prandials contribute most to macrosomia, so keeping my post-meal blood sugars as in-range as possible would help mitigate that risk.  (But let’s take a look at the risk list … pre-existing diabetes?  Check.  Over 35?  Check.  Previous pregnancies?  Check.  Having a boy?  Check.  Cool.)

The plan?  Actively and aggressively pre-bolusing the shit out of my meals.

This sounds like an excellent plan, in a perfect world.  Pre-bolusing works well for me when the bolus is delivered at least 20 minutes before eating, the meal is properly carb-counted, and nothing delays the process of eating.  But one monkey wrench in that process can muck the whole mess up.

Pre-bolusing can feel spooky, like I’m tempting fate and inviting a low.  Not doing it is like opening the door for a high.  The middle ground could use some xanax.

Over the last few weeks, my pre-boluses have been executed with precision.  A few fistfuls of jellybeans have worked their way into rotation when I’ve bolused too early, but that’s to be expected.  The temp basal option on the t:slim is stupidly easy to employ, so sometimes I use a temp basal to help back me out of a mild low, but overall, I’ve seen my post-prandials come down nicely and hopefully my ultrasounds continue to show a very boring, predictable pregnancy progression.

Makes meals interesting, though.  They’ve become a game of roulette.

“Do you think we’ll get seated right away?”  Or, “I forgot to pre-heat the oven and now dinner is going to be 15 minutes later than I thought.”  Or, “Fuck.  I forgot to eat!”

I’m pre-bolusing all over the place.  Usually it works fine.  Sometimes I end up wicked low.  But every time, it’s in effort to keep my post-prandials from causing chaos in my kid.

SOP for TSA and PWD.

This past week, when leaving Las Vegas and heading home to Rhode Island, I had another new experience.  The TSA pat-down agent, after making a horrified face when I told her I was wearing an insulin pump, told me she has to check the pump itself and then my skin where I was wearing it. Since it was in my bra, it was a new-to-me, highly intrusive variation on the different-in-every-city pat down procedure. When asked why she had to inspect my skin, she said it was standard.

I told her I had never experienced that before, and she said, “Well, then everyone else was not doing their job.”

First time in ten years I’ve ever had that particular experience.  So I guess everyone else wasn’t doing their job this last decade?  I have seen my fair share of airports, and most of the time, going through security is fine.  Except the pat-downs keep getting weirder and weirder.

I don’t enjoy the pat-down experience, but I do it about 90% of the time.  Why do I opt for a pat-down?  For my previous pumps, their company websites advised to avoid metal detectors, etc. (Animas, Medtronic) and my current pump suggests the same:

“Your pump should not be exposed to X-ray screening used for carry-on and checked luggage. Newer full body scanners used in airport security screening are also a form of X-ray and your pump should not be exposed to them. Notify the Transportation Security Administration (TSA) Agent that your pump cannot be exposed to X-ray screening and request alternate means of screening other than X-ray. 

Your pump has been designed to withstand common electromagnetic interference including airport metal detectors.”  — from Important Safety Information on the Tandem Diabetes Care website

Since I don’t go through the metal detector unless I’m traveling with my daughter (details here), my only option appears to be a pat-down.  TSA.gov assures me that if I opt for a pat-down at the airport, instead of going through the metal detector or the advanced imaging technology revolving door thing*, this is what I’ll experience:

“If you cannot or choose not to be screened by advanced imaging technology or a walk-through metal detector, you will undergo a pat-down procedure instead. You may also undergo a pat-down procedure if you alarm the screening equipment and/or at random. The pat-down will be conducted by a TSA officer of the same gender and you may ask that the TSA officer change their gloves before performing a pat-down. The TSA officer will ask whether you have an injury or tender area to treat such areas accordingly during a pat-down.

You may request to have a pat-down in private and be accompanied by a companion of your choice. You may bring your carry-on baggage to the private screening area and may request a chair to sit if needed. You will not be asked to remove or lift any article of clothing to reveal sensitive body areas. Please note a second TSA officer will always be present during a private pat-down screening. Learn more from these frequently asked questions.”  — from the TSA.gov website, under Pat-Down Screening

TSA has a number you can call for further explanation.  There’s even a card that I can present, making my case on paper that I’d like a minute to explain myself.  And our friends at the American Diabetes Association have provided some good, “what to expect” information on their website.

I’ve had dozens of pat-downs and these experiences are diverse but not remarkably so.  Sometimes the woman who is screening me asks me to touch the Dexcom transmitter and have my hands swabbed; other times, the transmitter is ignored entirely.  Sometimes they check the bottoms of my feet.  Sometimes they confess that they have a diabetes connection.  Sometimes they want me to hold the insulin pump in my hands during the screening while other times it’s okay to keep it where it is.  I’m always asked if I want a private screening.  I’m always asked if I can stand for five minutes.  And I’m always asked to face in the direction of my belongings.

Thankfully, most often the security experience is completely mellow and fine.

But there are some weird, unsettling moments.  Like the TSA agents who run their hand from my ankle to my groin, jamming their hand forcefully against areas of my body that I’d rather not have jammed.  Or the time I was asked to take my pants down for a (in my experiences) rare visual inspection of my sensor.  There was one time that a lady tickled me the entire time (Dave Rogers from Dexcom can attest to that awkwardness, as he watched, horrified, from the next aisle over), but that was more weird than wrong.  There was the time I was made to feel like my rights had been stripped.  And it’s not always the physical acts taking place that are varied, but the response from TSA.  Apologetic, apathetic, or stoic expressions from the TSA agent are easy to roll with; the moments where I feel judged or like I’m annoying them for opting out are not as fun.

There doesn’t appear to be a true standard operating procedure for interactions between TSA and people with diabetes, but there should be.  I should not have my genitals slammed by an agent.  I should know whether or not my sternum will be examined during a screening.  My medical situation should not keep anyone from doing their job, but I should know what to truly expect so that I can prepare, not be blindsided by the different ways that TSA executes this screening.  There are lots of resources I can point to that outline my rights, but I need to remember what they are in the moment of examination and stand up for myself.  Because no one wants to see my underpants.  And I sure as hell don’t want to show them.

 

 *  Revolving doors are terrifying.  I’ve gotten stuck in them more than once and it’s super awkward and always embarrassing.  I wish I had more of an Elf approach.  

Everybody Beeps.

(With deep, deep apologies to R.E.M. and Everybody Hurts)

Everybody Beeps

When your day is long
And the night, the night is yours for sleep.
When you tuck yourself in bed
For some rest … well hang on

Don’t close your tired eyes
Cause you wear a device
And everybody beeps … sometimes.

Sometimes reservoirs are low
And need to be refilled.
So you get up out of bed (set off, prime on)
Remove the older site (prime on)
You fill with what you need
For three days … well hang on

Everybody beeps
Takes comfort in the tech
Everybody beeps
Don’t throw your pump, oh no
Don’t throw your CGM
You feel like you’re alone?
No, no, no … you’re not alone.

If your islets are a mess
And you’re doing the best you can
When you think you’ve had too much
Of the beeps, well hang on

Well everybody beeps, sometimes.
But you are not alone.
Community is here.
All the time.
We’re here all the time.
All the time.

So hold on, hold on
Hold on, hold on, hold on, hold on, hold on, hold on
Everybody beeps

Open the Door.

For several weeks, I was flipping open the charging port on my t:slim insulin pump and plugging it in while I was in the shower.  But then I noticed the charging port cover was looking a little worse for the wear, and I connected with a friend about best practices.  (“Best practices” standing in for “How the hell do you charge this thing without breaking the door off?”)

Turns out the door swivels.  And swiveling the door keeps it from ripping.

Swivel that door! #tslim

A photo posted by Kerri Sparling (@sixuntilme) on

Well I’ll be (… more careful, more aware, a swivel-er).

(Also, you tell me if “Open the door” as a post title immediately made you think “get on the floor … everybody walks the dinosaur.”

 

[Tandem disclosure]

 

My Tail.

Do you know the source of this image? Please let me know so I can link!

“Miss!  Your tail!” the lady behind me called out, touching my elbow.

I looked behind me and sure enough, my insulin pump tubing – my tail – had come loose from underneath my shirt and wrapped itself around the metal shelving at CVS.  I was two steps away from pulling out my site, three steps away from jacking up the shelf of Maybelline cosmetics.

“Thank you!”  I said, walking back quickly and disengaging my tubing from the shelf, not before knocking over a display of wide-eyed Beanie Boos.

Awkwardness.  Maybe she’s born with it.  Maybe it’s diabetes.

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