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Fifteen Minutes, Fifteen Grams.

I just needed fifteen minutes, after fifteen grams of carbs.

“I can’t go with you, because I need to eat something else and wait for my blood sugar to come up.  You guys can go without me and come right back, if you want?”

The sentences sounded soft and measured.  Sure, go for the bike ride around the neighborhood, dear daughter and trusted neighborhood friend.  I’ll just sit here and eat fifteen grams of carbohydrate, then wait patiently for fifteen minutes while the food works its magic.

Instead, I was shouting up at them from the bottom of the well, hoping my voice carried in a way that didn’t make my kid nervous, hoping she’s hearing the reassuring tones of my voice instead of the panicked inner monologue that was playing out:

“HEY!  Go on outside and play and don’t watch me mop the sweat from my forehead while I inhale two juice boxes and a packet of fruit snacks.  Ignore me while I fight back the urge to lie down on the kitchen floor and let this weird wave of unconsciousness wash over me.  Pretend not to notice that I’m looking through you instead of at you while I’m talking to you.  Go on outside and let mommy fall apart for fifteen minutes, after these fifteen grams of carbs.”

My daughter and her friend strapped on their bicycle helmets and took off down the street, enjoying the sunshine and almost-summer weather while I stuck a spoon into a jar of Nutella, not giving a shit if this was the best option or healthiest decision but mostly because I wanted to have something sweet on my tongue, reminding me that I was still here and capable of coming back from this low blood sugar and that I could start making dinner soon because I would be capable of standing unassisted, without fear of falling into the abyss, in just fifteen minutes, after fifteen grams of carbs.

Blame the Hormones.

I’m still angry that the UHC/Medtronic issue hasn’t been resolved.  There is/was a ton of discussion about how this is not a decision that takes patient needs and preferences into account but instead seems to cater to what’s best for business needs. “Resolved” would be a reversal of this decision and reinstating the patient/doctor team’s right to decide which therapy is best.  I am very curious to see what the financial disclosure looked like for this partnership. I’m unnerved that the slippery slope is being greased by apathy. Where’s our raised voice?

Sometimes I feel like I don’t have enough skin in this particular game because I don’t have United Healthcare as my insurer and I also have a business relationship with Tandem, but at the same time, I have a full pancreas in the game because I have diabetes. I don’t want insurance companies telling me what’s best for my diabetes; I want that decision made between me and my doctor.

What to do?  I’m unsure.  I know I can share my story about personal diabetes preferences directly influencing health outcomes (hey, like using an insulin pump that fits my current needs in order to achieve an excellent A1C and so-far healthy pregnancy?)  I know I can talk about how access matters, because without it, my life gets ugly fast (she says with the security of three months worth of insulin tucked safely into the butter compartment of her fridge).  But I feel like my frustrations are in a holding pattern of waiting for someone else to do something or suggest something, watching as time slips by and people become more meh about decisions about our health being made by people who don’t live intimately with diabetes.

I deserve the right to choose.  Whether we’re talking about the insulin I take or the pump I use or the meter I rely on, these choices play directly into my health and well-being both physically and emotionally.  I didn’t chose diabetes but I deserve the right to chose how I manage this disease.

I’m still angry about this.  Frustrated.  Confused about what to do next.  And swimming in a sea of hormones that makes me unable to keep my mouth shut and my blog quiet.  What comes next, unfortunately, still remains a mystery to me.

t:slim with a Twist.

Several months ago, I switched insulin pumps.  (Here is the post about the switch, and please read this post about the disclaimer that initiated the switch.  My full disclosure page is here.)  My first impressions of the t:slim pump were drummed up over a year ago, after trialing one for a few weeks, but my real t:slim immersion came once I switched in full.

Funny thing is the timing of that switch.  When I packaged up my Animas pump in favor of a Tandem one, I had also just found out I was pregnant.  Which means that I was adjusting to life as a pregnant PWD and also to a new insulin pump.

tl;dr – There’s stuff about the t:slim pump I wouldn’t have appreciated so soon were it not for the baby-en-route.

Because dude, if I had switched a year ago, I would have been all, “Oh, it looks so cool and the touchscreen is badass, and the fact that it’s flat all the way across the front makes it easier to tuck into my clothes,” making the wearability the most important part of my switch.  Yeah, wearability matters, but not as much as ease of use and OUTCOMES does these days.

(None of the following is medical advice; remember, I’m not a doctor and currently can’t even see my feet in full these days.)

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Entering a bolus is stupid-easy.  And this matters, since every blood sugar counts double these days (for me and for my growing son).  It takes me a few seconds to unlock the pump and bang out a bolus, and only a few extra seconds to add crucial information like my current blood glucose and the carbs I’m consuming.  Part of my over-arching problem of diabetes management is keeping apathy from creeping in; the all day, every day tasks of type 1 diabetes wear on me in a way that prevents me from taking advantage of everything technology has to offer.  Oh, so an insulin pump can calculate my insulin on board (IOB) and the dose I need to bring down a blood sugar back into range, or what’s needed to cover X amount of carbs?  HANDY INFO!  The only thing I have to do is enter that information and it spits out a result?  ALSO HANDY.  But having to scroll forever to enter information is enough to keep me from entering that information.

It’s pathetic, how often I was taking 2u of insulin because it seemed “close enough” to cover what I needed, instead of spending the time calculating the proper dose.  Being able to input this necessary information in a matter of seconds makes me actually DO IT.  My endo is very pleased with this uptick in my management, and my A1C 100% reflects these efforts.

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Changing my basal rates is stupid-easy.  Being pregnant means that my insulin needs are changing rapidly.  First trimester brought about insanely sticky hypoglycemic events, which equaled out to dialing down my basal rates significantly and making frequent use of the temp basal option.  (Again, it’s about the button pushing – it takes me seconds to set a temporary basal rate.  Ease of freaking use FTW.)  Second trimester showed a steady climb in my weight and insulin resistance, with a marked rise in my basal rates and my insulin:carb ratios.  And now, at the beginning of the third trimester, shit is changing all over the place, with some basal rates going down a little bit and my insulin:carb ratio almost double what it was pre-pregnancy.  There’s a lot of math going on in my baby-building body, and being able to change my rates after reviewing my data on Diasend and t:connect makes for easier management.

Holding more insulin is stupid-easy.  The t:slim holds a ton of insulin (300u) and as my pregnancy progresses, I may need that cartridge to be filled in full, instead of the half-way filled I’ve been doing for the last six months.

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Seeing my status is stupid-easy.  One button push shows me how much insulin is on board, how long it will be active, shows how much insulin is left in the reservoir, the percentage of charge left in my battery, and the time.  Oh, and what day it is.  (This matters, as the day and time are bits of information that are being eaten regularly by intense pregnancy brain.)

Not everything is stupid-easy.  This isn’t a list of perfect moments with my insulin pump.  There are pros and cons, and the time it takes to change out the cartridge and infusion set is still cumbersome.  I also am not a fan of the luer-lock tubing bulge, as it takes on a “third nipple” appearance more often than I’d prefer.  And I’ve seen more occlusion alarms with the t:slim than I did in the past.  But I’ll these cons over the pros, especially when I review my lab work from Joslin and see how strong my numbers are.

Being more on-target through my pregnancy is not stupid-easy.  Let’s not make my successes as a pregnant PWD the product of an insulin pump, shall we?  I am working my ass off to make sure my body and my baby are healthy, with just over 11 weeks left to go before we release this particular Kraken.  But having a piece of technology that alleviates the bolus math angst, makes it impossible to forget whether or not I’ve taken my basal insulin, and being able to bang out a correction dose in a matter of moments helps take the pressure off, at least a little bit.

… even if the beeps and boops might startle my developing fetus.  (If that study has any truth to it, my poor kids are screwed.)

 

It’s Just a Blood Sugar Check.

Checking my blood sugar takes less than 30 seconds.  Truly – upcapping the bottle of test strips, inserting the strip, pricking my finger tip, squeezing blood onto the absorption pad on the test strip, waiting the five second countdown of my meter to see the result up on the screen, and then taking the strip out and turning off the meter.

Thirty seconds.

Great.  No big deal.  Easy-peasy, and other rhyming phrases.

Let’s add in the responsive elements.  First, I anticipate the result.

Have you ever had go force yourself to check your blood sugar because you don’t want to see the result?  You know you’re high, so you want to avoid confirming it because seeing that number adds to the emotional failure quotient.  Have you ever forgone checking your blood sugar because you know you’re low, choosing fast-acting glucose sources over the 30 second confirmation routine?  The process of checking blood sugar isn’t just the installation of strip, pricking of finger.  There’s oftentimes an emotional hurdle that needs to be leapt over first, forcing me to attempt to view data as data instead of data as self-worth.

Then I perform the glucose check.

Then I respond mentally.  What is that number?  Do I have insulin on board?  Have I exercised in the last hour or two?  Am I planning on exercising?  Do I need to correct the number, either with food or insulin or exercise, to bring it into range?  Am I okay to leave it alone?

Normal questions like, “Am I hungry?” come to mind oddly late in this hierarchy.

But before the mental response, I respond emotionally.  A blood glucose result of any kind stirs up emotions, even when I try to immediately squash them.  There’s pride built into a 100 mg/dL.  Anxiety built into a 50 mg/dL.  Guilt baked right the fuck into a 300 mg/dL.  This is what keeps me from viewing my data as simply “data,” because every number represents something I’ve done or didn’t do … and I need to remind myself more that the thing I’m honestly not doing is making insulin.  The rest is a basket of beady variables that spill out unpredictably.

Checking my blood sugar is important because it gives me a view of where I’m at and helps me set the pace for where I’m going.  But it’s never “just a blood sugar check.”  It’s more than that.  There’s so much mental and emotional real estate dedicated to a 30 second process.

 

Racing on Insulin: 100th Running of the Indianapolis 500.

What did you do this weekend?  Me?  Oh, I spent Sunday afternoon with 41 of my DOC friends at the 100th running of the Indianapolis 500 race.  Sort of.

Diagnosed with type 1 diabetes in 2007, Charlie Kimball is driving the narrative about type 1 diabetes as the first licensed driver with diabetes and first licensed driver to qualify for and complete the Indianapolis 500 in the history of Indycar.  He and I have known one another for many years (he’s been a good sport as far as videos, Twitter, and allowing my infant daughter to sit in his race helmet), and it’s been truly humbling AND EXCITING to watch Charlie rise in the Indycar circuit.

And on Sunday afternoon, Charlie Kimball got behind the wheel of his No. 42 Tresiba Chevrolet and took to the racetrack.  But he wasn’t alone; he had his Novo Nordisk Chip Ganassi Racing team by his side, and the names of 42 diabetes community friends emblazoned on the sides of his car.

I talked with Charlie on Friday, before the race, and he shared a little bit about why he raced with diabetes advocates on his car.  “With the Indianapolis 500, there’s so much history, so many stories, so many anecdotes.  Novo Nordisk and Chip Ganassi Racing wanted to do something to kickstart the conversation about diabetes.  We wanted to do something cool, something to make sure that the diabetes community had their story heard.”

This weekend, Charlie wasn’t racing as #83, but instead as #42.  “The number 42 comes up often – there are 42 names on the car, Tresiba [new basal insulin available through Novo Nordisk] lasts for 42 hours, and 42 is the number on Kyle Larson‘s car.”  (Kyle Larson races NASCAR, and Kyle’s cousin Justin has T1D.)  “People don’t often see that Chip Ganassi has real team relationships across series, which is why I’m proud of the tie-in this weekend with Kyle.”

“Yours was the first blog I read that gave me the confidence to talk openly about diabetes.  You, them, us as a group drive that conversation about diabetes and engagement.  Diabetes is a big part of what I do and who I am.  And [putting the names on the car] is an opportunity to encourage the story to be told.”

And Charlie told his story, and ours, by finishing 5th in the Indy 500.

 

Way to go, Charlie!!  Thank you for continuing to represent the diabetes community – we’re proud to be part of your team.

(all photos credited to credit to LAT Photography USA)

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