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Posts tagged ‘diabetes’

Reimbursements.

“I’m not positive I can make it in for that appointment, since I’m traveling for work for the majority of those weeks.  Would it be possible for me to send my device data by email and have you review it for any issues?”

Without pausing, my endo said, “Yes, we can do that.”

We’ve seen a lot of one another over the last seven months, as my pregnancy has progressed.  Appointments are at least monthly and while we review the same things during every appointment, reviewing these same things is necessary over the next few weeks.  She made a note in the computer system and something occurred to me.

“Do you get paid to review those emails?”

“The emails?”

“Yes, when I email you blood sugar logs and you review them.  Are you paid for that?”

She paused from her typing.  “No.”

I never forget that the issues I have with the hospital system are not related to my endocrinologist specifically.  She’s forced to work within that system, and her ability to flex her capable caregiver muscle is hindered by billing codes and administrative responsibilities.  But I do forget that she goes above and beyond in many circumstances, oftentimes not paid for the work she does for her patients.  And I’m not nearly as appreciative of her work as a clinician as I should be.  It’s not her fault the system sucks.

“Thank you for doing that,” I said.  “I appreciate it.”  Our appointment continued.

Being a patient is hard work.  I didn’t choose this road, and I would not choose this road.  But being an endocrinologist is hard work, and her road was chosen.  I have to remember to say thank you more often.

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.

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.

 

Diabetic Pregnancy: 25 Weeks and Counting Slooooowly.

A quick-ish update on pregnancy stuff.  It’s week 25 and I’m deep into the second trimester, just about ready to launch into the third and final lap on this baby stuff.  Warning:  I’m feeling uncomfortable and whiny this evening, so read this post through a lens of hopefully-forgiveable waaaaaaaaah.

Blood sugars.  I have them.  And they continue to be weird.  I remember dialing up my basal rates quite a bit when I was pregnant with my daughter, but this time there’s more focus on my insulin:carb ratios.  (Which, for the record, used to be 1:10 or 1:11 across the board, but now are 1:7 and 1:6.)  My overnights and mornings are very steady, but mid-to-late evening is where I am still falling apart and going higher than I’d like.  My endo has made tweaks.  I remain tweaked. But my A1C is the best it’s ever been in my entire life, so I need to stop bitching.

Doctor’s appointments.  I have them, too, and they all irritate me because I’ve made the horrible decision of anchoring each one in Boston. I trust the medical team at Beth Israel and Joslin (in combination) to help me see this pregnancy through to its successful conclusion, and I know my health and my baby’s health are in good hands with these medical professionals. BUT. I hate the drive into Boston from southern RI. I hate waiting for doctors who are running late (though this was not an issue last Friday – a very nice and welcomed respite from waiting 40 min to an hour to be seen by one doctor). Last week, I had an endo appointment, eye dilation, OB/GYN prenatal visit, and an ultrasound on the same day. I spent six hours in Boston being poked, scanned, and paying for multiple parking garages.

All of this is necessary for the health of me and the baby being built, but at the same time, the stress of trying to coordinate the appointments and corral childcare and take time off from work has been a lot to juggle mentally and physically.  And it causes major whining.  Like, MAJOR. (Like this whole post, perhaps.)

Thankfully, the endo appointment resulted in minor tweaks, the eye dilation showed nothing surprising or panic-inducing, the prenatal visit was an exercise in “Hey, everything looks awesome,” and the ultrasound showed a baby boy who was perfectly in range in terms of size and activity.  My c-section has been scheduled (and is subject to change, depending on how my blood pressure does for the next few weeks), but thankfully, I’m not even on blood pressure meds at the moment since everything is in range.

Lots of checks and balances to make sure everyone is safe.  The end-game is healthy baby, healthy mom.  And I’m on track for both of those things, so I need to keep my head on straight for the next pile of weeks.  But doing that has been hard lately, since I’m pretty freaking uncomfortable.

Planning for August.  Dude, I can’t wait for August.  We’ve dug out all of Birdy’s useable hand-me-downs (including the crib, which needs to be un-dissasembled, and a high-chair that shamefully still had three gluten-free sweet potato puff lodged into the base of it) and my son’s room is painted and somewhat figured out.  And in preparation for his arrival, my travel has been pared down to include just a few more things between now and the impending birthday, leaving me free to expand fully after Friends for Life this summer.

Body issues.  I have those, too.  Because yeah, I’d be lying if I said I didn’t have them.  I am expanding, and rapidly at that.  I’ve routinely envied women who carry their babies all beautifully, glowing and happy.  I’m kind of the opposite.  I love being a mom. Period. However, the process of becoming a mother again is hard on my body, and on my emotional state.  I wish I was more graceful and welcoming of all the changes, but I’m grouchy and weirded out by a lot of them. The influx of extra weight makes my body feel uncomfortable, my diabetes harder to manage, and the pregnancy aches and pains are kind of not my thing.  (Although I do like the kicks I’m feeling lately. It’s weird to be so happy about being kicked all day long by someone.) I am grateful this is happening in the first place, and I wouldn’t do anything to change it, but I need to remind myself that the body changes are somewhat temporary. And that I’ll feel normal again.  And that second pregnancies, from what I’ve heard, can be a little weirder than the first because things happen faster. And that it’s okay that my entire face looks different when I’m pregnant, because apparently I carry my babies in my face.

I’m excited to have my son safely out and healthy so I can go back to bending at the waist again without making strange “oooof!” noises.

Distractions.  In effort to distract myself from the discomfort of pregnancy in pursuit of the fruits of my (hopefully brief) labor, I’m easing myself away from the Internet here and there in efforts to be outside more.  I planted a garden.  Also potentially known as “a salad bar for all the asshole deer in my neighborhood.”  I’m eyeballing a children’s book writing class this summer.  I’m researching different writing opportunities, both in the diabetes space and waaaay outside of it.  I’m trying to monitor my emails without becoming a slave to them.  I’m aiming to keep healthy tabs on my pregnancy while also keeping tabs on my job. I’m looking at too many GIFs on the Internet and also missing The Good Wife (oh that finale). My brain is a fruit salad of mostly pineapple and random thoughts.

Basically, I’m slooowly losing my mind but only a few short months to go until my son arrives and I can start snuggling him.  Getting there. GETTING THERE!

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