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Posts tagged ‘type 1 diabetes’

Weak Away.

I accidentally took a week off from blogging, but there are reasons.  And they involve dinosaurs.  Bullet list, because that’s the only way to organize what’s swirling in my brain?  Yeah, let’s do that.

  • Last week started strong – a good visit to Beth Israel Deaconess Medical Center on Tuesday to confirm a strong and healthy growing boy.  More on the third trimester of this pregnancy in a bit, but for now, I’m holding very steadily without any blood pressure issues, no swelling, no protein spilling in my urine, and a baby of a healthy and normal size.
  • I think my son has the same nose as my daughter, which is weird to notice in an ultrasound.  And he definitely has my husband’s dance moves, which contributes to his cuteness.
  • The next day, I took a flight out to Salt Lake City (after putting Birdzone on the bus) and then drove out to Vernal, Utah for a diabetes event with the Tri County Health department.
  • Per my daughter’s request, I wore a bracelet she made me while presenting. It is as important as my medical alert bracelet, to be honest.

  • The people in Vernal are nice.  Super nice.  And there was a lady whose due date was the day before mine, so we had the chance to bond over babies.  (Hi, lady!)
  • The drive from Salt Lake City to Vernal is also nice, but extremely rural.  Like there’s one rest stop on the three hour journey on Route 40.  I saw lots of red rock formations.  And Strawberry Reservoir.  The drive through the mountains was beautiful.  If I didn’t have to pee every 25 minutes, this would have been a truly relaxing drive.
  • My cell phone didn’t work perfectly throughout the duration of the drive, so it felt weird to be tooling around in a state I’m unfamiliar with, in a car that’s not mine, entirely by myself, save for the seven month along fetus that was dancing while I drove.  There was a vulnerability to being out and alone that I liked and feared, simultaneously.
  • I did meet Dinah the Dinosaur upon my arrival in Vernal, which was a highlight.  Sending this picture home to Birdy earned me some mom points.

  • I found a dinosaur. #travelbetes

    A photo posted by Kerri Sparling (@sixuntilme) on

  • After presenting in Vernal and having the chance to connect with folks at the dinner, I went to bed and then made the three hour trek back to Salt Lake City for my flight out the next day.
  • Note:  I wore compression socks while driving.  Yep, I’m that old lady with the paranoia.
  • Second note:  The socks at least had a decent pattern, so at least it wasn’t a total loss.
  • Last sock note:  I neglected to remove said socks before going into to grab a snack at a rest stop.  Was also wearing a skirt.  May have looked a little off.  Do not care.
  • Then it was off to San Antonio, Texas for the TCOYD conference, where I rolled around like a hamster in one of those plastic hamster balls.  Only I was the hamster ball.
  • We talked about the emotions of diabetes-related complications, with the conversation tipping in favor of emotions related to diabetes on the whole.  The group attending the session was diverse in age, diagnosis length, and emotional response, which made for a very engrossing discussion.  As always, I learned a lot from my peers.
  • And at the end of the session, I saw people exchanging contact information, helping extend the conference bond beyond the moment.  Damn, that is my favorite part of any diabetes conference: the connection with peers.
  • After the conference, I crashed hard (sure, I may have watched three episodes of OITNB back-to-back before bed – don’t judge).
  • Sunday – Father’s Day – I was back at the airport to make the flight home to Rhode Island.
  • “Did you take a direct flight home?”
  • HA HA HA HA HAAAAAA
  • “The flight home to Rhode Island” isn’t ever direct, unless I’m coming from Chicago, Baltimore, or DC.  Every other location takes a ridiculously long time to get back from.  It took six hours of flying time to get home from Texas.  America, you sizable.
  • And on the first leg of the flight home, a PWD (T1D) in the back of the plane struggled with a serious low blood sugar, causing a bit of controlled chaos on the plane.  Thankfully, there were some smart and capable folks on board who were able to step in and assist, but it was unnerving to recognize that the good samaritan running to the back of the plane had that familiar orange case of glucagon in her hand.
  • Then it was home.  Beautiful, quiet home for a few days before the next leg of travel kicks in.  (See you in Seattle?)

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.

 

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