Thursday, December 18, 2014

How to Make Your Own Humalights

My last post included Humalog lights, or Humalights. In the event that anyone else has the mad desire to hoard every empty insulin bottle and string them on lights, I'm going to tell you how I made mine.

First, I pried all of the lids off of the bottles using a cheapie bottle opener (mine's a flamingo).

Next, I rinsed all of the bottles out. I'm apparently bad at numbers, because I thought I had a 30-light strand, so I originally only rinsed 30, but it turns out I needed 35. In this picture, all the bottles are sitting on my oven while I was baking to help evaporate any remaining liquid. 

PS: white stove tops are terrible
After that was over with, I plopped the caps back on the bottles and stuck the lights inside. I didn't like the way they sat inside the bottles, so I widened the holes so they sat just a smidge lower. I used the handle of a paint brush to do the widening, times 35. 

The left opening is wider than the right, see?

The final step was to make sure everything fit together correctly, and cemented everything together with Gorilla Glue. To Make sure it bound correctly, I taped the light strand to the bottle while the glue set.

They fit! They fit!

Voila! Humalights! Now I just need a craft to use up the rubber bottle stoppers! 

Wednesday, December 17, 2014

A Very 'Betic Christmas to You!

First thing on the tree!

In preparation for Christmas this year, I've pulled out all the stops. First, let me tell you that Christmas time is the only time of year when I possess whimsy. It's just not a trait I generally have. Something about the mildly colder weather makes me go nuts for fake trees, sparkly lights, and tales of flying mammals. 

Being the sort of person I am, I have spent over a year collecting insulin bottles for a holiday like this. As pictured above, I put a bottle on the tree. I've baked diabetes-inspired gingerbread. I used the vast majority of my bottle collection to make the most spectacular string of lights you'll ever see.

It was a painstaking process that included prying the damn lids off of the bottles, rinsing, and waiting for them to completely dry. After the bottles were prepared, I used Gorilla Glue to hold them to the light strand. It was... a process. I'll leave it at that. It was a process. I now have a strand of 35 illuminated Humalog bottles, and I haven't yet decided where to display it. I'm thinking of putting them up at my parents' house because my only diabetic cousin is coming for Christmas this year. It'll help us bond over our lack of beta cells. 

Monday, December 15, 2014

Hello, Old Friend.

Because I like having color options!

Two weeks ago I decided to change the type of set I use, again. When I started pumping in 2002, I was given QuickSets, and I didn't even know anything else existed until about 2012. I was having problems with the spring in my QuickSerter, so I was on the phone with a Medtronic rep who offered to send a sample of a different set (Mios) with the new inserter. My mind was blown when I was asked what color I wanted. Mios are self-contained sets that have an all-in-one package that includes a serter. They're cool. 

Fast forward a year. I was really trying to get better at diabetes. Two things led to me experimenting with Silhouette infusion sets: my fear of the set change and my desire to try new pump sites. I really wanted to try sticking sets in my arms and legs. As I've mentioned before, most of my body weight is in my middle; I have tiny little arms and legs. My legs in particular have almost no fat on them. To make myself feel better about it, I ordered a sample of the Silhouettes, the angled sets from Medtronic. They come with an inserter that is, quite honestly, terrifying. It reminds me of a handheld harpoon gun. I chose to insert them manually because I was developing anxiety of the spring-loaded serter. The Silhouettes are amazing for the leaner areas, especially when inserted manually. There's a great amount of control when using them. So why did I change back to the Mios? 

Big, angry red spots. Every time I put a site in, no matter where, no matter how well I cleaned it, they it was red and irritated the very next day. It wasn't an adhesive issue; the irritation was where the cannula entered my skin. A few of them got infected, despite my efforts to be super clean around them at all times. I tried using a few of the Mios I had left over, and I was actually able to keep them in for more than 24 hours. I called Medtronic to see if I could send my last shipment back and exchange them. Thankfully, they allowed me to do it.

I've been back on the Mios for two weeks now and things are going great. I can leave my sets in for their full three days. It doesn't hurt constantly! I still use arm sites, but the leg sites are a no-go. I've been exercising and my thighs are too lean for me to do sites there comfortably. 

Thursday, December 11, 2014

My Bone of Contention

This is my sore foot that has been bothering me for about a year now. I've been seeing doctors since January, trying to get some relief. I've tried physical therapy, ice, rest, steroid injections, topical creams, shoe inserts and pads... I've tried everything. The problem? A super high arch combined with an exostosis (extra bone growth) which rubbed against my shoes, causing persistent tendinitis. Then, over the months, the rubbing caused a cyst to form under the tendon in my foot. Now, I'm not an artist, or a doctor, but I'm going to try explaining this the best I can.

 The pink squiggle is the tendon that is irritated. The yellow lump is my new cyst (which I can feel and move under my skin. Kinda yucky).  The red line is where the surgeon is going to go in and shave my bone down. Yeah, shave. Hopefully the shaving will alleviate the pressure on my tendon and prevent the cyst from returning. 

I've already gotten my prescriptions for after the surgery. Ibuprofen, antibiotics, and Vicodin. Does anyone out there know if the acetaminophen in Vicodin is going to mess with my Dexcom numbers? I've tried Google, but the results are inconclusive.

I had my pre-op appointment this week, where they told me to not take any insulin at all the day of surgery. Um, that sounds like a terrible idea. Surgery is at noon. So I called my endo's office, who told me I should let my surgeon handle my insulin, until I told them what the surgeon wanted me to do. I'm still waiting on official word from my endo as to what I should do. 

I'll be posting an update eventually as to how everything went with my insulin needs and how the Vicodin affected my Dexcom readings, if at all. 

Monday, November 24, 2014

I Like to Laugh at Diabetes


I've been on Twitter for over a year now under the name Pancreassassin. In that time, I haven't changed my description line at all. It sums up the purpose of my Twitter account nicely: I like to laugh at diabetes. I do. I'm one of those "laughter is the best medicine" type people (obviously insulin is better than laughter for a plate of pasta, but you get my meaning). 

I started off using my Twitter to laugh at diabetes, and as time has gone on I've started using it for more than amusement. I get in touch with my DOC folks. I talk diabetes tips. I give real-life stories and try to help people. That doesn't sound very funny, does it?

Sitting and thinking about it, I thought I had failed my original mission:to find light in the many dark parts of diabetes. But have I? I don't really think so. I think I'm doing a much better job of Twitter than I originally set out to. I set out to be a joke monkey, but I ended up being more. Am I still funny, though? I hope so! Now I know where I stand, and what my mission really is: provide support for anyone who has been touched by diabetes, and hopefully make them laugh along the way. 

All in all, I think I'm going to keep my Twitter description just the way it is, because, well, I like to laugh at diabetes.

(I'm just going to leave this here to close things off. It should be noted that I have never, ever claimed to be an artist!)

Wednesday, November 12, 2014

Living Life With the Double D's (NOT another boob post)

I posted back in March about the other D in my life: depression. Then I wrote that things were okay, and they were. But okay slowly drifted into less than okay, which led to a change of medications. These new meds aren't really doing their job, and I'm fairly certain that at the end of their probationary trial period they will be replaced with another.

Strangely, it hasn't impacted my diabetes. Like, at all. In fact, I dropped my A1C by 1.2 points between February and May. Usually when depression hits me hard, my diabetes care suffers. The thing is, it's super easy for me to get down about my medical conditions. I'll likely be diabetic forever. My belly has little white scars all over it from years of needles. I have strange bits of machinery hanging off of me. I'll be on thyroid meds forever, and my brain can't function very well without pharmaceutical assistance. You get the point. It's incredibly easy to let my health (or lack thereof) get me down.

I've heard many times that challenges we have in life are what make us stronger people. I never really thought that was really applicable to me until I realized that diabetes is actually the thing that keeps me going some days. Some days it's hard to make myself do anything. By "anything" I mean even simple things like get out of bed, shower, and take the dog out. On days like that it is easiest to just fall into my standard routine. For some reason, I have to know my BG number first thing in the morning. Yes, I have a CGM now, but I still need to poke my finger and hear the beep of the meter to make it real. Glancing at the CGM screen is easier and usually just as accurate, but like I said, I fall into my standard routine when I need to. Then I eat the same thing I eat almost every day: something covered in peanut butter. It might be easier to grab something faster and sugarier than that, but I still don't want to mess up my BG.

I have no idea why, in the midst of caring about nothing, I care about my diabetes so much. In that moment, though, I'll take anything I can to keep my head above the water. So I get up, I check my BG and eat peanut butter, and take the dog out.

No matter what, I always care about the DOC. Usually, they care about me too. I know I've really dropped the ball on blogging lately. I kept tweeting, though. It's just that the last few months have been really, really bad with my depression. I'm not going to lie. It sucks, and every aspect of my life has been suffering (except the diabetes). I'm starting to feel a little better, I think. It's a good thing, too. I'm going to have so much crap to post about with the holiday adventures coming up, and my next endocrinology appointment coming up on December 1st!

So, stay tuned, readers, because there might be something posted one of these days.

Tuesday, July 8, 2014

50 Shades of Red

Red: the thematic color of the last few days.

The first red in this story was the red of my 6-pack cooler packed for a tubing adventure. For those of you who don't live near a river, this tubing is not related to insulin pumps or being pulled behind a boat. This tubing refers to sitting on an inflatable tube, drinking beer (or Diet Coke) and floating down the Chattahoochee River. I've never done this type of tubing before, but it was my boyfriend's birthday and he wanted to go with our friends. It was an impromptu trip, and I had 30 minutes to get my things together. No time to plan for diabetes, really. I did have time to do this, as my Dexcom sensor was about to fall off.

The second red was the small dry-bag I purchased on the way to the river. I packed it with my meter, hand sanitizer, and my CGM receiver. That's all that would fit, and the store only had one size of dry bag. I was promised I wouldn't get very wet, so I clipped my pump to the very top of my bathing suit. MM says their pumps are water resistant, and I've accidentally gotten a few of them quite wet without effect. I've been thrown in a pool, waded into the ocean, and watched an entire football game in the rain and my pump was fine. I wasn't worried. I had to borrow a raft from my friends because I've never done this before.

The third red was blood. This blood came from my thigh where I hit it on a rock when my borrowed raft broke out from under me. My friends saved me from drowning or being pulled around by the river. All in all. I was submerged for maybe 10 seconds. When I calmed my breathing, I checked my pump. I was shocked to see the screen filled with water. We stopped 30 minutes later to eat, and some of that water had turned to steam. It was difficult to bolus for food, but I managed. The pump was still working, despite being very, very wet. One of my friends rigged my broken float and traded with me. We were off.

The fourth red was caused by blinding pain when I hit my foot on a rock when the second tube I was using sprouted a hole and dumped me out. Another one of my awesome friends again traded tubes with me because, as they put it, they're more water resistant than I am. At this point, I chucked my pump to someone in a more stable tube, who gave it to someone with a larger dry bag.

The fifth red was figurative. I was angry when I realized I had to get a new pump. I called Medtronic as soon as I got back to my phone. I was promised a new pump within two days. I called them at 8 PM on a Sunday, so I figured they wouldn't have time to overnight one. I saw more red when I realized I would have to drive to the far CVS to pick up emergency Lantus. I was more angry when they told me it would take them over an hour to fill my one vial prescription. I'm usually pretty calm an understanding, but I can freak the eff out when it involved my diabetes. My BG at the time was 98, but I knew that wouldn't last, especially because I would be eating pizza before picking up my Lantus. Unfortunately, Henry ended up looking like this:

The sixth red was the marinara sauce I managed to spill while injecting Humalog with a syringe. After a long day in the sun/water, we were all craving carbs. I had a stromboli, and it was delicious.

The seventh red was blood again. This blood came from the site of my 48-unit Lantus injection. It wasn't a dot of blood, either. It was a blood flood.

The eighth red was the unsettling shade of fuschia on my urine ketone strip when I woke up to a BG of 360 the next morning, despite going to sleep at 120.

The tenth red was the giant red bruise on my foot from hitting it on a rock the day before. It hurt so bad I could barely walk. I went to the urgent care doc and spent three hours waiting to hear that I have a bruise. No break, possibly a nasty sprain because I can't walk. I was instructed to take it easy, avoid walking, and stop carrying my heavy backpack (because obviously my books will just magically carry themselves to my classes). I still can't walk well, but I don't want to use crutches (I might use them to get to class so my lab partner isn't so mad at me for missing class on Monday).

I'm no longer seeing red, but my brother missed the delivery of my new pump this morning. I went online this afternoon, and scheduled a self pickup for this evening. Lantus doesn't seem to do much for me, so I haven't seen many numbers below 200 in the past two days. I can't wait to get my baby back!

Saturday, June 21, 2014

Dexcom: the first few weeks

I've been using my Dexcom  for a few weeks now. I'm in love with it. Love. The very first night it woke me up at 4 AM with a low. It said I was 68, meter said 65. So I grabbed some tabs and went right back to sleep. Now, my body will wake me up when I'm low but it waits until I'm at about 50. At that point I feel much, much worse than I do in the mid 60s and I stay awake for much longer treating the low if I have to treat a 50 vs a 65.

I did a TON of reading before I got the Dexcom, and I did even more reading while I was waiting for it to ship to me. I prepared myself mentally for the onslaught of information and numbers. I told myself over and over to not fall into the newbie mistake of overreacting to every change I see on my graph. For the first three days, I just watched it. I lived my life as I usually would, but I had this thing squealing at me all the time for being too high/low. After the first three days I took what I'd learned from my graphs and applied it to my bolusing habits. I'm so, so much more likely to prebolus for meals now because I've seen the difference it makes on my graph.

Probably 90 percent of the time I have a peanut butter sandwich on whole grain bread for breakfast. I love peanut butter. I love sandwiches. What I love the most is that it is like glue for my BG. As long as I wake up in range, I can stay in range until I eat something else. On the days I skip lunch altogether, my sandwich keeps me going until dinner. We're talking 12 hours here, folks.

I'm a numbers person. Numbers, graphs, charts... I love it. I love when I can visualize my BG numbers. I feel like Dexcom Studio is much better at doing this for me than CareLink. Here is my first few days with Dexcom:

I just like it. Not the numbers, but this is a beautiful representation of what's going on. Just because I'm proud, here are the most recent three days:

This is a miracle, I know, and I don't think I'll ever repeat it. I fully expect to mess this up over the weekend. 

Saturday, June 7, 2014

If I Could Change Something About my Pump...

I'm usually the type of person who accepts her technology as it is. I don't bother to think about what I'd like in a device, because nobody is asking, and my dream device is never going to materialize. With that being said, I do have a few things Medtronic could tweak.

Appearance. I've been on a Medtronic pump since 2002, and all of my pumps have looked the same. Exhibit A:

Haha, yes, the '90's called and they want their beeper back. I know. This isn't really a huge deal to me, because my pump still does what it needs to do. It's also really, really hard to break. I drop my pump wayyy more than I'd like to admit. I'm also the type of person to trip over absolutely nothing. Its beauty isn't that big of a deal to me, but I can understand why people are moving to the flashier t:slim to avoid talking about their pager. 

Functions. There are a few features that I would really like to see on my pump. For instance, I like that I can set a temporary basal pattern when I'm sick or exercising. What I don't like is that it reminds me every 30 minutes that I'm using a temporary basal pattern. That gets really annoying, and I wish I had the option to turn that off.

 I like that I can have different basal patterns. For instance, my basal pattern A is all of my usual basal settings, but at 120%. This is useful during PMS, stress, and illness. What I'd like to see is a temporary setting for my bolus wizard, so I can also change my correction factor and insulin:carb ratios for a period of time. Otherwise I end up doing math in my head to add additional insulin, or I bolus for way more carbs than I'm actually eating, in hopes of keeping my BG out of the stratosphere. It would be useful right now, as I just had a steroid injection in my foot and my BG keeps heading into the stratosphere....or the ionosphere. 

More Beauty. This last one is just me being completely vain. I'd love to see the Silhouette infusion sets come in the same colors as the Mio! Oh, and while we are at it, I'd like to have the green color that Animas has. And some purple, because purple is the best color ever. I used to use the Mios, and I would order both pink and blue. I had two bathing suits: one with pink and one with blue. I could match my sets to my bathing suits. That was rad. I really prefer using the Silhouettes, but I'd love them even more if they came in more colors! If I'm going to have something taped to my skin for 3 days at a time, it should at least be pretty. :) 

So this post is just me lamenting on what I'd like to see in my pump. What about you? Which pump do you use, and what would you like to see it do (other than function more like a pancreas)? 

Wednesday, May 28, 2014

Update on A1C and Diabetes Goals

In January I posted my diabetes-related goals for the year. In March I posted my updates. To recap, my goals included getting my A1C below 8, figuring out how to exercise without dropping BG too much, and getting a CGM. My A1C went from 8.9 to 8.3, and now we are at....

7.1! That is a big improvement from 8.3! I can't help but feel... proud (?) of myself for this. I really don't have much pride in myself, so this is a super big deal. Also, my doctor never sent these results to me, so I had to face my crippling anxiety caused by phone calls (I'm not joking) to call the office to request my results. So, TAKE THAT, anxiety. 

In terms of remembering to change my set, I can't mention my calendar/sticker system enough. It really made the difference for me. Change the set, get a sticker on the calendar. It sounds so simple. It is so simple. It is exactly what I needed to get on track, though. 

Goal 2: exercise without BG tanking. Check. I now check my BG about 30 minutes before I plan to exercise and if I'm in range I disconnect then, before I start sweating. I like to hover around 130 when I go to the gym. It gives me enough of a buffer against low BG that I feel comfortable, but isn't high enough to make me feel gross or anxious. When I go to the gym I take a lanyard, and on that lanyard is a pouch with my meter inside and my glucose tab key chain. 

Goal 3: Get a CGM. Also Check. I've been using my new Dexcom G4 for 6 days now and I love it. The first night it woke me up with a low. Since then I've felt more comfortable going to bed, especially if I'm around 90. With my Dex I know the chances of crashing because of my trend graph. So far, so good on that.

Well, it's May, and I've completed the tasks I set for myself. What now? Get my A1C below 7! Reduce my post-meal spikes. Move more! Weigh less! Feel better! 

Tuesday, May 27, 2014

Manual Insertion of a Medtronic Silhouette Infusion Set

If I had a better computer with a better camera, I would record a video of myself changing the set. As it is, my camera is of very poor quality, so I'm going to stick with words and pictures. It's such a shame my camera is crap; I have such a lovely voice. My apologies if this is too tedious.

 Make sure you've chosen a spot where you can pinch an inch of skin up. As I've mentioned in previous posts, I have put sets in my abdomen, butt flesh, arms, legs, and boobs.  After your clean your hands and insertion site, take the plastic cover off the introducer needle and fold back the front flap of adhesive (DON'T take off the adhesive cover). It should look like this:

Now turn that around in your hand so the adhesive side will be toward the skin and the introducer needle side will be facing up. It's suggested that you insert these sets at a 30 degree angle, which for reference, looks like this:

Your skin should be the line AB and the needle should be line AC, in case you didn't realize that. For insertion, you can choose to pinch up the skin. I do this when I'm using my leg, but nowhere else. Now, take a deep breath and push that sucker in!

When removing the adhesive backing, first remove the smaller one, while leaving the needle in.

Next remove the needle, and THEN the second adhesive flap. 

Voila! Now you just need to prime the tubing as usual and prime the cannula. With the 13mm cannula, it takes .7 units to prime the cannula. If you don't prime it, that's almost an entire unit of insulin you're missing! 

That's all I have on how to insert these babies manually. If you have any questions, let me know! 

Saturday, May 17, 2014

Saturday Snapshot

This week is moving week. Actually, tomorrow is moving day! So I'm packing up everything in my apartment to go, and it looks something like this. In addition to finding rogue test strips and Diet Coke empties all over the place (and in weird places!) I've realized just how much medical *stuff* lives with me. Test strips, pump supplies, insulin, a whole host of pills.... and then there's normal people medical supplies. Ibuprofen, bandages, and on and on. I'm also really clumsy, so I need a lot of bandages.

When I was packing all of this stuff I got to thinking about diabetes. It's never going to leave. It doesn't matter how far I move or how old I get, I'm still going to have to leave a spot in the moving van for diabetes and its mountain of supplies. 

I have this sneaking suspicion that the next tenants are going to be find test strips for a while. Oops. 

Friday, May 16, 2014

Friday: Diabetes Hacks

Diabetes hacks... do I have any? I've been living with diabetes for a while now, and I still don't have a box of tricks. Today's prompt says anything from clothing mods to Dexcom in a glass. I might have a tip like that. Just one. Okay. Maybe two. Or three.

The first one is an easy clothing modification for ladies. Have you seen those dresses with pockets on the front? I love those dresses. I have two because I'm a sucker for clothes with pockets. I cut a hole in the back of the pockets and put super glue on the edges of the cut to keep it from fraying. Then I snake my pump tubing through the hole and keep my pump in one of the cute little pockets on the front. Easy. Not hard to figure out.

The second trick I have isn't much of a trick either. When I decided to get better about changing my set on time, I bought myself a book of Lisa Frank stickers. It only cost a dollar, and it's much easier to keep track of my set changes when I mark them on my wall calendar with a pretty sticker. Similarly, I have a dry-erase calendar on my fridge that I use to keep track of taking all my pills. Every day I take my pill and put a check on the calendar. Visualization is the key. 

My third and final trick is another simple one. Part of my New Year's resolutions was to leave less medical waste around the apartment. We all know how hard it is to keep track of the zillion used test strips we generate. I got some little desk organizer things to stick my used strips in so they don't get all over the place. Well, fewer of them get all over the place. 
Displaying image.jpeg

Okay, those are all the tips I have. They don't feel like clever life hacks, but it's all I have to offer. 

*edit* Okay, I have a fourth. When you're wearing a dress with thigh high tights, you can put your pump in the thigh band. It's actually not terribly uncomfortable. I posted about that here. Alternatively, you can harvest the thigh band to use without the tights.

Thursday, May 15, 2014

Thurdsday: Mantras and More

What gets you through a tough diabetes day? Succinctly: the internet. Because, after all, the internet is for... friends (thought I was gonna say porn, didn't you?). I know if I'm having a bad day, I can hop on Twitter, or my blog, or wherever, and bitch about it. Beyond getting support from my online diabetic friends, the internet is just full of really entertaining things.

Offline, I have my family, friends, and my marvelous boyfriend who will let me cuddle up to him when I'm feeling really down. He's a really good cuddler. I have my dog, who is also good at cuddles. She is ALWAYS up for going on a long walk, which is sometimes exactly what I need.

The best person I can talk to about my diabetes is my mom. My mom and I have always been close, and she's helped me through so much diabetes crap in the last 16 years. She'll listen to me complain about whatever is happening, give me a hug if I'm talking to her in person, and then move on. She lets me know that my feelings are valid, offers some comfort, and then asks me what the next step is. It's a useful tactic, one that I try to employ myself when others are having a bad time of things.

Sometimes diabetes just pisses me off, and I let it. I harness the anger and do something useful with it. Occasionally it's exercise, but usually I anger clean. Actually, I anger clean a lot. My favorite angry cleaning is anything that involves scrubbing. Bathtubs, carpets, counters, whatever. Vacuuming isn't bad, but scrubbing works the best.

Getting pissed is easier to get over than being depressed. That takes a while. Thankfully, diabetes usually just pisses me off. I get pissed and I move on. I don't really give myself time to dwell on it for too long.

There you have it, Courtney's methods for stress relief. 

Wednesday, May 14, 2014

Wednesday: What Brings Me Down

On this blog, I've already shared the other D in my life, depression. Quite obviously, that brings me down and adds an entirely new dimension to caring for myself.

I think this post is going to be a long one.

There are issues that diabetes bring to me. I hate diabetes for choosing me. Hate it. I hate that my parents had to deal with so much extra garbage while I was growing up. The amount of extra caring I required could not have been easy. There were times when I needed my BG checked every 2 hours, and my mom and dad would get up through the night to check my BG without waking me up. Certainly I have an extra amount of respect for my parents, but I wish they didn't have to have that extra layer of worry. Being a parent is hard enough without constantly worrying about what your child's blood sugar is doing. It brings me down thinking about this.

It brings me down whenever I think about all the things I can't do. With my medical fragility, my options are somewhat limited. I know, I know, anything is possible with diabetes... but it isn't. I'll never be able to take a summer and live out of a van with my friends. I'll never get to go on that dig in Africa. There are so many physical adventures I'll never get to go on. Yes, there are ways to get out and see the world, but there is so much extra planning and considering and hoping that sometimes I wonder if a "fun" trip will really be worth it.

Sometimes I'll be watching a movie or a TV show and I'll have some of those negative diabetes thoughts. Oh, that girl was just kidnapped? I hope she has enough insulin in her-- oh, right. Those people are running through the jungle? I'd get my pump wrapped around a tree or have a low BG. Sometimes it gets to me that diabetes isn't the norm for everyone else. Periodically I'll see people eating on TV without checking their BG first and it hits me again that I have another layer of crap to worry about all the time.

It bums me out when I think about my future. My employment will be dictated by my need to be paid enough to cover my medications. Diabetes isn't cheap. Will my future include complications from diabetes? Will I be just like everyone's grandma, blind and limbless? Will my efforts at management be in vain?

The overarching theme that really depresses me is thinking about how different I am, and how diabetes just isn't normal for everyone. My pump broke a few months ago, and it happened on the weekend, naturally. I had to go back on shots for a few days for the first time since 2002. I was expressing my thanks for having such great technology to someone I know, and she pointed out how not normal it is. I was saying how much I take my technology for granted, how I love my pump because it does so many calculations for me and makes my life a smidge easier. She turned around and said it's weird to her that I'm excited and thankful for something I need to live well, how weird it is that I get as excited for new diabetes technology as most people get about new cell phones.

There is absolutely zero chance I will ever get to be a super villain. Zero. I wouldn't survive the plots of most action movies, especially if there are zombies around. I'm sure vampires would be more tempted by my sweet blood than the regular blood of others.

How do I pull myself out of a diabetes slump? It's not easy. I give myself some time to wallow in it, because I need it. There's a whole part of my body that's just... stupid. Few people really understand how it feels, so I turn to the internet. Really, all my diabetic friends live in my computer. Stop number one on my road to happy is the internet, naturally. I have an entire Twitter dedicated to diabetes (@Pancreassassin, if you're not aware). I share my frustrations and try to tell some jokes. When I'm feeling down, it's hard to tell so many jokes, but I try. Step number two in regaining my happiness is to listen to the Spice Girls. Never Give Up on the Good Times, really. Step three is to get some exercise in. When I got my A1C result of 8.3, I pounded it out on the treadmill. I was gasping and growling... Eight...point....three...gahhhh...eight...point...three...!

Beyond that, I don't have any advice on how to deal with feeling down about diabetes. I look forward to seeing what others have to say on this topic today!

This wasn't as long as I thought it would be.

Tuesday, May 13, 2014

Poetry Tuesday

I'm not a poet, and I know it. It's slightly ironic because an old screen name of mine was i_write_poemz because in high school, I did write poems. And songs. My talents must have dried up with old age. I don't know. But here are some efforts:


We threw a great party for Matt,
So gathered together we sat.
When they cut the cake,
Inside was a snake,
But what do I bolus for that?!

Surely this must be a joke,
That waitress just brought me a Coke!
I found some solace
That I could just bolus
But oh what a fear it evoked!

Once when my BG was high,
I slowly started to cry.
I took a shot,
And surely I thought,
Today's not the day I will die.

In time to set out for a jog,
My head was filled up with fog.
I didn't know
My BG was low,
And I nearly tripped over my dog.

Insurance wanted to cash-in,
My test strips were carefully rationed.
One test a day
Is surely the way
To show folks you have no compassion.


Checking on the go
Suddenly a traffic light
Test strips everywhere

Snacking with my friends
Max bolus exceeded
Glorious pizza

That's all for now. I had to choose simple poetry forms that had easy-to-follow rules. I will also admit to using my fingers to count syllables.

Monday, May 12, 2014

Monday- Change the World: Battling Diabetes Misconceptions

The only way I feel I change the world in terms of diabetes is by combating the misconceptions and misinformation. I feel fairly informed on the subject. I've lived with type one since I was seven years old, and I've been thirsty for information on the subject for just as long. When you're reading about diabetes, it's impossible to avoid reading about all types, even if you're just looking for information on your own type.

It's a fact of diabetic life that T2's get the worst of this misinformation and public judgment. Poor diet leads to obesity which leads to diabetes. So, obviously, if you have diabetes, you have done something wrong. You're a glutton who can't put down the fork. If you eat right and exercise like you're supposed to, you can cure your diabetes. Obviously this is not the truth, but it is what most people unaffected by diabetes believe. 

So what do I do? I talk and type about diabetes, a lot. At first it was hard, because nobody ever wants to stand out from the crowd, nobody wants to be the cynic who ruins jokes with truth. Beyond that, people don't want to hear that there really isn't anything you can do to avoid diabetes, regardless of type. If you're doomed to develop insulin resistance, or if your body is just designed stupidly enough to attack itself... it's just going to happen. Sorry. But to know you can't avoid it, that you can't do anything, is terrifying.

 I believe that getting the truth out there is important for several reasons. First, we need to get rid of the diabetes blame game. Because of misconceptions by the general public, I get hit with the blame of eating too much sugar all the time. I know it's not the cause of my diabetes, but what about the T2's out there who hear this all the time? The T2's who believe it? I can't imagine how that feels. The second reason we need to spread information about diabetes is so the people who are eating well and exercising don't think they're protected from type 2 diabetes. We need to end the blame and end the shame. 

The thing that makes me the most vocal in terms of diabetes is when I hear of various ways to "cure" it. I'm sure you heard of these things: eat cinnamon, go raw, go vegan, eat super low carb, etc. That's cool and all, but unless you can turn around from your plate of cinnamon cucumbers and eat a cake without problems, it's not a cure. 

I could write a book about all the stupid things I've heard about this disease. Sometimes it feels pointless to keep talking about diabetes when nobody really cares. The part of me that pursues is the part that hopes that I can change the way one person feels about diabetes, or I can get one person to reconsider making a joke about Jimmy and his damn candy bars. It's the only way I can think to change anything about the world in regards to diabetes. 

Thursday, May 1, 2014

Putting my Best (or worst) Foot Forward

I went to the podiatrist today for the first time in my life. I'm 24, and I've been having foot problems for a while now, at least since January. I've tried resting, icing, wrapping, and it helps in the short term, but the day I stop doing these things my pain returns. I went to my primary doctor again earlier this week for the pain. The last time I was in, Dr. Dumbass told me to come back if it kept hurting. It did, so I went back. Thankfully, I got to see my regular doctor instead of the idiot I got last time. Anyway, he wanted to send me to physical therapy for my foot to try strengthening muscles and gain support. I asked him how we can treat something if we don't know what, exactly, the problem is. So he referred me to a podiatrist.

Now, being a diabetic, I get a little nervous when I start thinking about my feet. Every time I'm in the endo's office, I get a clean bill of health on my feet. They look good; strong pulse, no nerve damage, etc. It doesn't stop my worry though. We've all heard about the foot problems associated with diabetes. I was nervous going in. To my surprise, he didn't mention my diabetes once. Woo!

I had my foot X-rayed while standing.

Everything is normal, except for my high arches. I was given some orthotic inserts to bake in the oven and shove into my shoes. Done and done. For now, I hate them, but hopefully they'll help. I hope my problem was something this simple and it resolves soon. 

Wednesday, April 23, 2014

5 Stages of Low Blood Sugar

We've all had that low experience, the one where something goes awry in your brain and you don't treat it quickly and move on with life. The one where things happen so fast and someone else has to get involved. That is the low that this post is about. I just had one of these lows today in the gym, and I am so thankful that my mother happened to be there today. I didn't quite grasp what was going on as it was happening. It hasn't happened like that for a while. It also happened to be my first training session, so I was letting the trainer push me. That's his job. Apparently I let him push me into ignoring my low signals. So, here I present the 5 stages of low blood sugar.

1. Suspicion. Am I low? Am I shaky because I just did a bunch of squats? Maybe I'm low. Give it a few minutes and we'll reevaluate.

2. Denial/ belligerence. No, I'm not low. I don't want glucose tabs. I don't need glucose tabs. No, I don't want juice. No, I won't drink the juice. Get it away from me. I don't want any damn juice!

3. Acceptance. I'm low. Oh man, I'm so low. I'm just going to sit down, put my head down here. Just give me a minute.

4. Black Hole. I drank the juice. I ate the crackers. What else is there? I need to eat more. Now. Everything in my belly. Now.

5. Rebound high. I shouldn't have had so much juice. Crap, now I have to take more insulin. God, I hope I don't overdo it.

I know everyone experiences lows, but this is often how it plays out for me.

Tuesday, April 15, 2014

...But the Door Handles are Evil

The boyfriend and I have been apartment hunting for the past few weeks. Our current apartment is nice, but very poorly managed. Plus the door knobs are evil. Evil? Yeah, they're the kind that extend out horizontally and then curl on the end. They grab anything passing by- especially pump tubes. The one day  I wasn't wearing my pump, I managed to get my belt loop caught on the stupid door knob. I wish I were kidding. I told my boyfriend very early into our lease that I was never going to live somewhere with those evil door knobs ever again.

With door knobs in mind, we went out hunting. There were a few places we wanted to check out in our area. The area is nice, and we don't want to leave it. On the first Saturday we were out we toured about 6 different properties, including one willing to rent a 2 bed, 2.5 bath town home for $850/month, and give us two free months' rent! (PS, around this area, that is red-flag waving, send in the cavalry suspicious.) At the last complex we checked out that day, the lady giving us our tour kept commenting that I looked really tired. "Awh, you've been doing this all day. You look exhausted, bless your heart." Yes, I looked so tired she needed to bless my heart. In the car I decided it might be a good idea to test my blood sugar, and it was somewhere south of 50. Oh. That's why I was so tired. Okay.

This past weekend we went out again, expanding our search circle to include a little extra geography. Lather, rinse, repeat. We saw some really beautiful homes and some that made our skin crawl. This day I kept telling myself to look alert, stay sharp, keep going. At the end of this day, my blood sugar was also south of 50. I'm lucky my boyfriend does all the driving, or I'd have been sitting in strange parking lots, chomping on glucose tabs.

We have our list down to two apartments now, and depending on the apartment, we will either move next month or the month after that. Let's hope I can keep my BG up while moving. Last time I dropped into the 30's and had to chug some Mountain Dew. 

Thursday, March 20, 2014

...Right in the boob.

I'll stick a needle anywhere once. I'm getting pretty adventurous when it comes to these things. Recently I've stuck my arms consistently and I loved it. Last Sunday, I stuck my boob.
It actually wasn't a huge deal. I have plenty of space on my breasts to place infusion sites. I use the angled sets from Medtronic (Silhouettes). I insert them manually, so I am able to control to speed and angle of insertion. If I'm in new real estate, I can pull out if it doesn't feel right. When I put this one in, I didn't feel a thing. Nope. Not one.

When I was considering this spot, I compiled a few factors that determined exactly where on the breast it was going to go. It had to be somewhere my underwire wouldn't rub it. It had to be somewhere my backpack straps wouldn't interrupt. It had to be somewhere that I could take a non-pornographic photo of, because I share my entire D life with the internet. So, with all of this in mind, I showered and changed my set. After I put it in, I breathed a sigh of relief, and then promptly tweeted about my boob site.

So how was it? Not bad. Like I said, I didn't feel a thing with insertion. As far as absorption, I'd probably rank it with my butt flesh. That being said, I did have a cold this week so I know that messed with my numbers. I'll have to try it again before giving a definitive result on absorption. I didn't feel any of my infusions like I sometimes do with my thighs. It never itched as intensely as my thigh sites, either. It never rubbed on my clothes, and the tubing was always under my shirt, so I didn't catch it on any doorknobs for a few days. That was nice.

*edit* I've tried the boob site a few more times, and every time my absorption was fantastic. It leaves a little dot on my boob for a while, but it's worth it.

On a personal note, I don't think my boyfriend liked my boob site. I told him I'm going to do it again, and he just sighed. "Why there?" Heh.

I'm going to give it another go, on the other boob, before I draw any conclusions. I was not convinced of arm sites until my second try. Who knows, boobs could be my favorite place for sites!

If you're looking for another boob-site blog, C wrote about her experience with using her breasts here

Thursday, March 13, 2014

Update on 2014 D-Goals

In January, I posted my 2014 diabetes goals on this blog. They were few and not too lofty. How am I doing?

Bring A1C below 8. Going in, my A1C was 8.9. It was checked again in February, and now it's at 8.3. That number includes December, the month of Christmas cookies. I believe I am on my way to doing better, but the next A1C is going to include my 2 weeks with a weird pump where my BG was consistently 200+. We'll see.

I'm getting better at counting my carbs, and being honest about them. I'll look things up on my phone when I'm out eating and not sure. The biggest barrier to accurate carb counting was my unwillingness to put large carb amounts into my pump. I'm not sure why. It would send my BG high, but I still just wanted to not have that many carbs in my pump. So in addition to actually eating fewer carbs, I'm more honest about the ones I do eat.

I'm changing my infusion sets more regularly. I used to not change them until my absorption was crap or my set hurt. Now the calendar in my kitchen is full of Lisa Frank stickers. I get a sticker each time I change my set. It helps me remember when I changed my set, and I'm more likely to change it on time. I think I've only gone more than three days once since January. I'm also trying new sites, like my arms. I thought I would hate using my arms, but once I tried it I fell in love. The absorption is awesome, and it leads to discussions about diabetes with strangers. Bonus!

I've been exercising without my pump. It's an adjustment to actually do anything without it. I check my BG after 30 minutes, and if I'm going too low, I pop a glucose tab or two. They're pretty low-calorie and they get the job done. But then I sprained my foot, and everything went to hell.

Still no CGM. I didn't bring it up at my appointment, but I might next time. I don't know why I'm hesitant to ask, but... yeah. I've got nothing. I know I have a long way to go to bring my BG in line, and I think this could help. I'd catch the highs before they're at WTF levels.

So that's where I am in terms of my D-goals. Hopefully I have a better update in a few months! 

Friday, March 7, 2014

I Should've Kicked You With My Sprained Foot.

I hurt my foot. I am, without a doubt, one of the clumsiest people on the planet. I hurt myself without even trying. My foot's been bothering myself for a while now, so I went to my Primary Care doctor. When I got there, I was told that I'd be seeing a different doctor because mine was out today. Okay, fine, whatever.

After a general check of my weight, blood pressure, and pulse rate, the doctor came in to see me. I've never met this guy in my life, so I didn't know what to expect. I looked him up on my phone while I was waiting. He is a certified family practitioner, with a specialty in family medicine. Okay. He examined my foot, said I'd be fine, gave me a prescription anti-inflammatory, and told me to get an Ace bandage. He was scrolling through my file on the computer and getting ready to send the Rx to the pharmacy. Then he brought up my diabetes, and that's where things got ugly.

"Oh, I see you're a type 1 diabetic. How's your diabetes?" he sounded conversational, so I told him I was managing. Usually doctors leave it at that. Nope. "What's your A1C?" Eight-point- "that's not managing! That is terrible! You're on a pump, there is absolutely no reason you should have an A1C above 7. What? Are you not checking your sugars? Not bolusing? Sneaking candy?" That's when I used my stern voice to tell him I test a minimum of 6 times per day, correct when needed, and bolus for everything. "Well obviously something is not right. Do you actually see an endocrinologist?" Yes. Every three months. Given my circumstances, she is okay with my progress, and- "any endocrinologist worth their salt is not going to be happy with an A1C that high. What is your BG when you wake up? When is it the highest?" Around 100, usually mid-afternoon, but I have a non-constant schedule, so finding patterns is difficult. "Well, if you're high in the afternoons you need to increase your basal rate. Your carb ratios should remain constant through the day, but if you're higher after lunch, you need to increase your basal rate." Okay, whatever. At that point, I was over it, flustered, and taken aback. So I just listened to him talk, nodded, and left as soon as I could.

I'm still finding my voice when it comes to standing up for myself. I can defend other people all day, but I'm still working on advocating for myself. I didn't want to keep going with this doctor about diabetes, mostly because he seemed to have an overly simplified view of it. He was of the opinion that diabetes is a static, formulaic disease. Input the right number of insulin, and there is ZERO reason you shouldn't get the right numbers.

If I run into this again, I don't know what I'll do. Has anyone else dealt with this? 

Thursday, March 6, 2014

Wearing Diabetes on Your Sleeve

Recently I've started wearing my pump sites on my arms to give my abdomen a rest. Also, I fell up the concrete stairs yesterday and my whole tummy is basically a giant bruise. Anyway, having an arm site and wearing short sleeves does lead to a lot of sideways looks, and a couple of comments from people who sit next to me in class.

"What... what is that?" in a hushed voice from the girl in my chemistry class.

"Uh, you've got a... something stuck to your arm. Did you know?" from the girl next to me in my psychology class.

"What the hell did you do to your arm? That looks like it hurt!" from the guy on my other side in psych. This one was my personal favorite.

I take the opportunity to give them a little insight on diabetes. "Oh, it's not a big deal. I have diabetes, and it's for my insulin pump. It's how I get medicine" is usually enough. I try to make them not feel bad or embarrassed for not knowing. So far, so good. 

Tuesday, March 4, 2014

The Other D in My Life

Since this blog's inception, I have known that I needed to write this post. I believe that talking about issues (like diabetes) can help spread accurate information and help to reduce stigma. Not only do I struggle with the stigma of being diabetic, but also the stigma of having depression. I also have anxiety, but that can be its own post.

The first reaction to hearing of my depression is usually disbelief. The next reaction is that it's not so bad. Life is great. The conversation usually goes something like this: "No! You don't seem depressed. You just need to cheer up and see the positives in life."

The common assumption seems to be that depression is a personal weakness. I'm not strong enough to deal with the realities of life. Another assumption is that I choose to be depressed. Why I would choose depression is completely beyond me.

I don't seem depressed to outsiders. That's a big problem with these "invisible" diseases. You can't see the pain I'm in because I've left my infusion set in too long, just like you can't see  what's going on inside my head. That doesn't make it any less real to me.

I received my official diagnosis in 2010, and I started medication shortly after. I wish I could say that everything got better and it's all sunshine and rainbows now, but it's not. I started taking medications in 2010, and I haven't stopped. They have been working (mostly). These days, my depression is manageable. I can deal with it, and push through the fog. Sometimes I have to work a little harder to see the sunshine, it's true. The point of medications is not to make me happy; the point is to bring me back to even, so I have the same opportunity to be happy as everyone else.

Does depression affect my diabetes? You bet your behind it does. On the bad days, the days when it's hard to get out of bed, I force myself to do the things I need to do to stay healthy. I know everyone has bad days, so this isn't unique to someone with depression. Some days I need to remind myself to take it one blood test, and one bolus at a time.

In general, my body is extremely sensitive to stress. Having depression/anxiety issues does not help with that. The stress induced by my chemistry lab made my blood sugar rise 200 points during the first two labs, and then I got smart and increased my basal rate during lab. Performances, (watching) sporting events, and the most random sources of stress make my BG soar.

I know there are more people out there like me. I know there are other diabetics, maybe some reading this blog right now, who also have to deal with depression. If you aren't comfortable speaking about your depression, that's fine, not everyone is. I do hope that by putting this out there I can spread a little bit of information, or reduce the fear around the D-word. Maybe I can allow someone out there to know they aren't alone, that they aren't the only one trying to slay more than one dragon.

If you think you have depression, you need to find someone to talk to. The first steps are the hardest, but in the end you'll be thankful you took them. 

Tuesday, February 25, 2014

A weekend without Henry.

For those not in the loop, Henry is my pump. This weekend I had to go without him. Long story short, Henry crapped out. Over the weekend, naturally.

I've been meaning to address the issue of a backup plan with my endo, but I keep forgetting. Really. I've been pumping for... 12 years now. I've only had to resort to a backup once, and it was only overnight, so I just dealt with it using Humalog. Because all great things happen on the weekend, I had to call into my endo's office to talk to the on-call nurse, who didn't seem happy to hear from me. She ended up prescribing me Lantus. "Now, you remember how to use Lantus, right?" she said hopefully. No. I've never taken Lantus in my life. "WHAT?!? You've never taken Lantus?! What on earth were you taking before you started your pump?" I was taking Humulin N in 2002 when I started pumping.

After that ordeal, my mother drove me to the pharmacy to get my Lantus and a baggy full of syringes (yes, I'm 24 and I still run to my mommy when there's a problem. And boyfriend was busy).

I only had to inject it twice, but that stuff burns. Wowza. Mad props to the people who do this every day. In addition to the Lantus, I had to give multiple shots of Humalog. I'm so used to just pressing some buttons and getting my insulin. Now I have to do math? Ugh. Well, at least now I have a calculator on my phone to help me out and my ratios are fairly easy. 

Monday morning I rushed home from my anatomy/physiology test to get home in time to meet the UPS guy. I almost hugged him, but he mocked my shirt, so I just signed and took the package. 

All in all, I think having a broken pump was good for me. I mean, not the hyperglycemia or the blind panic, obviously. The experience of having to go back to MDI, even temporarily really made me appreciate how awesome it is to have a pump, and it highlighted exactly how much I depend on it. The dependency is a little frightening on its own, but I'm learning to cope with it.  

I'm so thankful for my pump. I love my little Henry. 

Tuesday, February 11, 2014

Why I Share My Imperfection

My most recent A1C results are in. 8.3. I swear it was going to be so much better than that. I'm actually very disappointed with that number because my day-to-day numbers do not average 200+, even considering the Christmas feast week that would be included in this result. I don't know what's going on, and it upsets me. As a matter of fact, I'm a little ashamed that I can't get things under better control.

If I'm so ashamed of my crappy results, why do I bother to post them on the internet for everyone to read? I do it because I think people like me need to share our stories too. A lot of places on the internet are run by diabetics with sub-7 A1C values who like to pretend that diabetes is easy for them and should be easy for me. For me, diabetes has never been easy, and getting my numbers in line has been a constant struggle since I was 7 years old. Somehow, I hope I'm reaching someone who is roaming the internet looking for people like them, people who are struggling to control this beast, but not seeing the results they'd like.

It's been a long battle for me to even get my A1C down to the 8's. I found an old lab report in my car the other day, dated November of 2012. My A1C was close to 12 at that point. I just... yuck. I mean, yuck. And I've been trying since January of 2013 to actually do something about it. 8.3 is the best I've been able to get. It's very discouraging. Sometimes I feel like giving up because it's never going to get better, but then I realize there is absolutely ZERO chance it's going to get better if I don't try.

I've never been a quitter. I hated playing basketball when I was younger, but I was pretty okay at playing, and I stuck it out to the end of the season. I'm a piccolo player, and if you know anything about piccolos and music, you'll know how much work I've put in to being able to do this 90% of the time:

Why should diabetes be any different? It sucks, and I have to hit a LOT of numbers out of range, but maybe, just maybe, I'll be able to consistently hit it in range consistently someday. 

I've been trying so very hard, and my results are not something I'm super proud of. 8.3. I can't remember the last time I had candy when I wasn't low. I miss desserts and waffles and all those other delicious things that make my body unhappy (this is where I'm happy pizza doesn't mess me up as badly as it seems to mess up a lot of people). I still eat these things, but I know the consequences, and that prevents me from eating them frequently.

So, in short, I share my diabetes imperfections in hopes that I can somehow help people in my situation feel less alone. Or maybe if there is someone out there who needs the kick in the pants to start taking better care of yourself, know that it's possible. Also know that the struggles is real, and just because you're doing everything right doesn't mean the numbers will reflect it. 

Thursday, February 6, 2014

From the trenches, reporting from the endo's office

Somebody once wrote: Hell is the impossibility of reason. That's what this place feels like. Hell. I hate it, and it's only been an hour. 

Okay, I took a slight liberty there. But I was at the endocrinologist's office today, and I couldn't help but draw the comparisons. The first step: Separate me from things I find comforting.

Of course, I did get it back, but it's the principle that is dirty. The left me sit to rot in boredom. Sure, I had a heap of textbooks that I could read, but they really wanted me to suffer like that? I did use the tools at my disposal to keep my mind sharp: text books and a feeble LTE connection. I needed to make sure those on the outside knew of my suffering.

I was onto their trickery.

And then finally... it got worse. So much worse.

This is an office run by sadists. They want me to be off of my mental game so I will spill my diabetes secrets. They want me to admit to eating four cookies on December 15th. D'oh! My mind is still mushy from the abuse.

Monday, February 3, 2014

Diabetes Art Day 2014

My family moved states three months after my diagnosis. My mother figured I was having a hard time with everything, and took me to see a child therapist. She pulled out a bucket of McDonald's scented markers (really) and told me to draw a picture of how diabetes made me feel. At this point, I just stared at her for a few minutes until she changed tactics. It was a good try with a sound theory, but my primary means of expression has been and probably always will be words. Writing. Emphatic speaking.

I made my entry back in October, but I never really explained it.

I started saving my insulin bottles after I was really getting into DSMA chats, specifically to create this image. The idea is that everyone in the DOC experiences diabetes differently. We are bound by our carb-counting ways, by medication and misunderstandings. In that regard we are the same. To me, diabetes management means one thing. For you, it probably means something a little different. For someone who is not diabetic, but is really trying to understand diabetes, they have to take in each shade of experience and blend them together to get the full picture. My management is red, and yours might be blue, but diabetes is altogether a spectrum that can't really be measured through one experience or one color.

And that, my friends, is the idea behind this image. 

Spare a Rose, Save a Child: Ditch Flowers this Valentine's Day.

February has just begun, and Valentine's Day is quickly approaching. The traditional gifts to give your sweetheart include chocolates and flowers, but what if you could give your darling something equally as inexpensive but infinitely more meaningful? What if I told you that for the cost of a rose ($5), you could provide a month's worth of insulin to a child in need? Through the Spare A Rose campaign, you can.

Why? In many countries around the world, a diagnosis of Type 1 Diabetes is a death sentence, and a child can die within a year of diagnosis.

Let me tell you a story about how it feels when I don't get insulin and my blood sugar goes high. It's hot. It's dry. I'm super, super thirsty. This unquenchable thirst would be bad enough on its own, but every time I take a drink I become more nauseated. So, there's general discomfort, tiredness, thirst, and nausea. Oh, yeah. There's also the peeing. Lots and lots of peeing. I'm sorry, but there really is no describing the total discomfort that comes along with high blood sugar if you've never experienced it. It's terrible, and this is how I feel after a few hours without insulin. I cannot fathom how it feels to exist like this for an entire year, not knowing if it will end.

So if you're looking for a way into your sweetie's heart, consider sparing a rose to save a child.

Thursday, January 30, 2014

What I learned from the Atlanta Ice Disaster of 2014

In the event you're unaware, Atlanta recently experienced some snow and ice. Long story short, and politics aside, nobody did anything to prepare any of the roads for this mess. It did come down quickly. My professor said we still had class at 12:30 when campus was closing at 1. I normally give myself 45 minutes to get up to school and park, but I was playing it safe and left at 11:30 for class. It started like this:

An hour later, it had progressed into this:

My parents live significantly closer to my school than I do, so I decided to go to their house and ride it out. Normally it takes me maybe 30 minutes to get to their house, depending on traffic. Tuesday it took me 4 and a half hours. I looked like this:

Not my best day, I assure you. I got to my parents' house, where I was not prepared to stay. I didn't bring any clothes or D supplies with me. It is my parents' house, and I usually have a horde of stuff here, just in case. Buuuuut I used my spare insulin when I was staying here over Christmas. I have tons of pump supplies, a few syringes, a spare meter, but I had no insulin. And then my pump started beeping. Fantastic. I dug through a bag that had been in my old room since a week after Christmas, and I came up with an unopened bottle of insulin, still in its box, sitting in a bag I had brought over in the week following Christmas. Great? Okay. That room gets really, really cold when nobody is there to crank up the space heater. The bag was in the sun for about an hour every day. Having no other viable option, I used it. And I ran high for a long time. Then I started increasing my boluses by 20%. Success! Well, success until I overcompensated and dipped to 50 overnight. Oops. But I'm still alive and kicking. 

So, next week when I show up for dinner, I'm bringing some insulin and test strips to restock my supply. Just as the city of Atlanta thought it was prepared, so did I. Fortunately I was only in my car for 4.5 hours, and I came out of it on the other side. Unlike the city of Atlanta, there is a good chance that I will learn from this experience and be better prepared in the event this ever happens again. 

Personal Reflections on Journal Article- Optimizing Insulin Pump Therapy: A Quality Improvement Project

I spent part of my lunch break reading an article from the November/December issue of the Diabetes Educator. The title is  Optimizing Insulin Pump Therapy: A Quality Improvement Project.

From the abstract:

Purpose The purpose of the study was to assess insulin pump use and provide ongoing education.

Methods A quality improvement project using a pump assessment questionnaire was implemented at an endocrinology office in the southeastern United States. The questionnaire was designed to evaluate all aspects of insulin pump therapy, including pump operations, infusion set failure, management of acute complications, and usage of advanced device features. Eighty-nine patients (80% with type 1 diabetes and 20% with type 2 diabetes) completed the questionnaire at the endocrinology practice. A certified diabetes educator reviewed the questions with each patient, identifying deficiencies and training opportunities.

Results The most common areas of deficiency identified after implementation of the assessment form included the following: expired or no basal insulin prescription in the event of pump failure or removal, no mupirocin (Bactroban®, GlaxoSmithKline, Research Triangle Park, North Carolina) prescription for suspected site infections, lack of insulin syringe if pump stopped working, failure to check urine ketones, no antiemetic prescription for sick day intervention, using manual bolus instead of bolus calculator, and lack of in-date glucagon kit.

Conclusions Use of a pump assessment questionnaire allows for focused discussion concerning patient behaviors related to pump operations, troubleshooting, and self-management. Incorporating use of a pump assessment questionnaire into routine practice may result in improved patient education and avoidance of adverse events specific to insulin pump therapy.

Essentially, the authors of this paper gave questionnaires to patients in an endocrinology office who used insulin pumps.  Those who were included in this study were exclusively Medtronic users with a minimum of one year of experience using their pump. The survey used closed-ended questions to facilitate conversations between the PWD and their health care team. The office has 2 endocrinologists, and an FNP who deals with most of their pumpers. It's unclear from the paper as to whether or not annual visits to assess pump use were a given for this practice or not, but it seems the office will start using these questionnaires annually.

The authors achieved their goal of identifying weaknesses within their practice. Through use of their surveys, they were able to determine which topics each patient needed to cover in order to increase the effectiveness of pump therapy. I'd be interested in a follow-up paper to determine if spot retraining helped with overall control.

My personal reflection on this post is that I can identify with many of the shortcomings elucidated in this paper. The one that worries me the most, but I continually forget to mention with my doctor is a lack of a backup plan if something were to go wrong with my pump. I have not had a prescription for a basal insulin in over 10 years. Only once has anything gone wrong, but when it did I was testing and injecting Humalog like nobody's business. For a day and a half. It was pretty crappy. I should really do something about that.

Along the lines of preparedness, I haven't owned Glucagon probably since diagnosis. Thankfully, I've never needed it. But I suppose the point of emergency preparedness is to, you know, be prepared for emergencies that hopefully never happen. The article also stresses that we pumpers should have a prescription for mupirocin in our bag of tricks in the event of a site infection. It's not a bad idea, but the few infected sites I've ever gotten were easily worked out with Neosporin.

Other than those things, I feel pretty good.. Of the identified shortcomings, most of them deal with being prepared and not having prescriptions for glucagon, mupirocin, and antiemetic drugs. With the exception of basal insulin, I am decently prepared.

The key to using an insulin pump is using it effectively. Perhaps more endocrinology practices should use similar questionnaires to identify weaknesses in pump use. Personally, I haven't had pump training in... well... pretty much since Medtronic introduced the Paradigm with the Bolus Wizard. I think I got mine in 2007 or so. I'm sure there are some gaps in my pump education.