This is hard...

As people with diabetes, we all have sort of an "nontraditional" relationship with food. Everything we eat must be measured, calculated, and compensated for. But there comes a time in some of our lives where we have to take a closer look and see if that relationship can be called healthy.

I have a sordid mental health history, as some readers may recall. I have anxiety, depression, and Borderline Personality Disorder. I see a psychiatrist regularly, and I see my therapist weekly. I'm a delight, let me tell you. But we are getting off track here.

It was about a year ago that my therapist noticed some odd behaviors around food, the most obvious being that I had stopped eating it as often as I could manage. In a nutshell, I only ate dinner most days. My therapist sent me to see a nutritionist. At first I was resistant because the only experience I had with a nutritionist was way back in 1997 when I was diagnosed, and it wasn't the best experience. I wanted to find a nutritionist who understood diabetes and would understand that sometimes I was making the logical choice by not eating when my blood sugar was high. I wanted to find someone who knew how weird the dynamic with food can be when you throw in diabetes. Naturally, I went to the nutritionist in my endocrinology office.

"Well if you're looking to drop the weight, Weight Watchers is a pretty good option," she said by way of greeting. The woman did not even ask me why I wanted to speak with a nutritionist. I'll admit, I am on the heftier side of the spectrum, but that was not what I expected at all. I accomplished nothing I had set out to do. I couldn't tell this judgmental woman that I was having trouble eating, not feeling hungry, and not caring one bit. I just couldn't.

I returned to my therapist feeling somewhat distraught. I didn't think I had a problem to begin with, but to not even be heard was something else entirely. My therapist then told me I had to go see a nutritionist she knew and trusted, and guaranteed I wouldn't end up feeling the same way.

So I set out again to see a nutritionist. I live in the Atlanta suburbs and I had to drive to a nearby town during the morning rush. What normally would have taken thirty minutes dragged on to an hour and a half. It was gray and rainy that morning.

My therapist was right; this office was much different. It didn't feel clinical, but it also wasn't overly homey. I met the nutritionist, and we sat on a couch to talk. We talked about my food habits, my diet, what I like to eat, my body image, and I'm sure there was more. She did take my weight for records, and I was given the option to not know the number. I signed a release of information so she could share her findings with my therapist.

In my next weekly session with my therapist, we talked about the visit. Wanting one more opinion, she sent me to see another therapist for a consult. Another day, another suburb, and another release of information later, I was back with my original therapist. 

An eating disorder. That's what they decided. All three of them had the same reaction and the same diagnosis. A restrictive eating disorder.

Horse shit. I have diabetes; I have to know about the foods I'm eating. I just don't feel hungry. I don't eat unless I'm hungry. None of this is pathological.

Well, nobody was buying my story. My therapist pulled my mother into the mix somewhere along the way. It was decided that I would work with the nutritionist and my therapist to get my eating back on track. I met with the nutritionist every other week for a few months. I kept a food (and blood sugar) log. She helped me make some meal plans. She called my boss and insisted that on longer shifts I be allowed to stop for a snack (that one was humiliating). She had me eating every four hours while I was awake. It felt like a lot. It was hard and I pushed back so hard on everything.

I wish the story could end here, with me eating regular meals and snacks. But life isn't exactly linear, you know? A few weeks ago my therapist asked me how my eating had been. Ashamedly, I had to look away. Suddenly the weave of her upholstered couch was fascinating. I knew I was no longer doing what I should be doing.

I'm not even sure where things went off the rails. I stopped seeing the nutritionist over the summer. I had to cancel one appointment, and then I never made another one. No longer keeping a food log, I wasn't accountable to anyone for my eating. I let snacks slide. Over time I decided lunch was for losers. Then I stopped breakfasts again.

My therapist insisted that I go see the nutritionist again. I refused. She told me I had two weeks to get my shit in order. Two weeks came and went, and I still don't have my shit together. The last time I went to the nutritionist, she and my therapist thought that doing a treatment program in Nevada (?) was the next step. It is a step I am fighting hard and part of the reason I don't want to go back. The other reason is that I don't like being accountable for what I eat.

Today my therapist dropped the A-bomb on me: anorexia. I don't meet the clinical requirements for that, but it still is something I never thought I'd hear about myself.

That's where the story ends for now. I know I have a lot of work ahead of me, and it's hard. It's really, really hard. Updates to come!

For anyone who bothered to read all the way to the end, thank you. Your support means the world to me. Drop me a comment below so I know I'm not shouting into the void. 

D Blog Week 2017: Diabetes and the Unexpected

Diabetes brings with it a ton of unexpected challenges. For example, take the humble banana. A simple food that, simply put, drives me bananas. One day I can eat the banana and take the right amount of insulin for it, yet my blood sugar will nose dive. The next day I'll eat a comparable banana and take an identical bolus and end up in the stratosphere. This is one of a million examples of unexpected challenges that people without diabetes will never truly understand.

The worst is when things to unexpectedly wrong and there's a possibility you could have prevented it. It's frustrating because something went wrong and because it's partly your own damn fault. Like the one time I decided to rely only on my CGM during a night out to maximize room in my tiny, fancy purse. Of course my Dexcom decided to give me the ??? of doom right when I needed it the most.

For my next example I'll give you a short (but true) story. Even when I thought I had everything planned out perfectly, things still went south. It was a few falls ago and I was going to a Georgia Tech football game (Go Jackets). It was a hot day in Atlanta and I had packed extra pump supplies, just in case. I sweated off the infusion set I had applied only the day before. Right there at the tailgate, I inserted a new set just as the pep band was rounding the corner to our tent and hoped desperately that I wouldn't have to head back to the car for my emergencies-only backup set. Just as we were heading into the game my tubing wrapped around something and nearly pulled all the way out. I was able to save it, but only just. Unexpectedly I had to locate the first aid station and hope they had some medical tape or a Band-Aid.

The upside to all this unexpected nonsense is that I get less worked up over unexpected happenings that are out of my control. Also, I'm more prepared than a Girl Scout in most situations. Usually if someone needs an emergency Sweet Tart, I'll have some in the bottom of my purse. They might be linty, but I have them. Diabetes has trained me to be prepared for the unexpected. 

Back to MDI

I love my insulin pump. I love the control it gives me. I love the freedom from the many pokes I'd otherwise have to endure daily. I took a break from my pump a little over a year ago and had mixed feelings about it. And here I am, about to embark on another pump hiatus.

Why? If I'm singing the praises of my pump, then why, why am I giving it up? Well part of me needs another break from being tethered all the time. The other part is really not up to me.

Ever since my suicide attempt last year, I've had a slew of professionals (and my mother) telling me I needed to give up my pump. They consider it to be dangerous and potentially triggering. It's dangerous to have several hundred units of insulin attached to my body, just waiting to be used against me. It's triggering because it's a constant reminder not only of my diabetes, but of how I have lethal means if my mood dipped that low again.

Do I agree with the plan to get me back on pens and away from my pump? Not entirely. When I tried to kill myself with insulin I used a syringe to inject 100 units of Novolog. The max dose for an insulin pen is 60 units. I already know that 100 units isn't going to kill me. I'm going to need multiple injections, so why does it matter if it's 60 or 100 units? I can still get the job done with an insulin pen. Another thing: diabetes doesn't go away just because I don't have to look at my pump! I think about diabetes all the time. It doesn't matter if I'm on a pump or MDI.

I have an endocrinology appointment on Tuesday. My endo is generally of the opinion that a pump is best for me, so we will see how things go this time around.

Given how low my moods have been recently, I'm willing to accept any help I can get. I appreciate the thought that switching to MDI might help.

What do you think? How would you keep a suicidal diabetic safe from themselves and their insulin? 

In Case of Overdose...

I've been out of the hospital for exactly a month now.

I was admitted around 5 AM on September 30th for an intentional insulin overdose.

 I took my total daily dose in one go, waited 30 minutes, and was about to inject another day's worth when I freaked out and did the only thing that made sense: asked Twitter what to do. I didn't know if it was something I could fix by chugging a lot of juice and monitoring it on my own. When I thought I'd gotten over the worst of it (blood sugar was 90), I got a call from my university's police department. Someone had anonymously reported from my Twitter that I was suicidal and in danger. I talked to the woman on the phone, declined help, and hung up. Five minutes later there were two cars from the city police sitting outside my parents' house at 3:30 in the morning. The police wouldn't go away until I let the paramedics check me over. Their meter read my blood sugar at 30, but the paramedics didn't quite believe it because I was coherent. After a recheck came back at 33, they believed it.

Fast forward half an hour. Three policemen and two paramedics are in my house, and there's a fire truck outside for some reason. The police dispatched to my house have had training in speaking to suicidal individuals, and are going on the word of the paramedics that I should really be going to the Emergency Room. By this point my parents are awake and the police are working to convince my mother to at least get me checked in the ER. So we went to the ER. I was drinking juice the whole way there.

When I checked into the ER around 5 AM, my blood sugar was 73, but quickly plummeted to around 40. I was given a Coke and IV glucose. The orders were written that I Was supposed to have my blood glucose levels checked every hour. Every hour they stuck my finger and gave me a can of coke every time I was below 90. The cans of Coke they give out in the hospital are 7.5 ounces. By my (and my bored caretaker's) best estimate, I had around one liter of Coke.

Finally, about 12 hours after my admission, my BG was >90 for two hours in a row. By this time, though, the nice doctors in the ER had transferred me upstairs and filed a 1013 on me (in the state of Georgia, a 1013 hold is basically a psych hold because I was considered a danger to myself). I was going to be stuck in the hospital for 48 hours to experience one of my worst fears: not having control over my diabetes management.

After ensuring my BG was stable above 90, the doctors did not want to give me any insulin at all, but gave me dinner, which I refused because they wouldn't give me insulin. A few hours after celebrating a BG of 110, they were looking for room in the ICU because they don't do insulin  drips on the main  floor and my BG was >450. Giving IV doses of Regular insulin eventually brought me under 450 (and kept me out of the ICU).

My usual dose of Lantus, when I'm on it, is 60 units. It's fairly large, I know. The doctors on staff did not want to give me more than 5 units that first night, and I fought my way up to 30 the next day. To this day I have no idea what the hell they did for my mealtime doses. They seemed like random numbers to me. In any case, I tried to avoid the carbs and pretend I wasn't hungry. After my initial lows, I didn't drop under 200 until I went home.

For some reason, health care folks seem to think my insulin pump is a problem. I went through this same thing last year when I was being treated or suicidal ideation. It's like they think I'd use my pump to give myself a ton of insulin? It'd be so much easier to use a syringe or a pen, in my opinion. Maybe they think it's a trigger? In any case, the doctors at the hospital (both the general doctor and the psych doctor) did not want me to have my pump back, but wanted me to go back on pens for a while. After discussing it with my parents, we talked to my doctor as a team and convinced him that using my pump is ultimately what's best for my health.

One of the most infuriating things about this whole ordeal is that the entire time I was in the hospital, they would not let me call my endocrinologist. At the same time they wouldn't trust what I said about my own treatment, which is fair given the reason I was in there in the first place. When I went to my endocrinology visit the next week I was told that the hospital I was in was the worst for diabetes care.

 At any rate, please don't worry about me. I'm at home with my supportive family. I have friends to talk to. I have a new therapist and she seems like a good fit. It's going to take some time, but I'm slowly getting over this hurdle and getting ready for the next.

It's taken me a month to get this blog post out because suicide is something that's hard to talk about. My hope is that by talking about it, I can help reduce some of the stigma around talking about it.

Dblog Week Day 5: Let's Get Physical Wild Card

A diabetic walks into a CrossFit gym, and...

It sounds like a punchline waiting to happen, but it also sounds like a regular Thursday night for me. For Christmas my parents got me personal training sessions, and I've been going pretty regularly since then. I'm still the flubbiest person in the gym, but it's important to try. In order to try, I've got to make sure my diabetes has itself in line.

I have to make sure my blood sugar is between 100-250. Any higher and I feel like crap. Any lower and I spend my workout time paranoid about going low. If I'm under 100, I pop a tab or two and trust that things will be fine. If I'm over 250, well, I might not go. This has only happened once. I keep an eye on my blood sugar during the day and aggressively correct my highs. It's always easier for me to eat something than to wait for insulin to work.

During my workouts I mostly put diabetes out of my mind. There is a shelf inside the door at the gym where I leave my stuff, and that stuff always includes my cell phone (serving as my Dex receiver) and a bottle of glucose tabs. My trainer knows I'm diabetic and doesn't say anything if I take a minute to check my Dexcom.

Now the bad part. If I go low during a session, I pop a few glucose tabs and keep going. I very rarely feel my lows, so I can just keep going, keep pushing through it. I know it's not the right thing to do, but I only have 1 training session per week and I don't want to waste 15 minutes waiting to come up. So I don't wait. I might get a little sloppy in my movements, but I rarely have to actually stop.

I'm really bad at the gym. I'm so bad that I don't feel comfortable doing weights without someone to watch over me and make sure I don't hurt myself. So I don't do much at the gym when it's not training day. My favorite type of exercise is no exercise, but the exercise I hate the least is dancing. I dance alone in my bedroom to very loud music.

It's hard to keep myself motivated to move. It's hard to keep myself motivated to do a lot of things. The only thing that keeps me moving is a desire to not look like a marshmallow. What? Have you ever played Wii Fit? If your BMI indicates you're overweight your Mii will look like a marshmallow. Both virtually and in real life, I don't want to be a marshmallow. It's vain, it's shallow, but it's true. 

Dblog Week Day 4: The Healthcare Experience

I want to start of today's post by saying how much I love my endo's office. By and large, they have their shit together. I know exactly what to expect when I go in and they rarely deviate from the script. I love that. If I get my eye doctor to send over a summary of my last exam, they will have it in their system and my doctor will know how my eyes are doing. Again: I love my endo's office. I do.

This post isn't supposed to be a love letter though. It's supposed to be a summary of things I would like to change about my healthcare experience.

My initial thought is that I wish everyone could just learn the basics about diabetes to avoid pissing me off. I know that this isn't going to happen; it would be unrealistic. If they have to know about diabetes, then they have to know about other conditions, and it snowballs into a huge mental Rolodex that our healthcare providers are expected to know off the top of their heads.

Realistically I would like to see better communication between HCPs. Mostly I want to see my other doctors listen to what my endo says. She's good; she will write notes to other doctors on what to do in terms of my diabetes. She's not telling them how to do their jobs, rather she's telling them how to make their work fit in with what she's already doing for me. They just don't listen.

Dblog Week Day 3: Language and Diabetes

I'm a person with diabetes, but I'm also a diabetic. I'm a person with depression, but I'm also depressed. I check my blood sugar, but sometimes I test it.

Words matter. What you say to others and how you present your ideas matter. I understand the concept of using person-first language when dealing with the chronically ill; sometimes we just want to be seen as people, not as diseases. I agree with treating people with respect, and for most of the diabetes folks online that means calling them a person with diabetes (PWD) instead of a diabetic. Symbolically they are saying that diabetes doesn't define them; they are more than a diagnosis. I understand the position they are taking, and I will fully support them by calling them by PWD if that is what they want.

I am a diabetic. I am a PWD. In regards to this issue, I don't care what people call me. I respond to diabetic, PWD, hey bitch, and most of what people want to call me. Personally, I have a thick skin and I don't feel more or less defined by diabetes if someone calls me a diabetic.

---EDIT---

I do not suffer from diabetes, even when it's making my life super hard. I live with diabetes. I endure diabetes. I battle diabetes. No matter what, I refuse to be known as someone who suffers from diabetes. Diabetic, PWD, whatever, but I am not a diabetes sufferer.