Traveling With Diabetes

It’s holiday time, folks. That means travel. Most of my holiday travel involves driving, but for Thanksgiving I’m going to visit my boyfriend’s family in Dallas, so we are flying. It’s around this time of year that travel questions start popping up in the D community. I’m not a frequent flier by any means, but I have been through quite a few airports in my day, and I’d like to share my average experience.

I live in Atlanta, so that is the airport I see the most. It’s supposed to be the busiest in the world, or at least close to it. There’s just something about the hustle and bustle of Atlanta’s Hartsfield-Jackson that gets my blood pumping. With so many people coming through every day, they have their act together for the most part. If you’re going through the Atlanta airport, feel free to use the Special Assistance line at the security check. This line is for people with wheelchairs, strollers, and medical devices, and you get to the pat-down a little faster..

Yes, I opt for the pat-down. Every time. Why? Because Medtronic can’t be sure the body scanners are harmless, and the last thing I need is to be a thousand miles from home with a malfunctioning pump. Also, since Medtronic’s official stance on the body scanners is “don’t,” I don’t know how that would affect my warranty, if at all. At any rate, I feel better playing it safe.

Back to the security line: take off your shoes, your belt, your jewelry. Pull your laptop and electronic gadgets out of your bag. The bag for your liquids? This is not where I put my insulin. Nope. I leave it in its carton, marked with the prescription information, in my bag of medical things. All my meds stay together: insulin, strips, pills, sets, reservoirs, needles, etc. They stay together.

As I already said, I opt for the pat-down. I just tell the nice person working at the machine I’d prefer a pat-down. Then I get to stand around while they shout “female assist!” and my boyfriend (or other travel mate) collects my things for me. The pat-down is fairly standard. Spread your legs and hold your arms out, palms up. Someone of the same sex will be rubbing their hands along your body. Then they will test their gloves for explosive residue and tell you to touch your pump before they swab your hands, too. Most of the time, it’s fine and I get to go. Sometimes, though… sometimes I set off the explosive detector. The first time it happened it scared the crap out of me, but now I just take it in stride.

What happens if they think you’re explosive? They will take you to a “private screening room” to give you a more thorough pat-down. Someone else will go collect your bag, and they will pull everything out and test it for explosive residue. They really wipe down everything. The first time I was deemed explosive, it was 5:30 AM in a tiny airport in State College, Pennsylvania. I was so not in the mood to have my dirty laundry aired (literally). But they do what they have to do, and thankfully they’ve never determined me to be a threat.

My top advice for dealing with the TSA: be friendly. Have a sense of humor. They see thousands of jerks every day. Don’t be another jerk. Smile. Thank them when they’re done. Maybe even throw in a “Have a Happy Thanksgiving” for good measure.

I’ve been through LAX a few times, and they’re usually not very amused, so my goal is to get them to lighten up while they’re feeling me up and testing my laptop for bomb stuff. Last time I went through security at LAX the lady at the scanning machine didn’t want to let me have a pat down, but she called over the female assist agent, rolling her eyes. “This lady says she needs a pat-down for some insulin pump thing,” to which the assist agent replied, “well, she does. Even if she didn’t, it’s her right to opt out of the body scan.” Then they glared at each other. It was a tense thirty seconds.

Most TSA agents are friendly if you’re friendly to them, though. Don’t let anyone try to talk you out of getting a pat-down, if that’s the route you go.

My only overseas experience is in Greece. I used to know how to say “for diabetes” in Greek, but I can’t remember it anymore. I flew from Atlanta to Athens, then Athens to Heraklion (Crete), and then back. I had one slight incident in Heraklion where they wanted to find an English-speaking agent to clarify the diabetes thing, but it was no big deal. The bigger deal was finding someone to speak French with a lady who didn’t understand she needed her ticket, but that’s a different story. 

Thanksgiving...and thanksforgetting

Turkey Day. National Overeating Day. Thanksgiving. Call it whatever you want, but it usually involves copious amounts of food, and copious amounts of insulin. Couple that with the stress of being away from my family for the first time ever during a holiday. And the stress of meeting various members of my boyfriend's family. This should equate to a lot of insulin. So, I squeezed myself into a nice dress and clipped my pump to the inside of my thigh high pantyhose. It worked very well in terms of keeping my pump secure in a dress. It's the first time I've kept it there. On the way to Thanksgiving lunch (my boyfriend's family is dealing with kitchen renovations, so we ate out), I discreetly did my blood test. I rang in at 200, but stress and croissants will do that. Then I ate a huge meal including potatoes, green bean casserole, and pumpkin pie. And cookies. It was tasty. I was working on a way to discreetly get away from the table to go bolus (for both the 200 and the food), but I kept getting distracted. Can you guess where this is going? I never bolused. It took me about 7 hours to realize this. When I checked... 205. I ate a zillion carbs without insulin and I didn't die. It's a Thanksgiving miracle!

For those wondering, this is what it looks like when you keep your pump in thigh highs:

Surprisingly, keeping my pump in my stockings was not uncomfortable, even though I ended up with a large indention that looks eerily like my pump. It worked well, and would have been great if I had managed to get to the restroom to bolus. On the other hand, how low would I have gone?! 

"Alternate" Pump Sites

I have to start out by saying this: I am not an adventurous person. At all. It takes me forever to try something new. I don't jump into swimming pools; I wade in. It's the same with my diabetes care. I started thinking about pumping in 2000, but I didn't get one until 2002. For the first three years of pumping, I only put my pump sites on my belly. Then I expanded to my butt in 2005. Intellectually, I knew there were other places on my body, more real estate. I knew it would be better for me if I rotated my sites into new areas. Anything other than my belly and butt, everything else was uncharted, alternate locations.

Here's another thing about me: I have the most disproportionate body you'll ever see. I have scrawny little arms and scrawny little legs, no butt, a big belly, and huge boobs. Really. Here's a picture of me being grumpy on the 4th of July:

Anyway... I was afraid to put my sites anywhere except my huge belly or tiny butt. Most of the sites on my butt hurt, and it had more flab than my arms and legs. In an effort to expand my real estate, I ordered a sample of Silhouettes from Medtronic (these are the angled sets). The spring-loaded inserter always made me anxious, so I was also looking forward to manual insertion (I could never get it right with the QuickSets). This year, in 2013, I did my first ever thigh site:

This week, I tried my first ever ARM site:

Neither one of them hurt like I expected it to. Now I love having my site on my thigh. It's especially great if I'm wearing a shirt that either is tight or leaves lint all over my site. The only downside to the thigh site is forgetting it's there and snagging it on my underwear. Also, my thigh sites tend to come out really kinked. It usually doesn't affect the absorption much or at all; in fact, I get good absorption from my thighs. I don't know if it's the proximity to muscle or what, but my blood sugar drops a lot more when I exercise with a thigh site.

My new arm site... I'm not sold yet. Again, the absorption is great. I think part of my problem with my arm site is exactly where I put it. I keep catching it on my sleeve when I wear a T shirt. It was my first time putting it on my arm, and I didn't get the adhesive part down all the way. It's fluttering away, so I had to put some tape on it. If I want to do anything that involves a lot of stretching, I either have to take it off or clip it to my shirt/bra. For normal, everyday life it doesn't pull when I walk or anything (I'm 5'7", for reference). My biggest hurdle has been using the bathroom. The tubing doesn't stretch that much. I've also had some trouble changing my clothes because I'm not quite sure how to juggle everything yet. I might give the arm site another try because I haven't decided how much I like it yet.

The point I'm trying to get at here is that if you're thinking about new geography, try it. The worst that can happen is you'll need to take it out and put it back in your comfort zone. Take it from someone who is very resistant to change: you can do it. You can try something new, and you might even end up liking it! 

A Day in the Life...and a Diabetes Primer

What exactly is a day in the life of a diabetic? I considered live Tweeting a day of diabetes. But that's a little boring, I think. Instead I'll give a basic outline. I have a feeling this post is going to be a long one. On a typical day...

Like most people, the first thing I do in the morning is wake up. Instead of rolling out of bed and heading into the kitchen, I roll over and grab the meter on my bedside table. This is the first number I see in the day, and sometimes if it's high it will put me in a grumpy mood for the rest of the day. I hate to say that, but it's true. Next, I go and eat breakfast. I try to avoid super sugary things for breakfast because they will make my blood sugar spike no matter how I bolus (give insulin) for it. I like things with peanut butter in general, so I usually eat a PB sandwich if I'm on the go. Maybe an apple and PB. Sometimes I eat Chex cereal with soy milk and add Splenda if I want it to be really sweet.

Now I'm good to go. I try to do a mid-morning blood test to see what's going on after breakfast. I especially try to do this if my blood sugar was high at breakfast. When lunch rolls around, I do another blood test. Eat food. Mid afternoon I do another blood test. If I know that dinner is going to be at a late hour, I will probably do another sometime before I start cooking. Before dinner I test again, and then again before bed.

Here are some diabetes basics:

How does Type 1 Diabetes work?

Type 1 diabetes happens when the immune system makes a mistake and thinks the beta cells in the pancreas are foreign invaders. Your immune system is supposed to attack invaders, so it attacks the pancreatic beta cells. Beta cells are, among other things, responsible for producing insulin.

Insulin's role in life is to allow sugar into the body's cells so they can use it for energy. It's kind of like the key that opens the cell's doors and lets the sugar inside. In the absence of insulin, sugar can't get into the cells so it builds up in the blood, raising the blood sugar. Trying to get rid of the sugar, the body starts spilling it into the urine. The diabetic person will be thirsty and will start drinking and urinating more. I've been there and done that. It's not fun.

Blood Sugar
The goal is to have my blood sugar between 70 and 130. If it falls below 70, I have to eat about 15 carbohydrates' worth of fast-acting, sugary substance. It can be candy, juice, or these large things that look like half-dollar sized pills. They're called glucose tabs, and I have a key chain that holds four of them, which will get me through one low blood sugar episode. Honestly, I prefer candy to glucose tabs.

If my blood sugar is high, I need to take insulin. If it's only a little bit out of range, I correct it using my insulin pump. Punch some buttons, and I'm good. I give the insulin some time to do its thing, and I check my blood sugar again. If my blood sugar is way out of range, I assume something is going on with my pump (I'll get there in a minute) and I go into manual mode. I go all old-school and pull out the syringe and insulin vial. Then I give it time, and test my blood sugar.

Insulin and my Pump
Instead of using syringes or insulin pens, I use an insulin pump. Before we get there, let's talk about insulin. There are two basic types: long-acting and short-acting. Long-acting (basal) insulin lasts 12-24 hours. It makes sure there is always some insulin working in the body. Why? Because that's what a normal pancreas would do! The liver is always secreting sugar, so there always needs to be insulin there to save the day and keep blood sugar levels in line. The short-acting insulin (bolus) is given whenever carbs are consumed or when blood sugar is too high.

Instead of giving myself all of this insulin with a syringe or pen, I have an insulin pump. Instead of injecting myself multiple times per day, I need to change the infusion set (the part in my body) every three days. It only holds short-acting insulin, so if something goes wrong with my pump, my blood sugar can go pretty high fairly quickly. It gives me a set amount of insulin per hour instead of using long-acting insulin. I can program it to give me different amounts/hour at different times of the day. I give bursts of short-acting insulin when I eat or if my blood sugar is high.

My pump saves me from having to do too much math. My blood sugar reading is sent straight from my meter into the pump. I tell it how many carbs I'm going to eat, and it combines the insulin I need for food with the insulin I will need for food and tells me how much insulin to take. Then I tap a few buttons and bam! Insulin. My pump's name is Henry, and he is pretty smart.

So What Affects Blood Sugar?

Carbohydrates, exercise, stress, the wind speed... anything, really. That's what is so frustrating. I can be doing everything just so, following all the rules, and then my diabetes just does something stupid. Sometimes I eat the same thing for breakfast every day all week and one day my blood sugar will do something different than it does on the other days. This is when it bothers me the most because I really tried, but it happens anyway.

Stress is the worst. It makes my blood sugar  go high, which makes me feel disgusting and unproductive. So if I have a major project coming up and I'm stressed, my blood sugar will rise and I won't work as efficiently as I should, which causes me to stress. It's a big, terrible loop.

Highs and Lows

Nobody without diabetes can really understand how terrible high blood sugar feels. Have you ever been outside on a hot day, really wanting a drink when there's nothing available? Oh, and imagine you've been running around. That scratches the surface of what extreme high blood sugar can feel like. You're hot, very uncomfortable, your heart is racing, and you would make a human sacrifice for a bottle of water. You're super thirsty, but the more you drink, the more nauseated you feel. You have to pee, and after you do, you have to pee again, right after another glass of water.

On the other end of the scale, low blood sugar makes me feel just as terrible, but in a different way. I might look drunk when my blood sugar is low. I feel weak, almost hollow. I'm shaky and unstable,and cold. Very cold. My words don't make a whole lot of sense, and they might be slurred (I'm not exactly sure, but they sound funny to me). My body just doesn't have enough energy to do much. I also get a little panicky because I'm basically like a phone with a low battery alert. I don't want to run out of juice.

Emotionally

Emotionally, it blows. There are times when diabetes does its own thing and defies logic. Sometimes I'm just really tired of having diabetes. I'm tired of poking and prodding myself all the time. It's hard work pretending to be a pancreas. Most times it just feels like part of a normal routine. But sometimes I let numbers get to me. I take them personally. I question everything. Did I count those carbs correctly? Did I forget to bolus for lunch? I internalize the numbers and it usually makes me feel terrible. Sometimes it hits me in the face that I have diabetes and I probably will have it forever. I'm going to have to keep checking my blood sugar, counting carbs, and poking myself for life. FOR LIFE. It's a lot to take in, and occasionally it gets to me.

What do I do to keep myself from jumping off of a bridge because of diabetes? I laugh at it. It hurts a lot less when you can laugh at it. I make a lot of bad jokes. I post them on the internet. I have an entire Twitter account for my bad diabetes humor. On this account I follow other diabetes accounts. I feel a lot less alone when there a bunch of people out there who know what I'm going through.


If you've made it this far, thanks for reading. If I left anything out, or you still have questions, ask away! I'll be around.

A1C, WTF?

I went to my endo last week, and had my blood drawn, as is pretty normal. Today I got the results of my blood work. Let me just day, I knew it was going to be bad news. My blood sugar has been all over the place. I have a brand new allergy (?) issue that is still being figured out. For now I'll blame that, and the bone infection I got overnight from a suddenly abscessed tooth. I went an entire week where I couldn't get my BG under 200 without rage bolusing and eating absolutely nothing. It was nearly as bad as the week I had to be on steroids. I tried all the dummy strategies: new insulin, new set/reservoir from new box, injecting correction boluses. I had very minor results. But, I got my A1C back, and it was bad. How bad? 8.9 bad. EIGHT POINT FREAKING NINE. Fuuuuuuuuh.

While going over these episodes of complete diabetes garbage with my endo, I said I knew I shouldn't have, but I just got so frustrated at seeing those bad numbers so I stopped testing as much (I didn't stop, but I cut my testing in half). Then she said something to me that inexplicably made me feel better. It wasn't a calming platitude, though. She said, "when you get mad at your numbers and can't figure it out, that's when you call me and we'll figure it out."

I suppose that's how it's supposed to work, really, this doctor-PWD relationship. Every endo I've had in my adult life has sucked pretty spectacularly. For the first time since high school, I feel like I actually have someone at my back. I know it's up to me to keep up with the day-to-day, but it's good to know your doctor is actually going to help you. My last endo was so distant he barely talked to me when I was in his office. He talked at me a lot. That didn't help.

Now I'm off to do things that will "improve my health" as recommended by my primary care doc. That means eating nothing, vacuuming (allergens), washing my sheets, and something, something, see someone else it's not his problem. Guess which doctor I'm replacing next!

Talking about diabetes; combating misinformation

First off, let me say something about myself: I am an introvert, 100%. It should be noted that I am not a misanthrope. I prefer to spend time not talking to people, but I don't generally hate humanity. That being said, there are some things that just get me to talk to people: my pets, anthropology, band, and, apparently, diabetes. If anyone has anything to ask me about my diabetes, I'm more than willing to share (except that time I was walking around Savannah with a BG of 45. I didn't want to talk about it then).

Diabetes used to be number one on my topics to never discuss. Diabetes was just another thing that made me that girl. I was the girl who was too honest for her own good, bad at speaking to others, freakishly tall (seriously, I was 5'5" in the 5th grade), and I just didn't like to even think about diabetes. Everybody had so many questions, and it was something I was living with 24/7/365.

These days I'm happy to talk about diabetes all the time. There is so much misinformation out there. Normal people who are untouched by type 1 sometimes have no clue what's going on. Many people don't realize the differences between type 1 and type 2. While it's really frustrating, it's hard to blame them. If I didn't have diabetes, I probably wouldn't know much about it. Sometimes I swear I'm going to punch the next person who tells me that eating XYZ will cure my diabetes, but the truth is they most likely read it as a headline of a trashy magazine at the checkout stand. They're just trying to help.

Maybe my diabetes is making me soft. I used to get mad at misinformed people, and then I started talking to them instead of brushing them off. I would much rather give people the truth than have them telling more T1's that a raw vegan diet will cure them.

With the awesome online community, it is so easy to isolate ourselves into this neat little pocket where everyone knows about diabetes. But the sad truth is that a lot of people don't know about diabetes, or what they do know they learned on TV. I've taken it upon myself to talk openly about my diabetes whenever I get the chance. I'm not obnoxious about it, needing to turn every conversation to diabetes, but people know if they have any questions about diabetes, I will talk to them.

I guess the main takeaway for this is: It took me years and years, but I'm now happy to talk about diabetes. I feel like it's better for everyone if I decide to educate people who don't know any better, rather than get angry and walk away. 

"Are you drunk?"

Last weekend I was hanging out with my friends, watching football on TV and just hanging out. Yes, there was alcohol around. There were snacks. I hadn't been drinking, and I knew my blood sugar was dipping. I could feel it. But for some reason I sometimes downplay my symptoms when I'm hanging out with a group, even though they all know I'm diabetic (yeah, I don't know why, either). I thought I was just getting low, right on the edge, not a big deal.

Apparently I was acting off. I've never really thought low blood sugar made me appear drunk. I knew it made me feel sluggish and weak, but I didn't know how drunk it makes me look. One of my friends came up and asked me how much I'd been drinking. Nothing, well, nothing other than Diet Coke. She then politely suggested I might want to do a blood test because I was acting really strange for someone who hadn't had any alcohol. I knew I was dipping a little low, so I did a blood test. 43 mg/dl. Oops. Then I sat down, had a regular Coke, and ate some snacks.

All in all, I was fine. The moral of this story: sometimes it's really important to have friends who know your low blood sugar signals as well as or better than you do.

This is why I pump

I see the question of whether or not to use an insulin pump come up a lot on various Internet forums, and I want to make my statement loud and clear: I love my pump. His name is Henry, and I would not give him up for anything (except a functioning pancreas).

Unfortunately, it wasn't love at first sight. I fought the idea of a pump for two years before my mother convinced me to try it for 6 months. If I didn't like it after 6 months, I didn't have to keep it and I could go back to shots. I really didn't want to give up the freedom of movement and be attached to that thing all the time. Reluctantly, I agreed and we contacted MiniMed to get a pump. We ordered blue (purple was not a choice yet). I went to a training class for three days before I was allowed to use it. Although I was only 13 at the time, I was the oldest kid in the room by at least five years. I felt like I had really gotten onto the pump wagon late. A few weeks, lots of hypos, and a few adjustments, and I was ready to go. Needless to say, this was just another case where my mother was right and I was wrong.

See, back in the day (2002) when I was on shots, I had to keep a strict schedule for my diet and insulin. This meant eating the same amount of carbs at the same time each day. That meant getting up at 6:30, even on a Saturday. I was not the favorite friend to have sleep over. The very first time I spent the night away from my house, my mom came to get me at 9 the next morning and my blood sugar was 43 and the friend's parents were out of the house. Getting an insulin pump meant I didn't have to keep such a tight schedule of my dining times. Hallelujah, sleeping in!

I love the flexibility in dosing with a pump. I don't have to pull out a needle every time I go high or want food. I just push a few buttons. My pump can dose in small fractions of a unit. Try that with a syringe or pen! It's much more discreet in social situations. My personal favorite: it does math for me. Not that I'm bad at math, but having dinner shouldn't include algebra. My meter is linked into the pump, so my BG readings are sent straight to the pump when I test. I tell the pump how many carbs I plan on eating, and the pump uses the carbs, BG number, and how much insulin is still in my system to calculate how much insulin to give me. It greatly minimizes the number of ways I can screw up my dosing.

With a pump, you have no long-acting insulin. Instead, you have a basal rate of insulin given as so many units/hour. If something goes wrong with your site or pump, things can escalate pretty quickly. It's important to keep an eye on things for that reason.

Being attached to the thing? Not so bad. I just keep it on a clip or wear something with pockets. In a pinch I will stick it in my bra.

A lot of people are concerned about exercising with a pump. I have done a whole host of things with my pump and I have been fine. Cheerleading, running, marching band, physical therapy... I've done all of those without taking my pump off. The only things I've removed it for are swimming and tumbling (for obvious reasons). During things like band camp where I knew I would be sweating my butt off all day in the sun for a week, I turned my basal insulin rate down to prevent going low. Of course it took some trial and error to get it right, but I got there eventually.

Sexy times? Yeah, it's not a big deal unless you make it a big deal. I'll let you work out the logistics on your own. I'll just mention that your partner should probably know where your site is so they don't accidentally rip it out. It kills the mood.

No, the inset doesn't hurt much. Well, it doesn't really hurt more than a regular syringe, in my opinion. You can't feel it under your skin unless something is wrong or you hit a weird spot. For me, at least, that is rare.

Yes, an insulin pump is going to be an outward manifestation of diabetes. You know what? Most people have absolutely no idea what it is. I've gotten cell phone, pager, and even a mic pack for going on TV (there were TV cameras around, to be fair).

After I got over my initial misgivings about trying the pump, I loved it. I still love it. I understand that pumps aren't for everyone, and if someone is doing well on syringes/pens, they can keep on rocking. Henry and I are together for life, though. So far I've had three Henrys.

Back that pump up!

I've been pumping since November 2002. Medtronic and I have been together for almost 11 years now. It has just recently occurred to me that I haven't had a solid backup plan since around that time. Thankfully, I've never needed one.

I didn't have my pump setting written down for quite some time. Let me fill you in on the panic that led to this realization. It was a normal Friday night, and my pump was beeping at me to change my battery. I pulled out my pack of AAA batteries and changed the battery as normal. But nothing happened. My pump never came back to life. I frantically ran through my apartment looking for my backup kit. I pulled fresh batteries from a fresh pack and tried again. Nothing. Panic set in. I realized that I have no backup plan in place. If my pump had truly just died, I didn't know my settings, either! Thankfully, the thing came to life after sitting around for a few minutes as I was panicking.

Fast forward a few weeks. Another Friday night. Time to change my battery again. I changed it and waited the requisite two minutes for its display to come back. Everything was peachy. I went to bed with a low reservoir beeping. I thought I had enough insulin to last through the night. I was tired. My pump ran out of insulin at 4AM. Fine. I got up and filled a reservoir. As I was rewinding the pump, the pump shut off. No battery power. Ack. So I ran around and found another new battery and replaced it immediately. I had to rewind the pump again since it stopped halfway through. Then I finished changing my reservoir, rolled over, and went back to sleep.

I called Medtronic in the morning. The rep didn't sound very concerned. My pump had been acting up in a few different ways, and the accumulation was starting to really bother me. In addition to the power failure, it has taken longer and longer for the pump to wake up after a battery change. It's taken longer and longer to register blood sugar results being sent from my meter. When I was scrolling through to set the carbs for a bolus, it would routinely skip numbers. It would scroll... 20,21,22,45,46,47... It was the number skipping which concerned the rep. At any rate, I got a new pump on Monday. They told me they were out of purple pumps, and I was really bummed my replacement pump was going to be blue. When I opened the box on Monday, I was pleasantly surprised. 

I'm a mommy... and other discoveries.

Last week I found an abandoned infant kitten outside my apartment. It was only about a day old. After I realized the mom was not going to come back for it, I took the little thing in. I've never looked after a kitten this young before. I have to wake up every 2-3 hours to feed her. I've taken this opportunity to do a LOT of overnight blood tests. I've made a very pleasant discovery. My blood sugar does nothing overnight. Nothing. 10 PM: 107 1AM: 109 3AM: 107 6AM: 112 9AM: 110. This makes me so super happy. I used to plummet overnight, and then we adjusted my basal rate and continually woke up high. Now I can bolus before I go to bed (if my blood sugar is high) and I don't have to worry about going low overnight.

I think about this kitten almost as much as I think about my diabetes. Almost every time I feed the kitten I do a blood test. Having a kitten is almost as good as having a CGM.

My blog... isn't the bloggiest of blogs.

I've been through this before, where I start a blog and only make a few entries before I give up. I really don't want that to happen again. It's much easier to keep up with Twitter. It's only 140 characters at a time! I started my Twitter so I could have a venue to post about diabetes in a funny way, where people would actually get the jokes. The Pancreassassin was born.

As I mentioned in another post, I had my diabetes rebirth around January 2013. I started taking things more seriously, and I got involved online. I figured humor was the way to go. I'm not saying that diabetes is not serious. I am saying that if you don't have a positive way to look at diabetes, it will destroy you. In order to avoid that, I'm trying to be funny. Yeah, trying. I crack jokes to people who understand diabetes all the time in my offline life. I wear diabetes-themed shirts, and I've had a few good conversations about diabetes with people I'd never speak to before. Also, at 23 years old, I'm finally okay talking to strangers, so go me (I'm the most introverted introvert you'll ever meet).

On and Off the Wagon

So, for several years I have had pretty bad control of my diabetes. There, I said it. I know it was bad, and I know it was wrong, but I was doing it anyway. I feel like most of the people in the diabetes online community have some wicked good control, or at least decent. I feel this is a coming out of sorts. I hope this can help anyone who has had bad control get back on track, or at least let them know they aren't alone.

This time last year, my A1C was about 12. Seriously. I don't know how I did it, but I survived for quite some time with A1C values above 10. Aside from being more thirsty than anyone around, I didn't feel too bad. I could exercise, think clearly, and see very well. I knew what I was supposed to be doing, but I never did it. Why? I'm not sure. It wasn't all laziness. Some of it was just apathy. I was experiencing some serious diabetes burnout. On average, I did between 0 and 1 blood test per day and bolused randomly. I changed my set when the old one fell out, which could be up to 14 days. I was bad news.

Things began to change for me when I got a new endocrinologist. My old endo (OE) was pretty bad. I was not taking care of myself, and he was content to let me continue that way. He put me on Metformin, which is usually described for type 2 diabetics. He said it would decrease the amount of insulin I needed. In reality, it did nothing to my insulin needs and gave me a terrible stomach ache for as long as I took it (over a year). After a while you just get used to feeling like garbage. I never did get a clear reasoning for the Metformin.

One day I called to make an appointment and was told that OE no longer worked there, but I could see the new doctor (NE). When I showed up to the appointment, they had no records of what medication I was on. OE had never made record of what he prescribed me! After sorting out the medication record, NE told me point blank that I had really crappy control and I needed to do better. She asked me why I wasn't taking care of myself. I (obviously) couldn't give her any good reasons. How hard is it to do a blood test? Then she changed a bunch of my basal rates and carb : insulin ratios. She then scheduled me for a follow up two weeks later with her nurse, and made an appointment with me one month later, when my prescriptions were going to expire. She asked me to do four blood tests every day for two weeks: breakfast, lunch, dinner, and bed. Okay, I could do that. I started testing and bolusing accurately, and my blood sugars plummeted. It felt strange because NE lowered all of my insulin needs before asking me to start testing. I thought maybe my carb counting was rusty, so I started being super, super vigilant about my carbs. I was still low all the time. When my blood sugar was normal it would bottom out as soon as I did anything active.

When I went to my follow-up appointment with the nurse, we changed a lot of my settings again, and added a few new basal rates. A month after that I kept going high. I had changed more pump settings. I think I'm now on some good rates.

 As a result of all of this, my A1C is now sitting at around 8.5. While it's not perfect, it's much better than my 10.5 A1C. I feel like right now I'm on the right path. I test about 7 times per day, minimum. I bolus regularly.  If I'm not sure about a carb value, I'm more likely to look it up than just guess. I mean, sometimes I do guess, but nobody's perfect.

Now that I have this off my chest, I feel much better. I feel honest. :)

Diagnosis

It took me a while to decide what to write as my first blog post. As my blog name suggests, my immune system assassinated my pancreatic beta cells. Get it? Pancreas-assassin....pancreassassin? Anyway, I've decided to start my blog by telling the story of my diagnosis I don't know why, but I like reading others' diagnosis stories, and if you're like me... pull up a chair and read on.

I was seven years old in 1997 when I started to feel like absolute garbage. Every diabetic knows what I mean. I was losing weight and peeing all the time. I started wetting the bed again. I was so embarrassed that I would not have friends stay over at my house, nor I would I stay at theirs. I remember going on an out-of-town soccer trip with my brother and his friends. I was teased for being  the stupid little sister who still wet the bed at 7. My cousin and my great-uncle both had type 1 diabetes at the time, and my mother was familiar with the signs. She took me to the doctor, had my blood drawn, and took me home, where my (non-diabetic) cousin teased me about never being able to eat sugar again. Not long after, I was on my way to the children's hospital. The ride seemed to take forever, and I slept on and off the entire way there.

In the hospital I learned to test my blood sugar and about the importance of insulin. I got an orange workbook with a clock on the front. It was called "It's Time to Learn About Diabetes!" Awesome. The workbook included letters to give to friends and teachers to tell them about diabetes as well as a list of famous type 1 diabetics. I understand the theory behind it- nobody wants to feel like they're alone, and knowing of successful people with your condition can help. Being 7, I didn't know anyone on the list, except for Mary Tyler Moore (and let's face it, a child doesn't have much in common with an adult).

When I went back to school with my new diagnosis, I wasn't exactly welcomed with open arms. Now, I don't blame my peers for thinking diabetes was contagious. They were children. But it still hurt to be shunned by everyone. I was the only diabetic in school. For the first few weeks my mom had to come to school at lunch time to help me with my blood testing because the nurse would not.

About a month after my diagnosis, I turned 8. My classmates had decided I wasn't contagious, and came to my birthday party. That was the first time I had to do a blood test and shot in front of my friends. I didn't want to. I hid in my closet. Actually, I hid in my parents' closet so they wouldn't find me. Eventually they did, and they got me to test and shoot. I didn't get to have cake during that party, and one of my friends squeezed the cat so hard he pooped. Worst party ever.

Later that year my family moved states, and we landed where we are now. My new classmates accepted me, diabetes and all. Nearly 16 years later, I'm still here, and so is the diabetes. And now here is this blog. Stay tuned for more updates!