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!