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! 

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 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: 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. 

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.

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: 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.

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:

Limericks:

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.


Haiku:

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- 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. 

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.