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. 

Dblog Week Day 2: The Other Half of Diabetes

When you have to endure a mental illness along with diabetes, you spend a lot of time wondering if the two are connected in any way. Obviously there are days where diabetes is just an annoying pain in the ass and affects my outlook, but is this monster of a disease at least part of the reason my brain is broken? There is a huge correlation between having diabetes and having depression. Because my depression has been presenting with suicidal ideation, I have spent more time than I'm comfortable with contemplating whether or not life is worth living with a body that requires not only round-the-clock glucose monitoring, but also 8 pills daily to keep me functional. On my bad days, it's a no, then it becomes a struggle to talk myself down from the proverbial ledge.

Interestingly enough, I still can't decide if my diabetes and mental health are totally linked. Most of the time my diabetes doesn't bother me on a conscious level. Even when I have days where I can't get my blood sugar into target range, I'm mostly able to brush it off. That's the best part of running a Twitter devoted to diabetes jokes: it forces me to look at this disease and everything surrounding it in a totally different light. It really helps my outlook when I feel like crap and try to come up with something silly to say about it.

Dblog Week Day 1: Message Monday

Who am I? What the hell am I doing here? Why am I writing this?

I'm here for a myriad of reasons. My online persona started on Twitter where I just wanted to make jokes. Through Twitter and the greater DOC in general, I realized that I have a few opinions and things to share that take more than 140 characters.

When I first started blogging, it was because I was really bad at diabetes. I had just gotten a new endo and I was just starting to take care of myself; my a1c was 8.5, down from 12. I felt like I represented a group that wasn't out there: the imperfect diabetic. Really, there is no "perfect" diabetic, but at the time I felt like I didn't measure up. I was reading posts about people who were dissatisfied with their sub-7.0 a1c when I was struggling to get my 8.5. It felt stifling that nobody recognized what was going on for people like me, so I started blogging. The support I received was overwhelming.

Given my beginnings, I have a hard time maintaining the original message. I was disappointed with my last a1c, which was 6.6. I'm now a part of the mass I never thought I'd belong to.

Now I blog infrequently. I only blog when I have something to say, an opinion to give that might not already be out there. There are tons of great diabetes blogs out there that usually write things a lot better than I ever could. Sometimes when I write here it's because I want to share a message or a thought not only with my diabetes friends, but with my non-D family and friends.

So, dear friends, that is why I'm here. 

The Post I Didn't Want to Write

I didn't want to write this post. I really didn't, and I'm worrying about pressing "publish" on it this time. I've written it several times over in the last few months. I just feel like I can't get back to regular diabetes blogging without letting this skeleton out of my closet.

I know this is a diabetes blog, but I have talked here about my depression before. (You can check the "labels" section in my sidebar.) I've always said that the easiest way to reduce stigma around something is to get people to talk openly about it. So I need to talk about some personal things now. I need people to understand. I'll be sharing this blog post with everyone I know online and in person, so excuse me if parts are a little vague. Feel free to shoot me a message if you have questions.

Some background: I have had depression for a long time. I'm 26 and at least half of my life has been covered by this dark cloud. The first time I had to see a counselor for depression, I was 13 years old. I fought against taking antidepressants until I was 19 and couldn't cope on my own anymore.

This past fall (2015) was a particularly bad one for some reason. My brain decided that it wasn't enough to just be depressed. I'd always had the occasional suicidal thought, but my brain needed to ramp things up. I couldn't stop thinking about killing myself. Everything became a plan to end it all. To top it all off, I'm usually attached to enough insulin to get that job done.

One morning was particularly bad for some reason, so I called into work and told them I wouldn't be in. Then I called my psychiatrist and told her what was going on. She told me I needed to come into her office, so that's exactly what I did.

I ended up spending time as an inpatient at a psychiatric hospital. After the inpatient stay I transferred to an outpatient program where we (the patients) spent time working on things like mindfulness, reflection, and various ways to cope with out maladaptive behaviors, be they drinking, drugging, cutting, or just being flat out depressed. I met a lot of cool people and was working hard at this program, but I was not getting any better. I ended up needing to spend more time on the inpatient unit because I was still very suicidal and the staff felt it was in my best interest to not be at home. Additionally, my psychiatrist thought it was a good time for me to take a break from my pump because he was afraid I was going to use it to hurt myself. I did write about taking a brief pump break, but I don't really remember doing it. Why?

Electroconvulsive Therapy. ECT. Even in psych hospitals it carries a bit of taboo. I was mentally in a dark place with no options left. I'd tried many, many drug therapies to no avail. I'd spent weeks in treatment at a psych hospital. Nothing was helping me and I was constantly suicidal, so I agreed to undergo ECT treatment.

Over four weeks I had a total of 12 treatments. It didn't hurt and I don't remember much of it. The main side effect of ECT is memory loss around the time of treatments. I don't remember most of December or early January except that I was pumpless and hopeless, yet optimistic this treatment would work. Did it work for me? Mostly. The visceral need to be dead is gone, and that is a huge relief to me. ECT did pretty much nothing for my mood. I'm still working with doctors to find a good pharmaceutical aid for that one. I'm seeing a therapist. I know that eventually something has got to work. It has to, and I'm not giving up until I find what works for me.

Thank you for reading this far. It seriously has taken me months to decide to hit the "publish" button on this.

Diabetes Goals: 2016

2016 already? Time does fly. I'm not normally one for setting goals, but I've done this for the past two years, so why not? Also, I know it's almost January 3, but whatever.

• Keep my A1C at or below 6.5 all year. I spent all of 2015 at 6.5 and 6.4, so I think I can do it again this year. It feels so good to have your endo actually tell you good job on your A1C. 
• Use as much insulin as I need and not feel bad about it. Somewhere along the way it got implanted in my head (by a certain CDE I visited) that using more insulin is some sort of failing. As I've already established, I'm fairly insulin resistant. I exercise, and I've taken Metformin (to no avail). I'm still insulin resistant and it's not my fault. I didn't do anything to cause it, and not using as much insulin as I need just because I don't want to see a high number of units on my pump is just stupid. 
• At least try decreasing the high line on my CGM. Right now it's set to 170. I'd like to at least try it at 160 and see how it goes. 
• Have more good days than bad, diabetes-wise. Sometimes there's absolutely nothing you can do about the random nature of diabetes, but I'd like to do my best to control the beast.
• Make people laugh about diabetes-related things. I'd like to continue my lighthearted shenanigans on Twitter. 

That's all. I like to keep my goals manageable and reasonable. The only thing I might add is to make myself blog more, because I got really bad at it last year, but I don't want to push my luck with too many goals. ;)