Diabetes Goals: 2015

Okay, it's January 3 and I have yet to commit to any New Year's resolutions. So here we are. It's good to have goals, it really is, but I've never been a huge believer in changing everything overnight just because the year on the calendar has changed. My goals aren't really specific to it being a new year; they're things I've been steadily working on anyway. Just as it's good to have goals in the first place, it's also good to have them written down and shared. At least for me, having my goals out there gives me a sense of responsibility to stick to it. So, diabetes goals...

• Bring A1C below 7.  I rang in 2014 with an 8.3, and I'm ringing in 2015 with a 7.1. I can do this, I really can. How? Listen to my CGM more than I do. I need to use it to live closer to the 100 line than the 150 line. Last year I started my CGM and I started changing my mindset toward numbers. 200 used to be my upper limit, and over time I've bumped it to 180. I'm afraid that if I bump it any lower it will alarm every time I eat. I think listening to my CGM will make the biggest difference. 
• Stop obsessing over BG numbers. I know it sounds counter-intuitive given my goal of decreasing my A1C, but sometimes I drive myself nuts stressing out over going to bed with my BG at 150+. I stress myself out sometimes for no good reason other than I'd like to see a better number on my meter. 
• Eat fewer carbs. This is a huge challenge for me. Not only are carbs the most delicious thing on the planet, but I'm a vegetarian who hates eggs and cheese. These are the go-to snacks and meals of the low-carbers I've spoken to. I know full and well I'm going to fail this so hard. I like salad and veggies as much as the next person, but potatoes and pasta are the best. 
• Like myself more. This isn't even related to diabetes, mostly. I've always had a hard time liking myself, from the things I say to the way I look in the mirror. Especially the way I look in the mirror. It's hard to admit, but I'm a bit vain. Yeah, the one who hardly wears makeup ever is actually vain. It's something to work on. 

There are my four goals for 2015, or just for life in general. Last year I achieved my goals by May. I'll give myself until June to check back for a progress report unless I beat my record (doubtful). 

Living Life With the Double D's (NOT another boob post)

I posted back in March about the other D in my life: depression. Then I wrote that things were okay, and they were. But okay slowly drifted into less than okay, which led to a change of medications. These new meds aren't really doing their job, and I'm fairly certain that at the end of their probationary trial period they will be replaced with another.

Strangely, it hasn't impacted my diabetes. Like, at all. In fact, I dropped my A1C by 1.2 points between February and May. Usually when depression hits me hard, my diabetes care suffers. The thing is, it's super easy for me to get down about my medical conditions. I'll likely be diabetic forever. My belly has little white scars all over it from years of needles. I have strange bits of machinery hanging off of me. I'll be on thyroid meds forever, and my brain can't function very well without pharmaceutical assistance. You get the point. It's incredibly easy to let my health (or lack thereof) get me down.

I've heard many times that challenges we have in life are what make us stronger people. I never really thought that was really applicable to me until I realized that diabetes is actually the thing that keeps me going some days. Some days it's hard to make myself do anything. By "anything" I mean even simple things like get out of bed, shower, and take the dog out. On days like that it is easiest to just fall into my standard routine. For some reason, I have to know my BG number first thing in the morning. Yes, I have a CGM now, but I still need to poke my finger and hear the beep of the meter to make it real. Glancing at the CGM screen is easier and usually just as accurate, but like I said, I fall into my standard routine when I need to. Then I eat the same thing I eat almost every day: something covered in peanut butter. It might be easier to grab something faster and sugarier than that, but I still don't want to mess up my BG.

I have no idea why, in the midst of caring about nothing, I care about my diabetes so much. In that moment, though, I'll take anything I can to keep my head above the water. So I get up, I check my BG and eat peanut butter, and take the dog out.

No matter what, I always care about the DOC. Usually, they care about me too. I know I've really dropped the ball on blogging lately. I kept tweeting, though. It's just that the last few months have been really, really bad with my depression. I'm not going to lie. It sucks, and every aspect of my life has been suffering (except the diabetes). I'm starting to feel a little better, I think. It's a good thing, too. I'm going to have so much crap to post about with the holiday adventures coming up, and my next endocrinology appointment coming up on December 1st!

So, stay tuned, readers, because there might be something posted one of these days.

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. 

I Should've Kicked You With My Sprained Foot.

I hurt my foot. I am, without a doubt, one of the clumsiest people on the planet. I hurt myself without even trying. My foot's been bothering myself for a while now, so I went to my Primary Care doctor. When I got there, I was told that I'd be seeing a different doctor because mine was out today. Okay, fine, whatever.

After a general check of my weight, blood pressure, and pulse rate, the doctor came in to see me. I've never met this guy in my life, so I didn't know what to expect. I looked him up on my phone while I was waiting. He is a certified family practitioner, with a specialty in family medicine. Okay. He examined my foot, said I'd be fine, gave me a prescription anti-inflammatory, and told me to get an Ace bandage. He was scrolling through my file on the computer and getting ready to send the Rx to the pharmacy. Then he brought up my diabetes, and that's where things got ugly.

"Oh, I see you're a type 1 diabetic. How's your diabetes?" he sounded conversational, so I told him I was managing. Usually doctors leave it at that. Nope. "What's your A1C?" Eight-point- "that's not managing! That is terrible! You're on a pump, there is absolutely no reason you should have an A1C above 7. What? Are you not checking your sugars? Not bolusing? Sneaking candy?" That's when I used my stern voice to tell him I test a minimum of 6 times per day, correct when needed, and bolus for everything. "Well obviously something is not right. Do you actually see an endocrinologist?" Yes. Every three months. Given my circumstances, she is okay with my progress, and- "any endocrinologist worth their salt is not going to be happy with an A1C that high. What is your BG when you wake up? When is it the highest?" Around 100, usually mid-afternoon, but I have a non-constant schedule, so finding patterns is difficult. "Well, if you're high in the afternoons you need to increase your basal rate. Your carb ratios should remain constant through the day, but if you're higher after lunch, you need to increase your basal rate." Okay, whatever. At that point, I was over it, flustered, and taken aback. So I just listened to him talk, nodded, and left as soon as I could.

I'm still finding my voice when it comes to standing up for myself. I can defend other people all day, but I'm still working on advocating for myself. I didn't want to keep going with this doctor about diabetes, mostly because he seemed to have an overly simplified view of it. He was of the opinion that diabetes is a static, formulaic disease. Input the right number of insulin, and there is ZERO reason you shouldn't get the right numbers.

If I run into this again, I don't know what I'll do. Has anyone else dealt with this? 

The Other D in My Life

Since this blog's inception, I have known that I needed to write this post. I believe that talking about issues (like diabetes) can help spread accurate information and help to reduce stigma. Not only do I struggle with the stigma of being diabetic, but also the stigma of having depression. I also have anxiety, but that can be its own post.

The first reaction to hearing of my depression is usually disbelief. The next reaction is that it's not so bad. Life is great. The conversation usually goes something like this: "No! You don't seem depressed. You just need to cheer up and see the positives in life."

The common assumption seems to be that depression is a personal weakness. I'm not strong enough to deal with the realities of life. Another assumption is that I choose to be depressed. Why I would choose depression is completely beyond me.

I don't seem depressed to outsiders. That's a big problem with these "invisible" diseases. You can't see the pain I'm in because I've left my infusion set in too long, just like you can't see  what's going on inside my head. That doesn't make it any less real to me.

I received my official diagnosis in 2010, and I started medication shortly after. I wish I could say that everything got better and it's all sunshine and rainbows now, but it's not. I started taking medications in 2010, and I haven't stopped. They have been working (mostly). These days, my depression is manageable. I can deal with it, and push through the fog. Sometimes I have to work a little harder to see the sunshine, it's true. The point of medications is not to make me happy; the point is to bring me back to even, so I have the same opportunity to be happy as everyone else.

Does depression affect my diabetes? You bet your behind it does. On the bad days, the days when it's hard to get out of bed, I force myself to do the things I need to do to stay healthy. I know everyone has bad days, so this isn't unique to someone with depression. Some days I need to remind myself to take it one blood test, and one bolus at a time.

In general, my body is extremely sensitive to stress. Having depression/anxiety issues does not help with that. The stress induced by my chemistry lab made my blood sugar rise 200 points during the first two labs, and then I got smart and increased my basal rate during lab. Performances, (watching) sporting events, and the most random sources of stress make my BG soar.

I know there are more people out there like me. I know there are other diabetics, maybe some reading this blog right now, who also have to deal with depression. If you aren't comfortable speaking about your depression, that's fine, not everyone is. I do hope that by putting this out there I can spread a little bit of information, or reduce the fear around the D-word. Maybe I can allow someone out there to know they aren't alone, that they aren't the only one trying to slay more than one dragon.

If you think you have depression, you need to find someone to talk to. The first steps are the hardest, but in the end you'll be thankful you took them. 

What I learned from the Atlanta Ice Disaster of 2014

In the event you're unaware, Atlanta recently experienced some snow and ice. Long story short, and politics aside, nobody did anything to prepare any of the roads for this mess. It did come down quickly. My professor said we still had class at 12:30 when campus was closing at 1. I normally give myself 45 minutes to get up to school and park, but I was playing it safe and left at 11:30 for class. It started like this:

An hour later, it had progressed into this:

My parents live significantly closer to my school than I do, so I decided to go to their house and ride it out. Normally it takes me maybe 30 minutes to get to their house, depending on traffic. Tuesday it took me 4 and a half hours. I looked like this:

Not my best day, I assure you. I got to my parents' house, where I was not prepared to stay. I didn't bring any clothes or D supplies with me. It is my parents' house, and I usually have a horde of stuff here, just in case. Buuuuut I used my spare insulin when I was staying here over Christmas. I have tons of pump supplies, a few syringes, a spare meter, but I had no insulin. And then my pump started beeping. Fantastic. I dug through a bag that had been in my old room since a week after Christmas, and I came up with an unopened bottle of insulin, still in its box, sitting in a bag I had brought over in the week following Christmas. Great? Okay. That room gets really, really cold when nobody is there to crank up the space heater. The bag was in the sun for about an hour every day. Having no other viable option, I used it. And I ran high for a long time. Then I started increasing my boluses by 20%. Success! Well, success until I overcompensated and dipped to 50 overnight. Oops. But I'm still alive and kicking. 

So, next week when I show up for dinner, I'm bringing some insulin and test strips to restock my supply. Just as the city of Atlanta thought it was prepared, so did I. Fortunately I was only in my car for 4.5 hours, and I came out of it on the other side. Unlike the city of Atlanta, there is a good chance that I will learn from this experience and be better prepared in the event this ever happens again. 

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?! 

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!