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. ;)

Back to MDI

For the past two months I've been back on Multiple Daily Injections (MDI), and I'd like to talk about the reasons. I had finally hit the stage I never  thought I would: total device burnout. I love my pump. He's a purple Medtronic 723 named Henry. I use him in conjunction with a Dexcom G5. I never, ever in my life (until recently) thought I would voluntarily give him up. So what changed?

Henry and I just hit our 13 year anniversary. Okay, it hasn't been the same Henry the whole time, but I've still been on an insulin pump for 13 years. That's half of my life. For 13 years I never took a voluntary break. The longest I was without a pump was 3 days when I completely wrecked my pump at camp. There were two other times I went without, but they were both less than 2 days each. In 13 years I had at most 7 days away from my pump, total. Other than that I was attached almost constantly to the thing for literally half of my life. Thirteen Years. I was starting to feel a little bit tethered. 

In the months leading up to our anniversary I was looking for reasons to not just throw the stupid thing into a lake somewhere. I have variable basal rates that Lantus can't address. Tons of people would kill to have the luxury of an insulin pump. It's awesome that I don't have to stab myself with a needle every time I want to eat. I'm really bad at the carb game sometimes, and I don't have to inject myself again when I guess wrong. My blood sugar likes to play by its own rules most of the time, and I don't have to inject myself yet again when my numbers are doing their own thing. 

All of the above were swirling around in my head, and then I had a thought occur to me (and it sounded suspiciously like my mother). "Nobody is saying you can never go back." I started to weigh the options in front of me. What did I stand to gain by going back to MDI? My skin, for one. My hips and stomach look like a battlefield. For another, I wouldn't have something logging my every carb and unit. My endo would only know if I recorded it for her, and nobody ever said I had to. The biggest thing was my physical freedom. For 13 years I've picked out my bottoms carefully to make sure they could hold the weight of my pump. If I didn't have a pump, that wouldn't be a problem. 

I called my endo to see about getting some pens. I had worked out my Lantus dose a few months prior when I destroyed my pump at camp. I knew I wanted to use pens because I was given a pen of Humalog and one of Lantus when I messed up my pump at camp because they had a few laying around. My endo was super confused as to why on earth I would ever want to give up my pump. My A1Cs were pretty good (6.4) with the pump, so there was really no reason to change. I listed my reasons. After a little back and forth, she agreed that it was ultimately my choice, and she wrote a 90 day prescription for pens and pen needles. 

Almost 2 months in, and I'd forgotten how much I hated MDI. This is hilarious to anyone who knows how hard I resisted getting a pump in the first place, but I think that's a different story for a different time. As I said before, I'm not always the best at the carb game and frequently have to correct a few hours after a meal. It's not my insulin:carb ratio being wrong; it's just me (sometimes) being really bad at counting carbs coupled with me being quite insulin resistant. 

Speaking of being insulin resistant, my Lantus dose is pretty huge. It's 60 units huge. No matter where I inject or how long I hold the needle in my skin after injection, some always comes back out. The amount that comes back out varies, and I don't know how much this is messing me up throughout the next day.

As it turns out, not logging everything can have its downsides. Like forgetting if I actually took a correction dose, and if I did, when I did it. There's some guessing that can be done, but sometimes I just can't be sure I actually took a correction or not. My memory is pretty bad. 

The people around me aren't fond of watching me stick a needle into myself. This isn't a huge deal for me, because my health comes above their comfort, in my opinion. I'm not a total asshole though, so it does weigh on me. For what it's worth, I don't care at all what strangers think of my injections. I really, really don't. 

I'm fairly insulin resistant and carb sensitive, so I end up injecting frequently. I mean, I have to take insulin for carrots. There are very few foods that won't mess with my numbers. The sheer volume of injections is annoying. 

I'd forgotten about the bruising that can accompany injections. Now my skin isn't dotted with old infusion sites. Instead it's mottled with bruises from many shots. Even in the beginning when I was a good girl and changed my pen tip with every injection, I still got the bruises. 

I'm not a wasteful person at all. I reuse just about everything I can, and try to not waste anything if I can avoid it. This adds annoyance when I get down to the end of a pen. Let's say I have to inject 15 units for dinner, but I only have 10 left in the pen. Do I waste the 10, or inject 10 and then another 5 from another pen? It's frustrating, but I can't stand to waste, so I will usually inject 10 plus 5. 

Remember earlier when I mentioned my variable basal rates? Yeah, that really has come into play. Because I'm still wearing the Dexcom, I can see exactly what happens when I try to use Lantus for my basal. I'll go to bed around 120, then dip down to around 70/75 around 3 AM, and be up to 250 by 9 AM. Then I'll spend a good chunk of my day trying to get my numbers back to where I'm used to seeing them- under 130 most of the time. This is the biggest reason I want to go back to my pump. It's not the number of injections I have to take, it's not the bruises, it's not the inconvenience. It's the fact that  I can't manage my basal needs with Lantus, and then it takes me hours to get back to a reasonable level. Because of this, Dexcom is now estimating my A1C to be 7.1, up from 6.4. 

All in all, I'm not okay with the way my care has suffered since switching back to MDI. I'm frustrated with the higher numbers I'm experiencing and I'm probably going to be back on my pump by New Year. 

Yes, the Crossfit Thing, Again.

It's been a little over 24 hours since the infamous Coke=Diabetes Tweet was sent from the official account of Crossfit. There have been numerous articles written about this fiasco, and I originally had no interest in writing one of my own. I spend a good bit of time on the internet, like most 20-somethings, so I've developed a thick skin for this type of ignorant joke. I was content to just let it go by; there were already articulate people fighting the battle with Crossfit on Twitter and Facebook. Then things started getting crazy. Instead of apologizing, maybe back pedaling, Crossfit not only stood by its tweet, but then opened its figurative mouth and spouted a lot of things that made it clear that the person tweeting for Crossfit does not understand diabetes. That's fine. Most people don't understand diabetes until they're forced to (and yes, it just highlights how far we have to go in raising awareness). The issue comes in the fact that they are not willing to let go of their misconceptions.


Before I get into the meat of this post, I want to express how strong the Diabetic Online Community (DOC) is. Generally, we stick together. We support one another, we chat, we fund raise, and we kick ass. Generally. When these jokes (obviously geared to the type 2 crowd) come out, the first issue always presented is "not type one! Nope, not me! I was diagnosed as a child and I only ate organic unicorn meat before I was diagnosed; I was perfectly healthy!" and the typical response is "oh, of course we didn't mean you! We know you guys are totally innocent!" So, I'm not going to touch that one. We are aware that type one and LADA (slow-onset type 1) are autoimmune conditions that we don't know how to prevent. We know.

My problem with the obvious "not me" gut reaction of type ones is that we are throwing our T2 brethren under the bus. I'm of the opinion that we have the more socially acceptable diabetes because it's generally accepted that we didn't do anything to cause our diabetes. But we need to stick with our T2 friends. I know there are quite a few T1 folks who resent the T2s because they feel T2 is easily preventable. I've already written about why I fight these misconceptions, but seriously, nobody asks for diabetes. Nobody deserves diabetes.

Some facts from the CDC:

As of their 2014 report, and estimated 29.1 million people in the United States have diabetes, and 95% of those cases are type 2. Out of all T2 cases, an estimated 80 percent of  them occur in overweight or obese individuals (those with a BMI of 25 or higher).

Okay, so dismissing the 1,455,000 T1s and the 5,529,000 "thin" T2s in the US, we are left with 27,645,000 overweight or obese type 2 diabetics. That's a lot of overweight T2s, I know. It shouldn't be surprising, given that being overweight is one risk factor in developing type 2 diabetes.  Newsflash: regular, full-sugar soda is a beverage that is relatively high in calories. Consuming an excess of calories causes the body to store the extra calories as fat, adding weight.

I am not denying that drinking cola can contribute to gaining weight, which can contribute to developing type 2 diabetes.

Given that 66.8% of Americans are overweight, and 35.7% are obese, I would honestly expect to have more type 2 Americans if weight were the biggest contributing factor. If HALF of all obese (BMI of 30 or greater) Americans had type 2 diabetes, there would be over 57 million type 2 Americans. It seems pretty clear to me that weight is only one contributing factor in the onset of type 2 diabetes.

Do you remember being taught about the fire triangle in elementary school? Fire needs three things to survive: heat, oxygen, and fuel. If you don't have all three you don't get fire. Weight is only one side of the proverbial triangle. But diabetes doesn't actually have a neat little triangle of causality. We're not really sure what shape it is because there are so many factors that influence T2: ancestry, age, sex, birth weight, and more. Blaming diabetes on obesity is overly simplifying a complex issue.

Ultimately, the big fuss surrounding the Tweet is really about fat shaming. For a fitness Twitter account though, that's business as usual. Because, you know, these elite fitness types work so hard for their bodies, and everyone who doesn't is just wrong. And if you're one of those wrong people, you could totally benefit from their fitness regime and supplements. You could fix yourself, you know. you could save  yourself from diabetes, because as long as you work out and don't drink soda, you can't get diabetes. Tell that to the 5 million T2 diabetics who are at an acceptable weight.

Another large component of developing T2 diabetes is ancestry. 13.2% of black Americans have diabetes, compared to 7.2% of whites. But we can't post a meme about having diabetes because you're black, because that would be uncouth, right? It totally wouldn't be cool to blame diabetes on something that an individual can't control.

Tl;dr If you say "drinking Coke will make you fat and give you diabetes," you sound like this:

Dblog week day 5: Foods on Friday

Okay, I'm going to start of by admitting that food and I don't have the best relationship. I don't advise eating like me. Some days I don't eat unless I go low, some days I don't eat, and most days I don't eat what a human should. Instead of listing off things I eat on a daily basis, I'm just going to give an overview of the foods I do eat when I eat them.

Breakfast: I hate typical breakfast foods. Most of them are filled with a gazillion carbs and lots of sugar. I also don't like eggs, which are a breakfast staple for many. That being said, I love cereal. My biggest weakness is Froot Loops. I have to bolus 30 minutes before eating them if I don't want to see a huge BG spike. If I wake up in the morning and I'm on the low side, I will fill a bowl with Froot Loops and chow down. My other favorite food for breakfast is a peanut butter sandwich. I know, I know, it's not a typical breakfast food, but whatever.

Lunch: Lunch is my meal most likely to be skipped. What I eat for lunch depends on what I had for breakfast. I eat a lot of sandwiches for lunch. Peanut butter is my go-to, but sometimes I switch it up and have some cheese or faux deli meat (I'm a vegetarian). There's usually a Diet Coke at lunch time whether or not there's an actual lunch.

Dinner: Dinner is the one I almost always eat, mostly because my boyfriend also has to eat and it seems like the thing to do. Dinner is highly variable in what I eat, but pasta and Mexican foods are my favorite to eat. This is the meal where my vegetarianism comes into play. My boyfriend loves meat, and we usually end up making our own versions of the same dish most nights. For example, I'll make a veggie burger and he'll make a burger. It creates more dishes, but fewer arguments.

Snacks: Hummus is the best thing ever. Seriously. It's also very versatile. You can dip so many things in hummus: veggies, pita, a spoon... anything! Sometimes I'll eat hummus on an everything bagel thin for a meal. Mostly this section is about my love for hummus. Tip: take plain hummus and mix is with buffalo sauce for hummus with a delicious kick. It's so freaking good.

Again, I don't advocate eating the way I do, or the way I don't, however you look at it. I know it's not exactly healthy, but the blog prompt said there's no judgments on this, so I'm presenting it just the way I am! 

Dblog Week Day 4: Changes

I was diagnosed in late 1997, almost 18 years ago. A lot of things have changed with my diabetes management since then. The technology, the theories, and so on. I've changed too. Obviously I'm not 7 anymore. Let's take a stroll down memory lane...

I remember getting my first glucometer, the OneTouch basic, when I was diagnosed. I thought it was huge, and I almost wish I still had one hanging around to see if it really was as big as my little mind remembers it being. For those of you who never got to experience the OT Basic, it took a large, pendulous drop of blood to cover a circle in the middle of the test strip. It came with a Penlet lancing device that I swear used paper clips as lancets. It never occurred to me that testing would ever happen any other way. After the OT Basic, I got the Profile, then was in for a big change when  Imoved to the OneTouch Ultra. Everything about it was so small! The lancer was smaller, the meter was smaller, the strips were tiny and the sample size was nothing compared to what I was used to. It was the first meter I ever used that had strips that sucked up my blood. That was so cool. Since then, things have continued to get smaller and easier. Now I even have a CGM that can tell me my BG any time.

When I was diagnosed. I was on older insulins that meant I had to eat the same amount of carbs at same time, every single day. I had to get up at 6 to get ready for school, so that meant I had to get up at 6 on weekends to eat the same number of carbs. I was not the favorite sleepover guest. My dad made me the same gross 45 carb shake for breakfast every day. It had peanut butter and eggs in it to keep my BG stable. I remember that very clearly. I also remember being a hungry kid and not being able to eat because it wasn't snack time, and sometimes 15 carbs just didn't cut it. I've never been a big meat or cheese eater, so a lot of the time I was just hungry. Whenever I complained about being hungry my mom would tell me to go have a glass of water.

In 1997 I was started on insulin vials and syringes. Those insulins could be mixed in the syringe so I only had to take one shot at breakfast and dinner instead of two. I remember being really excited when I got to use pens for the first time. It may have been because my hands were smaller, but they felt heavy, and I was terrified I was going to drop them while they were stuck in my body. I went back to syringes because of that. Eventually, after a year of nagging by my mother and doctor, I started on the insulin pump. Even the pump was different in 2002. There was no bolus wizard, so I still used my trusty calculator keychain to figure out my doses. The biggest thing about the pump was that it gave me more freedom. If I wasn't hungry, I didn't have to eat. If I was hungry, I could bolus. It was like freaking magic.

In 1997, I hated diabetes. Okay, that hasn't changed a bit. I still hate diabetes. I deal with that hate differently now. I used to throw hissy fits and refuse to take my shots. In my teen years I didn't want to be different from my peers, and I hated diabetes for making me so different. I tried my hardest to ignore diabetes. I did the minimum it took to stay out of the hospital. As I got older I got used to the doctors telling me that I was doing a really bad job of managing. I didn't care. Diabetes made me different, and diabetes was going to kill me. I was used the that idea. My a1c was 12 for the longest time. Even when I wanted to get better I didn't know how because I was so out of practice. Eventually I adopted a better attitude. I got a better doctor by chance, and now I wouldn't give her up. Now I'm active in the DOC, on Twitter, and sometimes I blog. I joke about diabetes, but not in the usual cupcakes=diabetes way.

So much has changed since 1997. Things I didn't even think of (like CGM) are now a part of my daily life. I can't imagine how different diabetes management will be in another 18 years. Part of me really hopes it will be cured. The other part of me is just accepting that I'll probably just have a few more gadgets to play with. Only time will tell.

Dblog Week Day 3: Clean it Out

I'm not in the mood for anything heavy today, so I'm not going to be cleaning out my emotional closet. As a matter of fact, my literal diabetes closet is actually in order. My purse... well, it's not. I'm not a super girly girl; I don't have a lot of purses. I mostly just carry around the one. It's become a catch-all for a variety of things. Take a look:

There's makeup, not that use it much. I have some gum, my test kit, lip balm, a pencil, a bottle opener I got in Seattle and subsequently forgot about, a AAA battery, the cotton ball from the last time I had blood drawn, an empty Humalog bottle, and, oh yeah, a shit ton of used test strips. The stack of test strips is what makes this post really about diabetes. This post has made me realize that I really should clear that crap out more often. I didn't even realize I had the cotton from my last blood draw. Grooooooss!