Wednesday, September 26, 2012

It's Beginning To Look a Lot Like Christmas!

Also like Christmas, is the fact that I am going to wait until I have a whole day to test it out - Saturday can't come fast enough!

Saturday, September 22, 2012

I Drive a Car and My Home is Protected by ADT

I like analogies.  And stories.  I have always liked stories.   The best days at work start with an engaging story about . . . well, what happens at work, stays at work. But I digress.

I think that using the common to explain the uncommon is one of the best tools of communication.

When I decided to start using the pump, I was super excited. But I had a few people say, "Oh, your diabetes must be REALLY bad now that you have to use that."  (My diabetes is already considered the bad kind to some because I have to take insulin in the first place).  My response is always that an insulin pump is just another form of transporting insulin.  Some people have a working pancreas, some people use needles or insulin pens, I use a pump.  It's like needles are a bike and a pump is a car (mechanized).  Neither one is good or bad - they are both different ways to get to the same place.

So, when I started thinking about using a Continuous Glucose Monitor, I had to figure out how to explain it without using the words "interstitial fluid" because I can't even explain that one.

I posed the question: "If you were living in an unsafe neighborhood and your home was prone to break-ins, what would you choose to monitor your home? Would you rely on a camera that takes still shots every 3-4 hours, or would you want a video camera that gives you a moment-by-moment recording?"  The answer is almost always "video surveillance"!

Essentially, a CGM tests sugar levels in fluid every 5 minutes and fills in the blanks between my finger tests.  A CGM is not accurate enough to stop poking my fingers, but assists greatly in seeing trends regarding how I react to exercise, certain foods, or may even answer the questions "Does taking my insulin 15 minutes before a meal really matter?" and "This chocolate covered caramel cheesecake can't be that bad for me, can it?"  It could also alert me when blood sugar is bottoming out or going sky high by indicator arrows that show me when my sugar is rising rapidly, staying steady, or dropping rapidly.

Blood sugar test from fingers: I know where my sugar is right now.  I don't know where it is going or where it has been since the last time I tested.  I just know where it is right now.  I can use my intellect, and years of thinking like a pancreas to guess where it might go (based on my exercise patterns or food intake) - but I am human and I get stuff wrong.

CGM:  I can get an idea of where my sugar has been and where it is heading.  I can also see how fast it is moving*. I can confirm with a finger test when necessary.

Piggybacking on the previous post, I usually test 10 times a day to try and get an idea of what on earth my body is doing.  Knowing and correcting my blood sugar level is a major way of protecting myself from complications and improving my quality (and maybe quantity) of life.

All that to say - with my deductible met, and a team of super helpful suppliers, I am making steps toward becoming fully bionic.  My CGM is ordered and on it's way.  I am a little hesitant to have one more device to wear but hopefully, like the pump, it will improve my control and be worth the extra baggage.

Waiting in breathless anticipation . . .

*In a perfect world, technology works perfectly. Granted, a CGM is flawed - sometimes throws out a false alarm, may not read consistently - but, heck, even blood sugar meters are acceptable by the FDA if they are within 20% of the actual blood glucose level.

Feeling Expensive

Diabetes is an expensive habit.  We spend 1/4-1/3 of our income on health related care every year so that I can maintin the lifestyle to which I have come accustomed.

I keep reminding myself (and my husband does too) that my health is worth it.

When bills arrive for trying to more tightly control my diabetes (seeing my Doctor more than the covered amount per year) or when restrictions are enforced that only cover testing my blood sugar 6 times a day (when I actually test 10) I get frustrated.  But then I realize that I spend way more on my health than I actually pay for - because when I meet our deductible, my supplies are covered 100%.  I may get $3,000 worth of supplies for "free" (after spending two and half times that to get there) because we have health insurance.

I am so thankful when suppliers of test strips, and pump supplies "get this".  I have companies that help me figure out how to get the most bang for my diabetic dollar.  To make the most out of the remaining billable year and squeeze in one more shipment before the dance of insurance claims and benefits starts anew on January 1st.

It makes meeting my deductible a little more enjoyable.

Tuesday, September 11, 2012


I was diagnosed with T1D in college.  It was a small college with a close community.  Even then, at my disposal were 5 people, around my age, also with T1D.  This meant questions were answered, knowing glances were shared over the occasional high carb cafeteria meals, and with a brief statement of "I'm 328" empathy abounded.  I'm not sure I fully appreciated the high value of a community tied together by diabetes.

Until I was without them.

Moving out of college, away from my support group, was tough.

Now, I live in rural Michigan.  I feel like I could walk 10 miles and still be nowhere.  But that's coming from a city girl. 

Don't get me wrong - I wouldn't change my deer-crossing, amish-traffic, peaceful setting for the hectic pace of the city (except at midnight when I am craving pizza delivery or chicken wings).  But T1D sightings are few and far between.

This is when I am so thankful for the support that I do have.

I am thankful for my local diabetic support group.  Even though it is made up of me and my elderly, male, T2 friends, it is lead by an incredibly passionate Certified Diabetes Educator.  She is an advocate, and daughter of a diabetic, who has the patience and passion to devote her life to a disease she doesn't have but is zealous about awareness and education (read: changed lives).

I am thankful for the friend and co-worker who's loved one has diabetes.  The one who, after hearing me open a third package of fruit snacks, asks "are you okay?" because she knows I am low.

I am thankful for my wonderful family who supports me from near and far.  The ones who bought me my first medic-alert bracelet and find delightful sugar-free chocolates (yes, they do exist), who tailor menus to my lazy pancreas and do their best to support me.

And I am thankful for my husband, who has never read so many nutritional labels in his life.  Who encourages good eating habits and walking because it is good for both of us.  Who supports the occasional emotional eating splurge, because he knows I need a break.  Who loves me and wants to love me for as long as possible - and from whom I hear "I love you" when he nudges me toward health, and away from 3 more scoops of ice cream right before bed.

I am thankful for the DOC.  With whom I share experiences and a nasty insulin habit that all of us are hoping to kick one day.  For all the blogging and tweeting that helps each one of us feel a little less alone.

Most of all, I am thankful for Hope.  The Hope that says "we will make it through another day" and "I know this feels like more than you can handle, but it is making you stronger" and "Someday this will all be a memory".

I am so thankful that I am never far from love and hope.

Wednesday, September 5, 2012

An Overwhelming Overview

One of the things I encounter are misconceptions about how T1D (Type 1 Diabetes) affects everyday life.

I knew nothing about diabetes before my diagnosis, except that my Grandma smelled like 'hospital' when she injected her insulin.  And when she died young, it was due to "diabetes complications".

Some people have asked me, "you just have to watch how much sugar you eat right?", as they get you a giant fruit salad because you can't have cake, or others, in the face of someone with "uncontrolled" diabetes say "why don't you just eat the same thing every day?"

As I said, before I was diagnosed, knew very little about the disease.  I learned (somehow) that "diabetics can't have sugar".  So when one of my T1D friends was passing out due to low blood sugar, I reached for the Diet pop. Not helpful, and in fact a dangerous misconception.

So in my desire to help others understand the magnitude and extensive reach of the invasive arms of diabetes, here is my list (by no means exhaustive, just exhausting) of what can affect blood sugar.

Food (let's get the obvious out of the way):

What you eat (not just sugar)
  • Carbs are found in every food to varying degrees that is not a fat (oils, butter, etc) or a protein (eggs, meat, etc).
  • Fat changes how your body absorbs sugar - I need to match how my insulin works with a fatty meal, which is different than a meal that is lower in fat.
  • Fiber and protein are very low in carbs (A hot dog won't budge my blood sugar, but the bun, sweet relish, and ketchup will!)
  • Fast acting carbs (simple sugars - white sugar, syrups, pop, etc) will raise my blood sugar quickly.
  • Along with carbs directly impacting blood sugar, PWD (People with Diabetes) are encouraged to limit their intake of fat and cholesterol.
When you eat
  • A regular schedule is encouraged for diabetics to reflect your body's natural ebb and flow (ever had a meal delayed by an unexpected appointment?)
  • Eating right before or after a workout? I need to know how the food will react with my insulin and stomach in both situations.
Medication (My drug of choice is Insulin via insulin pump):
Insulin works to lower the blood sugar. There are 2 reasons I take insulin - to cover carbs eaten (bolus) and as a continual background insulin (basal).  However, it's not that simple as there are many factors that impact my insulin needs.
  • Exercise - helps my body to use less insulin to cover the same amount of carby ground as a non-active day
  • Hormone changes - throughout the month my insulin needs change.
  • Weight changes - a loss or gain of even 5lbs can increase/decrease how much insulin I need.
  • Body's rhythm - throughout the day, the amount of insulin it takes to cover 45 grams of carb changes.  I use less insulin in the morning and mid afternoon than I do the rest of the day.
  • Site absorption - where I inject my insulin impacts my blood sugar levels.  My belly absorbs the most consistently, legs and arms are next however absorbency changes more rapidly with exercise, and my love handles are the lease reliable.  And though I would love to stick to the belly, scar tissue and other factors beckon me to rotate sites.
  • Age of site - by the fourth day of one injection site, my optimal insulin absorption wanes.
  • Age of insulin - insulin left in a hot car will render it useless, and insulin in a pump in a hot tub has the same results.
  • Timing - Insulin works best taken 15 minutes before I eat - but if I take it too soon and a delay happens, then it will lower my blood sugar too far.
  • Cardio - can lower my blood sugar rapidly, depending on how much insulin I have that is still active (IOB: Insulin on Board), unless my blood sugar is too high in which case no exercise is recommended.
  • Strength training (think weightlifting) also drops my blood sugar, but less quickly than cardio.
  • Daily chores and shopping are also included in this category as anything that involves physical exertion (*ahem* . . . any physical exertion) affects blood sugar levels.
Other Factors:
  • Stress - raises my blood sugar like you wouldn't believe.
  • Pain
  • Outside Temperature - on the hotter days my body uses insulin more effectively (it takes less insulin than usual to lower my blood sugar).
  • Hormone changes - everything from the once-a-month club (insulin needs may decrease but chocolate cravings increase!) to pregnancy.
  • Amount of sleep.
  • Illness and some medications (I have to take insulin if I want to take a dose of regular cough medicine due to the sugar content).  My blood sugar increases when my body is fighting an infection and is sometimes my first indication that I am getting sick.
  • Alcohol consumption.
To be able to comprehend how this practically plays out, imagine 2 scenarios:

Before a meal:  How many carbs am I eating (a SWAG (a Scientific Wild-@$$ed guess) is necessary if you are at a potluck or buffet)? How much fat? Will I be walking anywhere after this?  How far will I walk?  What about those 8 upcoming reports I have to get done this afternoon (stress)? I do still have IOB from my last bolus? When are we eating - how long will it take for the servers to bring our food out?

Before a walk outside:  What is my blood sugar now? Too high - can't exercise now; too low - need to drink a juice (my preferred vehicle for blood sugar raising - and btw, I can't think of the last time I drank juice just because it tasted good).  Do I have enough fast acting sugar for the duration of the walk if my blood sugar drops?  I do still have IOB from my last bolus? Too much IOB and my blood sugar will drop rapidly and often - taking more strength than the exercise would give me. Do I have my cell phone and i.d. in case of emergency? Do I have my tester and enough strips? Where's my Mp3 player?
A life with diabetes is far more complicated (excuse the term) than just managing what goes in my mouth.  It is broad and sometimes surprising.

This is not meant to overwhelm (contrary to what the title implies), just to inform.  Living with this disease for 9 years most of this feels second nature - but it is still a lot to consider day-to-day.

Any questions or comments, please post below!