Monday, August 30, 2010

That's What I Get.

For today's post, I do not aim to be eloquent or elegant.  What I do hope for is a gentle ear (or eye?) upon which I can recount this tale.

Simply put, Today seems to be what happens when I get cocky, and it's bleeping annoying.

For reasons I can't completely explain, Saturday and Sunday were great diabetes days.  I stayed around 90 most of the time, despite multiple snacks (yes, with carbs) and some SWAGing (no, I haven't kicked that habit yet).  This type of shenanigans-free blood glucose behavior is not normal for me; especially on the weekends.

Every once in a blue test trip, I'll get a day or two like this.  It gives me some confidence, and a sense of relief.  I almost start to think, Hey, you - this isn't so bad after all.  See how well you're doing?  And you're hardly trying!  You've got this!  It's all falling into place!  I want to give myself a big ol' pat on the back; like I've earned it somehow.  As if my 24 years of diabetes knowledge and experience has culminated to this focal point of awesomeness.

But, Today?, Oh no - today, that streak of awesomeness came to a skidding halt while I was at work.  Twice.


One of the most frustrating parts is my inability to see where I went so wrong.  A little wrong?  Maybe.  But not 35 mg/dL wrong.

I ate the same breakfast.  Took the same insulin for it, 15 minutes ahead.  Then I drank my coffee - like I always do - and took a few units for it, like I always do.  I watched my number creep up to just below 130 on the Dexcom, and was still headed upwards when it was time for my daily 15-minute morning walk.  When I returned, I felt... normal.  Nothing out of place.  I got back to work, but after a few minutes felt a little weird. 

Ping and I consulted:  35 mg/dL.

"What?!?!", I shrieked, in the safe silence of my own head.  This didn't make any kind of sense.  A 15-minute walk at that time of morning is very consistent in bringing me down between 50 -60 points.  I had the same amount of IOB as I always do.  NOTHING CHANGED.

I ate some dried mango (in retrospect, not the most fast-acting choice, but that darn dietician I saw two weeks ago is still in my head:  "You need to eat more fruits!").  I waited 15 minutes, then checked again.  I was 65 and heading back up.  Whew!  Back to work.

An hour later, I'm feeling weird again.  Ping, what say you?

41 mg/dL.

"You have got to be flocking kidding me!!!", I once again yelled in my head.  Puzzled, I busted out the Starbursts.  I ate four, waited 15 minutes.  Still reading "LOW" on the Dexcom (which means under 40). 

Ate four more. 



Ate the last four. 


Ping told me I was at 100, and so I stayed above that for a little while - but only a little.

Lunch came and went.  My one-hour post-prandial blood test was 113.  (Sweet!)  But it came at a price - half an hour later, guess who came a-knockin'?

45 mg/dL.

I ate some more mango, the yogurt I brought but didn't eat yet, and then proceeded to also get a cookie later that afternoon.  And you want to know what that did?  I peaked at 152.  (....really?  That's it?  After all that carbtasticness?  Um, okay...)

I just really don't get it.  My basals have been unchanged for weeks, I was eating the same foods I always eat.  Bolusing the same exact way.  Nothing in my routine changed... except the outcomes.

Um, excuse me, Phil?  Could you come back out here, please?  I just need...


Thanks, buddy.  I'm glad to have you on my side.


(Sidenote:  Phil is a ClipArt image a co-worker and I use frequently.  Phil gets his name from the fact that he has "had his fill/Phil of this crap".  He always speaks in italics, and with multiple exclaimation marks.  Sometimes he says "Roight!!" with a Billy Idol-esque flair, but mostly he's just peeved about everything.  I have a feeling he'll be making more guest appearances on this blog in the future, so I thought I'd introduce you all to each other.)

Saturday, August 28, 2010

A Great Start To The Weekend, I'd Say.

Woke up at 103.  Peaked at 136 after breakfast, then came out at 89 at the 2-hour mark - and my meter and CGM even agreed with each other!  Yay!

"89, right Ping?"  "Right, Jim.  High five."

Friday, August 27, 2010

How Could You Not Love This Place?

A and I went to dinner at my favorite local restaurant tonight, Lazlo's.  It was delicious, but that's not the point I want to make here.  They are a local corporate sponsor for the JDRF Walk to Cure Diabetes, and I was in awe of how many of those JDRF sneakers they had around.  I couldn't even take pictures of all of them (seriously, they were EVERYWHERE!) without getting weird looks, but here are a few.  Seriously, if you're ever in Lincoln or Omaha, Nebraska, please support these guys.  Their fundraising goal this year for JDRF is $20,000.  Wow.  I'll bet they can do it, too.  You'll even notice on their "In The Community" page, JDRF is listed first. 

I had to do it - I pulled a manager aside before we left and thanked him for all they're doing for JDRF.  I told him I've had type 1 since I was 6, and to see this kind of support is really heart-warming.  He gave a very enthusiastic "Yes!" when I asked if I could put up some pictures on my blog, too.  Ha!

$20,000 is a ginormous goal to have, when you only
have three locations...

See the sneakers hiding out above the fireplace?

Flyer for the local Walk - had one posted on
every door!

HUGE sign made completely out of JDRF sneakers.  Love it!

Some JDRF love, with a side of Nebraska love, too.

D-Feast Friday: Pumpkin Brownie Muffins.

I haven't even tried this recipe yet, but I'm really, really excited about it.  I'm a fan of both chocolate and pumpkin, so I kind of think you can't go wrong with this one.  Plus, the elimination of the oil and egg you'd normally add to the cake mix means this is a low-fat and low-cholesterol alternative (with a bit of fiber)!  Win!  Definitely not low-carb, though.  Lose!  This will probably make some appearances at our football parties this fall.  (Go Big Red!)

Yum Yum Brownie Muffins

(1 Muffin, or 3 minis - 181 calories, 3.5g fat, 37g carbs, 2g, fiber, 2g protein - 4 WW points)

1 box devil’s food cake mix
1 can solid pack pumpkin (15 oz.)


Mix the two ingredients together. Don't add anything else that may be mentioned on the box, such as eggs, oil, or water. The mixture will be very thick and you will be tempted to add in other things to make the batter smoother. DO NOT DO THIS AS IT WILL RUIN EVERYTHING! Place batter into muffin tins (or mini muffin tins) lined with paper, or sprayed with non-stick spray. Bake at 400 degrees for 20 minutes. Makes 12 regular or 36 mini muffins.

(Recipe credit:  Hungry Girl

Thursday, August 26, 2010

(Almost) An Hour With JDRF's Dr. Aaron Kowalski.

Tonight, JDRF's Dr. Aaron Kowalski (who is the head scientist overseeing the Artificial Pancreas project, among other responsibilities with JDRF) did an hour-long webcast to answer live questions about the AP.  I say "almost" an hour, because I forgot it was tonight and didn't get to tune in until about the 15-minute mark.

In true nerd form, I took three pages of very scribbly notes.  I tried to submit questions, but the log-in wasn't working for me.  I learned so much in this 45 minutes, and I wanted to share some of it with you all, in case you missed it.  Dr. K, as I will now refer to him, mentioned that the webcast should be up for viewing on the JDRF website soon, so I'll include a link to that when it becomes available.  (***EDIT - Here's the link! ***)  He came across as a totally nice, down-to-earth, and wicked smart dude.  I'm glad we have people like him on our "team".

Things I Learned:
  • Dr. K has type 1, just like we do, and has had it probably about as long as I have.  (He also mentioned that his brother has type 1 as well, and has had it for about 30 years.)  So, this cause is very near to his heart.  And pancreas.
  • Dr. K might be Clark Kent.  He kept doing that push-your-glasses-up-with-one-finger thing, and it cracked me up.  Okay, fine, down to the serious stuff.
  • Someone asked what the blood glucose range might be for the AP.  He suggested that it would probably be between 70 and 180 or 200.  (Hey, that's what my CGM range is!  I guess I'm 'practicing'.)
  • This part - I had no idea this happened, and I found it kind of fascinating.  Remember the story of Pavlov's dog and classical conditioning?  Ring the bell, and it would start salivating?  Turns out a non-diabetic's pancreas does that, too.  When people get hungry and even LOOK at food, he said the pancreas starts to secrete insulin into the blood stream.  I never knew this!  It helps explain why timing your bolus 15 or so minutes before eating makes sense - your body is used to insulin being introduced to the blood stream ahead of food being eaten.  This also is a reason why we need faster-acting insulins, which Dr. K said will be needed for the AP.
  • Someone asked what a realistic timeframe is for the AP being introduced to the general public.  The AP project is a four-year project, and right now we're only 8 months in.  All of the puzzle pieces exist (pump, CGM, algorithm); the challenge of course is getting those parts to work together in a safe way.  The process of FDA approval in the U.S. is a long one - safety is a HUGE concern - so a lot of the timing rides on that.  His best guess was 3 - 4 years.
  • Will the AP be appropriate for use by type 2's as well?  Absolutely - but he said the challenge will be getting those people to accept wearing it.  The "acceptance rate", or however he put it, for insulin-dependent type 2's compared to type 1's is very small.  I can't blame them - I don't particularly enjoy being half-robot either.  Dr. K mentioned that it maybe would even be "easier" for their bodies to accept the technology, as type 2's have better glucagon response than their type 1 counterparts.  The Kool-Aid Man would be proud. 
  • I'm not the only one who has to bolus right when they wake up, to combat the dawn phenomenon.  Dr. K mentioned that he typically, when seeing even a "normal" blood sugar at his first blood test of the morning, will take roughly 1/3 of his breakfast bolus then.  I take about 2 units when I wake up, providing I am not low, or needing a correction.  High five, Dr. K!
  • One of the dangers of the AP that they're working on figuring out is balancing risk vs. benefit, and making sure to avoid overdosing insulin.  (He mentioned an interesting statistic from research they'd done:  Of people who have an A1C over 7.0, most typically spend about one hour a day below 70 mg/dL.  Of people who have an A1C of under 7.0, most typically spend about 90 minutes a day below 70 mg/dL.  Again - turns out I'm not alone.)  The problem here is risk vs. benefit.  Yes, reduced average blood sugars lead to significantly fewer incidences of complications - but those lows have a short-term risk of death, while the risk associated with highs is generally long-term.  This plays into why it will take a while for FDA approval - mitigating the risk of hypoglycemia while wearing the AP is crucial.   
  • I already knew some of this, but it has been shown that diabetics still produce beta cells - the problem is that the immune system keeps killing them off.  That first part is great news, and helps explain why some of us find our diabetes easier to manage than others, and why some periods of time seem easier to manage than others.  Apparently, there are times where your pancreas produces those beta cells faster than the immune system can kill them off.  So, those days where I've joked that I'm "not diabetic anymore" because I had stellar numbers?  Turns out I wasn't kidding!
  • The question came up, "What are the expectations of success with the AP for long-term diabetics, vs. the newly-diagnosed?"  I made sure to listen very closely to this one, as parts of me wonder that since I've had this for so long, it might be that I'm just unfixable.  Dr. K said that the research is showing that the AP works "extremely well" for the newly-diagnosed, and the outlook is "good" for us veterans.  He mentioned the Joslin 50-year Medalist Study group and how well some of those people have responded to it.  This gives me hope, and that's one of the best motivators out there.
  • Combining pump and CGM sites into one, instead of having to wear two seperate sites/sensors?  "Everyone's driving this."
To wrap up the webcast, he called for those of us watching to advocate for research funding.  If you haven't done so already, visit the JDRF Advocacy website and please, please sign up as an Advocate.  The Special Diabetes Program is up for renewal in Congress, which currently funds $150 million a year in type 1 diabetes research (35% of the federal investment in type 1 diabetes research).  This is huge.  You can read more about it here.  As people living with and around diabetes, we have the loudest voices.  Make yours heard.

Wednesday, August 25, 2010

A Pancreas Confession Session.

Forgive me, Father Diabetes, for I have sinned.

(When was my last confession?  Um...  did you not catch the bra pic in my last post?  I think that level of over-sharing qualifies...)

I tend to pay a lot more attention to you on workdays, than on weekends.  When I'm sitting at my desk, it's really easy to remember to test every hour - because Ping is sitting right there, staring at me.  Weekends are another story; I sleep late, I never eat at the same time, nor do I eat the same foods.

I have gone weeks - maybe months? - without changing the lancet.  Ew.

I do a lot of S.W.A.G. bolusing.  Not as much as I used to, though, but I still do plenty of it.  I used to even SWAG when it wasn't needed - like, the nutritional information was right there and all I had to do was a little math - I guess because I felt tired of it.  But, I'm getting better; a lot better.  I'm sticking to some of the same foods, so that helps me remember the carbs in them, and I try to look up a restaurant's website first to check for nutrition info before I go out.  And, I try to remember that, Duh!, I have that food list in the Ping remote, just waiting for me to use it.

I've used you as an excuse.  I'm not proud of that, but it's the truth.  That middle school gym class where we were supposed to run a mile, and I said I was low, so I could sit it out and drink some juice?  Yeah, I wasn't.  But I did. 

I do all kinds of things you aren't "supposed" to do...  like sometimes I fill a pump cartridge with the remaining Humalog in a back-up pen, then use an almost-gone Humalog bottle for the remainder, and to get the air bubbles out.  (You aren't "supposed" to mix bottles like that.)  Hey - insulin is expensive, and I use a lot of it.  If there's a little bit left, I'm not wasting it.

I have often done a finger stick without washing my hands, using an alcohol swab, or anything even remotely close. 

I can remember times when I was younger that I would "fudge" my numbers.  You know - you test at 250, but you don't want to cause your parents upset (or have to admit that you snuck some candy/cookies/other yummy thing earlier), so you put down that it was 150.  I sometimes would take the proper correction for the 250, but write down that I took it for 150.  (Sorry, Mom.)  I didn't do it often, that I recall, but I know I did it.

I was never good about remembering to take my Lantus shots exactly 24 hours apart.  Sometimes it was 23, sometimes it was 28...

I don't remember ever telling any of my college professors that I was diabetic.  In hindsight, this was a bad choice - I could have had so many allowances if I had pointed out my medical condition.  I could have had food in class without getting called out in front of everyone for it (because then they would have known ahead of time why I was eating), I could have rescheduled tests if my numbers were wacky, and maybe I would have done better overall, my first time around.  But, I didn't want to be singled out.  I didn't want special treatment.  I just wanted to be like everyone else, if only in that respect.

During that same time period, I was very forgetful about replacing food to treat lows in my backpack.  I'd often walk around with absolutely nothing on me to treat a low, nor would I wear a medical ID bracelet.

I still don't wear a medical ID bracelet.

I've willingly sat through a low so bad that I could barely walk to get something to treat myself.  It happened during one of my college classes (Are you sensing a theme here, with this time period?  I call them my Dark Ages), where the classroom was very small.  Maybe 15 - 20 people.  I remember finding the instructor pretty intimidating, and they were of the persuasion that absolutely no one should leave during class for any reason, because it was only an hour-long class.  I can remember feeling that panic, breaking out into a sweat, and I'm sure my face went completely white.  How did he not notice this?  (Oh yeah, the Dark Ages were also my Goth Period.  Heh.  Oh, Kim.)  Maybe I was already so pale to begin with that he didn't notice?  I sat there, going back and forth with myself: "Okay, only 20 minutes to go.  But seriously, I feel like I'm dying.  I can't even hold my pen to write because I'm shaking so hard.  But I don't want to get in trouble... but I don't want to pass out, either.  But I don't want to get called out...  that would be totally embarrassing...  Okay, now the room just got fuzzy...  Am I even talking in English anymore?  Can people hear what I'm thinking out loud?"  I don't know how, but I somehow stumbled out to the vending machine and got what I needed.  (Another scary thought:  what if I ended up not having any change on me?)

I've traveled to the other side of the world with absolutely no back-up insulin plan.  (Stupid!)  This was back when I was on the Deltec Cozmo, my first insulin pump, and under the care of Dr. B.  Having my fair share of naivety, it never occurred to me that I could have a pump malfunction while away.  Thankfully, nothing happened and the trip was great, but geez... what if?  So many things could have gone wrong there.  I had no long-lasting insulin with me.  Heck, I didn't even bring any SYRINGES.  (Again, stupid!) 

And lastly - there are some moments, small moments, where I'm actually a little bit glad you're in my life.  Though you bring a lot of the "bad" with you, you've also raised me to be a strong, resilient, and compassionate person.  You require patience and hard work, and those types of things translate to every part of my life.  Because of you, I've had some great experiences and met people I may never have otherwise had a reason to interact with.  But most of all, you've given me some purpose.  Lending support to the other people you torment, and working to get you eradicated are two of the things in life that I'm most passionate about, and so I am thankful for that direction. 

As penance, I will continue to stab myself in the finger repeatedly every day, wear my robot parts happily, and live a long, otherwise healthy life. 


Sunday, August 22, 2010

How Does That Work?

Diabetes calls for user customization.  Sometimes you borrow an idea (like trying to find alternate places to put my insulin pump under clothing), and sometimes you come up with solutions on your own.  I thought I'd share a few of the tips I have found most valuable so that the next "me" that comes along might be able to use them.   

Tip #1:  Wow, this thing is ugly.

"Um... it's... a wallet.  With weird
plastic holsters and mesh pockets."
Challenge: One Touch (the manufacturer of the blood testing meter/remote that came with my insulin pump) sent me what every meter comes with - the standard, black, rectangular, business-like zip-up case. Except, this one is huge! I've had many, many test kits throughout the years, and they had all come in a pretty reasonable size, except for this one. And it just felt... clunky. Medical. Awkward. No one could be fooled into thinking it was anything other than what it was, which I'm not a fan of.

Solution: I found a $5 cosmetic bag at Old Navy, and everything fits - meter, bottle of test strips, lancing device, extra lancets, alcohol swabs, and spare pump caps. And it's sneaky!  Granted, everything slides around all willy-nilly in there, but it's a price I'm willing to pay.

Tip #2:  Free is better than spending $10.

Challenge:  I know you can go out and buy a sharps container, but I never have.  I used to just throw needles and other diabetes paraphernalia in the regular trash, until it was pointed out to me that it's a terrible idea to do that.  (Sorry, trash collectors of the past - I promise, diabetes isn't contagious.)  A CDE that I saw a few years back gave me an idea....

Solution:  Save your empty laundry detergent bottles to use as sharps containers - the rigid plastic and screw-on cap make the containers acceptable for sharps disposal.  The opening is too small to accept larger things, like my Dexcom sensor applicators, but it works great to house old insulin pump tubing, used insertion site harpoons, and other diabetes discards.

Tip #3:  I can't find my (insert name of diabetes object here) in this cavernous purse.

Challenge:  I have to carry a lot of d-stuff with me.  Testing kit, back-up insulin pen, pen needles (btw, the "snack size" Ziploc bags are the perfect size for these, no?), extra pump infusion set in case I rip out the one I have currently installed, IV3000 tape for CGM sensor secureness, glucose tabs, other snacks...  it gets jumbly in there. 

Solution:  Make sure cavernous purses have two sides.  One for, eh, normal stuff... and one for d-stuff.  Voila!  My hypoglycemic hands will never again be confused.

Tip #4:  I'm wearing a dress, and want to appear as non-robotic as possible.

Challenge:  I don't wear dresses a whole lot, but those occasions do come up.  Normally pants are an intregal part of pump wearing - the pump is either clipped to the waistband somehow, or stashed in a pocket.  With those options gone, there aren't a whole lot of viable options for invisibility. 

In the name of science, I'm uploading
a picture of my bra.  Parts of me can't
believe I just did this.  At least it's for
a good cause, right?

Solution: The pump-on-the-bra trick. I know others wear the pump on the side of the bra, or on the inside, but this is what works for me. It's hard to describe, so for simplicity's sake (because, definitely, it's not in the name of modesty or shame) I uploaded a picture of how I wear it. The Animas-provided clip comes in handy here, and the pump faces out.

Thursday, August 19, 2010

An Open Letter To Jim.

To My Dearest and Most Favorite Robot Part, Jim:

Our relationship is still “new”, as we’ve only been together since January. I can still remember the day you arrived in that shiny green and white Dexcom box, all full of promise and hope. We’ve had some great times, and you’ve been a life-saver more than once. But, like in all relationships, communication is important, and there are some things I want to discuss with you. Please don’t get me wrong; there are plenty of things I love about you - I’ll get to those in a minute.

First, we need to address something. There are times where you’re… well… irritating. Like last night, when you were telling me for two hours that I was “LOW”. I didn’t wake up right away (is there any way you could speak up a little more? I’m a heavy sleeper), but when I did, I totally panicked. I rushed out to the kitchen to test (I know, I know, bringing my meter to the bedroom nightstand would make MUCH more sense – but we’re talking about you right now, not me), and came up with a very reasonable 80. I tested again – 79. I really appreciate that you freak out on my behalf, but really, you need to work on your accuracy. I don’t appreciate your BEEEEEP BEEEEP!s at 2am, when I actually have a perfectly good fasting blood sugar going – which then becomes much higher, due to the stress of you waking me up. It’s rude, Jim.

Then, later this morning – you told me I was peaking at 172 after breakfast, and I was feeling pretty happy about that. It’s not an ideal number, but it had looked better than I’d been after breakfast all week. When I realized I hadn’t tested since breakfast, I consulted your friend Ping, and guess what I found? 227. Really? You’re going to lie to me like that?

Also, Jim, you should know that I don’t like compromising. You're expensive and highly touted, so I expect a lot from you.  When you say I’m 172, and I tell you that, no, actually, I’m 227 – don’t come back with “Oh, okay, how about 202?” You cannot meet me in the middle, when I’ve just proven to you that you’re wrong. Please take me at my word, and believe that I’m 227.

With all this said, you’re actually a great guy to have around. Most of the time, I’m very proud of you, Jim. I frequently find that you and my finger sticks match up quite nicely, and I appreciate all of the times you’ve saved me from Epic Lows and Holy Crap Highs. I like your fashion sense (those four jackets I bought for you look simply smashing), and I like that you can give me some “time off” (shutting down) when I need it.  You don't get confused (???) that often. You've given me the confidence needed to not be "afraid" of lows anymore, because I've got you there to alert me when I'm falling.  You have a great sense of balance, as evidenced by you staying straddled between the front and side of the towel bar while I shower every morning. (I was a little afraid at first that you’d fall off, but by golly, you always stick that landing.) But most of all, you’ve done great things for my A1C. I’m not sure I could have done it without you, buddy.

Here's to our future together, in whatever form you take later on. 

Monday, August 16, 2010

I Am A Diabetes Butterfly.

I'm not sure why it took so long, or why it was that particular moment in time (among so many others chances and opportunities) that it began, but the last year or so has been pretty transformational for me. (Speaking of a year ago, I have a great diabetes-related story in regards to my wedding day, but that will be saved for a future blog post. Okay, okay, it wasn't great while it was happening, but even at the time, I recognized that it would make a great story some day. Actually, we have two great stories from that day, that weren't so great at the time. Wait, what was I going to write about again?  I digress.)

For many of the 24 years I've had T1, I have felt... alone.  I eventually got to a place where I felt that living with diabetes was solely my burden to bear, and even if I could find someone to share the load of this disease, they wouldn't really "get it" -  because they weren't living it. I didn't think anyone could truly understand the emotional toll it takes, or that looming, distant yet threatening villain Complications, or legitimately sympathize with the never-ending annoyances and inconveniences it brings. I could throw myself a pretty epic Pity Party when I wanted to. 

I went to diabetes camp for a couple of summers, and that helped, for the week of camp and a few months thereafter. But, like with so many other people in your life, you grow apart. The phone calls and letters become fewer and fewer. We all had our "real lives" to go back to. (And this was waaaaay before email. Or internet. Or electricity. Okay, maybe not the last one.)

And so, for many years I was, for all practical purposes, the only type 1 diabetic I knew. I knew "others" existed but didn't have any close connections. I'd meet someone else here or there with T1, but never felt or stayed close to them. I can't recall ever sharing "war stories", or comparing notes past what type of insulin we used, or what doctor we went to. I was connected to JDRF through the annual Walk to Cure Diabetes, but never took advantage of any of their support groups or resources. I just planned to live it all out on my own, I guess. Did that make me... tougher? Was I proud that I could do it on my own, to put on a happy face when needed, only to let it all out in a tearful wooooosh when no one was looking? Maybe. I'm not sure. The "logic" that persuaded me down that path doesn't make much sense to me now.

JDRF sends out a Life With Diabetes newsletter periodically, which I would browse through, or not. (It was my fight, right?  No one gets it!) One semi-turning point I do recall is seeing a little article on the side, with a woman my age, diagnosed the same year as me, who was writing about her life with diabetes. Her name was Kerri, and the email mentioned her blog. I clicked on the link, and correspondingly something clicked inside of me.

One blog led to another. I found entire online communities of other T1's, and they shared the same frustrations and challenges I did. And they could joke about it! They'd talk about things that people without diabetes wouldn't get, and I felt like I had been let in on the most awesomest inside joke ever. I could ask questions like "How long can I let the "low battery" alarm go on my insulin pump before I actually have to change it?", or "When I'm running, I tend to drop low, but then spike really high afterwards. Why is that?", and get immediate, compassionate answers to my concerns. 

Soon, I felt a need to return this great gift that had been given to me. The wash of support made me feel that I had been given more than I needed to fill the hole I had, and I wanted to share that remainder with others. I found JDRF's Online Diabetes Support Team, and became (and still am) a volunteer there. I also wanted to give back to one of the online diabetes communities that had helped me so much, and became a volunteer moderator for Juvenation as well. (I'm also signed up as an Advocate for JDRF.)

And, in June, I started this blog. (I'm still undecided on how open I want to be - there's always that lingering fear that full disclosure could cost me a job offer someday, or some other similar situation.  Hey, T1 isn't cheap!) 

In short, the Diabetes Online Community (DOC) has played a huge part in shaping how I view diabetes, and myself, in the past year. Everyone in the DOC has been pretty awesome, and I'm just trying to keep up, really. We're all here for each other, to fight another day. Type 1 is a team sport, right?

What I'm trying to say is...  thanks, everyone in the DOC, for helping me to share my burden. It doesn't feel as heavy anymore.

Sunday, August 15, 2010

Back To School.

Well, not literally - but my body definitely has some re-learning to do.

In my adult life, working out has tended to go in cycles.  I can be really motivated and dedicated to it for a few weeks or months, but then "life" gets in the way - or, ahem, excuses get in the way - and I stop working out.  (Not all-together; I do two 15-minute walks during my workday.  I'm talking about work-outs where I'm in gym clothes, break a sweat, and can feel it the next day.)  I believe I have just wrapped up another "off" cycle.

A and I both know that the key to being less squishy (and healthy overall) is three parts - what you put in, what you work off - and how you balance those two components.  In looking at our food and beverage choices, we know there are a few things here and there that could be better, but for the most part, we're making good choices.  Mostly organic foods, not alot of highly processed stuff, plenty of veggies, and lean meats.  We cut out egg yolks, I switched to soy coffee creamer, and we've been frequenting the farmer's market near our house.  Pretty good start, right?

So, our problem would appear to be the "working it off" part.  We agreed that we should make ourselves go for a walk every night after dinner, even when we don't feel like it - even if it's only for 20 minutes.  Not only will walking help us feel better overall, but for me specifically, it will help with post-prandial peaks after dinner.  It would also be great if regular exercise could bring down my insulin requirements.  Over time, I've acquired more and more insulin resistance, and I feel that I take quite a bit compared to other diabetics.  Maybe this is due to weight I've put on, and losing that weight will put me back to those original insulin requirements; but some part of me fears that insulin needs will just keep going up and up and up.  And that totally scares the sheet out of me.  (I should perhaps make a glossary for my Censored Swearing, aka Work Swearing To Get Past The Email Filter, but I feel like they're pretty self-explanatory.  Maybe?)  Thus, for many, many logical reasons, I need to keep moving.

I've gotten myself in pretty good shape before (and was always in good shape, up until college), so I know I can do it again.  It's a very long road to get myself back there, and sometimes seeing the length of that path discourages me - but maybe I should focus more on putting one foot in front of the other, than how many footsteps I have to take total.

I'm telling you all this, in the hopes that it will keep me accountable.  I did the same thing when I signed up for my first half-marathon this year; I announced it on Facebook and told friends and family, a bit so that the fear of shame would keep me motivated to prepare myself.  And, it worked - I trained for three months prior, and although I didn't have stellar results in time or blood sugars, I finished.  (My goal was to finish without passing out or throwing up - gotta start somewhere.)  This takes it up a notch, since I'm now pretty much announcing to the world that I need to do this.  No turning back after I click "Publish Post", right?  :)

So that's the goal - exercise.  Every day.  No excuses.

Who's doing this? YOU ARE!

Friday, August 13, 2010

D-Feast Friday.

Last night at the grocery store, A and I decided to start out with some drinks from the coffee stand they have there. (Who drinks espresso at 8:00 at night? I do, I do!)  After I had asked the teenage girl working there about nutritional information, she compliantly pulled out a beefy binder, and looked up my chosen drink for me. 44g of carb? Yikes. Maybe I shou… well, okay, fine, I talked myself into it. (Coffee is a weakness.)

I pulled out my Ping and was ready to dial myself up a bolus, when I saw the screen and though, “Crap.” I had planned to refill my pump after I’d eaten dinner, but completely spaced it off, and now I was had 1 unit remaining. (Hey, I had puppies to post – who had time to think about anything else?) Luckily, in the last few months I’ve convinced myself that carrying a backup Humalog pen is a good idea. I hadn’t said anything to A about the situation yet, so when he saw me get out a pen and start dialing up, he said “Oh, wow, you’re going old school. Is your pump out?” “Yep.”

I had lifted the bottom of my shirt a bit and was cranked back, ready to inject. Since my infusion site was on my upper stomach, and my pump was on my hip bone, some of the tubing was exposed along with those few inches of my stomach. Never being one to miss an opportunity to make me giggle (even when the timing isn’t great), A waited until the last second to loudly whisper in a pseudo-panic, “Don’t stab the tubing!!”

I don’t know why that made me laugh so hard, but it did. Let it be noted: laughing is not the best thing to be doing when you’ve got a shard of metal in your stomach at that moment.

So, now that I've shared the lead-up story, I’m going to participate in D-feast Friday and share a recipe. Well, it’s not a recipe really – more of a recommendation.  If you use creamer in your coffee, I highly suggest this stuff. It’s amazingly delicious, gluten-free, and low carb.  Ta da!

Thursday, August 12, 2010

Uncontrolled or Unlucky?

I haven't mentioned where I work before, and probably won't name it specifically, but I work in a big ol' office.  And it's student loan-ish.  I spend most of my day sitting in gray, fabricy square, in front of a computer - and nowhere near a window.  It feels a lot like this:

There are some things I like about my job (epically laid-back boss who is completely cool with my zillions of doctor appointments; good co-workers/friends who lower my stress levels with well-placed puns and pictures of Corgis; I can wear "dressy" flip-flops and shorts), some things I could do without (mistake- and socially inappropriate conversation-prone co-worker; tendancy to be bored to the brink of napping) and some stuff that just "comes with it".

Part of what I do involves processing death certificates for borrowers, and natural curiousity leads me to always want to read through them more than is necessary - namely, the cause of death.  Hey, it's interesting sometimes.  Most are car accidents or drug overdoses.  But, every once in a while (read: today), there's one that hits a little too close to home.

Cause of Death:  Hypoglycemia; Uncontrolled Type I Diabetes

Well, sheet.  (Since I'm already in Work Mode by talking about this, I might as well use my Work Swearing To Get Past The Email Filter.)  No one likes reading that the disease they have was a cause of death for somebody.  What struck me most about this, though, was the use of the term "uncontrolled".  To most, it would probably look like this person didn't take very good care of themselves.  Didn't try hard enough.  Didn't care.  Didn't take it seriously.  Maybe that's true, but maybe it isn't... it really only takes one low while sleeping, one low where your body doesn't wake you up, and it's Game Over.  I'm not sure you can conclude that the person's diabetes was "uncontrolled" if they die of hypoglycemia.  What if it was just one Uncontrolled Night?  Or one Uncontrolled Afternoon?  What if they were otherwise healthy and balanced, and this was that one time things didn't go as planned?  That's something very different - and very scary. 

And yet, that's all we're left to know about this "uncontrolled" person.

P.S.  Have I sufficiently bummed you out?  Yeeeeah, sorry about that.  In an effort for balance, here's a puppy:

Tuesday, August 10, 2010

The Kool-Aid Man and My Liver.

"Who's thirsty for glycogen?!"

You can tell I'm concentrating really hard at work when thoughts like this pop into my head: 

My liver reminds me of the Kool-Aid Man.  (And yes, it's a clip from Family Guy.)

Here's some science-ish background*:  glycogen, which is the stored form of glucose (a fancy word for sugar), is the fuel stored in our livers and the cells of our muscles.  The liver is the body's main converter of glucose to glycogen, and also of glycogen back to glucose when immediate energy is needed.  (There's a lot to say about this subject, but I'm trying to keep it brief.)  For diabetics, not only does the immune system mess with the pancreas and its insulin productivity, it also messes with the "on/off switch" that tells the liver when to kick out some glucose. 

What does this mean for me?  It means that if my blood sugar level drops too low while I'm sleeping, my body won't necessarily correct itself, like "everyone else".  (Oh, diabetes.  How many more of my organs are you going to mess with?)  For a person without diabetes in the above mentioned situation, the liver would convert exactly the right amount of glycogen to glucose, it would go to work, and your blood glucose level would go back to normal.  (Ta da!) 

Likewise, it also means my liver can kick out glucose when it isn't really needed.  I've seen proof on my CGM screen when I wake up:  I drifted down to 80 or so, and for absolutely no reason, shot up past 200.  I mean, I'm sleeping.  Or was I sleep-eating?  (Maybe I should learn to sleep-bolus, in that case...  I digress.)

So, in my mind, my liver is the Kool-Aid Man.  He bursts onto the scene unexpectedly, without invitation, and fills me up with sugar.  (And apparently takes a lot of time off from work, too.)

What a jerk. 

*It should be noted that I have absolutely, positively no medical training or professional medical education, outside of my own personal medical history, knowledge, and understanding.  Hopefully I explained things in a manner that is at least mostly accurate.

Friday, August 6, 2010


Every year, I do the JDRF Walk to Cure Diabetes.  This year I had planned to participate in the one in Lincoln, NE (in September), but decided yesterday that I'll also be doing the one in Omaha (which is tomorrow).  I'm supposed to be running an information booth before the Lincoln walk begins to promote Juvenation, which is a type 1 diabetes online community (run by JDRF) that I am involved with.  I'm looking forward to seeing my family at the Omaha walk, to absorbing the good vibes from all the people there, and also to get a little peak at what the Omaha walk might be doing in the way of a table.  (Actually, I don't even know that they'll have one for Juvenation.  This is the first time I'll be doing a table at a walk, so any tips I can pick up would be super welcome.)

If you'd like to help support me either by walking with me or donating, here's the website you need.  You can register yourself to walk on the right side of the page.   To donate to my walk, you can search by my name and state (NE) on the left side where it says "Donate To A Walker".  (I would give a direct link to my fundraising page, but since I've not yet connected my full name to this blog, I'll remain a little sneaky...)  :)  Thanks everyone!

Monday, August 2, 2010

Unintended Consequences.

Like many other people living with diabetes, I tend to struggle a bit with balance.  It's pretty easy to swing to one end of the pendulum or another - you either eat, sleep, and breathe monitoring yourself and freaking out over every out-of-range number, or you resign yourself to the fact that you can't control it, and stop trying.  I've swung out to both ends of that over the last 24 years of being diabetic, and I still struggle with where the "happy place" is.  (I know it involves scampering puppies, abundant cheese snacks and limitless rounds of Skee-Ball, but where is it, exactly?)

Right now, I definitely know I'm more towards the compulsive side.  As I've mentioned, I check my blood sugar a lot.  There are days I'm putting up numbers in the twenties - as in, I'm doing over 20 finger-sticks in a 24-hour period.  While this change in my behavior has brought me some happy results, I also must admit that it comes at a cost.  A few costs, actually.

The first - and this is tough to admit - is that I haven't been working out, with few exceptions, in the last 3 months.  Running, which I love doing (even though I'm not very good at it) always messes with my blood sugars.  I know, I know, exercise is supposed to be good for you, right?  In the sense of general health, yes.  But, it involves some extra work for me to make it happen.  How many carbs should I eat before my workout to avoid going low?  How long of a workout do I plan to have?  How far ahead of exercise should I eat?  What combination of carbs and protein should I have?  How much insulin is still active in my system?  Did I remember to turn down my basal rate an hour before I start?  Then, there's The After.  Even though I burn through many of those calories and carbs during the workout, my blood sugar starts steadily rising after working out, no matter what combination of things I've tried in order to avoid it.  So, let's recap:  I have to eat something (which sort of cancels out the workout, right?), I have to time it exactly right so I don't have to quit mid-workout due to a low blood sugar, and then I need to take even more insulin after I'm done moving.  When my goal became lowering my A1C (which determines an average of my blood sugars over the past 2-3 months), my first thought was those skyrocketing highs after workouts.  So, unfortunately, I cut those out for the most part.

Secondly, trying to gain tighter blood sugar control means that, inevitably, you're going to have more lows -  and aside from the general unpleasantness associated with hypoglycemia, it's darn inconvenient.  Sometimes it means I'm eating half of my lunch early, because I need to eat the crackers I brought to treat a low.  Sometimes it means I have to turn down an invitation to eat outside during my lunch break at work, because I didn't have enough lead time to prepare myself, health-wise, for the ten minute walk.  Yes, ten minutes of walking makes me drop - by 50 to 60 points, if there's active insulin in my system.  So, when my dear co-worker asks me at 11:24 if I want to eat outside with her (and I go to break at 11:30), and my blood sugar is in range, I have to turn her down.  At that point, I've already bolused for lunch at 11:15, so the walk will make me drop dangerously low before I can even get a bite of lunch in.  Having to turn down her invitations doesn't sit well with me - it makes me feel guilty, even though I've done nothing wrong.

And third - it's just darn exhausting.  When I'm testing that often, and checking my Dexcom every five minutes to see what the new reading is (which, by the way, will drain the battery like you won't believe), and setting temporary basal rates in an attempt to correct every little thing, it's difficult to think about much else.  Diabetes is always in my brain, somewhere.  I'm looking at the clock to see if it's time to test again, checking to see how I feel and wondering if it's diabetes-related or not, and wondering if I bolused correctly for whatever I ate last.  There are so many variables to consider when trying to figure out "what went wrong".  Am I 200 because there were more carbs than I thought there would be?  Do I need to re-evaluate my insulin-to-carb ratios for this time of day?  Is my pump site clogged?  Did my insulin get too warm, and start to deteriorate?  Have leprachauns been messing with my basal rates while I sleep?  (Really, really hoping the answer to that one is "no", because... um... creepy.)

So, now that I've proved to myself that an A1C below 7 is attainable for me, I need to work on better ways of maintaining that.  I need to work regular exercise back into my routine, most importantly.  I can't let the tough path to get there prevent me from even trying to walk it.  I have to remember - an optimist sees stepping stones, where a pessimist sees stumbling blocks.