Stress + Diabetes.

In case anyone wondered if stress has an impact on BG levels.

NO IT'S NOT A STRESSFUL DAY AT WORK WHY DO YOU ASK PLEASE SEND MORE COFFEE

A photo posted by Kim (@textingmypancreas) on Jan 29, 2015 at 8:14am PST

Anatomy of a Dexcom Graph.

At first glance this graph looks... not fun, but something along the lines of "you were running high, did a correction bolus, and then you were low".

But looking at it another way, it's:

1. "Why is this high so sticky? I under-bolused for that sandwich at lunch because I could see I was dropping and knew I'd be home alone with my daughter for the next few hours, but apparently I overdid it. UGH. This feels so gross, and it's almost dinner time. Since all of those corrections over the past few hours didn't do much, I'm finding out what my pump would suggest for a correction bolus if I had no IOB and bolusing that amount."

2. "Yaaaaasss. Now stick the landing, you glucosey blood you."

3. "No no no noooooo [insert curse words here] do not want, stop it. Just level off! Stop dropping! You're good! Just stay right here!"

4. {inhales Peeps; notices legs are tingly/numb; delegates remainder of dinner assembly to husband; sits at dinner table waiting to regain self}

I find myself doing this thing where I underbolus for food or just run a little higher in general when I'm with my kid because I don't want to drop low while I'm the only one responsible for her, but I usually end up rage-bolusing my way out of it and end up low anyway, the very outcome I was trying to avoid in the first place.

Wow, so doge meme, how obsess, much annoy husband, very giggle!

The Answer.

All of a sudden, I couldn't focus my eyes on anything.

I knew my 8 month-old daughter had her eyes fixed on me; my peripheral vision worked enough for me to know that she was jubilantly swinging her legs back and forth in the seat of the grocery cart. I could tell that she was grinning and waiting for me to return her smile, as she often does. Instead I reached behind her to grab my purse.

My hand instinctively went first to my Dexcom receiver. I clicked the button to wake it up, and it told me I was at 113 mg/dL with a straight arrow, meaning that it thought my blood sugar was in range and steady. "I don't think that's right", I mumbled out loud - there's no other reason my vision would have suddenly changed. Reaching to the right-most interior pocket, I searched for that plastic tube's familiar shape; the one that holds my glucose tabs.

I picked it up and shook it. Empty.

"Ugh, are you seeeeeerious...", I muttered. I turned the cart around and headed for the checkout, still unable to really focus but knowing that all of the fast-acting sugar was up by the registers, so that's where we needed to go. Should I try to test?, I thought to myself. I decided against it for two reasons: I knew that trying to balance a testing kit on the handle of the grocery cart was a no-go because tiny hands would try to "help", and I also knew that it was safer to just treat the possible low blood sugar when in doubt, and test later to confirm. I caught Rabbit's gaze, smiling meekly at her. I would keep us safe. I would keep her safe. "We're okay", I said out loud in a sing-songy voice, mostly to her but also to try to convince myself because I wasn't so sure we were.

We got to the checkout and my eyes found the soda cooler. I don't want soda, part of my mind said. Don't they have juice? I don't see any. When I tried to look at the candy display to my right, it shifted and blurred. I could not come to a decision. Chocolate isn't a great low treatment because it doesn't work as quickly. Do they have Starbursts? Wait, that's not good either; lots of chewing. And on and on, until the rational part of my brain ducked its head in, cutting through the low-induced indecision for juuuuust a second to say, Literally ANY OF THESE THINGS can save your life right now, just pick one and eat it.

With Snickers bar in hand, I swiped my debit card. I didn't even know how much we had spent, but we had two bags of groceries suddenly ready to go in the main compartment of our cart. Maybe once I start walking, my eyes will be able to focus. (Sidenote: I have no idea why I thought this.)

I pushed the cart of precious cargo out to the parking lot, still not touching the Snickers. Too many things to juggle at once; I'll eat it once we get to the car. The sunlight hit our faces and the Rabbit squinted her eyes. "We're aaaaallmost there, punkin'." I felt the symptoms of the low finally kick in - I felt weak and helpless but determined that I would not pass out on the way to the car.

And I didn't - I even got the groceries into the trunk and my daughter into her carseat. (Not gracefully, but I did it.) Only as I finished inhaling the Snickers bar did I realize we'd bought bananas, so I ate one of those too. I turned up the radio (silent cars seem to upset the wee one) and we sat for a while in the parked car, my daughter batting at her toy monkey hanging from the carseat handle and me finally testing my blood sugar a few minutes later.

53 mg/dL.

That's the thing about living with diabetes - I'm fine, until I'm not. Once lucid again, I scolded myself for potentially putting us both in danger: Couldn't I have treated that low before we ever left the safety of the building, instead of confining myself to the car where no one might notice if I passed out? Shouldn't I have checked my glucose tab supply before we ever set foot in the store, knowing that grocery shopping makes me often run low? What if I did pass out? Would my daughter be okay? Would the paramedics find my medical ID bracelet; the one whose colorful beads make it look a lot like a normal, recreational one? Should I have said something to someone? Diabetes gives me so many reasons to question myself.


You can be as vigilant as possible, use the latest devices, dutifully take every medication on time, and eat all of the "right" things, and incidents like this can still happen. The answer to "Am I okay?" always has this asterisk on it, as the answer is never completely yes or no.

The knee-jerk response when I say that "I'm fine" belies the intricate nature of what's going on both in my body and in my mind, and I hate that sometimes I have to admit that the answer to the question "Are you okay?"  isn't so cut-and-dry:

Probably? I guess we'll know in a few minutes.

Diabetes Flop.

Some days I do my best with the life vests (diabetes devices) I have available to me, I leap into life and everything just works out.

Some days, I do my best with those life vests and leap into life and it's still not good enough.

Guess which day today is?

Occlusion alarms like whoa today.

No.

Will 15 units of Humalog cover this meal?

How about 20?

What if I do 23 units with an increased basal rate for three hours?

23 units, an increased basal rate for three hours, and I go walk for 15 minutes?

THIS IS THE WORST. Is it possible to eat breakfast without topping 200 mg/dL at the two-hour mark?

Fine. What if it's just milk, decaf coffee and-

Okay, then I'll inject-

Needless to say, I'm looking forward to my (again) visit with my endo this afternoon. The size of my recent boluses, and the increasingly stubborn insulin resistance that is the hallmark of the third trimester, is making me dizzy.

Revisit: There Is No Spoon.

After reflecting on the past few days' CGM graphs, I'm reminded of this post from 2011. Pregnancy is this exaggerated version of what living with diabetes has been like for me - with 100% less predictability, more exaggerated swings, and super stubborn blood sugars. While I want to achieve "perfect" numbers during this pregnancy so that we can avoid all of the stuff no one ever wants to deal with, I also have to remember that perfect doesn't exist in the real world.

But, perhaps, my best will still be good enough.

* * * * *

I'm not sure where it began.

It probably wasn't a singular moment or comment that began that ever-growing snowball. It likely was all of those little things, laid one by one on top of another; melting into a suffocating landslide of guilt and shame.

Probably, it was the college years when my A1C started climbing and I felt as though I was doing all I was able and willing to do at the time - but it was never anywhere close to good enough.

It could have been the many, many times where an endocrinologist visit ended in tears, because my answers were never the sort that could pass their test. It could have been the dread of those appointments eventually causing the pre-appointment build-up of apprehension, anxiety and just plain fear. (And then, beating myself up over canceling the appointment.)

It could have resulted from not getting to hear the experiences of other real-life patients - of not knowing one single soul on that college campus who also had type 1 diabetes. I didn't know anyone else there who was living this same routine of shoddy math, bodily defiance and food distortion that I was.

It could have been my almost certain belief that one day, because I could never "get it right", I'd inevitably lose my eyesight. Or kidneys. Or toes. Take your pick.

It could have been realizing that "good enough" might not actually be.

It was seeing the impossibly low goals that my doctor had for me, and wondering, "How on earth do people do this? How do they do this, and still live a life? How can they enjoy that life, when all they're apparently thinking and worrying about is what diabetes is doing to them?"

It was being absolutely convinced that every single other diabetic in the entire universe must have this figured out, except for me.

I was convinced that I was the only screw-up. The way my doctors reacted to my self-care only reinforced that belief - because the only reason they'd be so shocked and disappointed would be because I was their worst patient, right? Because everyone else was achieving these kinds of numbers? Isn't that what was happening?

It was partly because questions were phrased, "Why are you still high in the mornings?", and "You are low way too often; what are you doing to cause that?", and "Why didn't you do what I told you to?".

It was beating myself up over my failures, then resigning myself to futility.

It had never occurred to me that a "perfect" diabetic wasn't actually a real thing. My past experience had shown that the medical world (which was all I had at the time, as this was B.D.O.C.) tended to make it very clear that there is an acceptable range, and it's [here]. And if you can't get yourself there, it is because you aren't trying hard enough; you aren't disciplined enough; you aren't following their guidelines as you should be. The focus of blame tends to be on the patient's ability to self-manage, rather than the disease itself.

It's one of the greatest gifts that bonding with this community has given me. Though it took a while for this to really sink into the parts of my brain and heart that can truly believe something, I think I can finally start to believe that there is no "perfect". There is "try your best"; there is "learn from your mistakes"; and there is "never give up". There will be questions without answers. There will be numbers without logic.

There is no productive benefit to berating myself. There is no positive benefit to my health when I internalize what I perceive to be "failure".

I can choose to let the outcomes of my diabetes decisions define who I am and how I live my life, or I can choose to accept the reality that the only parts I can consistently control are how I feel and how I react.

I have begun to accept that there is no spoon.

I Need Better.

After my third snack of the day (it's for the baby, okay), I realized I'd been relying on Dexcom-supplied glucose guesses for the whole afternoon. "Huh, I should probably test." I pulled out the iBGStar from my meter case and stuck a strip in. Lancing my finger mindlessly, I then let the strip suck the blood off of my right ring finger.

....3.

....2.

....1.

>600.

Excuse me, what?

Frantically throwing open my "random stuff" diabetes drawer, I fished out my go-to backup meter: the Verio. Except that...

...the meter's battery was completely dead. As in, insert the strip in the top and nothing happens. AWESOME. Meanwhile, I'm having mental images of my child being drowned in maple syrup (because that's what the blood of high blood sugars is made of, yes?) inside me, while my stupid diabetes equipment won't just. work. when I need it to most.

Third try, I grab my purple OneTouch UltraMini and find a bottle of the test strips (because of course all three of these meters have to use separate ones; picky little divas). Guess what? They expired in October.

FANFREAKINGTASTIC ARE YOU KIDDING ME RIGHT NOW ASLKNDOWOEIUNGOIE. Cue Yosemite Sam.

I decided expired strips would have to do, and so they did: after realizing I'd just eaten an apple but hadn't washed my hands or used an alcohol swab - and alleviating that situation - I tested at 210. Better!

I went back to the iBGStar, and this time it spat out a 204. Okay!

Should I have been better prepared by having a charged backup meter, or test strips that weren't leftover from Halloween? Yes. But would it also be great if meters could distinguish between blood sugar and leftover food on my hands sugar? Yes.

(Speaking of meters, Lifescan issued a recall of all VerioIQ meters today. Check out this press release, and the OneTouch website for more information.)

Looks Like...

...a cowgirl who has spent too much time in the tanning booth.

It's that glamorous and elegant time of year where I have to collect all of my pee for 24 hours into a plastic jug, and then try to discreetly transport it in a tote bag to the hospital lab while hoping no one notices the slooshing sound as I briskly walk the hallways.

Man oh man, the adventures those people without diabetes miss out on.

C'mon, kidneys! Don't let me down now!

Good Enough To Not Eat.

Some might see something of beauty and think, "that looks good enough to eat".

Some might see a beautiful number on a glucose meter and think, "that looks good enough to not eat again for several hours".

One of the 3,547 ways that diabetes messes with your head, yo.

One Too Many And Eleven Short.

I just spent 39 minutes on the phone with Peyton, a member of Sanofi's iBGStar tech support team. What we determined (rather, what I unofficially deduced from our conversation) is that the iBGStar is not a fan of tequila. And neither is an 18 day-old Dexcom G4 Platinum sensor, for that matter.

Verio, my hero.

When I use the iBGStar meter, I typically keep it attached to my phone all day and use the case that encloses them both. I don't open the iBGStar app every time; actually, not even every day. When the app is opened, it automatically syncs the meter with your phone, and thereby downloads all of the readings it has recorded since the app was last opened.

After consuming a few margaritas and checking my BG eleven times throughout the course of yesterday evening (this is how I drink with diabetes - YDMV), I noticed that my last three readings were suggesting a pretty steep drop - and no thanks to my CGM, I couldn't verify this via visual aide - 356, 226, and then 184. Pleased that I was dropping but concerned with the velocity, I decided to open the app on my phone to help me remember the times of those tests. I had a need for speed (information).

Instead, I was informed that I would be on my own with this one.

Excuse me, what? I then clicked the (only) button on the meter, to see if I could scroll back on there to see the times there.

DENIED.

"Awesome".

What I realized, as did Peyton by the end of our lengthy phone conversation, is that there is no good reason my meter wasn't tagging date and time on those eleven readings. We tried everything to figure out why - close the app. Restart the app. Unplug the meter. Replug and sync the meter. Check the phone's time/date settings. Check the meter's time/date settings. Make sure the meter is fully charged (it was). Make sure the meter was fully plugged into the phone (it was). We must have gone through 30 different potential factors. (I also elected not to delete the app and re-download it. While I was able to back up the iBGStar data through my iTunes account, you can't actually look at it. Petyon told me that if I deleted and then downloaded the app again, I could reinstall the old data. I didn't want to muck around with it.)

We have no idea why, but the good-ish news is that it's recording those things again. I tested twice, voluntarily (he suggested I use control solution; I laughed) and both of those readings downloaded just fine, while continuing to ignore the previous 11. I could manually enter them, but seeing as how I don't know the times for most of those, I'm hesitant to do so.

Tidbits I learned:

1. it's recommended that you plug the meter into the wall, using the micro-USB cable provided, at very minimum once every six months - more frequently if you're a more frequent user. I asked him the logic behind this, seeing as how the meter is charging every time my phone is active, and he mentioned something about it being a more potent power source. I still don't get the reasoning - if it says 100% charge, is that a lie? - but okay, fine. I'll do it.
2. it's also recommended that when you first get your meter, you should charge it with the wall outlet cable for three to five hours. Again, I don't know why, but just do it.
3. Sanofi really wants you to be happy with this system, and will do things like send you more strips to replace the ones you used when the meter wasn't marking a time on them (they're sending me 20, which is lovely) or replace the meter if you feel it isn't working to your liking (I declined this time, but if it acts up again, yes please). I know that the test strips are where they make their money, and so a replacement meter really isn't that big of a deal, but it was still nice to find out.

I also was reminded that you always need a back-up for your back-up. CGM won't give you readings? Time for a fingerstick. Meter won't function properly? Use a different one. 

It's possible that everyone in your usual device line-up will fail you at the exact time you need them most. Channel your inner boy scout, and always be prepared.

Because I know some of you will like "closure", here is what
my graph looked like from midnight to noon.

One More.

I put in my last (?) Dexcom sensor two weeks ago. I did it a little ceremoniously, assuming that it would be the final one of the Seven Plus variety, as I had placed an order for the G4 after finding out that my insurance plan will cover the majority of the cost (a fact I'm very, very thankful for).

Last night, I got the following in my inbox:

Happy Snoopy Dancing aside, I think my sensor must have sensed the foreboding in the air as it got more and more wonky (technical term) as the day drug on. Wonky to the MAX. The kind of wonky that caused me to waaaaaay under-bolus for my nacho dinner. Evidence:

So much product placement!

Anytime you want to get here, G4, I'm welcoming you and your better accuracy-having self with wide open arms. I'm also wondering if I'll wearing both the Seven Plus and the G4 simultaneously for a while.

What's one more robot part among friends?

UPDATE: My G4 was originally scheduled to arrive Wednesday, but after checking the tracking ID, the G4 is on the delivery truck RIGHT NOW. (!!!!!)

Something New.

Have you ever plopped a fresh infusion site on your leg and then thought, "I immediately regret this decision because the place where I usually clip my pump and the place where my infusion set is are the same place and how did I not think about that beforehand"? This happened to me yesterday, and I made a mental note to be extra cognizant of where my robot parts where situated.

The thing about leg infusion sites, especially, is that you can't let down your guard while doing everyday activities, like... eh... well, you know.

Original cartoon here.

Get my drift? Tubing gets tangled, certain items of clothing have to be precariously stretched, and you can't pull any fast moves.

Because if you do, FFFWWWAAP! You've ripped out your brand new infusion site.

The bright side of this story is that ruining that new site provided me an excuse to try something new (to me): an arm site.

I promise I wasn't trying to take a photo of my towel hanger

But, ladies, I have to ask... how does this work? Do you tuck your tubing under your bra strap? I feel like if I don't, tubing is going to be dancing around under my shirt all day today, which is sure to cause some interesting "I swear I'm not feeling myself up" moments.

Once again: yaaaaay, long tubing.

App Photobomb.

I've been using the iBGStar a bit more lately, now that my insurance is finally covering (at second tier pricing, but whatever) the strips for it. I'm finding that when my meter is attached right to my phone it's pretty hard to forget to check my blood sugar, and that serves as a helpful reminder for me.

Cases will be available from the
iBGStar website "soon", I'm told.

Another benefit is the giggling that takes place when the meter is transferring data to my phone. If you're not familiar with the app, there's a little cartoon iBGStar that pops up in the bottom left corner of the screen while data is being pulled. It appears for only a couple of seconds, and then it slides out of view again.

Which, to my brain, makes it look like the little meter is photobombing my glucose readings.




Cheeky little meter, that one.

Skydiving, Revisited.

What it looks like on my CGM:

What it looks like in my mind:

Insulin Break Dance.

Thanks go to Gina for the Photoshop assist, and also for humoring me when I asked if she could "put an insulin bottle on some cardboard, like it's breakdancing".

Things To Love.

Even with all of the really big items on the "this is horrible" list of living with diabetes, there are a few things I relish.

One is the reaction I receive when using the iBGStar to check how the ol' blood is doing in environments like bars. When you're three sheets to the wind, things like glucose meters that attach to an iPhone will BLOW YOUR MIND OFF.

"What are you doing? ... wait. Wait, is that a meter? It's part of your phone? There's an app for that?!?"

Indeed, tipsy stranger. There is an app for that.

(Side note: the next time someone asks, I'm telling them that it tests my blood alcohol level and will be taking a mental video of their reaction for replay when I need something to giggle about later.)

One more thing to love: waking up to a between-the-lines graph after a night of beverages and dancing.

Yesssssss.

Dexcom MacGyver.

When I noticed this:

I thought I'd try something new. So Billy:

and I went here:

to find some of this.

Wielding little more than some aluminum foil and a Q-Tip, I got to work.

As it turns out, eyelash glue lives a double life as a Dexcom adhesive repair tool. Roll the Q-Tip around in the gooeyness, swipe it under the flappy adhesive, and press down for several seconds. Then, and this is important*, don't move that area for a few minutes.

MACGYVER'D!

*Note: I actually found that this didn't work well (and I needed tape afterall) for where I had my Dexcom sensor, which was precariously close to my armpit. I think this would work well in a less high-traffic area (read: a leg or hip, or maybe just more to the outside of an arm), and also if I had kept my arm stationary for a few minutes to let the glue set, so I'll be trying this again. Someday.

Semantics.

"Going for a ride" = exciting.

"Going for a ride" = exhausting.

Where's Waldo?

...if Waldo were a test strip, that is.

This particular cosmetic bag meter case makes great test strip camouflage, don't you think?

I Hate The Color Purple.

Not the movie... this.

Among the long list of things I probably don't do "right" when it comes to diabetes, getting myself to check for ketones (or even remembering that it's something I'm supposed to be doing in the first place) is pretty up there. It's right by "using the touch bolus button instead of dialing it in like a normal person" and "changing my lancet more than once a month".

I experienced some pretty wicked stomach problems early Sunday morning and throughout the day, with my Dexcom graph showing 200+ results pretty much the whole time. Even after the worst of the Real People Sick symptoms subsided, I still felt awful - flip-floppy stomach, a mild haze resembling but never quite crossing over to a headache, immense exhaustion and a desire to never look at or think about food ever again.

As the day drew to a close, I thought, "Hey, I wonder if I still have some ketone strips hanging around. I should probably test for those." I did, and I did.

I was greeted by a royal purple - somewhere between moderate and large.

Ugh.

And since even being cognizant of ketones is unfamiliar to me, I had to consult Google and some of my fellow PWDs. Large ketones with large glucose numbers seemed to point to an ER visit, but with my numbers staying in the low 200's, I didn't seem to fit that criteria. I drank as much water as I felt comfortable with (I wanted it to stay down, after all), slept a lot, and kept the correction boluses on repeat. I ate a few bits of food here and there, when I thought I could stomach it. At 2:00 am (I made myself get up every 3 hours overnight to check everything again), my blood sugar was down to 99 (YAY!) and ketones were down to small (YAY!).

Unfortunately I then made the dumb mistake of not eating anything then, so I'm now back up to "moderate" ketones as of this morning.

I'm recommencing the chugging of water and eating of crackers as we speak, as well as the self-chiding.