endo

We Are Broken

Getting Broken Things Fixed

I can feel it. It is slithering in like a snake through murky water. It makes little ripples as it moves in, just enough to sense it if you’re looking for it, but not enough to visibly disturb the peace and calm of everyday life. It is sneaky, resting still when you’re looking for it the hardest, hiding in plain sight. When you’re back is turned, it is busy, wrapping itself around everything that is good and dragging it under the surface, dominating.

It makes things heavy, without trying to lift anything. It makes my heart pound, even when I’m calm. It makes me want to cry, but the tears just won’t come. It makes me want to scream, but the effort is too great. It makes me want to fight, when I have nothing to fight about. It makes me forget hunger. It makes sleep something that I can only appreciate because I hear others talk about it.

It is awful.

It makes things awful.

It makes me feel awful.

After all my years with diabetes, it wasn’t until very recently that I learned that depression and diabetes go together like stink and manure. A quick Google search will tell you that depression from diabetes is due to the the daily stress of diabetes management. All the pricking and poking and stabbing and pinching and squeezing and dabbing and dripping and wiping and changing and checking and fixing and… Okay, I can certainly see how someone would get to that conclusion. Diabetes management is exhausting, and maybe that is part of the depression and diabetes picture, but it isn’t all of it.

Some sources say that it is the consequences of diabetes that drives depression. Things like nerve damage, loss of sight, loss of feeling in feet and hands, and weight gain all contribute to this sense of hopelessness. Having had diabetes for 30 years, I don’t subscribe to that. The consequences of diabetes certainly are nothing to shrug off, but I know many people with diabetes today, and those that do have diabetes complications definitely do not let those complications rule their lives. These are some of the most admirable people I know, who carry on in a daily pursuit of contributing to the world and helping other people. That is their focus, so no, I don’t subscribe to the “Oh, woe is me…” reason for depression when you have diabetes.

Sources even say that depression is the reason for depression with diabetes. No, that isn’t a typo or me repeating myself. Many sites, including the ADA, say that because of depression we slack on good diabetes care practices like regular blood glucose testing, eating right, routine exercise, and sometimes even insulin dosing. While slacking off due to depression our health declines, and then we feel bad about it, unintentionally making matters worse.

Something that doesn’t get reported enough is the science that also comes into play with depression and diabetes. In Will Dubois’s book “The Born-Again Diabetic,” he points out the often overlooked malfunction in the serotonin level production of people with diabetes, which can affect mood and cause depression. Will believes that all people with diabetes should be on anti-depression medications, and I’m starting to agree with him. Diabetes is hard enough without having to deal with feeling awful about it for no apparent reason.

The problem I have with depression, besides the general feeling of “blah” that comes with it, is that there is still such a taboo about it. I have a hard time admitting it to myself when I get depressed. Even now, I’m not certain that what I’m feeling is indeed depression. It could just be that I’m worn out from all the stresses of work, life, and responsibilities. Nevertheless, once I can admit to myself that I’m having a bout with depression, I start to blame myself for it. Maybe it is because I haven’t been taking as good of care with my diabetes as I could. Maybe I haven’t been making time to exercise as much as I should. Maybe I haven’t been eating as well, letting excessive carbohydrates creep into my diet more than I should. Never in all my maybe’s do I stop to say, “Maybe what I’m dealing with is something that has nothing at all to do with anything that I’ve done.”

I have felt it all day today. I’m upset, for no reason. I’m aggravated and annoyed, when I have absolutely nothing to be aggravated and annoyed about. I’m tired, yet I can’t rest. I’m not hungry, yet I haven’t had anything more than a pot of coffee today. I don’t know what is wrong with me. I just know I’m not me.

I have an endo appointment coming up in a couple of weeks, and perhaps I will ask him about it. But I probably won’t. As unrealistic as I know it is, there is a part of me that is afraid I’ll be judged as being weak because I can’t deal with things on my own; that I shouldn’t feel the way I do, and the way I feel is nobody’s fault but my own. I don’t want another prescription to pay for either, another pill to take, and another something to have to do on a daily basis. I’m also as stubborn as a mule, and I don’t want everyone trying to fix me and telling me what I need to do. I really don’t want anyone telling me what to do right now. (I know, I’m real mature like that. [sarcasm]) That sort of mentality is probably why the ADA says that depression begets depression. Writing this post took a tremendous amount of my courage, and I just don’t know if I have enough left to face depression (if that is even what this is) head on in the clinical setting.

I’m trying my best to get through this funk. As much patience as I need from others, I also need to be patient with myself when it comes to navigating my way through it all. I’m going to stop stressing over the fact that I can’t keep a CGM sensor on my body for more than 24 hours before it falls off, no matter what kind of sticky substance I put on or over it, and keep trying to find a solution that works. I’m not going to stress out over whatever my next A1C is going to be, and just focus on getting through diabetes one day at a time. I’m going to try to not carry around the guilt of low blood sugars that sometimes happen that I need help with. I’m going to start riding my bicycle again, because there is no room for all this baggage on the road bike, and it is really hard to have a bad day after you’ve started with a good bike ride in the morning. I’m going to get things that are broken fixed, so I can stop looking at broken things (like my TV, washing machine, and my old cruiser bicycle).

I’m going to do what I do best: Focus on the positive.

And somehow through all of this, I will get the most important broken thing of all fixed…me.

NYC D-Meetup

30 Years With Diabetes

Today’s Diabetes Blog Week topic is diabetes bloopers. You know, those things that make you go, “D’Oh!” and facepalm yourself. I’ve had my fair share of diabetes bloopers: Dropping & shattering glass vials of insulin, running off on trips without all of my diabetes supplies, forgetting to dose for a meal, forgetting that I already dosed for a meal, finding the cat playing with rogue pump tubing, catching the dog gnawing on a perfectly good tube of glucose tabs…the list goes on and on.

The blooper that is really on my mind today is the one that my pancreas made 30 years ago when it decided to quit working. Or maybe it was my immune system that decided to work too well. Or maybe it was because I had chicken pox. Or maybe it was because someone got me wet or fed me after midnight. Or maybe it was because a butterfly flapped its wings in China. 30 years after the fact there is so much more we know about diabetes, but what exactly causes it and how to cure it are still not on that list, despite what we were told about how close we were to a cure when we were diagnosed.

Today is a day of celebration, of blessings, thankfulness, and appreciation. I have learned more in my 30 years with diabetes than some people learn in a lifetime. Living with diabetes has taught me so much, and coupled with other life lessons, I would be remiss to not stop for just a moment and appreciate the gifts that I have been given…thanks to diabetes.

The 1st 10 Years

  • If you’re low, anytime is snacktime.
  • Bananas and peanut butter on vanilla wafers is the best snack in the world.
  • You can’t go play when you blood sugar is high. But if you can sneak away when your parents aren’t looking, it’s fair game. The back door doesn’t squeak and make noise like the other ones do.
  • Swimming always makes you go low.
  • Visiting the cute nurses on the Pediatric floor at the hospital when you’re there for lab work is always a treat. They know you by name.
  • When you hear the term “A1C” you think of steak sauce and hamburgers.
  • You don’t know anyone else with diabetes.

The Teenage Years

  • If you’re low, it’s a nuisance, and you have to stop what you’re doing and take a break to feed it. Not always ideal when you’re being paid hourly at a part-time job.
  • Whatever is fast and convenient is the best snack in the world.
  • You hardly notice when your blood sugar is high. Until it makes you feel awful. Then it is all you notice.
  • Swimming still makes you go low.
  • Visiting the cute nurses on the Pediatric floor at the hospital when you’re there for lab work is still a treat. Other floors are acceptable as well, as long as there are cute nurses. You know THEM by name.
  • When you hear the term “A1C,” you also hear words like “goal” and “lower.” Those cute nurses are a good distraction.
  • You’ve heard of other people with diabetes, but you still don’t know anyone that has it.

The Last Ten Years

  • If you’re low, your CGM alarms and you drop everything and treat it. Except when you have low-brain and can’t seem to focus. Then it becomes more of a struggle, and is sometimes followed by a hangLOWver.
  • Cheese, nuts, and other low carb foods are the best snacks in the world.
  • Because you are in better control of your diabetes, you can feel a high blood sugar in the upper 100’s now. 200+ makes you feel like dog’s ass.
  • Swimming still makes you go low, and now you have to replace a pump site when you get done because the sticky doesn’t stay stuck in the water. You are able to ride a bike for over 100 miles in one day. You’ve discovered OTHER activities that have the same effect as swimming on your BG’s, and are just as much fun.
  • Visiting the cute nurses, wherever you can find them, has become a rarity. Now you mostly settle for Helga, the former wrestler with the mustache and gallon sized syringe and harpoon needle to do your lab work. She knows you as a number.
  • When you hear the term “A1C,” you start thinking all about decimal pointed numbers like 5.6 and 6.5.
  • You meet an amazing community of people online and in real life who also have diabetes. You start a blog, and start sharing your life with diabetes. They inspire you.

The Next Ten Years

  • Your diabetes is tightly controlled, and you don’t have any of the complications that others who don’t take their diabetes seriously often suffer from.
  • You’re slim, fit, and eat right so that you’re able to do the things you love and experience the world. You look fantastic naked.
  • You accept that there will always be things that make you go low. You’re prepared for them, and never let diabetes keep you from being able to do anything that you set your mind to.
  • You have a family now, and your diabetes is not the center of the universe, but just a piece that helps explain your awesomeness during bedtime stories.
  • You vow to only have lab work done from cute nurses in the future. You have diabetes, so you deserve it.
  • Your doctor rarely mentions the term “A1C” anymore. He’s more interested in what awesome things you did in the last three months so that he has success stories to share with his other diabetes patients.
  • You continue to write about diabetes, speak about diabetes, advocate for diabetes research and better treatments, and share your world with diabetes. You challenge others to take control of their own diabetes, and cherish those stories of how you inspired someone else to save their own life.

Today, May 11, 2011 is my 30th Diaversary. Thank you all for being such an amazing part of it.

“You only live once, but if you do it right, once is enough.” — Mae West

 

NYC D-Meetup

Allison, Caroline, me, and Brenda at a May 2011 D-Meetup in New York City

Emergency Low Kit

5.6 Degrees of Frustration

I like reading about the experiences my friends in the DOC have when they go to their diabetes doctor appointments. Good experiences or bad, it teaches me a lot about what I want and need from my own endo, and things I should be thinking about.

For example, it’s no secret that diabetes and heart disease are BFF’s. Observing the thoughts and conversations that are shared in the DOC about statins, ACE inhibitors, blood pressure, cholesterol, and the effects on the heart of sticking your finger in electrical sockets makes me realize that I  don’t give this component of my life with diabetes near enough attention.

At my endo appointment last Friday, we talked about some of these things. No mention was made about my weight, but I know that I want to be lighter than I am. I’ve lost 7 pounds thus far with the switch to a low-carb lifestyle, and am making satisfactory progress toward my goals, so I have to take things one step at a time on that front.

My blood pressure was normal, so that was good. I’m not one of those folks that shoves an arm in the free cuff & fluff machines at the store, EVER, so if the endo says I’m good and it isn’t an issue right now, I’m taking that and rolling with it. He did order a full lab workup for my next visit, which should add all kinds of interesting new data points to talk about.

The results of the BIG test on Friday, that almighty diabetes report card mother of all tests, the A1C, took the wind out of my sails. I set a goal at the beginning of this year to get my A1C down to 6.2 or better. On Friday, my A1C was 5.6. I have never had an A1C in the 5’s before, so I should be celebrating that, and throwing myself a party. Instead, I feel like a failure.

Diabetes is a candle burning at both ends. You can monitor your BG’s closely, and stay as close to on top of everything as possible, but often when you focus too hard on one problem (too many highs) and fix that, you end up with another problem (too many lows). Diabetes doesn’t give very much room for error, and that frustrates me. Maintaining perfect blood sugar control is like trying to balance on a tight rope, hanging over a cliff, while juggling bowling pins and riding a unicycle. It’s possible, but good grief it requires a lot of attention!

I want to celebrate a 5.6 A1C. I want to upload my pump & BG data to my endo’s computer and see on the screen that I am an all-star diabetic, with nearly flat data charts with very few low or high BG’s. I want to EARN that 5.X A1C, and that is where I feel like I have failed. I did not earn my 5.6 on my terms. I have managed to keep from having very many high BG’s, but in turn I have had way too many lows, some dangerously low, and it leaves me screaming at my diabetes, “I just cannot win with you!” Then I throw a pot and pan at it, tell it to get out of my sight, and pour myself a big glass of Diet Coke and have a good cry while watching an ASPCA commercial. Don’t judge, you know you tear up too every time you see one of those commercials and those poor animals that need loving and adopting.

Friday was a bad day, but it progressively got better the more I digested that 5.6 A1C. It could be so much worse. That 5.6 could have come with severe low side effects, including occurrences of unconsciousness, seizures, ambulance trips to the Emergency Room, car accidents, or the inability to shut up while talking nonsense in front of a crowd of people. It could have resulted in the embarrassment of a low while at work and my coworkers having to help me. It could have included feelings of shame and inadequacy because I needed someone in a way that I can never repay.

My endo and I talked about what I have to treat a low. I have not had a Glucagon pen in…well, maybe not since I lived at home with my parents. That was 13 years ago. It wasn’t until this last year that I even kept a stock of glucose tabs. It’s really a wonder how I survived so many years without them. I did keep glucose gel, so I guess that is worth something, and keeps me from being a total bad diabetic. Now, however, I have an “Emergency Low Kit” so that I have as many weapons in my arsenal as possible to combat diabetes.

Emergency Low Kit

My "Emergency Low Kit" including Glucagon and glucose gel & tabs

I have settled on the fact that it is 100% okay for me to be frustrated with diabetes and an A1C of 5.6 that I don’t feel I earned by being an all-star diabetic. I have settled on the fact that I am going to be working closer with my CDE to adjust my basal rates so that I don’t have so many lows, and still avoid those highs as well. I have settled on the fact that there is no such thing as a perfect diabetic, but striving to be one may very well have played a part in keeping me alive and healthy all these years, and I don’t intend to stop now. I have settled on the fact that there are side effects to diabetes that I absolutely can control, and some that I cannot do a damn thing about.

Diabetes had just better get settled with the fact that I’m not going anywhere, and there is a good possibility that I am more stubborn than it could ever dream of being.

Stuart Smalley

Endo Affirmations

When I set my goals at the beginning of this year, #1 on my list was to get my A1C down to a 6.2 or better. That is a formidable goal, trying to achieve an average blood glucose over time of around 120, depending on what research you consult. At my last endo appointment back in December of last year, my A1C was still reasonable, but it had ticked upwards. I couldn’t let that upward trend continue.

I had gotten my Continuous Glucose Monitor (CGM) and new pump just after my previous appointment in September of last year, and with all the change, I was burnt out. Or maybe just overwhelmed. But really, is there a difference?

I was wearing my CGM intermittently, and was dealing with major information overload with all the beeping and pricking and checking and counting and pumping and beeping and…I was exhausted.

After I wrote my A1C down in my notes, and realized that I had allowed my control to slip in the short three months since my previous appointment, I knew that I had to turn the ship around. I don’t want my A1C to continually creep northward, and me pay for it with problems down the road. I have too much life and dreams ahead of me to get lax with my diabetes management.

So I sat myself down and gave myself a stern talking to. I said to myself, “Self, all is not lost. I want you to look in that mirror, and I want you to repeat after me. I can do better. I have some awesome tools to help me get to where I know I can be. I can wear my CGM all the time, and not take several days off between sensor changes. I can carry around glucose tabs right there in my little pocket to treat a low. I don’t have to be a great diabetic. All I have to do is be the best Martin I can be. Because I’m good enough, I’m smart enough, and doggone it, people like me.”

Stuart Smalley

Daily Affirmations with Stuart Smalley

 

I’m glad we had that talk. Since then, I’ve done really well with wearing my CGM. Every time the sensor battery runs out of juice, it hits the charger, and I’m already putting a new site in and getting everything ready for another round. I’ve gotten to where I really don’t enjoy being without my CGM, and am hoping that I didn’t do too much damage for all the years before now when amazing technology like this didn’t exist.

Lows are still creeping around occasionally, but they are manageable. Nothing a few glucose tabs can’t fix in a pinch. I expect my CDE and endo to want to make some adjustments, and I’m open to that. I’ve started a low-carb journey now, so I don’t expect that I need as much basal rate insulin at certain times of the day as I did with a diet heavier in starches.

Something else that I’m not happy with myself about is that I let myself get lazy, and stopped exercising the way I physically and mentally need to. The scale showed me the truth about that. So far I have lost six pounds, down to 184 lbs. It’s not a lot, but it’s progress, and that is the most important thing right now, to be moving forward. I’m making some big changes to my lifestyle to eat smarter and make better choices. I have my eye on my goal cycling weight, and to slim up and firm up so I look good naked, or at least in a swimsuit. Yes, I’m vain like that.

Back to the A1C, I know that we can’t base our entire diabetes report card on the A1C alone, but it still resonates with all of us where we are in our journey with diabetes when we see that number. I am confident about this upcoming appointment. I am determined. I have a plan. And it’s true, I don’t have to be the best diabetic. I just have to be the best Martin I can be. The rest will find its proper place.

Magic Strips

A Tale of Two Pumps

Once upon a time, in the land of Diabetes, there was a person named Martin. This stunningly handsome and striking specimen of a man had endured the variety of ways to treat and manage the kingdom of Diabetes his entire life. Having been abandoned in Diabetes at the wee age of two years old, he had lived through the olden days of determining blood sugar by careful aiming his sword at magic strips that could tell him the range of his blood sugar level.

Magic Strips

Back in those days, Diabetes was managed quite differently than it is in our modern day. Similar to the race between the tortoise and the hare, two different kinds of insulin were used in relay to get our budding hero through the day: One a fast-acting rabbit-like insulin aimed at beating the gangs of sugars and carbohydrates at the beginning of the day, and the other a turtle-paced insulin made to finish out the battles as the day grew long. This type of managing Diabetes seemed to work reasonably well for a good number of years, until the evil dictator Adolescence descended upon the land and threatened to throw the whole world into chaos.

Adolescence would attack with severe low blood sugars, often resulting in visits to the dreaded land of Hospital, where to this day inflation runs wild and it takes nearly a lifetime to escape. As Adolescence continued its terrible reign of…um, terror…our fearless hero Martin teamed up with his trusty wizard, Endo, and called upon the forces of Multiple, Daily, and Injections. Armed with the power of MDI, Martin was able to defeat the evil Adolescence back to the twisted realm of Puberty, and for many more years peace once again ruled the kingdom.

But alas, peace was not meant for a lifetime. As the years wore on, Adolescence’s cousin, Adulthood, came to power in the realm of Puberty and declared revenge on Martin. Adulthood struck suddenly and deliberately, causing seizures, confusion, and shaking from fear. Adulthood would attack at even the most innocent of times, during exercise, vacations, trips to the market, and even during sleep. Adulthood screamed from the mountaintops, “Hear me Martin, your MDI is no match for my wrath!”

Tired, nearly defeated, and not knowing what to do, Martin turned to his trusted wizard and said, “Endo, I just can’t do this anymore. I try so hard, and feel like I’m doing everything right, yet Adulthood still manages to outsmart me in this land of Diabetes.”

Endo knew Martin’s heart was pure and true, and that his will could never truly be beaten. With a mighty wave of his staff, the Rx Pen, Endo conjured a beast like no other. Formed from the power of lightning, the miracle of insulin, and the technology of the future, Endo presented Martin with a new tool for fighting Adulthood in Diabetes…the Animas 1250 insulin pump!

Animas 1250

With the Animas 1250, Martin was not only able to bring peace back to the kingdom, but he was also able to partake in the joy of eating at odd times, sleeping until midday on the weekends, exercising without having to eat more calories than burned, and even indulging in the occasional late night ice cream.

Yet, Adulthood would not go quietly into the pages of Diabetes history. Watching and learning how the power of the Animas 1250 was wielded, Adulthood planned its attacks carefully and maliciously. Adulthood would test the weaknesses of the Animas 1250 by introducing a slow and steady low blood sugar, fooling Martin into believing that nothing was wrong.

Finally, after Martin had spent a long day toiling in the fields, Adulthood struck in an attempt to finally capitalize on its long-awaited revenge. With a severe low of 33, Adulthood knew that its time had come to capture the throne.

Yet our fearless, well-groomed, and attractive hero was prepared. As Adulthood celebrated its victory and marveled at its use of a Larry Low, Martin fought back the surprise attack with the spirit of the swamp, Gatorade! Adulthood cowered in defeat, outmatched by the sugars and electrolytes in the magical potion.

Although Adulthood was defeated once again, Martin realized that the Animas 1250 was no longer the superior weapon in the Diabetes fight. Martin once again turned to Endo for a solution. Endo, who had locked himself away in the Diabetes research labs for years in anticipation of this day, with a mighty wave of the Rx Pen, revealed a new pump from the technological land of Medtronic…the MiniMed Revel!

MiniMed Revel

To this day Martin and the MiniMed Revel rule the land of Diabetes with a plastic grip. Partnered with the built-in omniscient Continuous Glucose Monitor, the influences of Adulthood on the kingdom of Diabetes have been mostly kept at bay, with only an occasional uprising. However, no one in the land of Diabetes can forget the low blood sugars that almost kept them from these prosperous times. Anticipating the next time Adulthood tries to rise up, the people of Diabetes vow to always remain a community, to support each other, to be Friends For Life, and to never give up in the fight for a cure, when Diabetes and Adulthood can finally live free from one another.

Ace of Diamonds

Holidays with the BG’s

You know what’s fun?

Christmas shopping. Finding that perfect gift for a family member, loved one, friend, boss, or frenemy that you’ve been waiting since last year to get back at during the White Elephant party. Yup, somebody is getting an angry-faced pig cookie jar this year, and it’s not going to be me.

You know what’s not fun?

My CGM alarming and saying my BG is 91 with two double arrows pointing down while I’m Christmas shopping. That does explain my lack of focus though, and why it was taking me an abnormal amount of time to evaluate the power tools when I originally went to the store to look for a flashlight. Go figure.

Holidays are treacherous times for us PWD’s, and I know I’m not the only one dealing with it. We have a sleigh load of food available at work, home, at parties, and it’s really hard to guesstimate exactly what is in all that “stuff” we’re shoveling in our mouths by the handful taste testing. I have a habit of overestimating, and then finding myself battling a Larry Low two or three hours after indulging.

Part of that is because I despise the feeling of a high BG. It feels like my blood has turned into molasses, I’m cranky because I don’t feel good, and I get impatient watching my numbers not drop back to normal at a rate that meets my expectations. A 200+ reading on my meter or CGM leads to me being irritated if it is anything more than a very temporary thing.

At my endo visit a couple weeks ago my A1C had bounced up a bit from 6.1 to 6.7, while I’ve been trying to prevent severe low BG’s that were plaguing me before. Now, I know that many people would jump for joy over a 6.7, and I realize that it isn’t a bad A1C necessarily. However, it makes me feel like a failure. For those of us waging war on a day-to-day basis with diabetes, we are harder on ourselves more than anybody else is. I hold myself to a high standard when it comes to my diabetes. Whether or not it’s the reality of diabetes, I need to feel like I have some control of it, besides just telling it where it can go with a colorful description of the hand basket it can go there in. I feel I can do better than a 6.7, and get it back closer to 6.0. This is just my goal, and YDMV.

For the longest I was pumping with a single steady basal rate, 24 hours a day. I know that isn’t how the body works, but I was bolusing and temp basaling all around it, basically manually adjusting my rate of insulin as necessary. Then I got my CGM and a Certified Diabetes Educator (CDE) and Medtronic rep who is really knowledgeable about how BG’s ebb and flow, the dawn phenomenon, effects of activity, and many of the intricacies of living with diabetes. Presently, I am working hard with my CDE to get my basal rates optimized, examining trends, analyzing BG’s, and getting a better grip on preventing my BG’s from dropping too low and spiking too high. Perhaps I could have chosen a better time than December to attempt this, but meh…pressure makes diamonds, and I’m determined to ace this.

Ace of Diamonds

Since I met with my CDE and adjusted my basal rates, and then made a few more adjustments on my own after finding times of the day that my BG’s would spike inexplicably, things seem to be getting better. My average BG in the last week is down to 157 mg/dl, from a pre-adjustment average that was closer to 200.

I’ll take that kind of progress any day, and even more so with the holidays.

Blueberry Muffin (photo by Minimalist Photography on Flickr)

Sitting On My Desk For Breakfast

This morning I got to work and went through my usual routine. Laptop was running slow, scouring the internet for every update it could find. Had a hot pot of Colombian coffee brewing. Had a blueberry muffin sitting on my desk for breakfast.

I checked my blood sugar, coming in at 161 mg/dl. Not horrible, a little higher than my target, but I’ll take it. Went ahead and combo bolused for the correction and for the blueberry muffin for breakfast. Trying to get better at bolusing 15-30 minutes before eating, so I took a few minutes to check the news and weather from my iPad. Weather said today would see a high in the 40-50 degrees Fahrenheit range. Chilly for north Florida, but it beats the snow. Coffee was done brewing, so I went and got me a cup, and chatted with my coworkers. Blueberry muffin still sitting on my desk for breakfast.

Got back to my office and saw that I had new voicemail on my work phone. I had two messages from eager vendors wanting me to buy stuff from them that I’m not yet convinced that I need. Laptop was still doing its update thing, so I couldn’t get into my files yet to figure out what my next steps were going to be with the vendors. Instead, I cleared off a spot on my desk to set up my new keyboard dock and charger for my iPad. Makes a great backup, and much easier to produce content from my iPad when I have a keyboard than without it. Coffee was hot and delicious as I got everything situated where it was supposed to be. Blueberry muffin was unassuming, sitting on my desk for breakfast.

I’m a sticky note person, and I think they breed like rabbits in my office when I’m not looking. There are sticky notes everywhere. It’s colorful chaos. To make room for my iPad keyboard dock and put it in a place on my desk where I can actually use it, I had to go through probably 40 sticky notes that had accumulated on my desk. I kept about five, just to be safe, and threw the rest away…I mean, recycled them. Blueberry muffin was being resilient, sitting on my desk for breakfast.

Finally my laptop decided it would show up for work and stop with the updates, and I was able to get into my email folders and files and start looking into the vendor proposals. One of them contained a list of a few hundred titles that needed reviewing before I could make a decision as to whether I needed them or not. Usually I know what I need better than the vendors do, but the offer includes one of those end of the year sales, and I love a good deal. Meanwhile, as I’m crunching numbers and having a good ol’ time in my spreadsheets, blueberry muffin was sitting on my desk for breakfast.

It got to be mid-morning or a little later, and I was cranky. Why didn’t my coffee work this morning? I’m going to upgrade to Italian Dark Roast if this Colombian good stuff doesn’t get its caffeinated act together. Why can’t I think clearly? How come I’m fighting the urge to bite someone’s (anyone’s) head off?

…wait a tick…

Blueberry muffin sitting on my desk for breakfast…great. I bolused and forgot to eat. Stupid. BG was 45 mg/dl. CGMS finally bit the dust after six days this morning, so it couldn’t tell me what was happening. And I was just working away, dum-dee-dum, completely oblivious.

I will get better at pre-bolusing, and that is just one aspect of my diabetes that I want to get better at. My BG’s have been all over the board lately, and I have been on the glucoaster way too much. I’m a perfectionist, and I have a strict idea of what “control” is for my diabetes, but even so I fear my A1C is going to be horrific tomorrow morning when I have my endo appointment. But, that’s diabetes, and that’s life. I can’t carry the blame all the time. I shouldn’t have gotten carried away with work, but I love my work, and it happens.

But I tell you this, the next blueberry muffin I get will be getting a stern talking to if it decides to remain quiet after 30 minutes of sitting on my desk for breakfast!

Blueberry Muffin (photo by Minimalist Photography on Flickr)

Firetruck Exam Table

Endo Anxiety

Tomorrow I finally get to see my endo. This city has few endocrinologists, but I grew up seeing this doctor as my pediatric endocrinologist and he knows both me and my history, so it makes sense that I see him now. It’s a good start…er, restart…at least. As it stands now, I am his oldest patient (at 31). I wonder sometimes if it would be awkward to talk with him about my adult life and living with Type 1 diabetes while sitting on a firetruck examination table.

Firetruck Exam Table

Anyway, moving on…

It has been a year since I’ve been to my endo. Maybe I didn’t go mid-year because I’ve been busy with work. Maybe I didn’t go because every time I thought about it I was out of town. Or I can be practical and say that maybe I put it off because my insulin and supply prescriptions didn’t need to be refilled until now anyway. Truthfully, it is probably because I have to live with diabetes every single day and just don’t want to deal with all of the hubbub and aggravation that comes with doctor appointments anymore than absolutely necessary (endo appointments, ophthalmologist appointments, PCP appointments, scheduling lab work, the dentist, etc…all of which I’m due for). Procrastination at its best!

It is hard for me to get my many experiences with hostile doctors out of my head when I have to find a new one and schedule appointments. You know the type. They tell you how you aren’t taking care of yourself, that you aren’t doing this or that right, shame on you for not doing what they told you to do last time, how they have other patients just like you who are in bad health (which I don’t get how that makes them “just like me”…but whatevs), and pretty much just make you feel like you are wasting their time and you’re a complete slacker when it comes to taking care of yourself. Too much gloom and doom, and I despise being blamed for having diabetes, as if it’s my fault and I caused this.

Fortunately, not every doctor is like this. Hopefully, not even the majority of them are like this. I know when I lived in south Florida, I loved my endo there. She was great, on top of things, and I could actually call her with questions (what a concept!). I hope I can have that sort of relationship with my old endo here in north Florida as an adult.

Living with diabetes is a rollercoaster. I can exercise every single day, count every single thing that goes in my mouth, check my blood sugar a dozen times a day, and still be challenged by the unpredictability of diabetes. I need a health team that gets that, not one that holds it against me and makes me feel like a failure. When it comes down to it, I probably know as much or more about living with diabetes as they do. I’ve yet to find a doctor who actually has diabetes themselves. I need to know about the science of managing diabetes, and the technology and treatments available that can improve my quality of life. I need a doctor and/or CDE who will listen to me, be patient, talk with me, help me understand, write my prescriptions, be compassionate, and give me their outside-looking-in viewpoint. I’m hard enough on myself, I don’t need someone else to do that for me.

I know me. Tomorrow morning I’ll be nervous, my heart rate will be elevated, and my blood pressure will be up. It doesn’t matter if I’ve seen the doctor 100 times, it is always difficult for me to find that comfort zone that allows me to just chill the heck out. So tonight I will get ready for my appointment, and follow some of the suggestions that my friend Mike (@mydiabeticheart) shared recently about preparing for a doctor visit. I’ll make sure I have my meter, my pump (as if I can forget that!), and my prescriptions that need to be refilled. I’ll write down my list of questions, especially considering that I need a new pump and I am very interested to find out if my endo has had any success in getting insurance companies to approve coverage of CGM. I’ll ask about the numbness in my hand, and if that is more likely to be from working on a computer all day or diabetes. I’ll also find out what my A1C is tomorrow, aka “the diabetic’s report card”, and determine whether I deserve to pat myself on the back, or if I should go to confession (like @txtngmypancreas).