endo

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).