food

We Interrupt This Irregularly Scheduled Diabetes

I’ve been running high lately, and I don’t know why.

BG 220

That’s a lie. I know why. I eat too much, too often, and too late. Or I don’t eat, and then I go low or get super hungry, and then I eat all the things. Dang those holiday treats!

I haven’t been working out, exercising, or bringing sexy back. I have a gym membership, so accessibility to a place to exercise certainly isn’t the problem. I always find some seemingly good excuse for not getting there. First I was busy trying to find a new place to live. Then I was busy moving. Then I hurt both hands during the move.

Hurt Hands

Then I got even busier than usual at work creating something that I am extremely excited about. We are starting a new diabetes journal, available to all, and we’re now accepting research and volunteers to be peer reviewers. Check out The PLAID Journal. You can see a couple of videos and news articles about the The PLAID Journal on the Announcements page. Also, the Facebook page for PLAID. (Lots more to come on PLAID, so stay tuned.)

Then the knee that I hurt while cycling several years ago flared up again. Add to all of that an ever-growing to-do list, and there is always something that keeps me focused on something other than me.

I hate it. I hate the feeling of my blood sugar being high. I hate that I can’t get my BG to stay where I want it. I hate when I prick my finger and see a number that is dramatically higher than I feel because my body is getting used to it. I hate being thirsty. I hate waking up in the middle of the night to go pee. I hate thinking about it. All. The. Time.

I also hate being overweight. I hate feeling like I am the overweight that I am. I know that we’re in an age where we are supposed to accept our bodies and all that jazz, but this is not normal. I can’t just accept this. I don’t feel like me at this size. I feel like I’m stuck in a heavy fat suit, and everything I do is just that much harder because of it.

But for whatever reasons, I can’t seem to change it.

Before April of this year, I was on Weight Watchers, and I was doing pretty well with it. I had lost over 10 pounds in three or four months, and was feeling pretty good. I was on track to get back to a weight and size that I wanted to be. And stronger. And back to a more human shaped geometry, instead of just round.

Martin and Amanda on Bicycles

Today, I’m the heaviest that I’ve every been. Almost 207 whopping pounds. I put that out there for no other real purpose than to make it real. I should be about 170, in an ideal world. And I’ve seen a human skeleton. Short of an anatomical anomaly, there is no such thing as “big boned.” I’m just plain old overweight right now.

As joyous as April started out with Amanda and I tying the knot in beautiful Key West, it ended in tragedy with the loss of our precious little cat Squirt, and I know that losing her has played a role in where I am now. To some it may sound silly (she was so much more than “just a cat”), but she was a part of my life every single day for nearly 14 years. It feels like the loss of an immediate family member, because that is exactly what it is. I think dealing with that loss, on top of everything else already mentioned, has made me do things like eat my emotions and talk myself out of doing fun active things.

Working out and exercising has always been like therapy to me. Be it gym, walking, running, or cycling, it’s a safe place for me to get out all of my stress, frustration, anger, aggression, sadness, and any other negative emotions that I’m dealing with. Some days I only need 30 minutes or so. Other days I might need a couple of hours. It also makes sure that I have a few minutes during normal human hours of the day that are just for me, Martin Wood, where I’m not making sure that the needs of everyone else are being met.

It’s my career choice to help people, and it is a major part of who I am, and I love it, but sometimes in order to help people we have to make the time to help ourselves. I haven’t been doing enough of that. Now that we are in a neighborhood where there is less chance of going for a walk or run and interrupting a drug deal, I finally feel that spark of motivation to get out of the house and move around.

I also enjoy doing other things, like reading, video games, movies, and basically anything that doesn’t involve repairing yet another kitchen appliance in my house. Sometimes it’s hard to make room for those things, but we have to. Down time is as necessary to life as to-do lists and full calendars. A friend said recently that “cancelling a holiday commitment is like heroin.” Try it. Substitute an evening on the couch with the dog and the first half of this season of The Walking Dead. (Beth…noooooo!!!)

Life with diabetes is freaking hard, man. Life with diabetes is about so much more than just diabetes. Life with diabetes is a complicated balance of biometrics, medical therapies, activities, unexpected events, important considerations, random emotions, bright sides, dark places, and things left unsaid that have to be factored into an inarticulate equation that hopefully results in a personal definition of success.

All of this is what it takes to get my A1C where I want it, to get my BG’s on a more level plain instead of high or bouncing all over the place, to get back to Weight Watchers and better control of all of the delicious things that I’ve been cramming into my face hole, to develop the strength and stamina to avoid future injuries, and to drop some pounds and be able to haul ass without it taking two trips. That is what it takes to focus more on the things that I do have in my world that bring joy, for me, Martin Wood. Like these two…

That is what it takes to start to feel better. To feel happy. To feel able. To feel normal. And if I can’t do it on my own, then I’ll have to figure out who the right people are and get them on my bus to help me get further along down that road. For now, it’s one mile at a time.

–MW

The Case for CGM

It can be extremely difficult to get an insurance company to cover the costs of continuous glucose monitoring (CGM) systems. The excuses that these holdout insurance companies provide as to why they don’t want to cover CGM are becoming less justifiable thanks to research and advancements in the way we think about the needs of people living with diabetes. This is why I am a Diabetes Advocate.

So far in 2014, I have only been able to get four Dexcom continuous glucose monitor sensors out of my health insurance company. Four sensors is a one month supply. It is now July. That means for five months out of this year (so far) I have not been able to wear my CGM or benefit from the data that it gives me and the alarms that it uses to tell me when my blood sugar is dropping too low or rising too high. Each time I try to get more CGM sensors, I have to restart the approval process with my insurance company, spend weeks going back and forth between Dexcom, my endo, and insurance trying to get all of the documentation together to submit for approval, just to be denied because either Dexcom isn’t a preferred provider, or because the insurance company has decided that there isn’t enough evidence to support that CGM is a benefit and results in better control of diabetes. So then I appeal. And I know there are many, many other people struggling with getting CGM coverage by their health insurance just like I am.

This is also why I am a medical librarian. Challenge accepted, health insurance industry. Bring it on.

The most dangerous side effect of insulin is hypoglycemia, or risk of dangerous low blood sugars. The ability of CGM systems to alarm and notify a person with diabetes is one of the most valuable and beneficial advances in diabetes technology ever. EVER. The fact that there are small devices now that can warn us, as if to say, “Hey dude, your blood sugar is dropping. It might be a good idea to get a snack or something,” is incredible. This is an incredible benefit to people with diabetes so that they don’t get in a dangerous situation with a low blood sugar that can leave them incapacitated, unconscious, or possibly even dead if it happens in the middle of the night while they are asleep. Do you know how health insurance companies make money off of a dead person with diabetes? They don’t.

CGM technology benefits insurance companies too. It is incredibly cheaper to provide the technology that will alarm and cue someone to get a sandwich, a juice box, or a Level gel to get their blood sugar up on an ongoing basis than it is to pay for home or work visits by paramedics, rides in the back of an ambulance, hours in an emergency room, and likely overnight stays in the hospital depending on the severity of the lows. A low blood sugar can happen at any time, and is usually unpredictable based on varying amounts of food, activity, stress, varying absorption rates of body tissue from one spot to the next, and any other factor in life that can cause any amount of change. Sometimes they happen for seemingly no reason at all, and therein lies the danger.

How about…

…a systematic review from 2012 that concludes, “There are indications that higher compliance of wearing the CGM device improves glycosylated haemoglobin A1c level (HbA1c) to a larger extent.”

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008101.pub2/abstract

…the research that concludes, “CGM with intensive insulin therapy appears to be cost-effective relative to SMBG [self-monitoring of blood glucose] and other societal health interventions.”

http://www.ncbi.nlm.nih.gov/pubmed/21917132

…the research that finds that regardless of prescription approach, “…patient-led and physician-driven prescription. Both modes of using CGM provide similar long-term metabolic improvement.”

http://www.ncbi.nlm.nih.gov/pubmed/22208716

…the one with early analysis of cost-effectiveness of CGM that says…well, I’ll just let is speak for itself. “…the overall quality-of-life effect of CGM arises from its ability to both improve the immediate quality of life of diabetic patients as well as reduce future complications through enhanced glycemic management.” But wait, there’s more! “The provision of greater glucose control data may have improved the quality of life of patients by facilitating decisions related to food intake and insulin regimens as well as by reducing the risks and fears of hypoglycemia.”

http://www.ncbi.nlm.nih.gov/pubmed/20332354

…real-world benefits of CGM. “Personal CGM, in a real-world setting, improves glucose control and reduces the rate of severe hypoglycemic episodes.”

http://www.ncbi.nlm.nih.gov/pubmed/20551007

This is only a start. There is more research out there, and more research on the way that shows the benefits of CGM on the lives of people who use insulin to manage their diabetes. It is time for health insurance companies to get with the program, and it is time for us to speak up and shout from the rooftops what we need, and make it happen. Some health insurance companies are better than others (PPOs tend to be more willing to cover CGM than HMOs, for example). Until coverage of CGM is non-negotiable, our work as advocates for our own health and well-being is not done. We should not have to beg and plead to get this widely accepted diabetes technology that has already been and continues to be proven to improve and save lives. Coverage of CGM should be non-negotiable, expected, and mandatory.

Now that we are staring down the barrel of the potential for the bionic pancreas in a few more years, the need for CGM acceptance by insurance companies is only going to grow. Without insurance companies accepting that CGM is indeed a good idea for people with diabetes, and without insurance companies making CGM technology accessible without the barriers and complicated processes of getting approval, and without more research documenting the cost benefits and effectiveness of CGM versus emergency responses to hypoglycemic episodes (low BGs), the bionic pancreas will never make it past the prototype phase. And we need this forthcoming technology that the bionic pancreas, and the research behind it, provides.

I’m tired. I’m so very tired. I’m tired of living every single day and running every decision that I make through a diabetes filter. I’m tired of having to prick my finger before I leave for work in the morning to make sure that my blood sugar level is okay for me to be able to drive. I’m tired of checking before meetings to make sure that my blood sugar isn’t dropping, for no other reason than so that I don’t get caught in the middle of a meeting not making sense because my blood sugar dropped too low. I’m tired of having to check before I put any bite of food in my mouth, and then having to check an hour or two after to see if that food and the insulin that I took to cover it worked the way that I thought it would. Sometimes it does, and sometimes it doesn’t. Most of the time it defies explanation. I’m tired of having to decide if I get to go to the gym and workout today based on what my blood sugar is right before I go. I’m tired of having to check so that I can drive home. I’m tired of having to check before I can go to bed. I’m tired of not being able to go to bed because I did check, and having to wait for my blood sugar to go up or come down.

I’m tired. I’m tired of the hassle. I’m tired of the bullshit. I use that word because that is just how tired of it I am. I don’t have pipedreams of a cure for diabetes. I’ve had diabetes for 33 years. It’s all I know, and all I have ever had to deal with, and I don’t walk around with imaginary hope that a cure is coming in five years, ten years, or even necessarily in my lifetime. I hope it does. Maybe it will, but short of a scientific breakthrough, I don’t feel like that is the best place for me to invest my energy. In this age of technological advancements, this age full of the smartest people that have ever lived on this planet, and this age where people are open to change and progress and opportunity, I want to be able to rest my mind when it comes to diabetes. Let’s work together to support things like the bionic pancreas, CGM coverage by insurance companies, and these things that simply make life with diabetes easier and better.

I don’t feel like making life easier with diabetes is really asking too much. If you think it is, then you try it. See if you can make it 33 years counting fingerpricks, carbohydrates, activity levels, insulin doses, times you’ve found yourself in a room waking up and not knowing where you are because of a severe low blood sugar, a tongue chewed up from a low blood sugar seizure, bruises that you don’t know how you got, and cracked ribs from the physical exertion of just trying to survive that low. Survive that, and then I dare you to tell me how CGM isn’t effective and isn’t necessary.

I double arrows down dare you.

CGM Double Down Arrows

Update, 7/30/2014:
I am so fortunate to have received a few sensors from other PWD who had the extras to spare. Thank you! You know who you are, and you have been a big help (he types, as he is recovering from a BG of 39 and still a little shaky). I received a call from Dexcom this afternoon, confirming that they finally got all of the pieces that they needed with insurance approval and documentation from my endo, and they are overnighting me new sensors. Yay! It took 7 months, which is ridiculous, but people with diabetes are experts at being stubborn and steadfast until we get what we need (*cough* bionic pancreas *cough* encapsulation *cough* smart insulin). So thankful that it appears to have finally been worked out. Ciao for now! (Did I really just type “Ciao for now!”? I must still be low…)

Update, 8/21/2014:
Order got delayed, again, before it could be shipped to me. Today I finally received a 90-day supply of Dexcom sensors, allegedly with auto-renew when I need more. Still not clear on what took so long, aside from the explanation from my Dexcom rep that it was dramatically delayed by all of the authorizations required in order for insurance to approve. I’d demand more of an explanation, but it’s been a long battle, and I’m tired. Glad to finally have CGM data again, even if it did take 8 months longer than it should have.

Just Ask

It’s the 4th Annual Diabetes Blog Week! If you want to participate, or if you want to see what other diabetes bloggers have to say about the daily topics over the next seven days, head over to Karen’s blog at Bitter~Sweet and jump in.

Today’s blog prompt comes from Melissa over at Sweetly Voiced.

Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see?

Unless I’m traveling or just too busy to stop what I’m doing (or in denial…yes, that happens), I see my endocrinologist (endo) and CDE every three months, my ophthalmologist (eye doctor) every year, and my dentist twice a year. That amounts to, at the very least, four hours a year in the office of my healthcare team with my pancreas hanging out, my pupils dilated, or my mouth wide open. Sometimes at the same time.

Considering that there are 8760 hours in a year, I spend about .5% of my year in doctors offices in various compromising positions (not counting labs, time on the phone with insurance, time spent hooking so that I can afford my copays, etc.), which begs the question… How the heck am I still alive?

There are plenty of other doctors that I could spend time with too. Presently on my list of docs to find include a dermatologist, a podiatrist, and a psychologist. That last one will likely make my doctor time (and spend) increase exponentially, but that’s a conversation for another day. When I’m less crazy. Because that happens too.

The thing is, I need all of the services and advice of all of these doctors in order for me to stay at my optimal health status and achieve my health goals. Yet, I struggle. What little bit of time I have with each of these doctors, we don’t have a chance to talk about some of the things that they could really help me with probably better than anyone.

At my endo, we talk about diabetes, pump settings, high and low blood sugar trends, A1C’s, prescriptions, and sometimes even new diabetes research and technology. We don’t talk about my struggle with my weight, and how it affects me both physically and mentally. We don’t talk about my depression, and how sometimes I’m smiling on the outside and absolutely falling apart on the inside, and nobody ever truly knows the extent of it. We don’t talk about stress, and ways to manage being overloaded, and strategies to cut it down so that I don’t have to add hypertension and heart disease to my laundry list of sh–stuff to deal with on a daily basis.

At the eye doctor, we talk about diabetes, A1C’s, and the importance of keeping and EYE on things (see what I did there?) in the back of my eyeballs. We don’t talk about how prescription glasses are expensive, especially when you need multiple pairs (stylish regular glasses, plus sunglasses that make you think you look stylish, plus sport sunglasses for when you play volleyball on the beach with no shirt on all Top Gun style). We don’t talk about how much time I spend staring at a computer screen, and whether or not that is good or bad. We don’t talk about anything to allay my fears and anxiety from potential and, in reality, way over-exaggerated diabetes complications. We don’t even differentiate between Type 1 and Type 2 diabetes, but rather treat it as just this overarching definition of diabetes that sucks and makes you go blind, your feet fall off, and your wenis not work properly. And I need my wenis to continue to work properly dangit! (I don’t even know how I got from eyeballs to wenis, but I’m mildly impressed and entertained with myself right now.)

I want my healthcare team to know that, just because it isn’t their area of expertise, all of these various other things in Martin World impact me, and are related in some way, and have the potential to impact my health in both positive and negative ways. Because I’m stressed out that my BG’s are running higher than normal may mean that I don’t check my BG as often because I don’t want to deal with the stress that I feel when I see that high number on my meter. So then I go get something awful to eat to feed the stress with, and then my pants start fitting a little tighter, and I feel like I’m the size of a whale and the idea of an 19th century style corset sounds like a pretty great idea if it will make my pants fit better. Then my pants get too tight and the pressure makes my eyeballs fall out and my teeth point forward.

What I also want my healthcare team to know is that I have absolutely no clue how to bring these things up and talk about them in the time limit and in a way that makes sense to them before they have to run off and see the next patient. I’m doing good to remember to even show up for the appointment most days. If it’s not on my Outlook calendar with an alarm, don’t expect me to be there. If there was one thing I wish they would all ask, it might be, “So all of these numbers aside, how are YOU doing? Feeling okay? Any particular issue not related to insulin, BG test strips, and pump supplies that I can help with?”

Just ask. The answer might be no most of the time. But sometimes it might be yes. And that’s when it is most important that you asked, and that you are there to listen.

To view other posts on this topic, click here.

32 Things

Today is an important day in Martin World. A day that I look back and reflect on some of my accomplishments.

1. I passed Chemistry in high school. It was the hardest class for me. Tutoring helped. The tutor had a cute daughter. Those last two statements are mostly unrelated.

2. I graduated. Four times. Because once just wasn’t enough. (HS, AA, BS, MS…in case you were wondering.)

3. I was a DJ. On a Christian music radio station. Yeah, I don’t believe that either. But it’s true.

4. I found love. And lost it. And found it. And lost it. And found it again. I’m like a country song.

5. I’ve changed the world. Sort of. I stepped on an ant hill. “World” is relative.

6. I’ve been a President. It’s a lot harder than it looks.

7. I rode my bicycle over 100 miles in one day. Most people have enough sense not to do that.

8. I had dinner with Olivia Wilde. Kind of. She was two tables away from me. I’m still counting it. Can we be friends?

9. I was fired once. They called it a “lay off” because of the recession. Lipstick on a pig.

10. I’ve worked in two libraries so far in my career. I’ve been the token male in both. I’m like a trophy librarian.

11. I’ve been an Apple, an Android, and a PC. I prefer being an Apple.

12. I was voted Most Intelligent in middle school. It was nerdy at the time. Now it’s dead sexy.

13. I grew up on a farm. I delivered a calf. I about had a cow.

14. I had a dog named BJ when I was a kid. I lived on Fifth Street. I’m usually on top of that “What would be your name?” game.

15. I write with Sharpies. People with dry erase boards hate me when I get excited about flowcharts and to-do lists.

16. I worked in a 1-hour photo lab. I got paid to stick my nose in everybody else’s business.

17. I am Jack’s complete lack of surprise. According to the first rule, I can’t talk about this. I do love the movie though.

18. I wear a Mickey Mouse watch. It reminds me that great things start with small ideas.

19. I have jumped out of a perfectly good airplane.

20. I have a tattoo. I’d like to get another one. I just don’t know what yet.

21. I love video games. They are a way that I escape and decompress. I also want my own personal Navi, like in Zelda.

22. I always have more to do than I have time for. In related news, sleep is a nuisance.

23. I like to explore a new city on foot or bike. You see things that you didn’t realize were there. Like celebrities.

24. I love New York, DC, and Seattle.

25. I’ve tried escargot (snails). It’s not my thing.

26. I speak a little bit of Russian. I would like to learn how to speak Spanish. English would also be helpful, some days.

27. I can’t speak in coherent sentences before coffee in the morning.

28. I’ve read every book by Terry Goodkind, Barbara Kingsolver, Tobias Buckell, and John Steinbeck.

29. I have pets that are some of my favorite people. Two dogs and a cat. All spoiled rotten.

30. I have moved nine times in my life so far. Books are very heavy. Save your back, buy an e-reader. And get a library card for Pete’s sake.

31. I gravitate toward leadership roles. Which probably explains why my to-do list is so long.

32. Today is my 32nd diaversary. 32 years with Type 1 Diabetes. Making it this long is nothing short of a big deal. But, as you can see, there is a lot more to me than just diabetes.

High Times in Jacksonville

For my birthday, A-Flizzle surprised me with a trip to Jacksonville for a weekend of good food, good times, and great friends. It was such a surprise! I never saw it coming. I was all, “Hey, I’m going to work” and she was like, “No, we’re going on a weekend getaway” and I was like, “Oh wow, I’m so surprised! This is so cool!”

Okay, who are we kidding? I hate surprises, and she knows it. That’s why she’s a keeper. To prevent me from freaking out, A-Flizzle made this awesome timeline of what was going on and where we needed to be. Actually, calling it a timeline doesn’t really do it justice…it was a FUNline. Look at this picture while I do the pencil sharpener…

Friday started with a beermaster’s tour of the Budweiser brewery in Jacksonville. Upon arrival, I struck up a conversation with the tour guide who noticed my insulin pump. She couldn’t quite grasp how in the world I could possibly have Type 1 diabetes and drink a beer, at the same time. It’s not an exact science, but I explained to her the basic idea of factoring in blood sugar levels and counting carbs and dosing enough insulin to cover the difference, just like anything else we people with diabetes (PWD’s) eat or drink. Yes, I know there’s some long division and a square root of Pi and other fuzzy math that goes into calculating carbs and insulin when drinking alcohol for some PWD’s, but your diabetes may vary (YDMV). Suffice it to say, it was nice to meet someone in the beer brewing industry who was legitimately interested in how everyone might be able to enjoy what they put so much effort into making.

The tour was fascinating, and getting to sample beer directly from the ice cold tanks was delightful. There is no way to get a fresher beer than that. One lady on the tour, who didn’t even like beer, even became a convert. I’ve got a newfound respect for the Budweiser brand of beers now, and the care that goes into making each and every one. It’s a process of Willy Wonka proportions, and I’d highly recommend the tour if you every have the opportunity. Also, the gift shop is a great place after you’ve had a couple. Just saying. (I left with a Landshark beach umbrella and a hoodie with a built-in beer koozie on the front. So…yeah. In my defense, I did pick those things out BEFORE the tour.)

I also found my dream job in the Budweiser brewery…

Afterwards, we met up with Jacquie and the family for dinner: Mediterranean food, for the win! Nothing chases an afternoon at the brewery like chicken shwarma. Shwarma…mmm. Just sounds delicious, doesn’t it?

The next morning, my pal Bob and I were supposed to get up and go for a bike ride. However, it was cold-ish, and the temperature was not appealing to my sense of get out of the warm bed and go pedal at all. After texting back and forth for a bit about it, we decided to do what any normal person who doesn’t feel like braving the cool air to go on a bike ride does on a Saturday morning.

We went and ate bacon.

After that, A-Flizzle and I made our way toward the spa, where she had us lined up for a facial and a 1-hour deep tissue massage, respectively. Now, I’ve gotten a massage before, and my pump was never a big deal for the masseuse. In fact, every massage that I’ve ever gotten, I was able to keep my pump on and just slide it to the side and the masseuse was able to work around the tubing and the infusion set. No big deal, right?

Except, this masseuse was different. Although she was plenty nice enough, and she did a spectacular job of getting some of the knots out of my back and neck and shoulders, she was really weirded out by the idea of having to work around my continuous glucose monitor (CGM) sensor and insulin pump and infusion set. Because I needed that ding dang massage more than I needed diabetes at that moment, I decided to dose a couple of extra units for the hour, and then I took off my CGM sensor and my insulin pump so that I could get some relief. Stop me if you’ve heard this one before.

In hindsight, I should have just let the masseuse be uncomfortable. Once the hour was up, I was a blob of mostly relaxation. A-Flizzle and I took a leisurely pace back to our room, at which time I stupidly decided a birthday cupcake was in order. A cupcake? Really?! Dumbass. Then I proceeded to get a shower, which was delightful, and full of hot water, and a window that I could look out of while scrubbing off eucalyptus oil. I’m like a cat. I can’t resist a good window to look out of. Hours of entertainment. Fortunately, the hot water didn’t last.

Keep in mind, I failed to put my insulin pump back on through this entire episode of Birthday for Dummies with Diabetes.

By the time I got done taking my sweet time with everything, my blood sugar was through the roof. I don’t even remember what it was by the time I put a new infusion set in and reconnected my insulin pump. Probably somewhere around 1,000,000 and rising. I felt like crap. Way to ruin your own birthday there, Wood. Brilliant.

I dosed the snot out of the high in hopes that I could get it at least dropping by the time we had dinner at one of my favorite restaurants in the whole wide world, 13 Gypsies. I was moderately successful, but really had to focus dinner on the lower carb items and lots of water to try and offset the effects of the afternoon.

See those eyes? That’s not glassy eyed from birthday beers. That’s worn out from fighting a high blood sugar all afternoon. I’d have preferred the former.

I guess the moral of this story is to never disconnect your insulin pump and remove the inset unless you have another one handy for immediately after whatever necessitated your getting naked. Because I am the last person in the world to vote against being naked. Also, maybe tell the spa and masseuse that you have type 1 diabetes and use an insulin pump so that they don’t freak the eff out when they see that you’re bionic.

Maybe also do this in an Austin Powers voice, just for style points. Yeah baby!

Finding My Inner Ryan Reynolds

Every year right around this time we all dream up our New Year’s resolutions. Some form of weight loss, get in shape, go on a diet, or eat healthy is almost always at the top of everyone’s New Year’s list. This year, I’m feeling the stretch, and I realize that I need to do something to get back to my size 4 bikini body again.

Actually, I don’t even know what that means. I just heard it on an infomercial for some kind of magic beans that are supposed to make your clothes fit better. Truth be known, they probably have a better chance of turning into a beanstalk and leading to a land of giants than they do making me lose weight.

I bet they are good with ham though. Anyway, moving on…

I freely admit that I weigh more than I want to right now. I’m overweight. Heck, I might even be considered obese by the current standards of how big a person’s butt should and shouldn’t be. (And don’t you dare tell me what the difference is. I don’t want to know.) What I do know is that my clothes fit a little tighter than I would sometimes call comfortable. I can’t really button the top button on my dress shirts right now because my head and neck resemble Jabba the Hut. If someone told me to haul ass, it’s questionable if it would take me one trip or two to get it all. At least, that is how I feel.

I’d love to lose some of the extra pounds that I’m carrying around. I know it would make me feel better, both inside and out. I mean, there is a Ryan Reynolds under all of this that is just waiting to get out. I’m just trying to find a real solid purpose that I can grab onto besides, “Skinny people are happier.” Oh yeah? With that kind of logic, rich people must also be less lonely, hairy people have more style, and short people enjoy the smell of toots. Give me a break. Happy has nothing to do with weight, just like loneliness has nothing to do with how much money you have.

And everybody hates the smell of toots. Unless you’re a proctologist. Then it just smells like money.

When I signed up for my last gym membership, my goal was simple: I wanted to look good naked. I could have said that I wanted to be able to run a marathon, or be in good enough shape to teach spin class, or ride my bike for miles and miles and miles, but…well…yeah, naked. You have your goals, I have mine. Unfortunately, 2012 was a really hard year for me to establish and maintain a routine of exercise, working out, riding my bike, and keeping active consistently, and I feel like I’ve lost my way a bit. I could blame it on a chaotic schedule, being overwhelmed by other things going on, not having enough time, or that the Mayan’s had predicted that the world was going to end anyway, so why bother. When it really comes down to it though, it was me. I didn’t take time or make time, and I realize that I really need time to exercise and work out for both my physical and mental well being.

In order to change all of that for 2013, A-Flizzle and I worked extremely hard in our garage over the holidays to get it organized so that we could have a functional workout space that would be available despite my busy and often chaotic schedule. If I want to work out at 11 o’clock at night, I can. I don’t have a bunch of expensive equipment, but what I do have I can definitely make the most of now. I’m SUPER excited about it.

In 2013, I’m trying to get back to establishing consistent exercise routines. I’ve really got to find a way to make time to train and get to where I want to be. The first place I want to be is on my bike in a few months for the Tour de Cure. My goal is to train consistently this Spring so that I can complete the 100 mile century bike ride in May. From there, who knows? Hopefully by then there will be other bike rides that I can train for. Or maybe even a triathlon. Wouldn’t that be exciting?! But, first things first.

I know that exercise is only part of the story. In order to get fit and have a set of abs worthy of doing laundry on (thanks Ryan Reynolds for setting THAT bar so high), I realize that I also have to eat right. What does “eat right” even mean these days? I look at all of the options for supposed “eating right” and I wonder how in the world I can adopt something like Weight Watchers, Atkins, Paleo, eating clean, gluten free, zero trans fat, and all the other whoop-tee-do diets out there for the rest of my life. I don’t want to make a change that gets me to where I want to be with my size and weight, just to reach that goal and balloon back to being the fat kid that I am now all over again. I also don’t want to not be able to have a Burger King fish sandwich WITH fries when I have one of these:

Basically, I’m a walking contradiction.

Weight Watchers I don’t get because of the point system. It’s difficult for me to understand how a banana (about 24 carbs, take or give) is zero points. It sure doesn’t feel like zero points when I’m having to bolus for the carbs and then check my blood sugar a couple of hours later to make sure I guesstimated properly and am not sitting at 300. Fruit is like jet fuel for blood sugars when you have Type 1 diabetes (YDMV – your diabetes may vary). “Free food” is really just a matter of perspective. Yet it works for so many people.

Then there is Atkins. How is it healthy to eat that much meat? I mean, essentially the diet is a version of a low carb diet, but it also talks about putting your body into ketoacidosis. Aren’t we supposed to be staying OUT of ketoacidosis? Diabetic ketoacidosis (DKA) can mean a hospital trip for many of us people with diabetes (PWDs). But there again, it works for so many people.

Correction: It’s KETOSIS, not ketoacidosis. Easy to get confused. Thanks Allison!

Those are just two examples, and clearly I don’t understand all of the ins and outs of them all. I see info about this meal plan and that weight loss option, conflicting testimonies and experiences, and I can’t seem to come to any conclusion about what is right for me. It is this lack of understanding that is paralyzing my decision making process on what it means, for me, to “eat right.” I see successes and failures with every single option. How do you pick one? Which one is the “right” one? It’s like walking down the cereal aisle at the grocery store. Can’t I just get the one that is delicious and has the best prize?

I don’t have an answer. I probably just need to commit to something and try it. For now, I know I can work out. I enjoy that, and even look forward to it once I get into the routine. Maybe my rule needs to be, “If you eat it, burn it.” Or maybe it’s, “Sweat like a pig to look like a fox.” It’s one of those. In any case, we’ll call it the “Running on Fumes” plan, and I’ll try to talk Chuck Norris into being my spokesperson. After all, Chuck Norris never loses weight; he knows exactly where it is, and it’s very afraid of him.

Level Up

A recurring theme in my diabetes world is running low. I can function normally with a blood sugar down to the mid-40’s most of the time, and not even realize it. That’s called blood sugar unawareness. It’s also dangerous.

Low blood sugars have a way of sneaking up on me. I finally figure out something is wrong when all of a sudden I’m unable to focus, or my mouth is running 90mph but the words aren’t making sense anymore, or I’m trying to communicate but can’t get any words out at all, or my mood swings from normal to highly agitated and upset for no reason, or I’ve sweat through my clothes and am a shaky mess.

Most days I wear a Continuous Glucose Monitor (CGM), which alarms when my BG drops too low. Most days, it even catches it in time. However, there are days that I go without my CGM, which is dangerous, stupid, and quite honestly, a total waste of money. Those CGM sensors are not cheap…at all!

When I was a kid, I was stupid and I guess I thought I was invincible, because I would run off to play or with friends and never carry anything to treat a low with me. It’s a wonder that I survived, as active as I am and as busy as I’ve always been, from childhood to adult. I don’t even want to know what my A1C must have been when I was flying by the seat of my pants like that.

After 31 years of Type 1 diabetes, and a lot of lessons learned, I don’t go anywhere without something to treat a low. I’ve got glucose tabs on my car keys. I’ve got juice boxes in my refrigerator. I have a stash of low blood sugar remedies in my nightstand drawer. In fact, I’ve probably got something to treat a low in every room of my house, every bag I carry, in my car, and in every drawer of my desk at work.

There’s a new product that I carry with me everywhere now. It comes in a pouch, and it fits in my pocket, in my BG kit case, in the easy access velcro pocket on the outside of my messenger bag, in my gym bag, in the back of my cycling jersey, in my car, and I’ve even managed to stuff one in my shaving kit for when I’m traveling.

I’m talking about Level. Level is a pouch of glucose gel, 15 grams of carbohydrates in each, that are perfect for me to treat a low blood sugar with…anywhere. I can swallow it easy when my mouth won’t cooperate, it opens easy so that I can rip it open with my teeth if necessary when my hands are being clumsy, and it’s delicious, unlike most other glucose products I’ve choked down in a moment of low blood sugar desperation. Level is available in four flavors: Mandarin Orange, Caramel, Strawberry-Banana, and Vanilla.

One thing that most people with diabetes (PWD’s) who run low can appreciate is that, when we are low, it’s a lot more fun to treat that low blood sugar with something delicious than it is to force feed ourselves with something that nobody would eat on a normal day. That is one thing I like about Level pouches. Treating a low with something that tastes like mandarin-orange, strawberry-banana, caramel or vanilla really isn’t so bad.

My advice: Try it. It’s worth a shot to not have to eat a handful of glucose tabs, at least for one low. Tell the folks at Level that you read about it on Diabetically Speaking, and they’ll throw in a bonus! Just enter diabeticallyspeaking at checkout on their web site, LevelFoods.com, and get 20% off any purchase of $25 or more. Pretty sweet! (Pun kind of intended.)

Now, this is the disclaimer part. I am in cahoots with the company that makes Level. They really didn’t have to push me very hard to get me to say good things about their product. I really wanted to share with those of you that read Diabetically Speaking because it works for me, it doesn’t taste like I’m eating chalk, and I can actually get into it when I’m having a shaky, clumsy, can’t quite get my body to do what it’s supposed to kind of low. It’s pretty much a life saver in Martin’s diabetes world, but in the effort of honesty and integrity, I’m divulging that not only am I a Level fan, I’m also a customer. So there. Remember, enter diabeticallyspeaking at checkout at LevelFoods.com, and get 20% off orders of $25 or more.

Make It So…Wait, Low?

We’re right smack dab in the middle of Diabetes Blog Week, and as much as I would love to be able to post every day, my schedule refuses to allow it. Today’s topic, about some diabetes thing that you or your loved one does spectacularly, captured my attention though, and reminded me of a story that happened just this past weekend.

On Friday, my 31st Diaversary, A-Flizzle and I ventured over to the Monticello Opera House, where I dawned one of these…

…and proceeded to serenade the sold out crowd.

Or maybe I just went there for the Star Trek Murder Mystery Dinner Theatre.

In any case, me and Number One (A-Flizzle) were there and made it so. This was my first murder mystery dinner, so I really had no clue what to expect. In diabetes terms, I didn’t pre-bolus, because I didn’t know exactly when we would get food, or even what the food was going to be. The menu said something about sliced Tribble, with a side of pok tar, and a big stein of Romulan ale. Yeah, go ahead…try looking THAT up in Go Meals! (Which is awesome, by the way, if you ever need an app to look up nutritional info. And no, they didn’t pay me or give me anything to say that. But if they wanted to…*cough, cough*)

Do you think the computer in Star Trek would tell you the nutritional info, or would it just beep and buzz at you like our insulin pumps and Continuous Glucose Monitors (CGM’s) do now? Inquiring Klingons want to know.

Back to the story…so we were sitting there in Act 1, and the galactic detective was setting the scene, something about how awful of a detective he was, or maybe he was getting ready to retire, or perhaps he had chased an alien rabbit down a black hole and had been warped to the other side of space and landed on some distant starship. Honestly, I have no clue, because while we were making it so, diabetes and the full-throttle day was making me low.

Near the end of Act 1, I was trying my hardest to focus and keep up with the story, but I was checked out. My attention was somewhere between Jupiter and Pluto. All I could think was, “I’m low…and is that person really wearing a Darth Vader mask under a hood and pretending to be in Star Trek?”

The spectacular of the story is that A-Flizzle noticed. A regular Coke and a couple of glucose tabs later, I was back in space, instead of spaced out. I caught up with the mystery, we enjoyed dinner, had blueberry cobbler for dessert that was to die for, and by the end I had even figured out whodunit.

The biggest mystery though is how A-Flizzle figured out that I was low in a crowded room with attention being diverted in the opposite direction of me. Somehow, she has figured out my low blood sugar tells, those hijinks that give away that something is wrong, sometimes even before my brain is capable of comprehending it…and that’s a pretty spectacular diabetes trick.

Just Another Day

This past weekend was a good weekend. No deadlines except that one that made a nice whooshing noise as it went by, nowhere to be, just an opportunity to enjoy things at a leisurely pace.

Saturday, A-Flizzle and I got a wild hair and decided it would be fun to go on a six mile urban hike, which is a more adventurous way out saying that we walked through a few neighborhoods and down a few sidewalks. It’s kind of amazing the things you notice when you are on foot that you never see from driving around in a car. We found a house with a dinosaur in the front yard, several Florida rooms off the sides of houses with beds in them that we were hoping to catch someone dozing in, a new sports bar and restaurant being built, and we learned that the pedestrian crosswalks have absolutely no rhyme or reason for when they decide to let you cross the street.

Throughout the day, I thought I had done a really good job of counting carbs, factoring in activity, and doing a good job of keeping tabs on things so that I didn’t go low from the activity or high from any of the delicious things that I ate, like the banana and Nutella crepe that I may or may not have had for lunch at about mile 4.5 of our urban hike. And by the way, this is my blog post, and I call it Nutella, not Noo-tella…because there’s a freakin’ “nut” in it. YPONMV. (Your pronunciation of Nutella may vary.)

After a day of near perfect BG’s, around bedtime on Saturday night I realized that I wasn’t feeling too well, so I did a quick check to see where things were. 342. I was pissed. Are you for real?! I counted everything! I know I got the math right, or at least in the ballpark enough to not merit a stupid 342 BG. What the #$@#%#$?!!!!

After I got done pitching a fit, I tried to think what might have jacked my BG up so high. Surprisingly, I don’t think it was the banana and Nutella crepe. There was nutritional info, and I’m pretty sure I was in the ballpark on that one. Since it was sunny and over 90 degrees outside when we were urban hiking all over town, I settled on the idea that the insulin in the tube of my pump probably got a little too warm during the activity and had lost its effectiveness. Insulin is supposed to be kept cool or at room temperature, and let’s face it, late Spring and Summer in Florida is far from being room temperature by any stretch of the definition. Something you have to be aware of if you’re going to sport an insulin pump is that, every once in awhile, heat happens.

I dosed down the 342 BG with a shot of insulin via the old faithful syringe, and then switched out the insulin in my pump. Either I overestimated how much I needed to pull that 342 BG back down to normal, or the activity of the day finally caught up with me, because I woke up around 3:00am at BG 35. After a juice box and a couple spoonfuls of peanut butter (which I may or may not have shared with Hopper dog), I woke up in the morning with a perfect BG of 88.

Diabetes is a total game of numbers. In order to stay alive we have to count everything. And guess. A lot.

We have to know how many carbohydrates are in everything that we put in our mouth, what our blood sugar (BG) level is at the time, and guesstimate how much activity (or lack thereof) is going to affect our metabolism and BG level. Then, on top of that, there are ever present questions about how accurate our BG meters are, we never really know for sure how effective the insulin that we’re injecting is going to be (especially after it has been in an insulin pump for a few days), and our bodies sometimes process that magical life elixir differently than yesterday, when we had the same food, the same activity, and the same BG levels.

My endo says that “doing the same thing over and over again and expecting different results is insanity…unless you have diabetes.” In Martin World, it’s just another day.

Why You So Stubborn, Diabetes?

I think of myself as a typically optimistic person, especially when it comes to my diabetes, because really my life with diabetes is better when I’m able to cast it in a positive light. Even so, that doesn’t mean that I don’t spend a few days in the trough of a wave every once in awhile.

Today was one of those days. I didn’t sleep much over the weekend, so this morning I got up early and fed the dogs and then decided I would try to sleep a little bit longer, considering it was Sunday and all and I didn’t have to go to work or anything. About the time I got comfortable, some masochist with a lawnmower decided that 8:00am was a fine time to mow the grass next door. Seriously, how do you get up so early on a Sunday and think, “I’ll go mow the grass this morning.” Read the paper and have a cup of coffee for Pete’s sake. Have a whole pot if it tickles you. Just don’t go outside and crank up the mower and wake up the neighborhood! </rant>

I like to make a big breakfast at least one morning on the weekend. I’m doing good to get dressed and get to work on the weekdays, so Sunday mornings are my time to pause and enjoy the thrills of a pot (or two) of coffee, eggs, sausage or bacon, and Meet the Press with A-Flizzle. If you ordered that meal at Denny’s, it would be a Grand Slam Nerdy, and could you leave a carafe of coffee on the table please?

I found a little bit of Bisquick left in the fridge, which is weird because most people put that in the pantry, but I decided to use it up and make a couple of pancakes. I limited myself to just one pancake, the one that came out looking like it had been put in somebody’s pocket instead of in the skillet, because I didn’t want my blood sugar to go through the roof or anything crazy. And it didn’t. It just hovered around the stinkin’ penthouse suite all day long, making me real frustrated because it wouldn’t come back down to the lobby where all the normal BG’s hang out.

That was the only starch that I had on the day, and I hovered around 200 mg/dl all day long. Being used to running a BG of around 100 lately, I felt that 200 in full effect. I even resorted to rage bolusing, just throwing a max amount of insulin at it to try and get it to budge. We went to see Hunger Games with some friends, and I barely touched the popcorn. Then we went to dinner afterward, and I couldn’t even eat because I was so nauseous and thirsty from the stubborn high BG. Finally, after I got home and gave up, I started to sink back down to normal again.

I ended up having to take over 100 units of insulin today to combat diabetes. That really, REALLY frustrates me, considering how a normal day for me (with carbs) is closer to 60 or 70. In hindsight, I shouldn’t have eaten that pancake, but there was no way of knowing that it would have been so stubborn all day long. The beauty of the conundrum is that it might not have even been the pancake. It could have been that my insulin lost its potency, or that I’m fighting off a virus of some kind, or that I was wearing green today instead of blue and my diabetes was offended. In other words, who knows?

Some of you may be reading this and thinking, “Wow, he’s got the diabetes real bad.” You may be thinking, “He really isn’t taking care of himself having to dose that much to get his blood sugars to cooperate.” You might even be thinking, “I would have been pissed too if that guy had woken me up with that damn lawnmower!” Or you might just be thinking, “Yup, been there, done that.” I’m convinced that some days diabetes has a mind of its own and does whatever it damn well pleases, regardless of what we try to do to “control” it.

Fighting back the tears, I was telling A-Flizzle about how frustrated it makes me when I feel like I have no control over what my body and diabetes has decided it wants to do. I hate feeling like I’m just strapped in and along for the ride, wherever it may take me. That is why I have the CGM, why I check my blood sugar on average 6-8 times a day, and why I try and count everything that goes in my mouth so that when I do make a mistake, hopefully it isn’t a complete disaster.

This situation is a good reminder to myself that we can do seemingly everything right in our lives with diabetes, from correct carb counting, insulin dosing, BG checking, and everything else, and yet we can still have those days where all of the pieces just refuse to fit together.

Tomorrow is a new day, with a new inset, and a fresh reservoir of insulin in my pump. So bring it beetus! I’ll be your Huckleberry.

	Rick Phillips on I Lied
	Tina on A Bunch of Sensitive Pric…
	Heather Gabel on Diabetes as a Disability
	Martin on Diabetes as a Disability
	Heather Gabel on Diabetes as a Disability