World Diabetes Day Postcard Exchange

I think the idea of the World Diabetes Day Postcard Exchange is so fantastic.  Thank you, Lee Ann for all of your hard work putting this all together.  I think your work is meaningful and important.

I'm a substitute teacher (currently, I taught full time for 8 years) and I knew I'd be teaching today. So, I thought it would be really fun if I had my class make some postcards for the exchange.  They loved it.  I gave them a mini lesson on diabetes, taught them about what the exchange was all about, and let them be creative for a little while.

They came up with some really great things!  Some of them, I REALLY love!

I'd like to send them to you.
I've already been paired up with 3 people, and I'm sending one to my partner from last year who has become someone I communicate with daily.  But, I still have about 20 more to give out.  If you'd like me to send you a postcard, please leave your name and address in the comments, email me at: sugarfreesweetie@gmail.com or DM me on twitter @sugarfreesweety.

Thanks!

Jen

American Association of Diabetes Educators (Utah Conference)

I had the amazing opportunity to attend the Utah Chapter of the American Association of Diabetes Educators conference in Salt Lake, Utah. It was a three day conference for nurses and doctors. I was asked to attend as a patient and live-blog the event on twitter. I used the hash tag #AADEUT if you’d like to see what was written you may search for it. I was also asked to write a summary on this blog at the conclusion of the conference. As part of attending, my entrance was paid for and my meals were provided. I’m a local so no transportation or boarding fees were covered.

So, now that the disclaimer is out of the way, let me tell you a little about the AADE conference. The conference was very well done with a full three days of speakers and classes. As I said before, this was an educator’s conference. I am not an educator, nor am I a nurse or training to be one. However, all of the information was very relevant to me as a diabetes patient and I learned a lot. In attendance, there were nurses, educators, dietitians, doctors, and pharmacists. They attended the conference to gain more knowledge about the work they do in their practice.

Given the length of the conference, and the amount of classes, I simply cannot write about it all. I’ve decided I’ll give my overall thoughts as well as talk about three specific speakers who I think this audience can most relate to.

The first was our keynote speaker, Ginger Vieira. Ginger spoke about motivating your patients by listening. By telling her own story, she was able to convince the educators in the room that it’s important to be a good listener and to motivate your patients by asking the correct kinds of questions. She shared her own story of diabetes and finding an endocrinologist who could understand the human side of diabetes. Sometimes blood sugars are out of control for no reason, or for really silly ones, like one autumn the apples in Vermont were really large. Ginger shared some feedback that she received on her Facebook page when she asked fellow patients with diabetes, “What advice do you have for your CDE?” I remember sending out this tweet: “So many great comments I'm unable to write them all. The mood in the room is thoughtful. These CDEs are REALLY listening! #AADEUT.” Ginger instructed that the visit with a CDE or Endo should not be a judgment zone. Patients feel a lot of negative emotions regarding their diabetes; they don’t need to be judged on top of it. The main point she made was that at CDE really needs to listen and then ask the right questions. This way, he or she is motivating their patients to make the changes necessary to improve their own health. Ginger is a life coach specifically working with people who have diabetes. She’s learned to ask patients what they want to achieve and works with them to guide them to success.

Her speech rang true to me in so many ways. I generally take really great care of my diabetes, but I can still relate to the statement; “Don’t treat us like idiots. I live with diabetes every day.” Her talk was really motivating and I know that the CDE’s in the room were able to see her point of view and understand it. I know that they were indeed motivated to be less judgmental and more helpful. Ginger can be found at: http://living-in-progress.com/ on twitter as @Ginger Vieira and by email at ginger@living-in-progress.com Check her out, it will be worth your while.

The second speech I’d like to highlight was given by Shara Bialo who was our concluding speaker of the conference. Shara spoke on Rising to the Emotional Challenge of Diabetes Care: The importance of getting personal. Her speech was incredible. She shared her own diabetes story, and it wasn’t an easy one. To summarize, she was diagnosed at the age of 8, took charge of her own care at a very young age, and was pretty well out of control until her early twenties. At that time, she met an amazing diabetes educator who changed her course and prepared her for the possibility of pregnancy. Like Ginger, Shara’s story was so amazing and really drove home the point that people with diabetes want to be healthy, live long, complication free lives, and sometimes, they just need help getting there. The amazing people who have chosen to work in the field of diabetes care are those who can help us get to those healthy lives, and stay there. Shara is on twitter as well at: @SharaSays

Lastly, I’d like to talk about a speech which really caught us all by surprise. I was really curious about his topic as I looked through my conference schedule. Dr. Lawrence Fisher’s speech was titled: “Diabetes Distress and Depression: Improving Motivation for Behavioral Change” He took a nice long time showing all sorts of research before the figurative light bulb in the room was turned on. We all saw where he was going with it. First, he made the point that clinical depression and diabetes distress are two totally different things. They are not related, and they do not have the same symptoms. He noted that most people have not been asked about distress related to, or brought on by their diabetes. The root of his presentation was this:

“We have become so focused on: delivering information, addressing plans for behavioral action, identifying barriers to behavior change, measuring behavior change that we have neglected to address adequately the very feelings, beliefs and expectations that actually drive the behavior we would like to see changed!!! So, the point is, get to the bottom of it. Address the feelings that are maybe even subconsciously driving the poor care behaviors.”

It was so good. Such a good speech, I really related to a lot of what he said. I know that I don’t have depression. But sometimes, I do feel distress over the care of my diabetes. It IS overwhelming; to have to take care of it 24/7/365 that sometimes it is just too much.

There were many other things that I learned throughout the conference. But the main thing I realized was that, as educators, they care about the work they do, and they care a great deal for the patients they serve. If you are interested, I suggest you go back in to twitter and read the #AADEUT feed for the dates of November 7, 8, and 9. You can also access all of the information including PowerPoint slides at: www.tinyurl.com/aadeutah2012 I hope you enjoyed reading my feed, and thank you so much for all of the retweets, comments, and interactions that I’ve received. In all, I had 17 new followers added throughout the course of the conference and retweets potentially reaching an audience of 10,159 twitter users. I had several interactions with fellow PWD throughout the conference via twitter and email.

 Thank you, Michelle Litchman @michlitch and David Winmill @dwinmill for inviting me and giving me this opportunity. I’ll just throw it out there that I’d be more than happy to do this again, for another event. I’d also be more than happy and totally willing to participate on any patient panels where my experience as a Type 1 diabetic, diagnosed as an adult would be beneficial.

Photo a day challenge

So, in addition to blogging about National Diabetes Awareness Month, I've decided to switch it up on the photo a day challenge and do the Diabetes one instead of FatMumSlims.  Just enough different to help me hang in there for the last 61 days of the year.  Holy Cow!  Hasn't 2012 flown by?!

Here are the prompts.
Join us on instagram or where ever you like to post your pictures.

I'm sugarfreesweety on instagram and I'll also be posting them on 365project.org

Diabetes Awareness Month

November is Diabetes Awareness Month.  I want to be more involved than I was last year, and build on that each year.  I've participated in the National Blogging Month NaBoPoMo challenge on my family blog before.  I doubt I'll be able to blog all 30 days but if you think that you can blog about your health each month, here's a place where you can receive a prompt.  I'm going to give it a shot.  I'll see how close I get.  Maybe I'll commit to one per week.  

Diabetes is an illness which affects almost 26 million people globally.  I was diagnosed with Type 1 in 2001.  It's a challenge in my every day life.  It is manageable, but there is so much more which can be done.  In an effort to raise awareness (this is Diabetes AWARENESS month after all) I've decided to point you in the direction of a few ways you too can participate.  

Firstly, you can log a Big Blue Test here.  You test your blood sugar, exercise and test again.  Each time you log a test, a donation is made to help those with diabetes.  

Secondly, this one is really cool, you can pretend to have diabetes for a day.  I hope all of my friends and family will do this one.  The Juvenile Diabetes Research Foundation is launching a program for you to receive text message alerts throughout a 24 hour period.  So that you too, can see what it takes to manage diabetes, for JUST one day!  Go here.  

Third, if you're wondering what the blue circle is, you should check out this website by the International Diabetes Foundation.  

You can sign up for a postcard exchange here. 

 You can always make a donation to the American Diabetes Association, JDRF, or IDF.  Or, request a free medical bracelet here. 

And last, but not least, you can wear blue every Friday throughout the month of November, and on Diabetes Awareness day- November 14th.  
Anything you can do will help!  

Site Change Problems

Last night was hell.  Pure hell.  And, as usual, Diabetes is to blame.  Here's what went down.

 
Yesterday, as I was prepping for my shower, I noticed that my insulin was kind of low.  I figured I had enough in the reservoir to last me through my breakfast bolus and three hours of church.  So, I didn't change my site.  It was Sunday and I had no plans so I figured I'd just change it when I got the NO DELIVERY error.

Well, that error never came and it was coming up on bedtime so I did the ever-dangerous bedtime pump change.  Actually, I changed my site at about 9 pm.  I checked my sugar and it was 117.  Sweet.  I set an alarm to test in an hour because I've been having trouble with absorption in my sites.  So, at 10 pm my sugar was 204.  Not too bad.  I took a little extra bolus than what the wizard said.

I could not sleep.  I was super worried about waking up early for swimming and having my sugar be too high.  So, I got up at 11:22 pm and my sugar was 281.  Shit.  More bolus.  This time I just did what the pump said and tried to get back to sleep.

Tossed and turned a little.  Had a nightmare about a 600 blood sugar, woke up at 12:39 am and my sugar was still 266.  Crap!  More insulin.

Here's the thing.  I would have changed my site out but I've been having an absorption issue with my sites like I said earlier.  So I figured as soon as I got past all the scar tissue, that my site would start working and insulin would start absorbing.

Then the wind started blowing.  Our bedroom is on the second floor and there's a large tree outside of our window which scratches at the glass all night long.  And the howling.  And the high blood sugar and I was just simply not resting.

At 4:45 am I checked my clock, 25 more minutes of sleep.  At 5 am hubs told me I better get up.  I told him the pool doesn't open til 5:30, tried to get a few more minutes.  At 5:10 I got up and my sugar was 166.  Perfect for a swim and a big blue test, so off I went, with about three hours of "sleep" and on to my workout.

I actually swam really well.  We did IM's so that was fun.  The dudes in my lane were lame and only did free the whole time.  I was keeping up with the slowest guy in the fast lane- fastest chick in the pool!  I love mornings like that.  Finished my set and coach told me it was 10 after so I had to go.  Checked my sugar and it was 108.  Sweet!

As I was wriggling out of my suit, I pulled on my site a little.  At first I thought it had come lose but it was fine.  I showered, got ready, got the kids ready, made breakfast and read to the kids for about 30 minutes.  I guess I made a critical error and didn't check my sugar.  An hour previous it was 108 so I figured I was fine.  I did feel a little high but didn't think anything of it.  Ate.  Bolused.  

Took the kids off to school, washed my car, vacuumed, washed the windows, and put on a coat of armor all on and came inside. Felt weird.  Tested; 410.  SHIT!  So I changed my site.  I thought about reusing the reservoir because I figured it was just the site that was bad.  But I noticed it had some bubbles in it.  And, upon further look, it was wet, and most likely leaking insulin out the back- not sure what that part is called below the ring....

Anyway, I completely changed my site, new bottle of insulin, and an injection of about 2 more units than necessary  I took the canula prime bolus as well as one more unit, just to be sure.  I tried to take a little nap before it was time to get little brother again.   About an hour and a half later, my sugar was at 221.  Before lunch it was 96.  Whew.  Finally.

I'm not exactly sure which was the final culprit.  Could have been many things, stacked on top of each other.  Too many damn variables when it comes to blood sugars anyway.  That's something I cannot stand.  When I get high like that, I get pretty angry.  I'm trying really hard to eat well and lose some weight this week so it's super frustrating when your sugar does this kind of thing.  I could have caught that 410 a little earlier had I tested when I first felt weird.  But, I did play it well when I tested all night long, even thought it resulted in a major lack of sleep.

If it 'aint broke...

I've had quite a difficult time getting in to see my doctor lately.  I usually see my Diabetes Specialist every quarter.  Last time I made my appointment, I scheduled the usual 3-4 months out.  The day was approaching and so I arranged for a babysitter for little brother and for a friend to pick up big brother from school.  The appointment was in the late afternoon.  As the date was getting closer, I realized I was having some major concerns with my weight.  I'd been exercising and training really hard for my triathlon.  Throughout that time, I was also counting my points (weight watchers for calories) and although I was creating a large deficit, I was still GAINING weight.  Oh the troubles of it all!  So entirely frustrating!I was really looking forward to getting to the bottom of some of the issues I was having.  I was prepared with food logs and exercise regimens and some really good questions for her.

When the day of the appointment came around, I got a phone call that morning, at about 9:30 or so.  The receptionist, who knows me by name and is very nice, let me know that my Nurse Practitioner had a family emergency come up and that my appointment would have to be canceled.  She tried to have me come in later that day and meet with another doctor in the office.  The appointment was at an entirely different time that would not work with my previously arranged plans (for picking up, dropping off, and watching my boys).  SO... the closest thing she had was this week, nearly 30 days AFTER my scheduled appointment.  I was so frustrated I believe there were tears.

As I thought about my upcoming appointment, I thought maybe it was time to switch doctors.  I have been seeing the team at the Diabetes Center for almost 10 years and while it was a great experience, they are quite a long ways from my home, they don't allow children to come along for appointments, and it causes quite a bit of pain and planning on my part just to make it down there.  In all, I usually spend about 3 hours for a trip to the doctor.  So, I kept my appointment with my NP but went online to find a new doctor.

I looked for Endocrinologists who practice closer to my home.  I found one who was particularly attractive because of his specialties with thyroid conditions.  It said that he even did ultrasounds on thyroid.  I didn't know if that was something I needed, but I was looking forward to someone who would maybe take a more whole-body approach to my endocrine system.  This particular doctor had an office very close to my house so I called and made an appointment.  I was looking forward to meeting someone new, and having a new doctor who would be so much closer.

I met with my regular NP on October 3.  The appointment went really well.  My A1c was 6.6, I was overjoyed!  We didn't make any changes to my pump settings as they were obviously working quite well.  She sent me home with a full panel of labs to have done at my earliest, fasting convenience.  We briefly discussed my weight, but things have sort of straightened themselves out on their own.  I keep thinking that something has to be wrong, or off, but I don't know.  She mentioned making an appointment to meet with the dietitian who specializes in weight loss.  I may still do that. 

I left thinking, man, that went really well.  The only draw-back really was that I found out my NP was moving to a new office and that I wouldn't get to see her again.  However, I love the main doctor there, so that wasn't really a problem for me.

Which brings me to my next appointment.  The second appointment I made was clearly unnecessary except for the fact that I was looking to switch doctors to a more convenient location.  I felt like it was more of an interview- I was interviewing this new doctor to see if he would be a good one to switch to.
I was really looking forward to seeing a doctor who could better treat my thyroid and whose office was closer to my home. 

The appointment was for October 8th.  So, I walked into the office and there was a woman behind the desk.  She did not greet me so I approached the desk and waited for her to admit me.  I stood there for at least 2 full minutes before she even addressed me.  Hmm...  She then asked me what my name was and gave me the paperwork for admittance   I sat down to fill it out and she she asked me probably 4 more times to come up to the desk while I was trying to fill out my patient profile, complete with a family history and all.  Next the Medical Assistant came up to the front desk.  She starts bad-mouthing a patient.  Right in front of me.  I couldn't t believe it.  Said patient comes up to the desk and is obviously upset.  He tries to handle his business and there is tension.  He leaves.  They continue bad-mouthing him.

I'm called back to the room.

They take my weight, bring me to a room, take my heart-rate and blood pressure (personal pet peeve- I can see my weight on the scale, but I cannot see my blood pressure, if you're going to take it, why not tell me what it is? I finally told the nurse at my OB/GYN that she needed to tell me when she takes it).  Anyway, let me tell you about this medical assistant.  She was gross.  Her hair was unwashed, uncombed and pulled back into a pony-tail (nothing against the pony, I wear it frequently), her teeth were disgusting,  hadn't been brushed in WEEKS, nasty breath too.  She wasn't rude or anything, she asked me a few questions, took my meter and left.

The room was small but I noticed that there wasn't a computer in the room.  I was curious as to how they'd upload my blood sugars.  The doctor came in and we visited for a while.  He pulled out my meter, turned it on, and started scrolling through my blood-sugars.  He never looked at mealtime averages, post meal sugars, or anything like that.  He just glanced through a few of my numbers.  Granted, my A1c was great, but he had no way of really looking at my blood sugars in a constructive way.  

He examined my feet, asked me when my last eye exam was, and told me that I needed to schedule an appointment for an eye exam.  The weirdest thing of all this was, he asked me if I was on a CGM.  Then he mentioned, ever-so-casually, that he "wouldn't advocate for them or anything".  WHAT??? Um, that was the straw that broke the camels back for me.  I couldn't believe a person in his position wouldn't "advocate" for a medical device that helps patients take great care of themselves, manage their diabetes well, improve A1c levels, etc. etc. etc.

Because I had already done all of my labs, he was able to go over those with me.  He mentioned that everything looked to be within normal levels except for my cholesterol   I've never had elevated cholesterol before so I was pretty surprised by this.  He said that because I'm 32, and most of the research on cholesterol meds were performed on patients 35 and older, that he wasn't going to put me on any prescription.  I'm fine with that.  Honestly, I was so put off by this guy that I was just going to wait and see what my other doctor said when they called to tell me about the same results.  But he never mentioned anything else about it.  He never brought up anything about diet, exercise, or anything else related to lowering my cholesterol   This guy was striking out with me.  

I  casually brought up the question about my weight.  I told him that I am counting calories, exercising lots, and not seeing great progress.  He mentioned that I should move more and eat less if I'd like to lose weight.  Um... right.  He then asked me how often I usually visit my other doctor.  I told him that it was about quarterly and he said, okay, I'll see you in three or four months.  Right.

The receptionist asked me how it went, and offered to make an appointment.  I told her that my schedule is really varied (it is) and that I'd call her to make a follow-up appointment.  But I won't.  And I'm pretty sure it's obvious why.

Needless to say, this "interview" didn't go so well.  The doctor was nice enough, but obviously not a great fit for me.  I need someone who is proactive with my care, who uses technology, and who is interested in helping me stay as healthy as possible.  His flippant attitude toward the CGM was one thing, the fact that he didn't look at BG averages was another, the "do nothing" approach to cholesterol was a third.  Not a great fit.  Perhaps he's better with other types of patients but I wont be going back.

I can Tri

In all of the hype and excitement of watching the Olympics this summer, I began to itch for a little competition in my life. So I did something pretty crazy and signed up for a triathlon, my first!  I have always been a swimmer and it's an easy thing for me.  I still swim at a decent pace and I love to jump in the pool and swim some laps at least once a week.  I love my spin class and think that my instructor is quite good at keeping me fit.  To put it bluntly, she's really, really tough.  I felt confident in both my swim and bike.  Running, I know is not my thing.  However, I have run a few races before, so I decided to go ahead and do it.  

I signed up for the Alta Canyon sprint Triathlon.  It consists of a 400 Meter swim, a 9 mile bike ride, and a 5K run.  I felt comfortable biting off this much for my fist tri.  I am so glad I did it!  It was an AMAZING experience that I will NEVER forget.  It's so amazing what you can do once you set your mind to it.  

 I followed a training program I found online.  My awesome friend Claire let me borrow her road bike.  The first time I got on it, I thought I was really going to have a hard time racing on it.  However, my awesome neighbor Deena took me out on a few rides and taught me how to basically ride a road bike on the streets.  We did some great rides around these nasty Sandy hills and I felt pretty prepared for the giant hill on the bike portion.  I probably didn't train enough for the run, but given it was the last leg, I think I did pretty well.  

The night before my race, I had to change my insulin pump site.  I think I chose a bad spot because the absorption hasn't been real good.  I checked my sugar before going to bed Friday night and it was at 345.  I should have changed my site again but I didn't.  I set an alarm for 1 am to check to see if my sugars had come down.  They were at 200 something so I tried to get some good sleep.  I was tired but nervous so I didn't sleep really soundly.  

I woke up at 6 am on Saturday a total ball of nerves.  My sugar was 131 so that was great.  I ate a small breakfast, bolused 50% of usual and packed up my stuff to leave.  I didn't realize it until I got there, but I forgot my water bottle.  Big mistake!  But I managed okay.  

I got to the race at about 7 am.  There were already tons of racers and their support people there.  I found a good spot for transition, set up my bike and laid out my racing gear.  At about 7:35 we had a pre-race meeting to discuss the path and a few rules.  I prepped my insulin pump with a 50% basal rate, disconnected, and headed over to the pool.  It was pretty cool outside so I was nervous about being too cold but it was all good.  We lined up by the pool in a general area based on our time for the 400M.  I wish I had put myself a little closer to the front of the line but it wasn't too bad.  My swim time was 8:48.  Should have been about a minute or two faster, but oh well.  

We were separated by a quick 5 seconds in the pool, snaked back and forth down the Olympic sized pool for the 400.  I passed several people in such a short distance so that's why I wish I could have been closer to the front.  Anyway, after the swim I jumped out of the pool, threw on my flip flops and grabbed my towel.  While I was running to transition, I was feeling super dizzy.  I almost fell over!  As I was getting my stuff ready for the bike, I figured I'd better check my sugar again.  It was a lot higher than I would have liked (260) and looking back I should have bolused.  I dried off, put on my socks & shoes, pants, shirt, my iPhone on my arm band, insulin pump, and headed out on my bike.  My first transition time was 3:24.  I wish I had taken a few more seconds to collect my thoughts and bolus.    

The beginning of the course is a huge hill up 9800 South.  The first time up was pretty hard. I took it at my own pace, lots of people passed me.  Once I got off the hill I felt great.  I pushed it pretty well on the bike and was confident on the down slope.  I took that a lot faster than I had without the race officials directing traffic.  I was thirsty as all get out though. On the straightaway before the hill, my friend Diane caught up to me and offered me some water so that was awesome.  My second time up the hill was much better. After the summit, there is a flat part and then a corner and a down slope.  On the flat at the top of the hill, I saw Colin and the boys in the car.  That was awesome!  I finished my second lap and went back into transition.  My bike time was 45:24.  I honestly didn't expect to do it in under an hour.  The last time I rode it, it took me 30 minutes for just one lap!  I was happy with my performance on the bike.  

I rode into transition and that was the only time I got yelled at ha ha ha.  They were like, "dismount, dismount". So I jumped off my bike, put it back on the rack, changed my shoes, and put on my headphones.  I didn't check my sugar at this transition.  This transition was 1:23.  

The run was pretty good.  I kept a decent pace for me.  And that was AFTER the bike and the swim.  So I was pretty happy with that.  There is this one part on the run that's a straight up hill.  Like straight up.  But then you get to run down the bike climb  on 9800 south so that was awesome.  Colin and the boys were on the downhill so they cheered me on and brought me some much needed water.  My run time was 37:56.  I was hoping for under 40 minutes.  I think my first lap was 19 minutes so my second was faster, I think.  My friend Diane saw me coming down the finish and ran out to cross the finish line with me.  It was awesome!  Colin was there just after I crossed the line and snapped some pictures of me with my metal on.  

He didn't get any pictures of the swim or the bike, darn it but we did take one of me in transition after I had finished.  My final time was 1:36:57.  I honestly didn't think that I could finish in under 2 hours.  Well, I way underestimated myself.  

I feel really good about this accomplishment and I think I'll totally do it again.  

Me getting ready in the morning.  Nervous wreck!  

Race map

The hill on the run.  Yikes!  

Me coming down 9800 South

Giving Ry a high 5.  

Giving Evan a high 5. 

Crossing the finish line.  

In transition- post race

Pump Vacation

This summer my family and I took a vacation to Southern California.  We planned to camp on the beach for 8 days and 7 nights.  Every day was spent at the beach, and every night sleeping in a tent.  This is actually a family tradition I've been doing my whole life.  I knew what this kind of trip entailed and I decided that I'd like to go ahead and take a vacation from my pump while camping at the beach.

I spoke with my nurse practitioner at my last appointment a few weeks before my trip about going on a pump vacation.  She wrote down my dosages, my conversion tables, and instructions for switching off of pump and back again.  She gave me samples of insulin pens so I didn't even have to fill a prescription.  I felt perfectly prepared for leaving my pump at home and taking my insulin pens and needles.  

I was really looking forward to going off the pump because everyone needs a break from it now and then.  I also knew that this vacation would be a LOT easier without worrying about my pump, my site, where to clip it while at the beach, changing sites, sand, sun, heat, water, etc. It was also a whole lot less to pack, I realized.  I only took my meter, extra strips, 4 insulin pens, 1 extra vial of insulin, insulin pens, and a few syringes.  Usually I haul insulin vials, infusion sets, reservoirs, setters, test strips, and my meter- lots more bulky.  

We left for California on a Friday night.  On Thursday night, my pump ran out of insulin.  So, I decided then was as good a time as any to turn off the pump and switch to MDI.  I waited for bed-time, took off the pump, turned the batter around, and took a 35 unit injection of Lantus.  Friday morning, my sugar was quite a bit higher than it should have been so the next night I increased to 37 and eventually up to 40.

I quickly realized that the computer at the doctor office had a 1:20 lowering dosage when I usually use 1:33. So, I was coming down too low after corrections.  I adjusted that to 1:33 and it wasn't quite enough so changed to 1:25 and that worked out okay.

My meal dosages were working out okay.  I noticed that I was significantly more aware of my carbohydrate counting and intake, especially at snack-time.  I had purposefully packed some low-carb and no-carb snacks for our trip.  Many of you know about my battles with weight and my attempts at calorie counting and dieting.  On the first of my summer vacations, where I spotted another pumper in the wild, I gained 5 pounds in 3 days.  With this vacation being 8 days, I did NOT want a repeat of our last vacation.  I worried quite a lot about gaining weight and I think that injecting helped me manage my portions and snacking pretty well.  Don't get me wrong, I ate like I was on vacation but I tried to keep it in check.  I also made sure to stay active walking, hiking up the beach stairs, swimming, riding bikes, boogie boarding with the kids, and just chasing the kids around during the day.

Despite all of my efforts, I struggled with SEVERAL high blood sugars.  I saw numbers in the 3 & 4 hundreds every day.  It was frustrating.  I was doing everything I could to get them under control, and keep them there.  But, no matter what I did, they still seemed to be out of control.  Even though it was so nice not WEARING my pump, worrying about a broken belt clip, or where to hook the thing while wearing a swimsuit, I looked forward to coming home and putting my pump back on.

I have to admit though, I wish I had played with the numbers, ratios, and dosages a little more to get it REALLY right before going off.  However, I knew that I had to get my numbers back under control and FAST.  So, the first night I was home, I threw my pump back on and skipped my Lantus dose.  I knew I'd go low during the night.  And I did.  But ever after, my sugars have been much better and I feel oh, so much better too!

I'm not sure what I would do next time.  Maybe I'd try wearing my pump at the beach, maybe I'd try being more aggressive with my insulin pens.  I'm just not really sure.  I suppose I'll cross that bridge when I get there.  I'll weigh my options, perhaps revisit this blog entry, and make a decision.

PS: my first weigh-in post vacation was minus 1.2 pounds.  I couldn't have been more thrilled.

Pump free me teaching my son how to boogie board!

Pump Spotted in the Wild

I went out of town with some friends for a long weekend.  One night we went to a pizza restaurant where an interesting chain of events occurred.  As we were getting ready to pay our bill, we noticed the man in front of us was having difficulty paying his bill.  We decided to go ahead and pay it for him. We anonymously spoke with the manager and offered to pay the amount for his meal.  As we were standing there, I noticed that he had a clear tube coming out of his pants pocket.  Sure enough, he was a pump wearer, spotted in the wild.  The longer I watched him, the more I realized that he may be experiencing a low blood sugar.  His movements were slow and lethargic, his speech was slurred, his thought process seemed labored.

The more I thought about it, the more compeled I felt to do something about the situation.  So, as we exited the restaurant and made our way to the parking lot, I told my friends that I wanted to confront him about it.  I walked up to him and began in with the small chat about diabetes.

"Hey, I noticed you have an insulin pump."  "I'm diabetic too, how long have you had diabetes?"

He was still acting strangely.  Told me that he was from a small town about 70 miles away.  He mentioned he'd had some meet-ups with other diabetics but hadn't done anything in a while.  He also mentioned that he had a daughter in the NICU up at a hospital in Salt Lake (about 350 miles away).  Side note: a friend of mine who was with me on the trip works at that same hospital treating infants. I began to feel sorry for him.  He seemed quite down on his luck.  I hesitated, but he had a young child with him, and I wanted to make sure he was safe, so I asked him if his blood sugar was low.

"Do you think maybe you're low? You seemed a bit shaky back there."

He told me that he didn't have a meter with him and that sometimes his meals were metabolized quickly but that he didn't think he was low.  I offered my meter and suggested that he test.  I asked him probably three or four different times and ways if he would like to test to see if he were low.  I figured that maybe he was just a little tired and that he probably knew that he was okay, although I really wished he would have tested with my meter.  He had a box of leftovers with him so I suppose if he thought I was right he could have finished eating that on his trip home.

We parted, and the more I thought about his actions, the more convinced I became that he was experiencing a hypoglycemic episode.  I did all that I felt I could have though, to encourage him to test and treat the low.  It was quite the experience and I don't think I'll soon forget it.  I'm not sure there was much more that I could have done for him, but I wish that I had insisted that he check his sugar, or offer him a juice (which I did not have) or SOMETHING more.

I'm not sure what the moral of this story is... but it was definitely an interesting spotting of a pump in the wild, so I thought I'd share...

Embarrassing Moment

I've gotten into the really bad habit of only eating 1 hour before spin class.  Let me just tell you that that is NOT  a good idea.  Ever.  But I do it over and over again.
 
This morning, when little brother came in to wake me up watch cartoons in bed with me, I decided to go ahead and wake up and eat.  I forgot to test my sugar (couldn't immediately find my meter) because it was earlier than I usually get up and eat.  I bolused about 10-20 minutes after I'd eaten and had eventually tested my sugar.  I was 168.  Not a bad pre-exercise blood sugar, especially for an intense spin class.  I took a little less insulin and on our drive to the gym I turned my basal down to 40% for the next 90 minutes (about 20 minutes before class started).

My instructor starts in with the, "today's ride is...." and then she says the words I absolutely D R E A D "all hill, we're going to ride a 40 minute hill".  I HATE hill rides.  Cranking up the dial is my least favorite kind of ride.  About 15 minutes into the class I could tell that needed to turn down my insulin some more.  I decreased my basal to 0% for the next hour.  15 more minutes and after a song of sprints, I wanted to test my sugar.  I got off my bike and tested.  Usually when I do this I'm at 130 and I just get right back on and ride.  No such luck this time... 68.  I walked back to my bike, wiped it down, apologized to the instructor and left.  That is so embarrassing!  But what else could I have done?  I guess I had too much insulin on board and no matter if I drank my juice (which was not in my bag, but luckily I had some cash and could pay $2 for a Vitamin Water) I still could not have gone on cycling.  SO FRUSTRATING!

Does diabetes ever embarrass you?

Why cure Diabetes?

I've been told that a cure for diabetes is fast approaching.  New research shows that scientists are getting closer and closer to a cure every year.   Most certainly every decade.  The latest and greatest thing to hopefully come on the market soon is the artificial pancreas.  This is an interesting concept.  I think  it shows some pretty cool technology.  I think it shows that we are getting closer to a cure.  A cure, for me though, would be to have some kind of medicine, or operation which allows me to not have to check my sugar ever again.  To be insulin free and to not have any complications of diabetes.  This cure... is this a possibility?  Is it a reality?  Will it ever be?  But more importantly; do those with the power to cure diabetes actually WANT a cure for diabetes?

Let me back up and give a little background here. A few months ago I attended the ADA expo.  Remember?  Anyway, while I was waiting in line to talk to the representative from Omni Pod, there was a man about 10-15 years my senior.  He got into a deep discussion with the rep asking him why he thought diabetes would ever be cured.  I thought it was an interesting inquiry.  For the most part, I thought he was being pretty pessimistic.  However, if you think about it, he may have a point.

I mean, why would all of the pharmaceutical companies want to cure diabetes?  Why would they want to put money in to finding a cure which would take away the dependency of so many customers?  Think of the financial side of things.  People with diabetes have to pay for medications: insulin, oral medications and most frequently other medicines that help treat complications of diabetes, meds for heart disease, thyroid issues, cholesterol, and the list goes on and on.  Diabetics pay for meters, pumps, test strips, syringes, infusion sets, reservoirs, alcohol pads, glucose tablets.  Some people with diabetes buy special shoes, artificial sweeteners, and other food products manufactured with less sugar.  Why end all of that revenue?  Why find a cure to something so profitable?

Its a question I think too few of us are asking.  I do not consider myself to be a pessimist.  However, I certainly don't consider myself an optimist either.  I'm more of a realist.  At least, that's the way I see myself. I usually analyze things the way they are and don't try to put a negative nor positive spin on things.  I wish I were an optimist, but that just doesn't come very naturally to me- in most situations.  ANYWAY, I do think that there may be some truth to the fact that doctors, scientists, pharmacists, and most certainly DRUG COMPANIES do NOT want to find a cure for diabetes, not now, possibly not ever.

Thoughts?
Anyone want to chime in?

11 Years Today

Well, today is the anniversary of my diagnosis.  It's been 11 years and the memories of my diagnosis and the two or three weeks leading up to the diagnosis are crystal clear in my mind.  I wrote my diagnosis story a year or so ago, so I won't bother you with that again.  But it is sort of hard to believe that it's really been that long!  Eleven years!  I've lived about one-third of my life with diabetes.  That's an even more sobering thought.
 
Most days aren't so bad.  I test my sugar before each meal, bolus for the carbohydrates, and just go about my business.  Some days it stops me in my tracks with a low... or a high.  Occasionally I get pretty emotional about an unexplained high; or frustrated with a low that makes me suspend my activities for 15 minutes or more.  The majority of the time I don't worry about long-term complications.  All of my doctor appointments are always good, test results normal.  Some days I even forget I have it.  Other days, it's all I think about.

I've definitely learned how to be a healthier person.  Not that I was really unhealthy before.  I wasn't.  And I shouldn't tell myself (or others for that matter) that I was.  I exercised, I ate well (mostly) and I was a healthy weight.  My weight isn't ideal right now but I'm working on it. Plugging along with the diet and exercise program.  I'm managing my diabetes to the best of my knowledge.  And hopefully, I'm a good example to some people.  I think that I am.  I am well.  That is all.

Is someone going to make me a cake or something?

ADA Expo

Yesterday I took the opportunity (amid all the moving) to go over to our local Expo center and attend the ADA  (American Diabetes Association) Expo.  I arrived pretty late in the day, I spent my morning packing and doing yard work on our house, so there were not very many people there.  I missed out on the speeches and demonstrations but was able to just browse the booths without the crowds.  

When I first got there I figured I had wasted my time even going because everything seemed so irrelevant.  They had lots of cookbooks, overpriced stuffed animals for sale, and diabetic shoes, and socks.  Who wants that stuff?  Well, I certainly did not.  I wanted to check out the new technology.  Look at the new pumps.  So, I wandered around a little trying to see what was there.

I accidentally ran into the Dexcom CGM booth and display.  Ah!  Now that's something worth looking at.  So I stopped, talked to the rep. for a while, and I was pretty amazed at how cool that thing is.  I've blogged about wearing the Mini Med CGM before.  I think the guy asked me if I had ever worn one before.  I told him I had and he knew it had to have been the Medtronic one.  I saw the insertion site of this CGM and was TOTALLY blown away.  I had NO IDEA those things had gotten so small!  My Medtronic CGM was so large and it really hurt sometimes.  By 7 days I had to rip that thing out!  Anyway, so he launches into an infomercial of all the great features of the Dexcom CGM.  It was pretty neat.  It all comes down to relevance for me though.  Do I really need one?  It would be great for control.  But, my control is pretty good already. I know that if I wanted to get pregnant again, I would get one for sure!  I don't really see that in my future though.

As I was wrapping it up, this young girl walks up.  She wears the CGM, and has an Omni Pod insulin pump.  Saddest thing of all, this girl is not at all excited about having diabetes.  And I don't know why anyone would be.  But I just felt bad that she seemed so bitter about it already and she couldn't have been more than 10 years old.  So I hear her dad say that he keeps hearing that "any day now" they're going to get the Dexcom and the pump communicating.  I thought that Dexcom had a pump, or was a pump.  So.  I set out to find the Omni Pod table.

I walked all the way around the ADA Expo floor like three times (it wasn't very big) before I finally found them.  Omni Pod was taking up just a corner of one table.  I couldn't believe how small their display was.  But, there was a crowd and I had to wait for quite a while to talk to the representative.  He asked if I had a quick question, "No, I have a lot of questions."  I responded.

The Expo closed at 4:00pm and I was at his booth probably at 3:45.  So he and his guys were packing up but he's the representative, so of course he's going to take the time to talk to an intelligent "potential buyer" such as myself.  This pump totally blew my mind.  The part where he showed me how the needle works is where I was SOLD on this pump.  So cool!  Omni Pod is really, for me, a total mind-shift.  I love that there is no tubing.  I love that the pump and the meter are controlled on the same device.  I love that it will soon be integrated with the CGM.  And, I love that it's totally water proof.

There were a few draw-backs for me.  First, it doesn't hold as much insulin as my Revel.  My Medtronic Revel holds 300mL of insulin.  The OmiPod only holds 200.  My body requires an average of 75 units per day of insulin so I'd go through that every 2.5 days, that would be annoying.  Second, I just got a new pump so my insurance won't cover a new one for a few more years.  And third, I'd really have to take some time to get used to the larger site.  They say they are decreasing the size of the pod, which is good.  But I'd really like to see it in a larger vial capacity too.  Having such a large pod would definitely take some adjustment.  At the same time though, NOT having to wear a pump on my belt every day could be pretty amazing.  Hey, I could maybe even wear a DRESS again!  Wow.

Anyway, I think that when my insurance is ready to cover a new pump, I'm going to do some more  research and most likely, I'll be switching to the newer and better technology.  Just way too cool!  Those are the kinds of things I CAN get excited about.

365 Project

I'm doing a photography project this year.  I'm taking a photograph every day for a whole year.  So far, I've done really well at sticking to it.  Some days, I take multiple photos and some days I take none, but for the most part, I've been able to remember to take a picture, upload it, and post it.  I'm using 365project.org and I really like it.  I've also decided to use a list of photographs for the month of February.  In January, I just did my own thing.
Here are my pictures.  If you click on the picture below, you'll link to my "project".  I'm posting most of them to Instagram so if you have an account you can follow me: sugarfreesweety

adjusting to a new schedule

Keeping good control over diabetes means making frequent adjustments.  A friend of mine, and diabetes podcaster recently asked the question; "How often do you make changes to your basal rates?"  This questions means making adjustments to the amount of insulin your body receives throughout the day.  Basal rates are the amount of insulin your body requires at different times in a 24 hour period.  Each time I visit my Endochronologist, like I did about 2 weeks ago, we look at my blood sugars, analyze my A1c, and examine my basal rates.  Usually, we make some little adjustments.  My doctor has taught me that there needs to be a minimum of a 10% change in basal rate for an effect to take place.  I see my doctor every 3 months.  Occasionally we don't make any changes, most of the time however, we do.  I rarely make adjustments to my carbohydrate ratio (the amount of insulin I take for the amount of carbohydrates I consume) but in the beginning I made those changes more frequently.  I also made carb ratio changes when I was pregnant because EVERYTHING changes and gets really wacky when you're pregnant and diabetic.

Anyway, recently, my weekend schedule has changed.  I wouldn't say that it has changed dramatically but it has changed enough for me to notice a pattern of change- for the worse.  So, I've got to decide what I'm going to do to make some changes and adjust to this new change.

Each year, our church schedule changes.  We attend church for a three hour block of time.  Each "ward" or congregation, is assigned a different start time so that the buildings may be shared by more than one ward.  This year, its our turn to attend the 12:30-3:30 block.  AND I HATE IT!  I absolutely detest this schedule.  It's not good for me, and it's not good for anyone else in my family.  Last year we were lucky enough to attend the 9-12 block.  Yeah, it's nice to sleep in on Sundays but I'd much rather be finished with church by noon.  Also, when do you eat?  Either you sleep in and eat a big, late breakfast; or you wake up early and eat two small meals before attending church.  This is what has been really whacking out my blood sugars.  In the 5 weeks we've attended church in 2012, I've had ONE Sunday where my sugars were under control.  The other weeks, I've had one issue or another.  I've been high, I've been low, I've been quickly rising and falling fast.  Ugh.  I cannot figure out this schedule.

Yesterday, it finally clicked that something had been off for five straight weeks, each and every Sunday.  Yesterday I took the day to sleep in.  I slept until 9:00 am like a total slob (for a mom) and didn't eat breakfast until 9:50am.  At that time, my blood sugar had dropped to 59.  I didn't even feel it.  I almost always feel lows. Not this one.  So I ate.  And I ate.  And I probably did eat too much.  And I didn't take any insulin.  So, 2 hours later, my sugar was like 280.  Then I got to take my naked and free shower (where you aren't wearing a pump site or sensor) and put in a new site after my shower.  I bolused and figured I'd come right on down.  Only no.  1 hour after my bolus I checked my sugar and it was 316.  I felt super dizzy.  And super thirsty.  And it just happened to be the first week of the month which means that everyone is fasting.  So I'm taking down at the water fountain when all the adults around me are fasting from food and drink, including water, for 24 hours.  Ugh.  But you do what you have to to take care of yourself, right?
Eventually my sugar came down and I spent the rest of the day fighting lows.  Which leads me to tomorrow's post.

So, let me get to the point here, I know I've got to make a change.  And I hope it will be an easy one.  I just need to wake up earlier.  No more enjoying the ONE BENEFIT of this stupid late schedule, I've got to get up at my regular time and eat breakfast at my regular time.  As for lunch, I don't know.  I think I'll just go for a little carbohydrate and protein combo snack before church and maybe another portion when I get home and then have dinner at the regular time.  That should do it.

I'll let you know how it goes.

a visit to my Endo

I saw my diabetes specialist today.  It was probably one of the easiest appointments I've ever had.  I had to take my almost 4 year old with me but he fell asleep about 2 minutes out and slept in my arms the whole time.  I didn't get weighed in or my blood pressure checked because I was holding my sleeping "baby".  My bp has been excellent recently and it's usually only slightly high when I'm pregnant.  Yea for not having bp problems!  My weight has also decreased and I was only slightly sad I didn't get to weigh in to prove it. 

ANYWAY, last time I went in, the doc had me do a full lipid pannel and 24 hour urine collection- on the fun things you get to do when you're diabetic!  Today we went over those results and all of my tests were really good.  My A1C today was a 7.0.  I was hoping for a 6.8 but I'm still happy with 7.0.  All of my lipids were normal and I'm so happy that I don't have high cholesterol either.  The LAST thing I want is another medication to take!  The only test that was a little off, but still in normal range, was my Vitamin D.  Usually Vitamin D isn't tested in patients and mine had never been tested before.  So, he went ahead and had it run with the rest of my blood work.  It was within the normal range but a little on the low side.  I have NO idea what that means or anything but Dr. Day didn't seem too concerned about it. 

I pretty much told doc that I have stopped taking Symilin.  He wasn't too surprized, or concerned so I guess that's okay too.  He increased my basal, like always.  I'll make the changes, be low for 3 days striaght and lower them back again.  It's a common cycle.  But I'm not too worried about it. 

He asked me if I was planning another pregnancy.  When you're diabetic, you HAVE to plan, plan, plan for pregnancy, and you cannot just "accidentally" get pregnant either.  In the past, I've begged my insurance company to cover birth control in the past and didn't hesitate to have Dr. Day write me a letter of neccesity.  Usually, and currently, however, it has been covered.  But I digress, I told him I have started thinking about maybe having another one.  I aksed him what he thought, if I were healthy enough.  He said I was healthy enough, and young enough, but that I did need to get my A1C down to a 6.5 or less. 

I've GOT to make this decision in a year or less.  Why?  Well, because little brother is almost 4 and I'm opposed to having a kid farther than 5 years difference from him.  Since he was born, I've struggled with this decision.  I always thought I'd have more than 2 kids.  But somehow, it seems like enough for me.  I had a really, really hard time recovering from my second c-section.  Pregnancy is mega, super hard when you're diabetc.  Do you hear me rambling?  That's me trying to make a decision.  Husband told me JUST TODAY that I'm terrible at making decisions.  I am.  (but so is he).  ANYWAY, I'd love to have a baby girl.  or boy, maybe.  But I just don't know if I'm up for it. 
It means testing my sugar every 2 hours for about a year.  That's 4,382 tests.  It means wearing a CGM.  It means GAINING WEIGHT.  Lots of weight.  And I'm already 25 pounds over weight.  It means DELIVERING a baby.  It means having ANOTHER c-section.  And then RECOVERING from that surgery.  It means sleepless nights.  But, it also means another wonderful, beautiful, special human being in my family.  I just don't know!  I wish God would come down and just TELL me.  "Jen, you need to have another baby."  Or, "Jen, it's  okay, you're family is complete."  I just have not received an answer on that prayer.  And I've prayed about it for four years. 

Anyway, I really feel like 2012 is OUR YEAR.  It's our year for change.  Could be another baby, could not.  We'll just have to wait and see.  :) 

Diabetes Doesn't Care

Diabetes doesn't care if it's 2 hours after you went to bed. Diabetes doesn't care if you just fell into a deep sleep. Diabetes doesn't care if you've counted all your carbs, bolused correctly, had a bedtime snack, did your exercise, and otherwise followed through with all of your normal "diabetic" routines. Diabetes doesn't care if you're sick, or tired, or if you have a big day the next morning. Diabetes doesn't care if you have carefully calculated your basal rates.

When Diabetes wants to strike you with a "low" or a "high" then Diabetes is going to strike. Diabetes is 24/7 - 365. It doesn't break for holidays, sick days, birthdays, or Sundays. It doesn't EVER go away!

Monday night I went to bed at a decent hour. Back to a regular routine in the morning. My blood sugar at 10pm was 130. Just about what it had been all day long. Nice and steady.

I worked out at about 10am that morning, so it had been a good 12 hours since then. I ate my regular 6:00 dinner.

I had NO REASON to believe that my blood sugar would plummet. However, just about an hour into my deep sleep, I woke with the distinct feeling that I was low. When I was first diagnosed with Diabetes, I thought for sure that I'd never wake up with a low blood sugar. Little did I know, I just wasn't experiencing them. Once I did though, I knew they'd always wake me up. I don't know how my body does that. But I'm really glad it does. Sleeping through a low could be very dangerous. I wake up and think, "aw crap, I'm low". I reach over to the bedside table and flip on my light, test my sugar: 53. So I stumble down the stairs to the kitchen on my terribly aching feet and get the rest of the juice out of the fridge. There's only a half cup left and I water it down for the kids so I know it isn't going to be enough. I grab a slice of bread, pour some honey on it and climb back up the stairs to bed.

Then this post starts running through my head until I can finally fall back to sleep. My sugar at 7:30am the next morning: 130. Just what I thought it would be... without the escapades in the middle of the night.

New Year: New Goals

So, I've been thinking about what I'd like to work on this year. 2011 I did a great job of improving my diet and increasing my exercise. I'm a regular at our local recreation center. I swim, spin, and when my feet don't hurt take Zumba or run on the treadmill. I've even been to a couple of yoga classes.

One year ago this week, I started on Weight Watchers. I've done a really good job at tracking what I eat, focusing on the power foods, and sticking to that program pretty well. It hasn't really worked great for weight loss for me. But, I haven't GAINED any weight, not even over the holidays. They recently made a few changes to the program and since then my weight-loss has really improved.

Anyway, my last A1c was 7.0. My blood sugars since then have been great! I go see my Endochronologist in about 3 weeks and I think my A1c may have come down a couple of points.

So... as far as goals for this coming year.... I think what I'd like to do is decrease my soda intake. I don't drink regular soda... only if it's the ONLY option for a low blood sugar, that's super rare. Like maybe 3 in a whole year. BUT, I'm a HUGE Diet soda drinker. I LOVE my Diet Coke. Too much! Way too much. I think what I'd like to do is just slowly decrease my intake of diet soda to where I'm drinking one or less per day. I didn't buy a 12 pack of cans this week at the store. So, Sunday I had 1 and today I've had 1. So far... so good I guess.

The other thing I want to do is the "take a picture every day" challenge. I think I'll do the 365project.org. My URL there is http://365project.org/sugarfreesweety/365 I'd like to let Diabetes be the main focus for this project but it will probably end up being pics mostly of my kids... like everything else I do. Kind of a fun way to document the year. Hope I'm not taking on too much with this tho.

So, yeah, those are my goals for this year. I think they're ones that I can definitely work on; and I get pretty determined when it comes to setting goals so I hope I do as well this year as I did last. Now, if I could just get my damn foot healed, then maybe I can start running again.