Friday, August 29, 2014

Oh crepe!

When I was first diagnosed, I carried a little book around with me to look up the carbohydrates of everything I ate. Since I didn't always have access to the packaging of the food, I would look up every food and add up all the carbs in my meal. Now, that same information is available right on your smartphone. However, after adding up the carbs for thousands of meals over the years, I've memorized the majority of the foods I eat and have gotten pretty good at estimating.Yes, there are times when I over or underestimate, but I generally feel pretty confident in my abilities.

In fact, one could say that I've gotten a little too confident and maybe even lazy when it comes to carb counting these days. And this attitude is dangerous. Because when I am significantly wrong in my counts, the results can be pretty catastrophic. The continued importance of being accurate in my carb counting was made abundantly clear to me last week over a meal of crepes.

I was excited to try a new crepe restaurant for dinner with a coworker. Although I knew what a crepe is, I greatly over estimated the number of carbs for the thin pancake like wrap. While a typical crepe is about 10 carbs, I had figured it was at least double, thinking of it as more of a tortilla.

Everything was fine for awhile and I figured that I had successfully calculated the meal. I drove home and decided that I was going to go for a run, never mind that I was still really full from dinner. After my second mile, I started to feel off. I figured it was just from running on such a full stomach. I headed home and showered. It wasn't until after I finished my shower that I realized that the weird feeling was feeling more like a low blood sugar. I checked my blood sugar. 34!! Ohhh crepe!

I treated the low and eventually felt better, but the experience was definitely a reminder that even after all these years, it's still important to look up foods that I'm not as familiar with. It's easy to fall into old habits of guessing and being a little lazy, but I realize it's definitely worth the extra time to look something up in the beginning than to deal with a low blood sugar later. Next crepe, I'll be ready.

Tuesday, August 19, 2014

The time has come

Sometimes it's so much easier to give advice than to take your own. I know how important it is to be your own health advocate, to stand up for yourself when you aren't receiving the care and treatment you deserve. I know how important it is to ask questions, be involved, and make sure you are heard when you see your doctor. I know these things, I tell others these things, but it's time I practice what I preach.

I've been going to the same endo office for about 8 years. However, over the past couple years, I've had some truly horrible visits at that office with the staff, the doctors, and just the overall experience. Each time something went wrong, I would give some excuse on their behalf. "They aren't normally like this." "They seemed really sorry." "They promised it wouldn't happen again." My family and friends told me to find a new doctor. "But they know my history." "It's so close though." But enough is enough. It's time to demand the treatment, respect, and courtesy that I deserve as a patient and a person.

I'm leaving my endocrinologist.

I have to admit, I'm a little nervous about the switch. Even if my new endo has my old charts, she doesn't know my story, my struggles, my successes. She doesn't know me. When my new endo opens up my chart and sees my numbers, my history of my A1cs, my biometrics and glucose graphs, this is what I want her to know:

Those A1c's, they're not the best, I know that. I have room for improvement. But they're not awful either. And man did it take some work to get them to where they are! I try really hard, even if those numbers don't show that. I wear my CGM almost every day. I check my finger too throughout the day.  I try my best to carb count accurately and give insulin on time. Yes, I slip up. I'm off in my counts or I wait too long after eating to give insulin, but these are things that I'm constantly working on.

Doc, I care about my health. I get my blood work done, I see my eye doctor. I try to eat healthy. I exercise 5-6 days a week. I get enough sleep. But I'm scared by the statistics. I know about potential future complications. I know that when I'm ready, that I can become pregnant and have a healthy baby, but that it will take work and vigilance. I'm here because I care. I'm not non-compliant, I'm not uncontrolled.

I want you to understand me. I want you to work with me. I want you to help me.

I'm ready to close the door on one doctor and open it for another. I'm ready for a doctor and an office that cares. I'm ready for this change. I hope that the switch will be worth it.

Thursday, July 31, 2014

The Missed Meeting

It was 10:28.

I was late. I was never late.

Every day at 10:15 we have a "stand up" at work, a quick standing meeting, sometimes just 15 minutes long, that I haven't missed...until today.

10:28. How did I miss it? Oh yea, I remember.

Gigi had been acting up all morning, never really connecting and so not graphing my blood sugars. I had started the morning within my normal range, but at the higher end. But I was starting to feel pretty sick. With no help from Gigi, I tested my finger. 437! Shiiiiiiiiit.

I wasn't sure how that had happened.. I went to the bathroom and first changed my set. It was close to being empty and I didn't want to take any chances. Then I gave myself a shot. Since I don't normally use syringes at work, I wondered if my workplace had a sharps container.

I walked to our front desk to inquire. "Do we happen to have a sharps disposal here?"

My question was returned with perplexing looks. "Like"

"Yea like needles." Then I quickly added, "for insulin shots," not wanting there to be any misunderstanding.

"No we don't have one. But we can look into getting one."

"Oh, it's not a big deal, I can take it back home, I was just wondering."

I started to walk away when the office manager stopped me. "Hey, one more thing. We are working on our emergency preparedness plan for the office. We are going to get cases of water, would orange juice be something that you would want us to get too?"

For some reason this question caught me by surprise. For as long as I can remember, I've always had to be prepared. I look out for myself, never knowing when a low blood sugar might strike. I guess I wasn't expecting that my office would want to be prepared for me specifically as well. I thought back to a few months ago when we were all stuck in the basement for 3 hours during a tornado warning. I had a few packs of fruit snacks with me, but I did worry if I ran out. It would be reassuring knowing there would be an office emergency stash.

"Um actually yea, that would be great. Orange juice is perfect for low blood sugars. Thank you!"

"We'll be sure to pick up some and look into the sharps container."

I thanked her and walked away, glad that I work for a company that is so understanding and accommodating. I walked back to my desk, checked my blood sugar again, and looked at my clock.

10:28. Crap. I quickly emailed my coworker, apologizing for missing the meeting and explaining that I had some diabetes issues to take care of and lost track of time. It wasn't a lie, but at the same time I try never let my diabetes be my excuse and didn't like using it this time. I know my diabetes is disruptive. It wakes me in the middle of the night, it stops me in the middle of my workouts, it makes me rearrange my plans. But now it had gotten in the way of my work and made me miss a meeting. I was upset at myself for losing tack of time, even if I was taking care of my health, and hoped my coworker would understand.

Thankfully I had nothing to worry about. My coworker was more concerned with my health and wellbeing than with the fact that I missed the meeting. With my blood sugar on its way down, I hoped that the worst of the day was over.

I have to say how glad I am that I work in a place and with people that are so understanding of my health condition, I know that I'm lucky. And I know diabetes isn't the only health condition that can get in the way of people's productivity, everything from headaches and migraines to chronic pain, allergies, and stomach issues can be just as disruptive. But I hope that this was the last time that I'll use my diabetes as an excuse and the last meeting I'll miss because of it.

Thursday, July 10, 2014

The boot camp bond

The sun burned brightly in the sky as sweat dripped down my face, falling on the concrete below. My legs burned as I jumped from one side of the block to the other.

"10 more on this side! Keep going!"

The instructor urged us on. It was halfway through the boot camp class, and today we were outside using stepping blocks, jumping up and down, side to side. 

My body was shaking, I was getting light headed. "It's just the heat," I thought, "Your body is just getting tired. Don't give up now." I encouraged myself, trying to push through. But this feeling wasn't exhaustion, it was something different. 

As everyone continued with their workout, I pulled out my glucose meter and tested my finger. 52. Once I stopped, the low hit me full force. I rummaged through my bag looking for my fruit snacks. I couldn't find them, but remembered I have a whole box in my car. I walked silently behind the class towards my car, ignoring the questioning looks. I grabbed a couple packets and poured the contents in my mouth as I headed back to my mat.

The instructor had moved on to the next exercise. I stood there awkwardly, waiting for my blood sugar to come back up so I could join back with the class. I don't usually get self conscious while treating a low, but this time I did. I was sure everyone was wondering why I had suddenly stopped exercising, why I was standing there while everyone continued to jump around. When I tried to join back in, my body felt weak and dizzy. I couldn't do it, I knew I would just have to wait it out. The class is only an hour, and I knew I would be wasting 10-15 minutes waiting to feel better. And while I know this is necessary, I was mad. I was mad that I was missing part of a workout that I wanted to do, that I paid to do. I was mad at how disruptive my diabetes can be. I was mad that I was being forced to eat sugar that I just worked so hard to burn off. And I was mad that my diabetes had singled me out once again.

I sat there as the instructor walked over to ask if I was okay. 

"I have type 1 diabetes and my blood sugar went low. I'm fine but I just have to wait for it to come back up." My voice was full of emotion. I don't know why, but this particular low had made me feel vulnerable. I was afraid that the instructor wouldn't understand. I was fine, I just needed time, but I'm strong and capable. I didn't want her to underestimate me.

But the instructor looked at me and said something that made me confident that she understood.

"My son has type 1 diabetes."

I looked at her and smiled, instantly relieved. As a parent of a T1D, I knew she got it, and I knew I was in good hands.

Friday, June 27, 2014

Oh the Irony

I have this ritual. Almost every time that I go for a long grocery shopping trip, I treat myself to a cold bottle of diet A&W root beer on my way out. I don't drink a ton of pop and root beer has always been one of my favorites. Having performed this ritual enough times, I've come to recognize the diet bottle just from the color of it. I was finishing up a particularly epic grocery shopping trip and grabbed the A&W from the cooler as I got in line to pay, confident that it was the right one.

Parched from my long shopping excursion, I got into my car and immediately cracked open the pop and starting chugging, relishing the cool and refreshing taste. With half the bottle gone, I glanced down at the bottle. Something was off. I didn't see the "Diet" sign anywhere! Shit.

Two thoughts immediately crossed my mind. Well technically first I silently cursed myself. But then my first thought was "What a waste of calories!!" followed by, "Holy crap that's a lot of sugar!" A bottle of regular A&W root beer is a whopping 80 carbs! And here I had just drank close to half.

I took out my insulin pump and immediately started figuring out how much insulin to give. It looked like I drank half, but the top half of the bottle is skinnier than the bottom half, so maybe its not actually 40 carbs. I decided to subtract some to account for bottle shape and gave myself some insulin.

Within 5 minutes Gigi (my CGM) was already buzzing, displaying the two upward arrows showing that my blood sugar was rising quickly. I cursed again. Maybe I should give a little more insulin. I could just picture my blood sugar rocketing to the 300's. I was pissed. What a stupid, careless mistake. Really I was thinking that if I was going to have that many calories and sugar, I would have preferred ice cream or at least a root beer float!

I went about my afternoon and tried to put the incident behind me. That is until about an hour and a half later.

Something wasn't right. Gigi was being quiet, but all of the sudden I did not feel well. I got out my glucose meter and tested my finger. 37. Ummm what?! The low caught me off guard, as I was sure that I had given the appropriate amount of insulin according to the label. I needed sugar, and fast.

The bottle that only an hour earlier I was cursing, was now my salvation.

Ohhh the irony.

Friday, May 23, 2014

A1c Accuracy

"So how have you been?"

A seemingly innocent question asked by my endo as she sat down across from me. I never know quite how to answer this. I've been good. Really I have. My new job is going well, I'm enjoying living on my own in my new apartment, my weekends have been filled with fun events with my friends. I've been trying to get back into working out, I've been getting better at cooking and trying new healthy foods, things are good. But that's not really what she wanted to know.

"I've been good."

"How have your blood sugars been?"

Ah now we get to the real question.

"Have they been high, low, are you having any problems, do you notice any patterns?"

"Shouldn't you know?" I thought, assuming that she had at least looked at my graphs and A1c (which in fact she hadn't since they were still being downloaded).

"They've been high lately, higher than I want, but I haven't really noticed any patterns."

"What about lows?"

"Yea I have them after the highs, probably from over correcting. Lots of roller coasters."

We talked a little and made some adjustments and she got ready to wrap up the appointment.

"I was just wondering, what's my A1c?"

"Oh I hadn't even looked yet. (Ummm what, why not?") It's actually pretty good, 6.9."

"Seriously? Are you sure?? That doesn't make sense." My doctor turned the screen so I could see it on the computer. I looked at her perplexed. "I'm shocked, are you sure that's right?" It's not that I didn't believe that it could happen, after all almost exactly a year ago I was at 6.7, but I know what my blood sugars looked like then and I knew how they have been the past couple months, and something just wasn't adding up. But I was hoping that maybe I was wrong. Maybe I was just remembering the worst of the past few months and in general I was doing pretty well. "I want a re-check," I joked.

"Yea I'm pretty surprised too, that doesn't really make sense based on these graphs."

I'm not going to lie, I kind of wanted my doctor to prove me wrong, to not agree with me. To point to some trend or something that showed that I wasn't as off as I thought.

"We'll have them test it again."

In the 13 years that I've had diabetes and the over 50 A1c checks that I've had, I never really had a reason to doubt the accuracy of the test. But here I was, getting my first recheck. As I sat there waiting for the nurse to come back with the results I debated in my head whether it was better to be right or wrong in this situation. Right in that ordering another test was the correct decision, that the first result wasn't accurate and that I know my numbers and my body. On the other hand, I was hoping that I was wrong. That I was doing better than I was giving myself credit for, that maybe my A1c was 6.9, a number I've been working to get back to.

The nurse walked in and I looked up expectantly.

"It's 7.3."

"Yea that makes more sense."

Slightly disappointed that I wasn't 6.9, I was still okay with that number. It's been where I've been stuck at for the past 9 months so at least I wasn't doing any worse. Okay, 7.3. it's not my best, but it's not my worst. I said the number over and over in my head...and then I let it go. I'm trying to use my numbers to guide me, but not get caught up in them. So instead, I thought about what I need to do different between now and my next appointment in 3 months. Rather than focus on the number itself, I thought about what I can do so that the next time I see that 6.9, I won't doubt its accuracy.

Saturday, May 17, 2014

Diabetes Blog Week- Day 6: The Diabetes Lens

"Back for another year, let’s show everyone what life with diabetes looks like! With a nod to the Diabetes 365 project, let’s grab our cameras again and share some more d-related pictures. Post as many or as few as you’d like. Feel free to blog your thoughts on or explanations of your pictures, or leave out the written words and let the pictures speak for themselves."

In many ways, diabetes has become a lens through which I see everything in life. Thus every picture becomes a diabetes-related picture. So for this post, I chose 4 pictures that at first glance don't seem "d-related," but as you'll see, my diabetes is there in all of them.

Voted Best Tacos in My City

The newspaper of city where I live decided to have a poll to see what the best tacos in the city are. These are from the restaurant that won first place. Having never been before, my friends decided that we had to try them. I have to say, I definitely agree. But looking at this plate, I see more than the delicious food, I see a complicated equation of trying to figure out how many carbohydrates exactly I'm eating here and how much insulin I need to give. 

Spring Is In The Air

On this particular day, my coworker and I decided to take a walk after lunch around the city. Since we've been having unusually cold weather lately, we were excited to see that the flowers were now in bloom and stopped to take a picture. My coworker walked out of the office for our walk carrying nothing besides her phone. I on the other hand knew that I had to be prepared while away from the office. As I pulled my phone out to take this picture, I reached into a bag that also had 2 packets of fruit snacks, my glucose meter, and a little money just in case. The thing is, I can never walk out of the office empty handed because I never know when I might drop low. 

The New Dress

Wedding season is upon us and I've been shopping for some new dresses to wear. With any dress, I look to make sure that I like the style, the cut, the fit, the color, and the material. As I try on each dress I ask myself, will it match the occasion? Is it flattering? Will I get good use out of it? These are the normal considerations. But with every dress or outfit that I try on, I also have to consider my diabetes and specifically, where my pump will go. Does it have pockets? Will my pump show if I strap it around my leg or wear it on my hip? How easily will I be able to access it? My diabetes can influence what I end up buying and wearing.

The Bike Ride

Within the last year, I've gotten pretty into bike riding. My mom and I would go for beautiful, long rides in the summer together. I love the exercise, the scenery, and this quality time that we spend together. I look at this picture and I see the beautiful lake, my awesome jersey with the Detroit cityscape, and my bike. But what you don't see are the 2 packs of fruit snacks and granola bar stashed in the pockets on the back of my jersey. You don't see my CGM and more emergency sugar in the red pack attached to my bike along with my phone, ID, and insurance card in case of a real emergency. Having diabetes means always having to be prepared, especially when you're out exercising.