New Diabetes Firsts

When you've had Type 1 for a while, you start to forget the first - the first finger stick, the first shot, the first infusion site, etc. You remember them in these vague ways with hazy memories with pinpoint details about the pain and the size of your tools.

Today, I had not just one but two firsts (which after more than 15 years is always surprising). I woke up feel laden down but convinced myself that checking my blood sugar would help sort out the source of my morning apathy. This fingerstick glucose test is one thing I've done several thousand times. Today was the first time that I lanced myself while pulling the highly engineered poker out of its holster. It happened so fast that I'm still struggling to grasp what happened. In one swift motion the elastic cocked the spring and somehow pushed the button before the tester was entirely free of its holster. So my PSA for the day: don't grab your poking device quickly, otherwise you'll get stabbed when you're least expecting it.

The incorrect way to remove a lancing device from a holster
Don't try this at home!

Of course I tried to use the blood drop that squeezed out. The little red point on my abused finger seemed like a reasonable size, but of course, I got the dreaded "Error 5: Not enough blood on the strip" message. After grabbing  another strip and shoving it into the mouth of my meter, I squeezed the same finger hoping to save myself from another stab. Apparently, I squeezed a little too hard or a little to vehemently but it turned into a squirter. Not suprising for anyone who sticks themselves with sharp objects. What was surprising was that not only had it squirted along my finger (which happens every now and again), but also it had squeezed with such violent force that there was as Bob Ross would have said - a happy little red puddle on my chin. Never have I ended up with blood on my face because of my unruly pancreatic condition. Until today. Yay.

Rollercoasters Bring More than Fear

This is a post I've been working on for a while...and despite that, I ask for your patience with the ungraceful writing. I just want to get this out. Shout. Shout. Shout it all out. Right?

I'm terrified of heights. Everyone wonders how I rock climb and enjoy the big metal rides of steel. Once I test my climbing anchors with a full lap, understand the safety mechanisms, and watch someone do it, the fear melts away like butter. Monkey see, Monkey do. (Goes very well with "See no evil, hear no evil, speak no evil." but I digress...)

When the rollercoaster changes in unexpected ways and my safety mechanisms don't work, I get very upset. When I was younger, I'd be able to tell a low was coming when I got to 75 mg/dl just by a little nudging feeling inside me with some light shaking and perspiring. In the last two years, I've become very dependent on my robotic paraphenalia aka my Dexcom Continuous Glucose Monitor aka Eggy.

This week I had a monster low. Eggy was unhelpful, because it was reading confuzzled with the ??? staring back at me. I didn't feel it. I didn't see it. I didn't hear it, taste it, or smell it. I didn't realize it at all until I stabbed my finger before leaving my apt to drive into school (PSA for the day: Always test before you drive). It. This crazed monster of the low bloodsugar variety. Hypoglycemia. The thing that makes every cell in my body silently scream without hope for a solution.

The signs change. The feelings. The nudges.

It started with some lethargy. A bout of nasty nasty depression question whether or not grad school was the wrong choice for me. Ensuing panic. Freezing cold.

All I knew was that I felt wrong. I felt unlike myself but I couldn't do anything about it. I felt this way (at varying levels) for at least 4 hours. I put my to-do-list on hold and seriously questioned one of the largest undertakings I've committed myself to accomplish. Graduate school is not something to undertake lightly kids. No tears. No screaming. No sweat. Just a quiet but persistent inquisition. I honestly believed I should just give up on everything I spent more than a third of my life on for a solid few hours.

I've come to expect lethargy and anger with a high. Not with a low. Lows are supposed to be urgent. Unseasonably warm. Loud. Metallic tasting. Making the energy inside me feel like I'm going to explode. like every little blood cell is bouncing off my capillaries vibrating and hunting for the last molecule of glucose.

Dear diabetes, it's not cool when you change the rules. It's not cool when you make me wonder if I'm me first or you first. It's not cool when I begin to question my sanity. It's not cool when I have to scrutinize my emotions and decisions for the lingering presence of sugar effects. Sometimes, I want my body to belong wholly to me and not to the monsters created by the absence of a single hormone: Insulin. Hear me RAWR. I won't let you take over my life like this.

Things My Blood Sugar Should Not Equal

1. My age
2. Number of hours in the day
3. Almost the speed limit in school zones
4. A TV show staring Kiefer Sutherland
5. Total number of ribs in the human body
6. The number of carats in pure gold
7. Yotta
8. The atomic number of chromium
9. Players on the field in a Canadian football game
10. Total number of pieces in a game of Checkers

And yet, this surprised me today:

After a few double takes, I rechecked 4 times with two meters: 28, 26, 29, 25.

Of course, this occurred in the two hours I was waiting before calibrating Eggy. No symptoms. I felt a little funny but wasn't suspecting a low at all. No shaking until 20 minutes later when treated with a few gulps of orange juice. Oh diabetes, you get stranger and stranger everyday.

Not Coordinated or Together (or a Good Example)

I don't pretend to be a good example. Or a maker of good decisions.

Most days, I carry around a massive black backpack. One filled with my laptop and folders for school and all the fun diabetes supplies I carry around. In addition to my little tupperware case of medical swag and glucometer, you can usually find a big bottle of glucose tabs, Clif bars, a Nalgene water bottle, and an emergency Diet Coke can (because you never know when you'll need caffeine).

For a variety of reasons, I've been experimenting with downsizing. Instead of bringing my laptop with me (which is the main reason for the humongous backpack), I managed to bring two folders, my d-tupperware, a snack, a tube of glucose tabs, my tester, and my water bottle on the very first day of classes this semester. But I've been going back and forth between my big black backpack and my slim blue tote.

Monday was a crazy (read: super unprepared) mad rush to school. I *almost* forgot about my weekly seminar. I stuck my folders in my tote with my tester, d-case, and a fast snack, and then, I dashed to my car. As soon as I pulled out my notebook during the seminar, I realized I forgot a pen (not a girl scout without my big prepared bad with 9 of everything). No biggie. Just borrowed one from a friend. During my 20 minute break between the two classes, I quickly ran up to the lab to straighten out a meeting I had missed cause of the seminar. Checked Eggster to see a nice flat line around 90. No worries...

Until the ominous triple buzz set in 5 minutes into my second class. And Eggy says? 64 mg/dl. No prob. Just need some sugar. But since I grabbed the slim tote, no sugar in site. Just mozerella sticks and carrots. Instead of saying something or just taking a few minutes to hunt down some sugar, I sat there. I suspended my pump. Devoured those cheese sticks as discretely as I could. Kept pressing the button on my Eggy to prevent the LOW screeching. As soon as class was over, I ran to my car an chomped down on four glucose tabs...

But I had to hurry for my first gym class of the semester (or ever...). My roommates and I signed up for this flexible exercise series at the school gym. I want more structure (read: an external motivator) in my sweatabetes. And I'm always willing to try something new. So I needed to dart to the gym for my very first Zumba class. Still low though. And it's raining. But I'm very functional. The gym is only a 1 minute away by car. 10 minutes later. Still low. More glucose tabs. Run in and change. Still low. Find the room. Only at 68 according to Eggy. But I'm exercising anyway.

I know it's not healthy. But I wasn't doing this for my diabetes. I was doing this for me. Because if I skipped number 1, I'd skip the next one. And the next one. I don't want to sit on the sidelines. And a little low isn't going to stop me. At some point the glucose tabs kicked in. My pump was still on suspend and I turned it back on once I was past 100 mg/dl. I peaked at 130 and then slowly came down with the exercise. The rest of the night was filled with little glasses of juice. But I survived.

I spent over an hour in a hypoglycemic state (under 70 mg/dl according to Eggy) and an hour in in severe hypoglycemic state (under 55 mg/dl according to Eggy). And I'm lucky nothing happened. But now, I'm taping a tube of glucose tabs into every bag I own for next time.

(By the by, I'm not coordinated. But I survived Zumba. Kept up pretty well and only screwed up a fourth of the moves...I think. Someone needs to teach me how to pick up my feet instead of planting them. Oh and need new sneakers. STAT! The only thing that hurt when I was done was my ego and my feet.)

So Much to Carry

Having diabetes inadvertently means carrying TONS of extra stuff around all the time or suffer some rather unpleasant consequences.

For my first decade or so of being a diabetic, the only thing I made sure to have with me all the time was my glucose monitor. Some luxury of trusting the school nurse, my parents, and friends meant that I was never really worried about carrying something to treat lows. And by the time I was in high school, I had a pump, which meant no lugging around insulin or taking shots. I made a point to leave some extra pump gear and some needles at the nurses office but never ever used ANY of it. Somehow, I was lucky enough to not see a clogged set or malfunctioning infusion site for the first 12 or so years as a diabetic. AND then things changed.

I started experimenting with different sites more. Travelling on the fly more. Paying more attention to my good friend, Diabetes. Having more bad experiences without extra supplies. Whatever the reason, I realized how important it was to carry more than just a glucose monitor with me.

So now, I try to carry:

• Glucose meter
• Lancing device
• Test Strips
• Continuous Glucose Monitor Reciever (Eggy!)
• 2 pump reservoirs
• 2 infusion sets
• An Extra Bottle of Strips
• 1 AAA battery
• Current Vial of Insulin (and an extra if it's looking low)
• A bajillion alcohol swabs (that I don't realllly use except for site changes [shhh!])
• A tube of glucose tabs (or a bottle if it's a bad day/big bag)
• Glucagon (usually there's one case in my backpack but I can't say it wanders out to dinner with me all the time...)

When I was a kid and we went on long vacations, I remember the green army pack looking thing that my mom put all my supplies in. It was pretty sturdy and seemed like you stuff enough syringes and other supplies to last me 2 months. But I hated that thing. It exemplified the idea that diabetes was ugly and just a burden to carry around.

Now that I'm older, I have purchasing power. I COULD buy whatever I wanted to hold this in. Coach. Nine West. Dolce & Gabana. (Alright, I'm kidding. If you know me, you know I'm no where near that trendy). In reality, I'm an eternal college student. I'm also really picky when it comes to bags and shoes. I like simple. Sleek. Elegant. The green army pack was never going to make it. But sometimes, my engineering side kicks in. So instead of buying a bag, I just macguyvered things around the house.

My favorite thing to carry supplies in is a tupperware container. Nothing fancy. Or blue. I ordered takeout sushi one night and the plastic container in was just the right size to fit all I needed. Plus, it's super easy to swap from my backpack to my purse to my overnight bag/carry on without losing any essential pieces. And the vain side of me loves that it's black instead of that ugly white plastic. If you were feeling crafty (or sticker-y), you could easily paint or wrap that clear cover to look cooler.

Large tupperware container filled with pump supplies!

On the inside of the large container

I was talking via Twitter to Mr. Mike Lawson (who's really cool if you didn't know) and he was wondering about something more manly and sleek to carry d-supplies around in. Since he's on multiple daily injections (MDI), there's a little less gear to tote around in some ways. I was thinking of other things to stick supplies in just in case tupperware isn't your thing.

The best thing I found around my apartment was my hard shell sunglasses case. I can't really remember where I got it from but it's pretty easy to stuff in the essentials (testing supplies, insulin, and syringes). There's tons of hard shell cases online and in stores and most are less than $30.

Sunglass Case, Small Takeout Container, Large Takeout Container

Small Container with MDI Supplies

Sunglass Case with MDI Supplies

Playing around with different things, I think the size of the case is most important and the limiting factor is really the size of your meter. Most syringes and vials of insulin are the same size. But really if your meter is big, your case needs to be large enough to hold it. A OneTouch Mini is pretty tiny but the only meter I had at the moment to test with. Also, I recommend any makeshift case be water proof/resistant, sturdy, and easy to clean. If making/modifying carrying cases isn't your thing, there are tons of cute or manly carrying cases out there to buy nowadays. Some even come with built in slots to hold syringes and vials! We'll see how long it takes me to graduate from tupperware...

Trust Yourself

I saw my endocrinologist just three days before the beginning of the new year.

In the hustle and bustle of the last few weeks of my first semester, I may have let my diabetes care slide a little bit (read: like WHOA). Something about the stress of finals and staying up all night leads to intermittent to non-existent finger sticks along with copious amounts of diet coke and nothing but take out dinners. There were definitely days when I only checked what my blood sugar twice and saw numbers floating in the 200s and 300s (if ever you were curious, stress does make your blood sugar rise). I leaned heavily on my Egg-shaped friend and took somewhat random correction boluses. This routine disturbingly echoes my diabetes managements techniques as an undergraduate, except I didn't have a continuous monitor to keep an eye on my waxing and waning sugar levels.

Between celebrating that school was over, driving up and down the northeast, and trying to unwind, I completely forgot about my appointment. Somewhere in the back of my head, I knew there was some reason I hadn't made any plans for travelling or adventuring with friends for that Thursday. When the receptionist called, I mumbled my affirmation that I would be there. A mental image of a mostly empty spreadsheet appeared in my mind instantaneously. I didn't even pause before thinking my HbA1c would be somewhere between 7 and 9. The worry and fret weren't far behind.

I always want to be doing my best. If I can walk into my doctor's office knowing I've been trying, I don't have anything to fear. I can hold my head up high and answer any doc's questions. But this appointment was different. All I had to show were a bunch of excuses. Life gets in the way sometimes, but my good health gives me the ability to do more.

All bundled up, I walked into the office and handed the receptionist my dismal looking log. After a few minutes of waiting and watching dLife clips (love seeing people I "know" and know of on television), the nurse called me in. We went through the weight and blood pressure routine while exchanging niceties. She laughed when I told her I was a professional pin-cushion as she checked my blood sugar and loaded the on-site HbA1c tester. My doctor walked in a little hurried looking while the tester was still counting down. We chatted a bit and then she said something about not wanting to make any changes to my basal rates since she trusted my abilities to do so, she didn't have a log to look at, and my HbA1c hadn't changed much. I was so taken aback that I didn't notice or correct her about the log. In the 4 months at school and the crazy stress of finals, my HbA1c had only risen 0.2 points, which is well within the error range of those machines. She wished me well after my brief verbal and physical examination and was on her way out after before the full realization of that sunk in.

I don't usually make New Year's resolutions, because they are very rarely kept. This year, however, I'm very determined to make and keep a very different resolution. Do I want to lose weight? Yea, but that can be tackled later. Right now, all I want to do is trust myself more. I want to trust my behavior. I want to trust that I'm doing my best. I want to trust and have faith for better results than the rational side of me would expect. Because stressing and worrying about what's coming isn't healthy for anyone. My resolution for 2012 is to believe in me, to believe in good things, and to believe in optimistic outcomes.

Vacations, Bad Luck, & Emergency Baking

It's weeks like these that make me feel like Diabetes isn't going to kill me. Stress on the other hand...

I apologize for the impromptu hiatus in blog posts. I'm a little disappointed for not making a goal I set to post regularly. Honestly, I'm burnt out on responsibilities at the moment. I needed to take a real break from everything for a little while, which was amazing while that feeling lasted (and unfortunately it was extremely short lived).

So what have I been doing? I took the week after Christmas to sleep out the exhaustion from my first semester and the crazy holiday/semester-end celebrations. There was quite a bit of driving around. I think I spent 14 hrs in a car over a 48 hr span of time. Every day that week began with many hours of sleep and a few enjoyable hours on the couch watching bad television (because really, it's the only kind).

Unluckily, my laptop crashed the day after I returned to New Jersey after only functioning for about 45 minutes. It was a serious blue screen of death followed by a "I won't boot regardless of how nicely you ask me" tantrum. Two system restores, many phone calls to HP tech repair, and 48 hours later my laptop was mildly functional. I just recently (as in the last few hours) installed Windows 7 and restored its functionality (read: it's no longer a very expensive paperweight).

This past Saturday, I managed to have my cell phone and One Touch Ultralink meter lost (and probably now stolen) in a public restroom. That lead to a very unpleasant 24 hours where I was relying very heavily on my continuous glucose monitor (EGGY TO THE RESCUE!). Needless to say, I have had multiple moments of undue stress, unclear thinking, and reckless panic. I still haven't slept to make up for all of it.

It proved to be a fairly (but not insanely) expensive mistake. I bought a new phone from AT&T and a One Touch mini from my favorite pharmacy. To try and unwind a little, I googled a quick recipe for my favorite (and mildly famous) chocolate chip cheesecake cookies since all my recipes are hiding in the backed up files on my external hard drive somewhere. Whipped up a batch as speedily as I could. I'm all sorts of discombobulated still. But indeed a delivered pizza and baked goods do ease large quantities of stress, in case you thought otherwise.

I'm sure you'll see upcoming posts that were intended for well before their actual post date. I hope they haven't hit their expiration dates.

Favorite Pricking Spots

So I spent a fair portion of my time with my CDE talking about alternate sites for my infusion set, but it hasn't really occured to me that I need to be rotating my finger stick sites around.

I'm the very first to admit how poorly I managed my diabetes for years. 1 stick every once in a while to make sure I was... alive.

Now that I've gotten over my D-burnout and into a regular pattern of checking my bgs and remember my boluses, I've realized that my finger stick pattern has changed. MY favorite finger spot was the right side of my right ring finger. A few years ago the finger looked awful and gouged. For some reason, my new favorite finger has become my right middle finger. It's not in as bad shape as my ring finger was but it's getting there.

I've started adapting to using my left hand a little more often now, and I know that you can pretty much stick yourself where ever you think you can manage to strike blood (palm, forearm, etc.) I remember being not terribly shocked when the pamphlet inside the pricker device said not to use anything other than your finger tips for hypoglycemia or rapidly changing numbers (physiology says that the blood in your forearm lags behind the blood in your fingertips). Despising exceptions (because well, golly gee, IF I knew I was low, then that kind of defeats the point doesn't it) and already knowing how inaccurate meters can be (UGH & RAWR), I've always just stuck to my fingers.

So my question to all of you is where are your favorite spots, why are they your favs, and do you always pick your fingers?