The Hardest Thing

I was going to write this after a week, but my desire to be kind overcame my desire to spill my guts. One of the most valuable things I've realized over the years is that writing angry is simply a bad idea. In overcoming my anger and frustration I chose silence until I could accurately come to grips with my feelings about my diabetes technology. I was more concerned about being nice than voicing my unhappiness, which is a horrible thing as a consumer (and blogger). So here are my thoughts as unfiltered as possible. Scroll down to the bottom for a brief recap.

I forgot how much picking a pump is like buying a car. You have these perceptions and this belief in what you'll get: sometimes it's better and sometimes it's worse. You never know until you drop into the driver's sear for a while. Fun fact that I learned: Medtronic Minimed (MM) has a 30 Day Return Policy. It's not advertised anywhere but they will tell you if you ask. If they really want to continue testing out their device, they will offer to extend that to 60 or 90 days. Honestly, I wish the 60 or 90 days was standard because how can you really know whether the system isn't for you or if you just need to become more comfortable with using it? More on how I knew for sure later.

After one week, I wrote this: "I've been waxing and waning between excited and apprehensive. So far, the Minimed 530g has me running Barenaked Ladies lyrics through my head, but the pump should be singing to me, including the the anger and frustration to the mutual apologies." I stopped there. I may have gotten a little stuck in the symbolism.

The first Enlite sensor I put in with the Minimed trainer was surprisingly comfortable. The insertion was easy-peasy. Loading the sensor into the insertion device was adult-insecurity-proof. Hold it flat against your stomach. In the sensor goes straight down at 90 degrees after on button press. Press and hold to pull the inserter off. So simple you could do it with one hand - I found that gimmicky. Seriously, when am I going to do this one handed especially considering the cost and lifetime of a single sensor. Using two hands is not the end of the world. Pulling the needle out and having it retract into it's personal housing was a spring-loaded cool and painless. Medtronic gets my props for designing that.

One of my old gripes about MM's previous CGM sensor was that the little seashell transmitter never stayed still. The eventually started selling seashell-shaped backing tape individual of the sensors but I hadn't stuck around long enough for that. The Enlite comes with backing automatically attached to the portion under the transmitter. That along with a special overtape (to go over the sensor but not over the transmitter unless you want a second piece) helped everything stay in place. Add one more short piece of tape to hold the seashell down and the sensor was pretty secure (wayyy more than the old one). The trainer told me that all the adhesive that MM selected was pressure sensitive so holding it down for 5 or 10 seconds would help the sensor stay on longer. Of the fours sensors I've worn, only one came off early and honestly that may be my own fault for getting caught on a door way (really, who's surprised).

I was happily surprised to see that charging the transmitter wasn't as big of a deal as I made it sound in the last post. Not eight hours. More like 30 minutes between each 6 days of wear. I only spaced on that once (with the sensor that came out early) where charging the transmitter slowed me down from running out the door, but I managed to keep myself busy with other things in the meanwhile. I imagine that taking a sensor out and putting the transmitter on the charger becomes second nature after you've been wearing it long enough so no reason to fuss.

After the initial sensor placement, there's a 2 hour warm-up period after which you put in a calibration (same as Dex). For a Dexcom, you actually need to put in two readings after the warm up and I usually do two immediately (aka I use the same value twice - shocking I know). For the Enlite, you need to enter another calibration within 6 hours. You should only put in one calibration in every 30 minutes. You must calibrate once every 12 hours or the Enlite sensor stops providing data. The way that the MM algorithm works is based on weighting the last four calibrations in order to translate from ISF to blood glucose. So if one of those calibrations is sub-optimal, then your accuracy is off until you get rid of the bad value in your log.  None of this weighting nonsense exists with the Dexcom G4 system.

One of the big claims that I kept hearing over and over again is that you can calibrate the sensor whenever you want, with few exceptions. DEFINITELY a sales gimmick. For the previous MM sensor, you could only calibrate at times when your blood sugar is stable. I NEVER understood this. If I knew my blood sugar was stable, why would I be using your device? There are a ton of unreasonable assumptions: your blood sugar is stable when you wake up, when you go to bed, and before meals. Is it true for a lot of people? Sure. Does it work for me? No way. When I get up is the only real guaranteed stable point in 24 hours. After that, I'm running around like a madwoman, eating bits and pieces of healthy and unhealthy crumbs all day long, with nothing that resembles a schedule between two adjacent days. I'm in graduate school and everyone knows that college-life is not a steady well scheduled thing. I will eat ice cream before I go to bed. I will snack through my two-hour post prandials.

Different people will tell you different things. One rep told me it was okay to calibrate with one arrow. One told me never. A technical rep told me not to calibrate when I saw the sensor and meter values were far apart even when my blood sugar was stable at a high or low number. I could only calibrate when I was within a happy range. Another technical rep told me that I needed to get up and get my body moving to get my interstitial fluid (ISF) moving when that happened (to which I asked, I REALLY have to get our of bed in the middle of the night to stretch???). Coming from a Dexcom where you can ACTUALLY put in a blood sugar whenever you want, I couldn't handle this only calibrating during "stable" times especially since accurate calibration is what seriously affects sensor accuracy.

Another thing that is a little bizarre to me is the insistence that I use the Next Link Meter. Supposedly, this Bayer baby has better accuracy than other meters. I didn't notice a difference between it and my one touch mini the few times I did double fingerstick experiments. The 530g system was FDA approved with the meter, even though you can't bolus with it just transmit fingerstick values. No real complaints about the meter. The case is weird. The strips are a little harder to insert. I found myself looking down to see that the new strip hadn't registered even thought I had already splashed blood over. It is kind of nifty though that you can add blood afterwards if the sample is too small.

This accuracy issue goes right to the Low Glucose Suspend (LGS). I actually like how the LGS is designed and demonstrated. Basically, the pump turns off for 2 hours if your blood sugar is low. If you don't respond it basal insulin stays suspended and the alarm keeps hollering. There's a nice message on the display that says something along the lines of I'm a diabetic and I need help. Great for non-responsive situations. If you are responsive, you can chose to suspend the basal insulin for two hours to resume the basal activity. Let me say this again: I LOVE that this feature exists. I LOVE how simple it is to use. I LOVE the way it was designed. However, I cannot stand it when combined with bad sensor accuracy.

Every time (4 times total) I put in a new sensor I had the same problem: surprise LGS in the middle of the night when my blood sugar was fine. I verified that with finger sticks twice. I assumed the other two with good reason (::cough cough:: my Dexcom). The first time, the low alarms and LGS just kept me awake all night. The second time, the LGS went off and I slept through it, I never got the high alarm because the sensor was out of range, and I woke up high at 250ish. The third time, the LGS went off and and I slept through it, I got the high alarm as I woke up saying 186 mg/dl when my meter was saying 290ish. The fourth time, I kept getting low blood sugar and weak signal alarms, and I didn't get any sleep.

Accuracy when compared to my Dexcom was reasonable after 48 hours. Those first 48 hours ranged from atrocious to mildly irritating though. The Enlite sensor did much better on day six than day one. The Dexcom G4 sensors take about 12 to 18 hours before being a trustworthy accurate for me. However, their warm up period never quite reaches mildly irritating because I can always pop in a calibration ans see semi-immediate alterations in the blood glucose calculations. Also, an awkward comparison since the G4 sensors are good for seven days.

This brings me to my last few gripes. Sensor range. The range of a MM sensor should exceed my body. Getting a weak signal alarm when the sensor is in my left hand pocket of my jeans when my transmitter is on the right side of my stomach is asinine. There's no better way to say it. I shouldn't be getting weak signal alerts or lost sensor alerts when I'm in my bed. This is 2013. We can transmit things across countries. Bluetooth works at greater range. What kind of low grade tech are you putting into the transmitter that prevents this? Oh right, you didn't upgrade the transmitters. Just the sensors...

Alarm volume? Comparable to the Dexcom. However, I can amplify the Dexcom alarms in a low tech way (glass with coins next to my bed). I cannot sleep with my pump next to my head, because of the weak signal problems. My sheets and comforter muffled the alarms so much that I had no idea a LGS was going off til I peeled them down. Not cool. The vibration isn't all that strong either. I've had a whole lot of phantom pump alerts trying to keep an eye out for them.

Battery life? Well I guess you can say this was low because of the number of alarms. But really? 2 weeks before my first battery change is kind of sad, but I don't really know how to compare it since my Dexcom is only checking my sugar...

After the fourth sensor (and the 10th or so night of not sleeping), I decided to stick a fork in my diabetes tech experiment and ask for a return. You can't tell me I can calibrate whenever I want and then tell me I'm calibrating at inappropriate times. I also did not enjoy being treated like a child when I said it wasn't for me. I don't think medical devices should be a hard sell. My trainer put me on the verge of tears because they blamed my D-control was the problem when I blamed sensor accuracy and they almost had me believing it, which is super uncool with a condition that comes with as much of a mental burden as a physical one. I did break down on the phone with the continuing care representative a little bit. I all out bawled afterwards out of exhaustion, frustration, and high blood sugar. That said, all in all the customer service was much better than I was expecting. Lots of follow up. I know that they are people too. They get judged on who stays and who goes. I'm sure the everyone's under pressure with this new system.

So now, MM is processing the return. Two weeks minimum before everything is sorted out from the device end. No idea on how long refunding the insurance claim will take. I'm crossing my fingers that it won't be longer than mid-December so that I don't have to pay through the nose for a new pump and a new transmitter for my Dexcom because of deductibles (ironically the battery on that died this Sunday before I decided to return the MM system). What am I getting next? Still keeping my options open and doing way more research before I take the plunge again...

TL;DR
Pros :-)
Ease of sensor insertion
Adhesion of the sensor
One device
Low glucose suspend
Mehs :-|
Transmitter charging
Battery consumption
NextLink Meter
Cons :-(
CALIBRATION!!!
Sensor accuracy (and therefore low glucose suspend)
Alarm volume
Transmission range

My recommendation: Only use the system if you're comfortable with MM's CGM tech already. Otherwise Dexcom rules.

If there's anything I didn't discuss and you're curious about, leave me a comment!

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.

Bullet Points: Catching Up

So it's been a little more than a month since I've last posted and way too much stuff has happened. I promise to come back and write real posts about some of this stuff but for now, all you get is the abbreviated version:

• I finished my first year of doctoral classes.
• Many, many all nighters
• May have given myself a stomach ulcer (not really)
• I love seeing old friends.
• Somethings never change
• Especially in NYC
• Time flies!
• A neighbor backed into my rear passenger side door.
• No human damage
• Car still drives
• Mostly other driver's fault (Insurance split it 80%-20%)
• My doctors suspect I have developed Diabetes Peripheral Neuropathy (DPN).
• Almost 15 years complication free
• Intermittent numbness in my feet
• Diverging opinions between two primary care physicians
• Started taking a B-complex vitamin
• Still investigating my next steps
• I spent 12 hours in the ER.
• Somehow double bolused too much insulin when out with friends
• Extreme disorientation
• Blood sugar of 28 mg/dl & unresponsive for 30 minutes while in the ER
• My friends are awesome at taking care of me

I'm sure there's more stuff but those are the things that are glaring in my mind. Oh yea, in case you missed it, I was Fan of the Week over at the Blue Heel Society. Check them out, because they're awesome.

The Bad Kind of Comfortable

Since I've acquired my Eggster (aka my Dexcom Continuous Glucose Monitor), I've also noticed a bad trend.

I'm more comfortable with lows.

I'm less scared until hypoglycemia really, really hits me at a 40 mg/dl or even a 30 mg/dl.

I'm more complacent about letting my blood sugar chill in the lows 70s and high 60s. (everything about that statement makes me feel like a diabetes weather forecaster)

In reality, this has nothing do with Eggy and more to do with me. I don't know why I'm so unphased by lows but completely terrified of the lethargy that sets in with highs (read: leaded limbs and instant naptime). I'm sure it has to do with my insulin sensitivity. The longer your blood sugar is low: the more your body adapts to that environment. It's bad. I like my brain cells and my insides. I don't want them to slowly die off because I'm happier experience a mild low than a mild high. Eggy should be helping me out with that. But instead he's just begging me to do something with each buzz, and I just let him buzz away.

The worst is that I know that this is a major issue for working out and studying. I need to be in tip-top shape to be performing at my best. Exercising while low and studying while low have the same results. NOTHING GOOD.

What am I doing to remedy this? I'm lowering the low blood sugar alarm on my dex from 80 mg/dl to 70 mg/dl. Because when it buzzes and I'm rocking out at 78 mg/dl, I'm wayyy less likely to pay attention to it until it gives me the quadruple buzz at 55 mg/dl. Here's to hoping for some positive momentum to get back to a good kind of comfortable.

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.

Post World Diabetes Day

404 ERROR: PANCREAS NOT FOUND!
Try reloading the pancreas every 5 years for the impending cure...

Why? Because my pancreas is a paperweight. Why? Because my immune system thinks my Beta cells look strange. Why? Because my T-Lymphocytes are "easily" and "permanently" confused. Why? I WISH I KNEW!

Big Blue Test

This is simple. Climb. Jump. Walk. Dance. Just move. NOW!



Diabetes or not, you can help donate medical supplies to people in need across the United States and the Globe. For more information (AND TO PARTICPATE), check out www.bigbluetest.org!

To test, or not to test...

DSMA Blog Carnival Question: What types of decisions and frequency of diabetes related decisions do you make in any given day?

My man, Shakespeare (or Hamlet), had the question phrased right even though he missed my topic. There are so many questions that role around in our minds all day long. Especially as a diabetic, the questions seem like they never end. I don't think that it's ever "noble" to choose laziness or indecision over responsibility or action but I can't say that I always represent myself as Queen of my diabetes...

I had a professor in my Freshman year of college tell me that computers are dumb machines. You tell it what to do and that's exactly what it does. So if it's malfunctioning, there's a good chance the problem lies between the keyboard and the chair (aka you told it something other than what you meant to). Whenever I think of decisions, I think of that little snippet of wisdom.

Making diabetes decisions isn't as nearly as easy as writing a computer program (okay, that's pretty difficult sometimes). I can't say if this crazy number appears, then I need exactly this much insulin to fix it (even though I wish I could). I constantly have to keep track of all these extra variables (sleeping, eating, exercising, etc) and my simple little if-statement blows out of proportion with extra clauses. If I ate, did I eat more protein, more carbs, or more vegetables? If I bolus, did I account for how long it takes my body to break down an apple versus pizza? Did I remember to subtract some for all the extra exercising I'm planning? Is it enough aerobic exercise or is it anaerobic and am I going to need more or less insulin? AND how do all of the answers to these gigantic questions come together?

The toughest decision I make is the one I run into most often. Should I test my blood sugar? Do I ever really want to test? NO. It's really that simple. But without knowing that little piece of info, it's like wandering around in the dark without knowing anything about where I am. Yes, sometimes I'll treat based on what my Dexcom (aka my blood sugar etch-a-sketch) says, buzzes, or screams at me. I don't feel good about it, but gosh darn it, it's a whoooooooole lot easier. I wake up every morning struggling with that decision. It plagues me at lunch when I realize I left my tester at my desk or in my car, and I really don't want to go wait any longer to eat. It nags me at night when I haven't checked, but I'm already tucked into bed. The way I understand it (and explain to everyone else too), I'm SUPPOSED to test:

• Whenever I wake up (yes it can happen more than once if I nap) [Let's guess once for this example]
• Whenever I go to bed
• Before I eat (Between 3 and 6 times a day) [That's why eating 6 meals in CRAZZZY but good for you nonetheless]
• 2 hours after I eat (Between 3 and 6 times a day) [post-prandial test. I despise them]
• Before I exercise
• After I exercise
• Before I drive my car
• Anytime in between when I feel "off"

So for anyone keeping track, that's a minimum of 10 times and a maximum of 16 times I "should" test everyday assuming I don't feel low or high all day long and don't drive. If I sleep for 8 hours, that means I’m testing about once an hour if I divide that maximum number up evenly. Do I ever test that often? Sometimes. Everyday? I'd lose my mind. Usually it's between 4 to 7 times a day that I stab my cute little fingers. I really can't stand doing post-prandials unless it's in preparation for a snack or I feel off.

For brevity, I won't talk about the decisions revolving around food or actually bolusing insulin. They occur way more than 3-6 times a day (somedays it feels like I’m hungry every second of the day). I won’t talk about the decisions I make in fear of low blood sugars (like drinking an extra swig of juice), high blood sugars (why, yes I’ll treat those double up arrows even though I know my continuous glucose monitor will be nose diving in ten minutes), and glucose roller coasters (how long can I go, eating nothing but vegetables and drinking nothing but water?). AND we really won't discuss my aversion to changing my infusion sites or sensors (REALLY REALLY hate it) and the decisions that those devices add to the situation (yes, I should put those extra supplies in my bag even if I'm going out on the town).

What makes diabetes really overwhelming is that I can't pass some of those decisions along to someone else (like when I tell my roomies to decide what our plans are for the evening). These silly diabetes decisions stick to me like glue. And when I decide to do nothing or be lazy, I end up paying the price with a hyperglycemic-hangover or a hypoglycemic-slump.

If I could build a little decision making diabetes robot or some sort of awesome diabetes-centered Magic-8 ball, then I would in a heartbeat. I'd save my decision making power for more important life and fun decisions. I'd instantly forget about how many silly Diabetes decisions I have to make every moment of every day and instead, spend more time deciding how big my smile should be or the minimum amount of sunshine I need to soak in a day to appropriately fuel that grin.

This post is my October entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/october-dsma-blog-carnival/

Updates?

Things are crazy. As the usual. So bullet point time!

• In case you missed it (because I forgot to mention it), I did a guest post for Kim (textingmypancreas.com). I think that the post was awesome [the title says it all: "I Get By With (Or Without Real Life) Help From My Friends"], and if you're not already reading about her awesome dog, Billy Corgin, you're seriously missing out!
  
  
• When I was volunteering at the UNite for a Healthy Future event in NYC, some awesome peeps from HealthiNation.com were shooting a video about the one and only d-community superstar Manny Hernandez (aka the creator of TuDiabetes and founder of the Diabetes Hands Foundation. They asked to interview me (I still don't understand why but anyways). Apparently, they really liked what I had to say because they used some (or lots) of it. Check it out here!
  
  
• I have approximately 3 different d-meet ups scheduled at 2 week intervals with super awesome diabetes rockstarsss (more about that after they happen...)!
  
  
• I almost had a no hitter yesterday minus the crazy coming down from a bad infusion set over night (but we won't talk about how I didn't really eat dinner and drove 2 hrs [yes, I'm okay and nothing eventful happened]).
  
  
• On Friday afternoon, an economics major interviewed me for about 1.5 hrs about chronic conditions for a really cool design project. He was originally going to work towards a focus on sickle cell anemia and/or cancer patients, but I think I may have changed his mind a smidge (Listen, I'm not saying that Diabetes is cooler. I just think the patients might be a little more awesome).
  
  
• I have another cell biology exam in 2 weeks and I'm trying really hard to bust my butt with the studying (didn't do as well as I needed to on the 1st one), which inadvertently means...
  
  
• I've become hooked on diet coke again, which advertently means...
  
  
• I'm trying to get back to drinking more water, taking my vitamins (every day, ugh), and eating healthier. Sweatbetes? Hopefully I'll get to work on that soon.
  
  
• I think there may or may not be a DSMA blog carnival in the near future if I can manage to sneak more time away later...
  
  
• This weekend's sugar-filled bake fest with my college friends ended with Apple Crisp (x3), Apple Pies (x3), Apple Crumb Pies (x2), Apple Cider Doughnuts (2 batches), and Apple Pie Cookies (yes, we went to an orchard. yes, the apples that we ACTUALLY baked came from a grocery store). I picked up pumpkins as well for some well needed pumpkin pie and pumpkin oatmeal cookie things. Definitely for a later time... Apparently requests for my baked goods are now coming in from ALL OVER THE GLOBE. Must make friends with the mailman...

Back to work for me now!

Sweatbetes Week!

So it's the first week since I've moved to this new-old place (moving back to the state when I grew up but an hour away from the actually city I grew up in) that I've managed to do something awesome and outdoorsy. The awesome part of this week is that I got to do both things that made me so happy as an undergraduate after not experiencing either in a while (2-3 years and 2-3 months). Mind you that sweatbetes and I (while on fairly good terms) haven't hung out in a while...

Ultimate Frisbee and I used to be best friends. I was one of the few women that played in our small college's mostly male intercollegiate team (apparently I'm not eligible for intercollegiate play anymore [alas getting old really does happen]). My living room at my old apartment was decorated with my large (and ever growing) frisbee collection. A disc is never more than an arms reach away for me, but unfortunately, I haven't been playing Ultimate in a very long while. Our friendship got strained by real life issues. Pick up games can be hard to find sometimes because of the number of people required (5+ on a team) and my schedule for the last few years has been, well, unpredictable so playing in a league has been out of the question.

After scouring the internet for hours, I found a pick up game that is fairly consistent and not too far away. Despite my fear of being wayyy to out of shape (isn't round a shape?) to handle the required running, I dusted off my cleats and walked to the park a few blocks from my house. There were many more people than I was expecting and the game was intense as always. But I survived. And felt amazing as I left.

There's something freeing to me about making a little piece of plastic fly. I forget about my diabetes. I forget about my schoolwork. I forget about my problems. It's enthralling and cathartic to run my heart out and make a Frisbee soar. I can feel the wind it feels (as crazy as it sounds). I missed it. I'm glad I didn't let a little anxiety keep me down. Or low blood sugars. Glucose tablets cure me (Thanks to my Dex for warnings!).

In addition to squeezing in an hour and a half (with breaks) of Ultimate, I managed to go rock climbing at a gym with one of my buddies from high school. He's learning for the first time, but I'm getting back into learning technique & balance so it's not a bad fit. We're trying to make it a regular thing. [In case you didn't know, my love of rock climbing is what lead to the name of the blog ;) ]

The silly thing about rock climbing and diabetes for me is that unless there's a 30 minute hike to where the climb is, I need more insulin to get my act together otherwise after one climb (aka 40-50 ft in my case), I'll be in the low 200s while I start in the low 100s. So after some experimenting (a la Ginger Vieira), I've learned that an extra bolus before I climb helps keep me in range. No lows while climbing = more fun!

Why do I love climbing? It doesn't quite make sense. I have a fear of heights, so I never look down on the view of a climb until I've done it at least once comfortably. There's something about the puzzle aspect (where do my hands and feet go exactly?) and the amount of finesse required to accomplish overcoming a giant wall that is extremely rewarding. I love the feeling of leaving all my energy on the wall. If I'm not tired by the end of a day of climbing, it wasn't fun. I forget about the D when I'm trying to solve a climb. My brain gets into the zone. Sooo much better than playing with equations all day long.

Sweatbetes 3X this week is a win. I'm trying to squeeze in some at-home stuff/school-gym stuff. Step 1: Gym bag with necessities in my car. I'll keep you all posted on how it goes.

Vampire Infusion Sets

Yes, vampires can be cool. Vampire infusion sets are definitively not. If you're not fond of blood, then I don't know how we can be friends (not really, because I have all sorts of friends but read on). Mostly because little finger pricks for blood drops are involved between 4-15 (it feels like a billion most days) times a day for me. I have to warn you that if you get faint at the sight of gross things like blood, you DON'T want to scroll down (although even if you were, you would because I just told you not to).

I posted a few weeks ago about some issues rotating sites with my hips. Apparently, the same is true with my thighs. To be honest, I'm just having all sorts of new issues with infusion sites that make me want to go back to just using my stomach again. I'm fairly certain that the last site I pulled out was infected from the gooey stuff that oozed out of it and the raised . I'm used to seeing some liquid (I can only assume it's insulin) come back out when I pull out an old site (actually it happens sometimes with regular needles too). Most of the time, I don't account for it unless my blood sugar is rising/high.

What I've noticed is that any of my bloody (no, no like the English mean it) infusion sites usually take 6-24 hours and then they're fine. No more blood (not in the cannula, not on my clothes). Just the gross outline of it on the little gauze adhesive that surrounds it (see any of the pictures). This is what keeps me from tearing them out and putting in a new one. Because I don't think they're is ever a guarantee that it won't bleed (but I think its cause I dread putting in new ones). And it's not like a stab myself with one and it's gushing blood (cause if there were I might even do a glucose test with it for fun). It usually takes an hour before any blood starts showing and three before there's a weird pool of gunk on my infusion site.

I know that everyone says to pull out a set that is overly painful or bleeding. I can't say that they hurt. And to be honest, I HATE wasting perfectly good supplies. So is it worth it? An hour or two or twelve of a little uncertainty with my infusion set in exchange for a little less pain? I do it. I don't recommend it. The only thing I can recommend is trying to change sets in the morning or the middle of the day so you can push more insulin, because waking up at 262 mg/dl is not the way to start off any day. If you have any feedback, I'd love to hear from you. In the meantime, here are the gross pictures I mentioned (and no, they haven't been enhanced for total gross-ness):

Fresh and bloody infusion site after 24 hours

Bloody site after being removed

Feel It Coming

Funny tidbit: Blogger only let's me update html post from my phone. Weird but I'm just happy to be writing despite no "real" broadband internet til Friday.

Anyways! Today is day one of unpacking into my new place. Let's just say that I'd rather be anywhere else doing anything else. So I kinda chalked up my lack of motivation to distaste for the task instead of low blood sugar.

Normally, I'm as bright eyed and bushy tailed as everyone else (and sometimes more so). Today, I experienced that slow, losing steam at the cracks sort of feeling. Arms that felt like lead made me think that maybe I just needed to relax for a few minutes on my bed and troll the web for something exciting to read. Somewhere, the better half of my conscience said, "It could be a falling number." But I looked at my CGM and saw a flat arrow at about 90 and decided it really was just too much moving stuff around.

Gradually, I became more and more tired, like a gradual fog settling in on the folds of my brains. I said to myself, "This kind of feels like a mild low. I should test. Where's my meter?" That notion was immediately battled by my inner child with a very whiney (sans cheese), "I don't want to. Please don't make me get up. I'm comfy."

That should've been my sign. But no. I kept reading and putzing. Meandering from site to site until I got really sleepy and suddenly Eggy buzzed loudly in my ear. 52 and slanty down arrow. Got up and tested to find a 49 waiting for me. I actually ate 6 glucose tabs (21g), set an alarm for 15 minutes for the recheck, and started to wait for that feeling of preparedness to come back.

Instead, I started zoning out while thinking of bookshelves and grocery lists. Luckily, I set a 15 minute timer on my phone because apparently I fell asleep on my comfy little airbed otherwise I would've missed the second reading of 49 on my little black OneTouch Mini.

I worry about my meter and my sanity when I see the same number. I always question myself as to whether I really ate those glucose tabs or whether that was low bg hazy delirium. And if it's a high, I ask myself, "Did I really push the ACT button?" and immediately pull out my pump to check the last bolus. The worst cases are late at night but sometimes it happens between meals and really freaks me out, because I know my body. I know there's no way my sugar levels have been at a constant for 4 or 5 hours after eating sometime. Is there such as thing as diabetes coincidences? Or does my meter just have an affinity that day for that particular number? This post makes me think that might just be a possibility.

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?

Parents Just Don't Understand

Patience is the key when living at home. Unfortunately, it's been less than a week and my patience is already wearing thin. My mom wants me to start organizing stuff in the house and chucking stuff. I am cute and smart, but I am not a minimalist. I'm their kid. I like my stuff. She proceeded to wander around my bedroom for 5 minutes poking and prodding the boxes. "Why did you buy a yoga mat? I have one downstairs." I know I could have parents who don't care, but right now, I'd like them to just be a little more understanding instead of inquisitive. Stress doesn't affect my blood sugar or mood at all, right? (exit sarcasm)

Today, I managed to get up and convince myself to eat some light breakfast (greek yogurt and a banana). I followed that up with some phone calls and apartment hunting online. Broke a sweat with 30 minutes on the Wii after confirming that the result of the number on the bathroom scale wasn't my imagination (because technology never lies). More water instead of soda or juice [Day 2]. I nibbled on a veggie burger between some slices of cabbage and managed to get only a smidge of the condiments on my pjs.

Mowed the lawn for my dad (aka he watched while I did most of it instead of going to the gym as he originally intended). Emptied the dishwasher. Watched alot of crappy tv. I can't seem to find anything to motivate me to explore NH especially when I have to wear an extra layer for warmth.

All in all, the monitoring and substituting food seems to be sticking and helping. Dexcom hasn't been alarming high all day and it's actually at an appropriate number before I'm going to bed. I've managed to get between 7 and 9 hours of sleep for the past 4 days. Now to try a regular and preferably normal sleep schedule. Time to close the laptop and catch some zzzs.