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Book Review: Your Diabetes Science Experiment March 6, 2014

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A book title with ‘Science Experiment’ made me worried, as no science class in the past went superbly. But, experiment indicates I’ll be trying out things. Science indicates logic and reason behind these things I could try. Any area of diabetes that even has a chance of logic and reason is something I’ll spend time on.

Seemingly illogical stuff, like going high after intense exercise, has actual explanations. But those explanations often become so complicated, that the explanation only adds to the confusion.

That’s where Ginger comes in (oh, she’s the author). Ginger’s book is solid and full of information. And, refreshingly, I feel like this book focused on ME. A long time Type I diabetic who exercises frequently and with variety, and am struggling to best manage my diabetes but also the benefit from exercise itself. That is not to say that if you were diagnosed yesterday, you would not find this book helpful. You would. Or, if you exercise once a week. Or if you have Type 2 diabetes. That’s the beauty of this book – Ginger writes in a way that respectfully reaches all different groups. Ginger presented examples applicable to me (I’m also vegetarian). A LADA meat lover could say the same thing.

This book discussed topics such as insulin sensitivity, carbs, protein and hydration all related to exercise and diabetes. Plus, exercise itself related to diabetes. Many chapters include real-life examples that Ginger had the guts to put out there. The book includes worksheets and steps to help navigate your own solutions and to help make diabetes work into the life you currently live. Ginger also realizes that these steps are tough, and offers encouragement throughout the book. However, I think the book could have better addressed some of the mental challenges that are likely to come up when you begin to take a hard look at diabetes in your life – burnout, overwhelmingness and intimidation.

Overall this book is real, it is helpful, and will be helpful each time your life pattern takes a shift. My favorite quote from this book sums up the idea that diabetes requires huge amounts of effort. But, it is something you can always work on. It is something you might not get right at the first try, and that is alright:
“You are a work a progress.”

Title: Your Diabetes Science Experiment
Author: Ginger Vieira
Ideal Audience: Insulin dependent or insulin-using diabetics partaking in any kind of regular exercise. Curious folks interested in how exercise, insulin and timing can all work together.
Read when: You have a couple days to think about you and your exercising. Be able to keep your own exercise routine in the back of your head while reading. If the book topic sounds overwhelming, read it right away. That feeling fades by the third page.

Disclaimer: I met Ginger at a conference, and a long story short (plus sweet potato fries), I left with a copy of her book at no cost to me.  As with all entries here, my comments and opinions are my own unless otherwise stated. I am not a medical professional. Contact your medical team regarding any health-related concerns, questions or changes.


When the Star Player Goes Down December 17, 2013

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I didn’t expect the appointment to go well. I recently switched back to multiple daily injections (MDI), and struggled to maintain a solid focus on waiting to eat, carb counting and over treating. I expected about a week of mountain-range style numbers while I adjusted my insulin dosages as compared the pump.

But not two months of drastic up and down numbers. Two months (for me) is more than an adjustment period – that’s frustration, emotion, lack of caring, lack of effort, lack of interest and not enough time to ‘fix’ it all before my next endo appointment.

I knew how to fix what was wrong. I just wasn’t doing it. I knew I would walk into this appointment feeling somewhat guilty, unprepared and defeated. I expected to leave slightly motivated, but not necessarily encouraged for the long haul.

But my endo team cared. Nobody was disappointed in me. Nobody was mad at me. Nobody made me feel guilty or like I had failed. Nobody insinuated that I was dumb or incapable.

My endo team cared. My nurse cared that I was am struggling, and provided a few simple things to work on. My endo was worried about my too-close-for-comfort-night-lows that some people don’t wake up from, or wake up from in the ER. He wasn’t worried about my highs. Other people don’t worry about these things because I don’t often share. But at the endo’s, that is his sole focus – to help me keep me safe and healthy.

I left feeling cared about. I could handle the few things my team suggested. I wasn’t overwhelmed with my failures or the solutions. My endo team IS a team. A team where I am the star player. A team where if the star player is hurt, the team rallies. A team that pushes you to be better, catches you if you fall and helps you back on your feet.

That’s a team I want. And it’s a team I need to remember that I AM on.

Diabetes Santa God! Or…I’m Addicted To My CGM. (Part 2) December 4, 2013

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Part Two…Continued from, Part One, when I’d just contacted a local D-member!

  • At work, less than 24 hours preflight: No success with a charger, but local D-member had an older Medtronic CGM she was willing to lend me.

I’ve never used Medtronic anything. I’ve heard mixed comments about the system, including its less than reliable sensors and its harpoon insertion situation. And I’d be carrying an extra pump as the receiver. Was it worth it? I tried to think logically. But as the nerves and what-if scenarios ballooned in my imagination, yes, it would be worth it. Learning a new system in half-hour, less than 12 hours before my flight added to my nerves, but I felt comforted and protected knowing I would have a CGM system during the diabetes disaster that is Thanksgiving. HUGE SHOUT OUT to the local D-member.

And then I pulled into my driveway.

I walked towards my front door. And held my breath.

There.was.a.box. I’d ordered other items this past week, but this box, this possible gateway to complete relief, was perfect Dex transmitter size.

I slowly walked towards this box, my eyes fixated on the return address label, knowing exactly what it needed to read.
Byram Healthcare.
Could it be? Is that even possible?

I carefully lifted the box, fumbled to unlock the front door, and walked inside. Everything else fell to the floor but this box.
Scissors! Where the fuck are my scissors? Ah ha! I carefully cut open the box. I lifted the sides of the box and peered inside.
Nothing but a transmitter could fit in with this packaging. I pulled out the brown packing paper.

There it was.

I felt like the M&M® in the M&M and Santa commercial, “They do exist!”
Some Santa, diabetes god, leprechaun, unicorn was on my side. And I realized how much trust and dependence I have with these devices, the ones that offer me protection, safety and let me live my life how I want. And for that I am thankful – I know others do not have that luxury for which to make complaints.

Diabetes Santa God! Or…I’m Addicted To My CGM. (Part 1) December 3, 2013

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Part One…
I had a sneaking suspicion that my warranty was about up on my CGM system. I had to switch to a 3rd party supplier, who I haven’t quite figured out as opposed to DexCom direct. I called 3rd party company, and wouldn’t you know – my transmitter expired in spring.

No, Ms. 3rd party company, I have no Low Battery screen alerts from Dex. What, my receiver’s warranty is up in two weeks? Great – can I just wait and reorder both things at once? Cool, I’ll do that. Talk to you then.

And then…

LOW BATTERY (go see Brian or Scott for a more colorful display)

Of course. Two days after I called about this very possibility. I immediately ordered the transmitter, which required a new prescription. I wasn’t too worried at this point – most Dex warnings about failure/low things tend to stretch out. An upcoming Thanksgiving trip weighed on the back of my mind, but I figured I could react appropriately after I received confirmation emails about the order.

  • About one week pre Thanksgiving trip: No transmitter, no confirmation emails. But I still wasn’t worried (for future reference, get worried here)(or be smarter and call the company).
  • Three days pre Thanksgiving trip: Transmitter starts consistently losing communication with the receiver, even when less than one foot a part. Still no confirmation emails.
  • Day and a half pre Thanksgiving trip: This transmitter isn’t going to make it. Now I am a little nervous, but I’ve had diabetes for about 20 years without a CGM – I should be able to handle one holiday with travel using my trusty meter and strips.
  • About two hours later: THANKSGIVING! Holy Carb Motherload! Airplanes! So much alcohol! No CGM! Panic ensued. And no confirmation emails.

Now in my panic-mode, I search through my diabetes closet. No random transmitters, but I had one Seven+ sensor, multiple combinations of Seven+ transmitters and receivers…and no Seven+ chargers. I tried to plug things into other things that should probably never plug into one another. No luck. Double-arrow stress increase. In one last-ditch effort, I emailed the only local CGM user I knew.

Stay tuned…

Wordless Wednesday: A Year of Dex November 13, 2013

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Year's worth of DexCom sensor placements.

I use my bathroom mirror to track my DexCom sensor placements. Here’s a year’s worth!

Cruising. Not Along. But to Alaska. October 9, 2013

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Cruising. To Alaska. With the family. Because this is a diabetes blog, I’m skipping over my general cruise commentary and going straight to stuff you might care about.

Cruising Awesomeness:

One of the last questions on the health info boarding form included, Do you need a sharps container for syringes, needles… ?
What? Of course I would love a sharps bin! So…a small sharps bin was delivered to my room before we even left the dock. Delivered!

Purell® everywhere. Perfect for removing sticky substances from fingers before testing.

Handheld shower head thing! Perfect for successful showering without a direct water stream on the Dex and insulin pump sites. (Side note, to get hot hot water, you have to push IN the red button and then turn. Side side note. Try to figure that out before your fourth shower).

Lots of stairs. Our room was on the 1st floor, and we mostly ate on the 9th floor. Eight flights of stairs provide the perfect opportunity to give a meal bolus, skip the elevator and be in perfect BG range for breakfast. Also ideal for keeping your ass in shape while cruising.

Reading Time! I finally had time to finish Ginger’s book (review coming).

Cruising Goof Ups (aka, Where I Screwed Up):
Hydration. This was my first cruise, so maybe I missed something, but staying hydrated took some effort. Glasses and mugs were small, and I only found beverage stations during meal times. Take a water bottle from home and keep it filled from your room sink.

Food. All sorts of food. Food with no nutrition labels, five-course evening dinners, carb-filled breakfasts. Buffets. BUFFETS. With soft-serve ice cream and cookies. However, many of the food options stay the same. For instance, I had French toast and fruit every morning (plus or minus eggs, mini chocolate croissants, you know…). The first morning I bloused generously, but cautiously. Learning lessons from Morning One helped set me up for the remaining mornings. Guestimating carbs didn’t get easy, but I did get a handle on it.

Timing. Getting in insulin just around 20 minutes before a meal, not too late (hello HI) or too early (oh…LOW), was difficult. Some meals are at set times, but many were during a time range. I think you could circumvent some of this issue based on your cruising group and their ability to be accommodating.

Cruising with diabetes is definitely doable. Be prepared that things won’t be all flatline all the time. Or at all. But, with a little planning and a little extra effort, and you’ll come back with a great cruise story and steady BGs.

Wordless Wednesday: Bumpy Transition September 18, 2013

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Has MDI always been more colorful??

First 12 hours from pump back to MDI is not going well…

If You Want To September 6, 2013

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“…if you want to,” said my endo. He added on this last phrase, as an afterthought.

My endo plays significant roles in many top Type 1 diabetes studies, including a recent study for the closed loop solution with automatic suspension. Essentially the closed loop system means an insulin pump and a continuous glucose monitor (CGM) talk to one another and can make a treatment decision without user intervention. A key part of this particular study is when the CGM alerts to a low during the night, the pump automatically shuts off for two hours*.

I am not cool with this.

If I turned off my pump for two hours in the middle of the night I’d be sky high by morning. Sure, you can override the turned off pump, but that kind of defeats the purpose of an automatic action. (YDMV – I can see the value of this for kiddos, worried parents and hypo-unaware folks).

I don’t trust my Dexcom CGM 24/7, the best sensor on the market today, enough that I’d be okay with it talking to my pump and making a decision without my input.

This closed loop system uses a different CGM and pump than what I currently use. I picked my system for a reason. Because it works for me and my life right now.

Those are three significant downfalls, for something that I am not convinced will improve my care. And “…if I want to.” is the LAST phrase from my endo after his spiel?

I’ve lived with diabetes for a long time. Since I was old enough to make decisions, I made the decisions about how I handle my care. Yeah, I could be in better ‘control’, but the things that often throw me out of control have nothing to do with my choice of treatment tools.

So Dr. Endo, you are absolutely right – if I want to. It is my decision, not yours. I value your bias yet educated opinion, but only if I want to, will I take action. The tools I use every second of my life – those are tools that I use because I want to. Because I see their value to my health and because I want to find a way to incorporate those tools into my health care.

Don’t you dare make me feel guilty if right now, I don’t want to.

*Note: I am not a doctor. I have not read the study details. Talk to your doctor or do your own research for the scientific facts. The study is titled Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia .

Why Would You Want That On Your Foot? August 20, 2013

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My right foot sports an insulin protein representation tattoo. To an unknowing observer, it looks a little like DNA. When explained, it says Type 1 diabetes.

My diabetes is not often topic of conversation with my coworkers, let alone work co-acquaintances. I see Mr. Espresso Man weekly in the kitchen; we partake in small talk for a minute before heading separate ways. But one day while waiting for his steam thing to do whatever, he asked about the tattoo.

“What’s that on your foot?,” he asked.

“Oh – it’s a representation of an insulin protein,” I answered (if you follow this with a patient “Duh.” you’ll get the right tone).

“Oh. Why would you want that on your foot?” he logically asked.

I had to laugh. Why wouldn’t I? The whole thing seems so logical to me, I forget that people don’t see the connection between my foot and who I am. I realize I probably do the tattoo explanation in reverse and that I should start with the fact that I’m diabetic. Diabetes and insulin are just part of my life – putting it on my foot makes perfect sense to me. It slips my mind that that idea would make no sense to anyone else.

I went on to explain why exactly I wanted a tattoo of an insulin protein on my foot. Like most people, he didn’t say much else, but at least agreeably understood why I would put an insulin protein on my foot.

Wordless Wednesday: Oh! A Slide! July 24, 2013

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Just proving the color options in Dex...

First thought when I looked at Dex: Oh! A Slide! And all the colors! How pretty!
Low brain + before 5 AM…