Monday, November 21, 2016

diaOCD


 I sat in my office today looking at the brand new Medtronic 630G insulin pump boxes and supplies spread out on my conference table. 
My patient sat their with apprehension painted on his face. He has been diabetic for the last 10 years, 9 of them wearing a pump similar to the Medtronic Revel still attached to him.
"Is it totally different? Like will I ...have to relearn everything..?". His question was more than valid. This new pump suddenly looked strikingly dissimilar to his current pancreas.
Of course it was different, even if the basic ideology was the same. And this struck fear in my patient. Change often strikes fear in a type 1 diabetic. We have daily routines and rituals that we develop and form. We choose our medications, devices and supplies and then cling to their normalcy as fixtures in our activities of diabetical daily life.



The sound of panic in voices as the call my clinic because of their formulary changes. "But I've been on Humalog for 15 years, how could they possibly expect me to use Novolog??."
Whether it be a new meter, type of test strip, a pump or new lancet device, anything new and unfamiliar causes a type 1 to have a nervous tic. We have our Rain Man routines, and when that is threatened, when we can't buy our underwear at K-Mart, we fret. 

I can tell someone via text how to change pump settings, step by step. I have worn each one long enough that each key stroke is ingrained in my diabetic brain. When my ex, Dr.  C, and I first began dating, he used Humalog, whereas I used Novolog. Our butter compartment in the fridge was suddenly like a throw down between the Crips and the Bloods. His Accu-Chek drum strips mingling with my One Touch Ultras on the floor, like a scene from Westside Story. Each one of us steadfast that OUR way and OUR products were THE best and THE way to go.



Change is scary. Especially when we are talking about a chronic disease that requires daily, almost hourly attention. Rely on your endo team, CDE, pump rep and fellow members of the DOC when faced with decisions regarding change. They are all wonderful wealths of knowledge and experience. The goods, bads and the uglies.

Thursday, September 8, 2016

Dating: diabetes edition


So we already covered the fact that divorce SUCKS. You have to split your diabetes stock pile, you can't rely on your diabetic spouse to have backup insulin/finger poker/test strips when you run out, and you no longer have the comfort zone of that person knowing every inch of your diabetic body. Where do you like to give your shots? Which fingers do you prefer to prick for blood samples? Which long acting insulins do you hate, and which brand of tape do you like for your Dexcom. You don't have a Dia-buddy to help you put your Dexcom in hard to reach places, or fix the tape when it starts to peel up. You don't have someone that can just glance in your direction and instantly "know" that your sugar is low and that you need candy or juice. All of those luxuries that come with a long term relationship while having diabetes slowly spin down the drain and are gone forever. I don't know about you, but I don't just trust anyone to jab a needle into my skin or to get my GrifGrip tape perfectly smooth and in the correct spot.

Dating with type 1 hasn't necessarily been challenging, but I get a LOT of questions. What's that on your arm? Are you bionic? Is that a microchip? Are you actually on house arrest? Are you allowed to eat sugar? Will your kids get it? Will you have this forever? Why do you take insulin when you're high but not when you're low? My buddy's brother was 800 when he was diagnosed and now eats whatever he wants and take shots for it, why can't you do that? Why don't you have one of those dogs? *during a low* Should I call your ex? Do I need to call 911?
OMG YOU GUYS ARE AMAZING FOR CARING BUT JESUS PLEASE JUST CHILL THE EFF OUT. I got this. For 24 years. Without y'all. Let me share on my own. And for the love of all that is holy, don't tap on my Dexcom transmitter. I will literally cut you. With a knife.

On a date a couple months ago I really needed help placing a GrifGrip so I asked my date, a fire fighter, to assist me. I figured he's also a paramedic, he's got this. Omg. I had to go home and rip it off it was crooked and wrinkled and pleated. FAIL. And sexy time? Holy crap. Talk about embarrassing. "wow, you're like..really sweaty..are you turned on..?" *BEEEEP BEEEEP BEEEEP* uhhh no Casanova, my sugar is 55, now hand over my Smarties.

In my college days I kept it under wraps. Didn't tell the dude unless we made it past 3-4 dates. Would test before I left the house and do my shots in the bathroom (I know, ick). And I didn't have to fret or angst about all of this. Because I do worry. Do they see me as damaged goods? Because as a divorcee single mom, I already feel tainted enough, without adding the chronic lifelong and altering disease on top of it! Is it a turn off? Do they see my Dexcom and say "ew, I can't even"?

I don't know that I would ever date or marry another type 1, though. Being the spouse of a type 1 was hard work. The constant worry and anxiety. Making sure snacks and low treatments were always available. Having all of his prescriptions readily available, and pump supplies at the house. Not only was I keeping up with my own diabetes, but his too. And for me, personally, I think it caused a lot of resentment. Let someone worry about ME, let someone grab MY insulin out of the fridge or run by HEB for alcohol swabs. I think for once that would be amazingly sweet. Let someone else worry about keeping fruit snacks or Gatorade around in case I drop low (which I do!). Everyone wants to feel loved and cared for, even the care takers.

So that's all I got, really. Tinder & Bumble are some scary places to meet people...the variety is insane, and the unique attributes of each contender can be quite entertaining. I share some of these over at my private diabetes group Team Diabadass...if you're type 1 and have a raunchy sense of humor, we'd love to have you! 

Friday, January 8, 2016

Divorcing diabetes




Chances are, you know someone who's either going through a divorce, been divorced or is a product of a divorced household. Fact of the matter is, 30-40% of all marriages end in divorce, which is actually an all time low for our nation. But you can barely blink without being surrounded by celebrities marrying and divorcing for various reasons: monetary, adultery, differing schedules or one partner's dislike of the newest Beyonce track. Divorce is everywhere.

That being said, why does it still feel so taboo? Why do I still feel like a failure? Why do I hesitate to admit I am knee deep into a divorce, why do I fret about asking for help? The institute of marriage is held extremely sacred to some, and these people likely have great marriages and think we should too. They want to share their "secret" and want to convince you that this isn't the path God wants for you. They kind of make you feel like a loser. Then there are the ones that point fingers and play the blame game. "Well had you not done such and such, maybe he would have stayed with you"....yeah well..umm NO. We tried. We fell in love while I was a nurse in his budding endocrine clinic and I was fresh out of nursing school. He was 10 years older and one of the smartest men I had ever met. I admired how he approached patient care and advocated for education. He wanted a family, he was a smart ass and he thought I was beautiful and funny. So we got married. Yes there were red flags here and there, but nothing a baby or two couldn't fix, right? What about a few marriage counselors? Writing each other letters mapping out our feelings? Yeah. We fought the good fight. We tried. And now we want to give the other the chance to be happy in the future.

Fast forward 10 years. We have built  a wonderfully amazing pediatric and adult private endocrine clinic. We have thousands of patients that feel like family. Patients whom I share my personal cell phone number with because I truly want them to know they can call if they ever need us. These people truly care for me and the good Dr and our two awesome sons. Through social media many feel like they know my boys and get to share in their daily funnies and goofy smiles.
We are choosing a path less taken by continuing to run our practices and clinic together, even in the wake of deciding to dissolve our almost 10 year marriage. So far, so good. By being able to place the utmost importance on our children and patients we've been able to form a united front and stop being so...so...pissed off at one another!

Not saying I still don't break down and cry sometimes while I'm driving and hear a song that played at our wedding, or when our boys ask why we don't do things as a foursome anymore. It's sad. It sucks. There's no way around making a divorce a fun thing for anyone. Looking at houses, organizing finances, discussing custody agreements...it's anxiety producing. It drives my sugar up. Keeps me from sleeping. Don't even get me started on dating. Sometimes I wish I could take my health issues to him the way I used to so freely. And I catch myself. He's not my best friend and partner anymore. I have to allow him to heal and move on, the way he's allowing me to. We have to learn what our new normal is.

Thank you to everyone that checks on me and the boys. Thank you for your prayers and support. This new season of our life is a stressful one, and we are taking it day by day...and having an amazing family, friends that are to die for and little boys that make laughing so hard hurt is certainly helpful. 

Monday, November 16, 2015

Stick it to me..


Yeah, yeah..I know it's been awhile since I've blogged. I've been busy running a busy endocrine practice, raising two hoodlums and training all the dogs. Don't judge me. Just be thankful I have returned to the diabetes blogosphere AND during diabetes awareness month, because: timing. I'm a class act like that.

I have had type 1 diabetes for almost 24 years. I've had my ups and downs, ebbs and flows, "ohholyshitwhatthehell" a1c readings, and double back handspring with a twist results {disclaimer: I, personally, cannot perform said back handspring}. And you know what? Some of those results were on pump therapy, and some were while doing MDI {multiple daily injections}. Many in the diabetes world, both educators and endos alike, promote pump therapy, or CSII {constant subcutaneous insulin infusion}, as the gold standard and as the end all be all. Not going to lie, I used to be one of these educators. Pumps are great for better mimicking a physiologically working pancreas, and now with integration of CGM, they are getting better and better. Many studies support and tout the benefits of insulin pump therapy, and hey, I'm all for them...and wore one religiously for many years {my favorites are the Tandem T:Slim and Medtronic 530G...I also worked for Schmoni Plod as a Clinical Services Manager for a bit and wore one of their products}.

Close to 2 years ago I realized my weight had become an issue. I had given birth to two beautiful boys, gained close to 70lbs with each, took on the diagnosis of Hashimoto's, Celiac and Ankylosing Spondylitis following said pregnancies, and just really kind of let myself "go". Carbs weren't restricted, insulin flowed like a champagne fountain at your cousin's wedding, and I wasn't exercising. My glucose levels were good, but I was tipping the scales at around 235 lbs {see my pic with THE Gary Scheiner above at AADE 2013 Philadelphia}. I needed to get my ass in gear and I couldn't blame it on "the baby" any longer {he had just turned 3}.

Many of you are familiar with my love of Crossfit and low carb/high fat {LCHF} eating: it was these two things that helped me limit my insulin needs, which in turn lowered my insulin resistance and overall inflammation in my body. During my journey over the last two years I have lost around 80lbs, and I have never looked or felt better.


My weight hasn't been the only thing that has changed: so has my preference for insulin delivery. The more weight I lost and the more active I became, the less I enjoyed my pump. I wanted to wear more form fitting clothes, be able to do push ups without a device awkwardly poking out of my sports bra or stabbing me in the chest, I didn't like how insecure I felt about it at the gym and I didn't like having it on when wearing a bikini for the first time in years. So I made the switch to injections. At first I would flip flop between shots and pump, a couple of weeks here and there...then I would go for longer stretches. Now it's been almost a year since I took off my T:Slim, and I'm doing well on Toujeo and Humalog {I prefer the bouncy button of the Humalog KwikPen}. I do the best when I'm wearing my Dexcom, which I'm not the most compliant about, I'll admit. I have some pretty bad lows here and there, and they are stark reminders that this disease isn't going anywhere anytime soon, and that I can't, and shouldn't, ignore it.

I don't have to worry about bad pump sites, vampire cannulas, my dog ripping out my tubing, occlusion alarms, button errors, itching under sites or marks all over my body.
I don't have the bolus calculator {waaaaaa..maaaaath}, I don't have exact basal increments I can adjust, no temp basal feature, no extended boluses {this makes high fat/high carb cheat meals difficult} and no added benefit of utilizing 20% less total daily insulin.

So there you have it. The down and dirty of it. I guess I just get sick of the comments sometimes in regards to my lack of pump use {uhhhh, do you even pump, bro??} when I maintain my a1c goal just fine with injections. Some are just so judgemental and high and mighty when it comes to disease management. We are all just trying to win this fight the best way possible, and make it suck the least amount of suckage as possible. And honestly? Now that my boobs have shrunk so much, it's a lot harder to hide that damn pump..so lay off me!



Tuesday, October 29, 2013

Sweet Mama Drama

Sometimes I struggle with my role as a mom that juggles multiple autoimmune disease states. Type 1 diabetes poses glucose a swings that can affect my mood, ability to drive safely, carry on a conversation and just function as a parent. My sweet, brilliant 6 year old is so bright he is able to pick up on the cues for both his mom and dad's "diabeebees" lows. He is able to notify the other parent to these changes, and is quite hip to diabetes lingo and can accurately describe how too much insulin in the blood means you must eat or drink sugar to bring the blood back up to feel better. How many 1st graders should have to explain the pathophysiology behind hypoglycemia? It breaks my little heart, but also makes it beam with pride. My 3 year old will jump right in and ask to have his glucose tested. He loves blood and guts and actually enjoys the ritual. I'm sure in some ways this should be worrisome, but for the time being, we will just let him be a little weirdo and partake in the activities.

My greatest fear is that my children will develop my disease. That I have passed this on to them. That they will grow up having to test, inject, worry about complications, feel the angst of a low glucose, the nagging fatigue and grossness of a high, the never ending Endo visits. When they ask for a drink of water or accidentally wet the bed, my pulse quickens and I immediately scream in my head "ITS HERE, LORD, ITS HERE...DIABETES..GET THE METER AND CALL THE ENDO"....which means screaming for my husband in the next room, and then he tells me I'm a psycho and that my kids are just thirsty because it's Texas and 170 degrees outside in August and they pissed the bed because I let them drink a quart of Gatorade before bed because I'm an excellent mother and they looked like they over exerted themselves at peewee flag football. This whole living with a pragmatic Dr thing sometimes is annoying and I often wonder if I should slap him around so that he knows that I'm actually the boss. No?

Dr. C and I actually consulted with a genetic counselor prior to conceiving the heathens to asses the risk of passing on our diabetes, and the risk was very low. We also have the boys enrolled in the Diabetes TrialNet (http://www.diabetestrialnet.org) and for the past 2 years their blood work has remained negative for antibodies. Does this mean they will never develop type 1? Maybe. Could they ever? Maybe. Who better to care for them, is the way we have always looked at it. But still, the fear is real. 

Being a parent with diabetes, a different type of "PWD", is difficult. Hats off to the d-moms and dads out there. I salute all of your hard work. I admire you more than you know. But we work hard too. There are days where I go hours without having looked at my CGM because I become so preoccupied with work, life, kids, who peed on the floor, who colored on the wall, who painted their nails, why are their transformers in the freezer and why is the dog locked in the closet...?
Life can runaway from you, but the diabetes is always there. It's hard to explain to a 3 year old why mommy can't share her juice with him right that moment, or why mommy has to pull the car over to test and eat a snack on the way to pick up Bubba. 

And hats off to those of us that created a life inside of us with diabetes. Glucose can fragment DNA from the moment of conception. The risk of birth defects is much higher amongst women with type 1 because of hyperglycemia, which is why it is recommended our A1c is <6% prior to conception. Yeah, ok doc. I'll get right no top of that! Super easy! Pfffffft!! Pregnancy is turning your body into one large walking hormone attached to a pump of hormones and all you want is to eat food and fuel the monster and don't get in my effing way. The end result is so majorly worth it, though. So bravo, Mommas with diabetes!

What's your take on being a parent with diabetes or pregnant with diabetes??

Wednesday, August 14, 2013

Gone to the dogs




As many of you may already know, I work closely with a service dog organization that specilaizes in training diabetes alert dogs (DADs). These animals are amazing and mind blowing all at the same time. They are trained to detect low and high glucoses in their handler with type 1. They are trained using saliva samples, and the first time I witnessed a DAD-in-training alert, I wept. Like tears. From my eyes. Yeah.

Bringing these dogs into my home for training purposes has been a blast. Each dog has its own unique personality, likes, dislikes and channel preferences on my DirecTV. Learning each in and out of the many dogs in the pipeline has proved to be both hilarious and frustrating. WHY WONT YOU JUST DOOOOO WHAT THAT OTHER DOG DIDDDD!?!?
Stuff like that. But each dog I have hosted in my home has "live alerted" me to a dropping glucose. Some before my Dexcom, even. The nose knows.

So, this organization I work with approached me a while back about having my own dog, that is with me all the time. They would also want to utilize this dog as a "demo dog" when we travel to spread the good word about DADs. This was pretty exciting to me, as you all know, I LOVE PUPPIES. So we looked at the upcoming planned litters, and then we waited. Mojo was born on Wednesday, May the 1st. He is a handsome yellow Labrador Retriever. His registered name will be: "Chillbrooks BL Mojo Cosmic Storm". Now...I know what youre thinking...that I'm on an acid trip. But really, I just took his breeding line, and parts of his mom & dad's names and tried to put them together.

Mojo will join my family in September, when he is about 5 months old. He began obedience training at around 9 weeks of age. His little brain is like a sponge, and he's progressing well! I can't wait for him to meet my boys and family and patients and friends and neighbors....can you tell I am excited??!

With that excitement, though, comes apprehension. Yeah, I've had service dogs with me before, but never for any great length of time. And they haven't been mine. They haven't been a dog meant to service me with MY disability. That's been a bit of a hard pill to swallow. Knowing that the general public may view my owning a service dog as admitting that my diability requires assistance. Hmmmph. I always strive to be so upbeat and independent, and encourage my patients to do the same! Will they view me as weak? Will people wonder if there is something MORE wrong with me, something they can't see? What if I want to go have drinks with my friends, does Mojo come with? Does Mojo care that I have a glass or 4 of wine? Will people wonder why someone with a service dog is talking loudly with her friends while eating dessert??

And then I feel guilty. I am extremely blessed to be as healthy as I am when it comes to my diabetes. Some families may not be so fortunate, some families may not have the funds for a service animal, some may not know how to ask for fundraising and grant info. So they go without. Some remain silent. So I'm going to take my handsome man, strut around with him proudly, and spend exorbitant amounts of time talking to individuals and families about how these service dogs work IN ADDITION to my insulin pump and Dexcom G4 Platinum CGM. So, here I am, about ready to yank up my big girl panties and change my life completely. Follow me here. And follow Mojo on Facebook at "Mojo, The diabetes alert dog".

Come on, September!

Wednesday, July 17, 2013

That time my thyroid hated me...

After I calfed my first kid, in 2007, I became completely run down, exhausted, hair falling out and a raging lunatic. I would cry at the drop of a hat, and felt like my newborn son hated me. My endocrinologist, encouraged me to get blood work done. Pffftttt. Stupid Dr...what does he know, plus, the thought of taking my newborn son into a lab with me around ALL THE GERMS was just out of the question. So my psychosis moved onwards, and I continued to spiral downwards. My face became puffy, my anxiety and depression seemed to be out of control, and I was gaining weight, despite hardly ever eating + breast feeding.

At this point my endocrinologist, who also happens to be my baby daddy, laid down the law. I WOULD get my labs done, I WOULD take the baby in public, and NO he would not catch Ebola from accompanying me. Hmmmph. Asshole. I did it anyways. Had my blood drawn, had them send the results to Dr. C. Whatever. Everything was going to be normal. I just KNEW it. Because I'm me. And I know. Better than a physician. Duh.

My hubby brought my blood results home. Something had popped up. Oh. Humph. I was severely hypothyroid. Suffering from a condition called "Postpartum thyroiditis". This occurs when a pregnancy triggers your immune system to attack your thyroid. Hashimoto's Thyroiditis was the cause. I could barely pronounce this. Holy Guacamole.

Dr. C promptly started me on Synthroid. I was now one of "them". One of those crazy women muttering about her thyroid and how it was the cause of ALL BAD THINGS EVER. Worst part? It was going to take 4-6 weeks for my medication to kick in. 'Scuse me?? Ummm hi, Mr. Endocrinologist....I'm your wife...I need INSTANT GRATIFICATION. Fix me. Now. I'm not just "some patient". He was all "sorry bout ya" and told me to keep taking my drugs. I sobbed. I now had to take this tiny pill every morning. On an empty stomach, nothing else. I THEN had to wait 30 minutes before administering coffee or food into my mouth. ERMAHGAWD. He was killing me. This was terrible. This was worse than my diabetes in my mind. This was A PILL. Aghhhhhhhh!!!!

Fast forward 5 years. I have good months and bad months. There are days {ahem, sometimes weeks} where I forget my medication. I have a LIFE ya know, thyroid. Dumb. But then I get run down, my face and joints get puffy. Then I cry at the drop of a hat and start feeling stabby towards ALL THINGS. And I can't shit for days, and all I want to do is nap. Usually the Endo knows when things are off. Better than me. Sometimes I think he should become a thyroid expert or something.

My hair has never been the same. It's more brittle and can fall out in gobs. My nails break more easily. My temper can go from zero to WATCH YOSELF, FOOL in a matter of seconds. The weight gain. OHHHHH the weight gain. Really, Endo Gods? You couldn't have just left my waistline alone? This is hard enough as it is! I try to check my levels every 3-4 months, or more often if I'm feeling off. But sometimes it's like, well....is this diabetes? RA? Thyroid? Syphilis? Brain tumor? How am I supposed to know!? I've been on pretty much all doses of thyroid medication. From 50 to 300 mcg. There have been days I take a week's worth because its been that long since I've taken it. My memory? What memory. The sick joke is that you can't remember the last time you HAD a memory when you have thyroid disease.

Recently I began following a popular thyroid disease support site. It has a super hip name and is endorsed by a B list celebrity. Hmmm.. Cool. I can dig it. They claim that the only way to take your thyroid meds is if it's "natural", AKA dessicated {dried pork jerky} pig thyroid ground up and put into pills. In endocrinology we are taught that this stuff is the devil. That it's inconsistent and all over the place and that most Drs don't even Rx it correctly. So of course, I forced my husband to give this to me. He said I would be sorry. I told him he was a nay sayer, just like all of THEM out there. So I started it. This pill I had to take TWICE a day, once being at lunch. Ohhhhhhh shit. It just got real up in hurrrrr. I can barely remember to EAT at lunch, let alone REMEMBER TO REPLACE A HORMONE IN MY BODY.
1 month goes by. My trainer is seeing I'm struggling working out, I'm going to sleep at 7pm and my face turns round, like a mutha effin moon. Endo sayssssss: check your damn labs. Verdict? Most awfulist thyroid levels of all time. Ohhh. Oops. So yeah...about that pig jerky I've been taking....not real sure it's working that great for me. So now he has me back on Synthroid {synthetic thyroid hormone} and a dose of Nature-Throid in the AM and at lunch. After a week I'm feeling a bit better, but would still like to be asleep. Like right now. Like in bed writing this with my eyes closed. Please.

All of my thyroid patients out there I know can relate to this. You're not alone! Even the wife of a board certified Endo struggles with this. Like a LOT. So know the signs and symptoms of hypo {low} and hyper {high} thyroid.
As seen here: http://thyroid.org/wp-content/uploads/patients/brochures/Hypo_brochure.pdf

Annnnnnnd here: http://thyroid.org/wp-content/uploads/patients/brochures/Hyper_brochure.pdf

And know that your primary care doctor may be following a lab's guidelines for what a "normal" thyroid level should be. 60% of our thyroid patients were told at one point or another, that their levels were normal. When they were un-normal. And whack. So do your due diligence when getting checked out and push for more than just a "TSH" test {which is most Dr's idea of "checking" your "thyroid", even though TSH is made by the "pituitary gland"}. And if you have diabetes, your chances are increasingly elevated for developing thyroid disease. Have a blood relative with autoimmune disease? Increases YOUR risk for autoimmune thyroid disease {Hashimoto's & Grave's}. I tell my parents that they genetically screwed me.

Oh...and for all of you that take thyroid replacement, make sure you're taking it CORRECTLY. First thing in the morning, on an empty stomach, with a sip of water, nothing to eat or drink for 30 minutes and at LEAST 4 hours apart from vitamins. Iron and calcium will actually bind to the thyroid hormone = you won't get your dose. Many patients are NEVER told how to do this. Which sucks for everyone involved! DON'T BECOME A STATISTIC. Wait...now I sound like an after-school ABC family movie. But for real, y'all...be educated.

So that's all I got about thyroid. Can you tell I hate it? And it hates me? Yep...me too.