Friday, December 31, 2010
Grrrrr. WHY did I drink so much water before bed?? Its 3am..I'm comfy in my bed, under the covers, snuggled up to the 3 year old (NO judging..he's too darn cute to kick out!!)...aaaaand I have to pee..BAD. Fine. I fling the covers back. I swing my legs over the side of the bed. I face the curious look of the dog and kitten, as they raise their sleepy heads up to investigate the raucous. As I get up, CLANG BANG BUMP BUMP...TUGGGGGGGGG. Great. My pump has come unclipped from the PJs and is swinging like a pendulum, and banging up against the bed.
I also like it when I get hung up on something. The ole dog-on-a-chain feel. My parents have the only drawer pulls in the state of Texas that are angry enough to actually rip out a pump site. That's always fun. The other day I was doing a pump start for an older gentleman. AS we neared the conclusion of the start, I was attempting to explain, and demonstrate, how to disconnect from the site. He was really struggling with this concept, for some reason. His knuckles white, squeezing with all of his might...it came off...like the whole damn thing. I did what any other supportive educator would have done. I started cracking up! He then looked at me all confuzzled...and asked if he had to "stick the plastic back into the whole" when he was done showering. Yup. Right back in. To the hole. My face was bright red at this point.
I was at the grocery store the other night, and at the checkout line, I flopped the ole wallet out onto the counter to pay...but instead of just my faux croco wallet, about 4 USED test strips, some Border Collie hair and some glitter (wtf??) came with it. The college-student-checker-outer-chick makes a face at me. Whatever beesh! If I want all of this grossness living at the bottom of my purse, then so be it! I then realized what a hypocrite I am. Dr. C somehow always leaves used test strips sprinkled about the house in the most random places. Like, seriously, dude?? How the eff does that happen? My Dyson is formatted with the incapability of picking up One Touch Ultra blue test strips. Its says, "Screw you...and you're 'betes". DRIVES ME INSANE. I thought i was all keepin up with my used stuff, discarding them in the trash (once my meter pack becomes overwhelmed with them!!), and being the picture of sanitation. Hmmmph.
So, yo...what's your most embarrassing, crazy, 'betes related story?? Get hung up while knocking boots? Dropped low during a date? Been caught putting your bloody finger in your mouth after testing and realizing the person watching is mortified that you are just gross enough to do that...yeah, uh, this has never happened to me...just seems like, ya know, something that COULD happen......
PS. Happy New Year, everyone! I'm going to re-start bootcamp, be a better friend to my peeps, make my kid brush his teeth at least a few times a week, stop eating out so much...and stop being so "narcissistic" and "juvenile" (you know who you are). Love to you all!!!
Friday, December 24, 2010
Yesterday was weird...on the eve of the eve of Christmas, Dr. C and I were forced to do something that neither one of us has done in years: see an endocrinologist. GASSSSSP. Our stupid insurance required us to see an endo, other than Dr. C, in order to pay for our new insulin pumps (ours are out of warranty). Sooooo, we saw him. I haven't seen an actual endo, other than my hubs, since 2005!! It was weird...he actually looked at my sugars, palpated my thryoid (mmm sounds dirty), and made observations about my control. Crazy. Dr. C tries to do these things, too...but I usually think he's just trying to get into my pants.
Dr. C hadn't seen an endo since he was in med school...and that endo introduced him to a fancy, new thing called "Humalog". He's been self treating ever since. He did, however, allow me to start him on a pump in 2006, and he's been a tried and true Medtronic pumper ever since. He also wears a CGM to help ward off his difficulties, both with hypo unawareness...and his nagging wife, who has actually had to deal with her anger issues with his hypos in marriage counseling. True story. Maybe I'll delve deeper into that in another post....
So, we strolled out of our appointments, prescriptions in hand, a little humbled by the experieince. So, thanks HealthFirst TPA, for being complete ASSHOLES and requiring us to seek medical counsel elsewhere. They flat out said they would continue to pay for our Rx's from Dr. C...just not a pump, since they are so expensive. Asshats. They are just mad because I wrote them a rude email offering to send them a video of Dr. C having a seizure, I'm totally nice like that.
I don't take criticism well. I know, shocker. So during my pregnancies, when my A1cs were less than 5%, and Dr. C would chime in his $.02 about my management, I would get soooooo pissed at him!! I wouldn't listen to anyone other than my perinatologist. Going to the endo yesterday made me realize what a wench I had been to MY endo, when all he was trying to do was be my doc. Being married to my endo, being a nurse educator AND working with him poses a very unique scenario for our diabetes care. Very rarely do Dr. C and I seek help outside of our own expertise. Is this good? Is this bad? We have pretty good control, and both are complication free...so are we doing ourselves a favor...or preventing a greater good from being done? We both struggle with these questions. And had we not been forced to yesterday, would probably have gone the rest of our lives without seeking care from a colleague. Is it against the law? Nope. Is it unethical...maybe a little. But, dammit...I don't want someone else telling me what I already know!!
What do you think? If you were me (and I know you wish you were...dont lie) what would you do? Would you continue to self manage? Allow Dr. C a bigger role? Or see someone else entirely? I'm actually quite curious to see what the blogosphere thinks about this sitch...
So Merry Christmas, Happy (late) Hannuhah, Happy-Merry Kwanzaa...and try to limit how many ass-dimpling sweets you consume over the next week.
Love, Nurse Kelley & the little Crumps
Sunday, December 12, 2010
Soooo blogosphere...I decided to take a pump vacation..a holiday..a pumpcation, if you will. Why? WHY? Why would I dare do such a thing??? Because. That's why.
10 bad pump sites, moderate ketones and a shit load of stress drove me to it! I decided to kick it old school...but like 2003 old school..back to MDI (multiple daily injections for all of you diatards), poppin with Novolog and Lantus pens. Is it a total pain in the ass to have to remember to bring my pens along everywhere I go? Yup. But, you know what, my 7 day average on the Mini shows 109 mg/dL (6.1 mmol/L for my Canadian followers, eh?). I'm doing pretty effin fantastic on shots! I'm testing more, bolusing 10-15 minutes before meals...I haven't been above 140 in a week! Soooooooooo, what gives??
I don't usually recommend this type of therapy for my patients. Pump issues are usually pretty easy to trouble shoot for a (self appointed) expert, such as myself. A change in pump sites (most likely my issue), a change in insulin settings, a change in pump real estate (areas to insert a pump site), treatment for infections, or just getting a brand new pump per your warranty. Hells to tha NAH. NONE of this was working for me....so I ripped that puppy off, removed the battery, and told the hubs to bring me home some pens. He didn't question me...good boy. In hindsight, I think my issues lie within the type of pump sites I was using, or may even be an issue with real estate.
Pumping has changed my life. For the better. It has allowed me to do, be, think of things that I nebver could have imagined possible on shot therapy. I give CSII therapy mad props. I just needed a break. Much like a husband or boyfriend that lingers around the house too long, when all you want is a bubble bath, glass of wine and Lifetime Movie Network. That't what this is. My pumpcation is just a chillaxer, a breather...letting me recharge. I've had an assload of personal stress, recent (minor) surgery, and then the chronic hypers. I felt as though I had no choice! So I took control, and did what I know best. I did diabetes. I did sugar managment.
It seems like a lot of my followers are moms of type 1s. I welcome you. I wish my mom had been able to turn to someone while dealing with my non-compliant ass growing up. As one of my fave TV characters, Hank Moody, implied...its too late to drown teenagers :) Hang in there. Immaturity, being a teenager AND dealing with the concepts of managing a chronic disease don't all mesh well. The good news? The ankle biters all, eventually grow up. They usually realize their own "AHA!" moment, and take the reigns from the parentals.....and amazingly enough? Complication free!
So, world. Keep on keepin on. JKL. Whether it be MDI, pump or twice-daily insulin...keep shooting up, and keep reading.
Love, Nurse Kelley
Tuesday, December 7, 2010
Title of this post could be interpreted many ways...what *exactly* am I implying?
-That I'm obviously a Julia Roberts fanatic because she has now appeared on my blog TWICE
-That I'm referring to Dr C as "the enemy"...much like you would refer to "big brother" or "the man"
-Referring to dawn phenomenon
-Don't be a douche...its dawn phenomenon
Dawn phenomenon is the rise of your glucose level in the early morning hours, and occurs due to the production of your body's stress hormones (epinephrine, growth hormone, cortisol, glucagon) all of which cause your sugar to rise, and your insulin to not be as effective. BULLSHIT is what I call it. Our bodies seriously can't just TELL we don't produce insulin on our own? I mean, we already know our livers are stupid...and about half of our insulin requirements go towards this stupidity and the hepatic glucose that is released into our bloodstreams daily.
I get asked all the time, "Hey Kell, tell me about dawn phenomenon!"....well, not really, but either way, I'm gunna tell you about it, you don't have a choice. There are several schools of thought in the treatment of DP (that's Dawn Phenomenon...not donkey punch). Some studies done in people with type 2 (AHEM insulin resistant peeps cough COUGH not cool like us COUGH) show that taking either a cinnamon or apple cider vinegar supplement at bedtime can help curb this rise in sugars, but no formal statements or regimens are out there. Another idea is to eat a protein rich snack at bedtime. Or if you are a genius (ME! Like ME!) you slap on an insulin pump and fine tune your basal insulin to cover this rise. If you want to go off the grid, rogue, you can try an intermediate insulin at bedtime that peaks, thus covering the rise....but this is tricky since NPH is very unstable, and can peak at different times, causing an increased risk for overnight lows.
Slapping on a CGM, either personal or from your doc, is a great idea. We run weekly CGM clinic in our office, and it gives us tons of data. What you might THINK is DP, is really that bowl of ice cream you had at bedtime, fat ass. Or, you may be dropping low earlier during the night, and rebounding, something we call the Somogyi effect (Google it, I'm too lazy to also have to explain THAT to you).
Another enemy in my bed?? My 3 year old!! Ugggggg potty training, attitude, opinions and stuck sleeping in my bed....I so need a parenting intervention. I seriously think stressing about him in our bed makes my sugar rise even more. Any suggestions for ME???
As always, sports fans, don't make ANY changes to your regimen without first speaking to your doc or educator, because that would just be dumb, got it??
Friday, December 3, 2010
Camp. You're either a camp person, or you're not. Simple. Non-camp people usually hate on camp people, such as myself. They don't get why we wear stupid hats, make total fools of ourselves, give up a week or two of our Summer, and want to live in a bunkhouse, and not in our warm comfy beds at home. Every summer, as I drive through those gates, leaving camp after the session ends, I bawl like a baby. I crank up Journey's "Don't Stop Believing", roll my windows down, start sobbing and leave that special place in the Hill Country that I love so.
When I was diagnosed, my pedi-endo insisted that I attend a summer camp for kiddos with diabetes. It sounded totally frightening to my 9 year old self, so my parents signed me up! I was a newbie, and had only been on insulin for 4 months when I arrived. As I swallowed back my tears, and said bye to my parents, I took a deep breath, and got in line to have my sugar checked and get my insulin before dinner. "Here ya go!", I stared at the syringe as my med staff held it out in front of me. "uhhhhhhhh", was all I could muster. "Well it ain't gunna give itself", she said in her East Texas twang. "Arrrghhhuhhhummmm IIIII uhhhhhh", I protested. "Girl, you gotta take it, or you just ain't gunna get it"....she then demonstrated proper insulin administration technique (she, too, had the 'betes), and handed the orange tipped syringe to me. I pinched up my non-existant fat on my leg (I was still emaciated from pre-diagnosis), looked at my med staff, who nodded her head in encourgaement, and I took the plunge. Hmmmph. Not bad, not bad at all! And that my friends, is how I became the boss of my 'betes.
So once I became a nurse and joined the endocrine world, I wondered if I could give to camp, what it had given to me. That first summer at diabetes camp was like no other experieince in my entire life. I was placed in charge of 5 diabetic boys, ages 10-11, and they were MY responsibliity! Ahhhhh! What if I did something wrong? What if I lost one? What if one fell down and hit his head? What if I missed their insulin dose? It was nerve wracking! But those boys were hilarious....they were discovering girls for the first time, asking questions about their bodies and diabetes, and had an obsession with spraying Axe body spray....EVERYWHERE. If I am ever diagnosed with lung cancer, I'm sure it will be traced back that the summer of 2005, where my lungs were over exposed to Axe clouds in the bunkhouses. I learned alot that summer. I learned that kids are resilient. I learned that many families don't have access to diabetes educators, or even endocrinologists in some cases. I learned that some kids are fed some crazy shit about their 'betes...one Mom told her son that he was given diabetes by God because he was not well behaved. Seriously, lady? These kids are like sponges!! They thirst for knowledge about themselves and this wacky disease. I have such great pride in knowing that my job as an educator at camp, literally, helps change some of these kiddo's lives.
One of my favorite camp stories occurred in the infirmary a few years ago. We have a long table, surrounded by chairs, that the kids come in and sit around to change their pump sites. We had a group of about 9 kids that required site changes that first night at camp, so they were all chit chatting at the table, discussing which boys/girls were hot, who they planned on asking to the dance, the rumor that they were getting ice cream for a snack...all the good stuff. When suddenly, a blonde headed little boy, I would guess he was about 9, exclaimed "DID YOU KNOW THAT EVERYONE AT THIS CAMP HAS DIABETES??? MY MOM DIDN'T TELL ME THAT! COOOOOOL!!"......***silence*** as the other med staff and I coped with the realization that this kid was dropped off at "summer camp" and his mom just failed to mention that it was summer camp for kids with diabetes. That moment still makes me laugh to this day.....
Diabetes camp is brutal...you don't sleep, you have to wear stupid headlamps at night for midnight blood sugar checks, you have to constantly be aware of bloodsugar cues for 200+ children, know where you are supposed to be and when and whether or not you are supposed to have the emergency backpack, or wait, weren't you supposed to pick up the snacks?? Ahhhhhhh! The super cool thing about diabetes camp, though, is that alot of the med staff has diabetes themselves. Kids like knowing that they are going to grow up and be normal...they like seeing that a grownup is wearing the same type of pump that they have, parents like hearing our success stories...that we have gone on to lead productive, healthy lives, that we have children and college degrees...and that we aren't blind and on dialysis.
I was a bad teenager. BAD. I don't know how I survived, and I definetly don't know how my parents dealt with me. My A1c was 16% when I was 16...I had to be hospitalized for DKA, my pedi-endo fired me for continued non-compliance (he is now one of my most esteemed and respected colleagues, and at times,he even uses my story when speaking to patients ) and I just didn't give a crap about anything. Except boys and my friends. Once I got to college I had an "aha!" moment and realized that good sugars = feeling good (Duh). So I kept a closer watch on things, and my endo was great with working me and making sure I knew how to adjust my insulin doses when I went to the bar or out to eat. Once in nursing school, I had THE wake up call. Seeing diabetics in the hospital for amputations, laser eye surgery and dialysis made me want to puke (Not from DKA, don't worry). It was then that I decided to join the pump world. And I have never been happier with a decision in my life. It has allowed me to do what I want, when I want, eat whatever, and most importantly, become a mother (see previous post).So, I like sharing my story with families...letting them know that sometimes, non-compliance is just a stage, and that you can grow out of it, learn from it, and go on to do great things with your life and disease.
Even if you aren't medical, you can still volunteer your time at diabetes camps. I encourage you to look into it. And if you are going to ignore me (I don't recommend this avenue) then donate some CASH MONEY to your local diabetes camp...many of these kiddos get to go for free, and at no expense to the family, so help us continue to provide that service, and don't be a stingy a-hole.
Thats all I gots for today :)