Sunday, October 23, 2011

Let's kick some pancreASS!!!

My first pump was an Animas IR1275....it was silver and black, and I grinned from ear to ear when I received it. I was 21, in nursing school, engaged to be married...and a total badass. My CDE (whom I couldn't stand...Like literally...we used to argue) had tried desperately to have me choose a Medtronic Minimed Paradigm 515. As usual, I told her she could eat me..and to go ahead and order what I wanted. I loved my Endo at the time, and even asked Dr. C when we were dating if it would be weird if I continued to see Dr. Moore....Dr. C was less than amused.
Fast forward a few years, and in strolls a Medtronic rep. All sparkly and heaven sent. She presented me with my first demo pump. I was in love. Less button pushing and integrated CGM? I'm pretty sure I made out with her that day...or maybe I dreamed that? She was hot, either way. My Medtronic Paradigm 522 was Smoke...and on fiiiiire. When it came to portable pancreases, I was sporting a Bentley.
As many of you know, I went to work for company X in March...for 3 months. I was told I had to switch to their tubeless product if I were to work for them. I cried. Seriously. Bawled. This should have been a sign for things to come. Chronic pod errors, alarms all the time, ripped skin and bruises, pods falling off for no reason...I wanted nothing more than to be strapped to my Medtronic love, again. So when I broke it off with company X in June, I was more than happy to shove that thing in a drawer...even though the pod errors and such had improved. Most surprising? Dr. C is STILL sleeping with the enemy. He loves that damn thing. If it's tubeless, he's pumping.
After a 3 month Pumpcation, I strapped on my newest toy: Medtronic Minimed Revel 523...and...AAAAANDDDD...it was PAAAAAANK! woohoo (shout out to blog favorite, Julia Roberts!)! I have been lovingly tied up to my Revel since September, and despite the baby toes, inquisitive cats and rogue door handles, I have never been happier!
Medtronic has had a tubeless pump in the works for a couple of years...and as to whether or not I will jump back on the tubeless bandwagon is questionable. With FDA delays, and lack of technology perfection, I'm a hopeless cynic. I hosted my support group for Type 1s the other night, and out of the group of us there, 3 had tried Product X, 2 of us had returned to ole Faithful: Medtronic. 
One thing DID ring true, though. All of us were pumping...and all of us would rather laugh and commiserate, than cry in solitude. Chronic diseases are no fun, y'all. And even yours truly (Goddess of all things snarky and diabetic) has a bad BS day (blood sugar...bull shit...both work). It's easy to say THIS SUCKS...and not think about your body, but then they start shoving large bore needles into your arms and lopping off your toes. My toes are insanely cute, thank you very much...so I think I'll keep em. If you're feeling down about being pancreatically challenged...talk to someone! Your Endo..CDE...BFF...anyone. Sometimes just getting it off of your chest can be cathartic.
So, to the world of auto-immune misfits: know this...you're not alone...and in this day and age, reaching out is easier than ever. Tube, no tube...pump, no pump...thyroid, no thyroid...welcome, friend....kick back and have a seat, take a load off, enjoy a (diet) soda and enjoy the proverbial ride.

Signing off,
Queen of the auto-immune, pancreatically challenged misfits with 10 toes.

Wednesday, October 12, 2011

Not-So-Fertile-Myrtle


Infertility...the inability to become pregnant within 12 months of trying to conceive..it affects about 10% of the population. You know what else affects about 10% of the diabetic population? Type 1 (Type A? ha) diabetes. Are the two related? YOU BET YOUR ASS THEY CAN BE!!

Little known fact about Nurse Kelley (see: ME): Both of my children were conceived through In vitro Fertilization (IVF). Yep...the spawn was created in a petri dish. Makes me love them THAT much more. The road to obtain fertility was a long and painful one. Nothing is more crushing than not being able to become pregnant once you have set your mind to do so. It was during the workup process that I was diagnosed with Polycystic Ovarian Syndrome (PCOS) and tubal infertility. PCOS?? WTF?? I tell my patients that it is a cousin of Type 2...and I CERTAINLY was not a T2!! This prompted further nursey investigation (see: Dr. Google).

I found out some interesting things: approximately 1/5 of women with infertility suffer from PCOS. Hmmmph. PCOS is caused by high levels of Testosterone and Insulin in the blood. Double hmmmph. More and more, well controlled type 1 diabetic women are being diagnosed with this disease. Ok...seriously...someone was effing with me. So, apparently, because we take higher amounts of insulin to keep our sugars at goal, our body views those insulin levels no differently than if they came from the ole pancreas. High insulin scrambles our Pituitary gland, and we end up making more testosterone...and then growing chest hair. Haha...just kidding...maybe..ok not...or am I? These high testosterone levels prevent us from succesfully ovulating every month, making conception next to impossible.

Common medications used to treat PCOS include birth control pills. Nothing is sadder than the day you are told you have to take BCPs for 3 months before you can try having a baby...seems backwards, right? Infertility certainly ain't fun. I was lucky to have found a wonderful support group with 4 AMAZING ass women who were going through issues similar to mine. All 5 of us now each sport 2 children, respectively, and aren't too bad looking for it, if I do say so myself ;) It was so nice to commiserate with others that were dealing with the constant nag of diabetes, which is then compounded by a diagnosis as devestating as infertility. As I watch some of my patients begin this long road of fertility issues, I long for them, have the utmost sympathy...and empathy... for them and wish that everyone could be pleasantly surprised by a positive pregnancy test at home. Not us. We are juiced up on hormones, we undergoe surgical & radiological procedures that are both uncomfortable and humiliating, suffer through periodic blood draws, spending thousands of dollars out of our own pockets, and dealing with the constant angst over "will this work for me? what if it doesn't?". Not that, in the end, it is all worth it...but many "fertiles" as we refer to them, will never know how much I went through for my children. So forgive me for being annoyed when you brag about your super fertile powers, and being able to get pregnant on the first try. I would love to be happy for you...but I'm too busy plotting punching you in the thyroid.

Another tip I can share in my dealings with infertility: Find a reproductive endocrinologist. A GREAT reproductive endocrinologist. Don't let your regular ole OB/Gyn fiddle around with your hormones and life for 6 months, when you could be in the hands of a specialist. I was SO fortunate to have found the amazing doctors and staff at Houston Fertility Instituite (832-838-5100). I have never hesitated to send a patient, friend or family member here, because I know they will be in the best hands possible. If you can't trust your RE...find a new one!!!

Something that is NOT for joking is a type 1 diabetic woman's higher incidence of children born with birth defects related to uncontrolled sugars. Yes, if you have horrible sugar control, you can actually cause your developing baby to be born with a horrible defect. Scary shit, ya'll. We want your A1c under 6.0% FOR A REASON. I've seen some awfully scary things, and wouldn't wish them on my worst enemy. So if you have type 1, a pregnancy should be something you plan..not an OOPS! Your glucose levels needs to be in line, you need to be taking a prenatal vitamin, and you need to include your OB and Endo in on your decision to procreate. (I will now step down off of this soap box...does soap even COME in boxes that can be stood on, anymore? Someone go look that up for me...).

Soooo, have fun, control your sugar, wear a Jimmy, or don't, just be prepared, ya'll!!

Love, Nurse Kelley