DiabLaziness

I was laying in bed several nights ago, and it struck me: "I am diabetically lazy". A shocking realization, it is not. An epiphany when examining those of us with chronic disease lazies after decades of just "dealing", YES.

It all started when my new Dexcom G4 Platinum {Yes, I IS fancy} required a finger stick for calibration. This would have required several actions on my part, including getting up to grab a new vial of test strips. It was then I decided my bed was just too comfy...my book just too enchanting...the soundness of my sensor, just not THAT important...So I did it. I calibrated my CGM with a MADE UP NUMBER of my choosing. GAAAASSSSSSPPPPP. I calibrated my sensor with a number close to what it was already reading, hoping it wasn't that far off from what my actual sugar was reading.
Now, why is this a BAD idea?? What if my sensor was WAY off? I could have just caused my sensor to continue to read "off", and thus miss any important shift changes in my sugar, rather that be low or high. This could have resulted in a missed "LOW" or "HIGH" alert, rendering my sensor useless. At the time, I seriously couldn't have cared less. But in retrospect: DiabeDUMB.

We have all been guilty of DiabeLaziness. Changing our lancets only when the clock falls back or springs forward, using a new pen needle or syringe only when it begins to bend into our skin from over-use, or simply skipping out on a fingerstick or insulin dose all together, what about injecting in the same area over and over? Using a pump site past 72 hours??. Do I condone this behavior?? Certainly not. Do I partake in these behaviors? DUH, I'm human. Remember the old addage "Do as I say, not as I do?", yes, precisely.

Will these things harm you? Possibly, and that is a risk we all take with our bodies. Re-using lancets sets us up for pain and infection, same with re-using needles for injection. I've had patients who have had a needle actually break off in their skin. What about re-using the same injection spots/pump site areas repeatedly: insulin is a growth hormone and will antagonize the growth of tissue, the technical term being lipohypertrophy. Lumps and bumps from over insulinizing a site can also prevent you from fully absorbing your insulin dose, the tissue becoming sponge like, sucking up the insulin and preventing your body from using to lower the sugar. And we ALL know skipping out on insulin doses is bad dog behavior: and will absolutely result in a higher A1c, which results in a grumpy Endo, which results in sad face immediately following said Endo appointment. I am reminded of the genius comedy website DogShaming.com. We need a DiabeticShaming dot com. Ok, so maybe not. As my patients would probably get pretty upset when I force them to wear their bad habits around their neck while I crack up and post their mugs on the site. Hmmm Ok, so probably a bad idea wrapped in pure awesomeness.

I know we are all guilty of SOME of these offenses. Some of the milder ones like putting a bloody finger in your mouth or not using an alcohol wipe before an injection. Overtime I think we learn what we are able to "get away" with, and which of these rules truly matter. There is scientific evidence that wearing your pump site past 72 hours decreases your ability to fully absorb your insulin...so...DON'T DO THAT! But if over time, not changing your lancet works for you AND you've weighed the risks involved, then be my guest. Balance your smarts with your dumbs, and all will be well with the world.

What are some of YOUR worst offenses???

Double Agent

We have discussed "pumpcations" here , before. And because this is my blog, we are going to talk about them again..dang it.
I have been a pumper since 2004, before I met my hubs, the infamous "Dr. C". I loved my first insulin pump, an Animas IR1250, like pre-color screen and hugeness, Animas. It was silver and sleek and meant I didn't have to take shots anymore: suhhhhh-weeet.
I then transitioned over to a Medtronic Paradigm, and had met my true love in the pump world. The ease of use and having a back button were probably more exciting than they should have been.
Then marked my stent with Schmomni Plod, where I was told I MUST wear their product if I were to remain employed...you know, a totally legal request {insert sarcasm font}. Going tubeless WAS nice, having a tumor under my clothing, not so nice. Plus, at any given moment, a bad pod would awkwardly begin loudly beeping, and is only silenced by a hammer...or defusing it like a bomb, which easily breaks your nails. Rude.
About 2-3 years ago I began my annual pumpcations. A vacation from pumping, where I switch over to multiple daily injections {MDI} for a few weeks or months out of the year. It's so liberating. To not deal with pockets or clips or shoving it in my bra. Not having to worry about my site while getting bussaaaaayyy {yes, yes I just said it like that}...or worry about what my husband thinks of how it looks on my body. Not worrying about what others think about it, feeling stares when they catch site of my tubing or see me bolusing. Don't get me wrong, I'm the biggest pump proponent out there, especially for a Medtronic pump, but sometimes...I just need a break. And that's ok.
I take great care in explaining pumpcations to my patients. That they ARE ok, that they won't get in "trouble" for wanting to switch from time to time. We always have a back up plan for shots. We sit down and calculate the correct basal injection doses, adjust the carb ratio and correction factor, and review the fundamentals of MDI.
I found something surprising, though. People are even MORE apt to make comments about my diabetes management choices when I'm using insulin pens. "Aren't you supposed to be on a pump? Did it break? Why are you STILL on shots, I could NEVERRRR do that...." And so on. Geeze, people. Let me be pancreatically challenged on my own. Calling attention to my injection in a large group of people is awkward and uncomfortable. I will talk diabetes all day, any day {lets get real, that IS my day} but don't be a douche and point me out to the vast majority of folks that don't even notice me!!
I guess diabetes, especially type 1, is something new and unknown to most. Questions, comments, insensitive statements..the general public has no filter. I've seriously heard it all. If someone you knew was diagnosed with cancer, would you ever consider walking up to them and saying "oh! You have cancer?? So did my uncle..he lost his leg..and then died.", uhhhh no. So I wish more common sense was used in that regard.
It's ok to be different. Even if its a different different every week. If you need a break from pumping: take it. Discuss with your team, and take a pumpcation...but use common sense, and have a game plan. Make sure you have long acting insulin to replace your basal rate, syringes or pen needles, adjusted doses {you use about 20% more insulin on injections} and a plan.
And to you non-diabetics: we are people, with feelings, with a chronic disease...use caution when relating your anecdotes to us. We are very sorry your grandmother lost her life or limb, but that is not us. Do we look immobile and unhealthy? Yeah, well we probably won't ever be that way. Ye of little faith. I've had this disease for 2 decades, and I'm pretty darn healthy, diabetically speaking.
Ok..rant over, pumpcation: month 3, set to begin! I am looking forward to slapping on a T-Slim, since I have no current endorsement deals with Medtronic..hint, hint...but also, so I can report back to my public {see: you, lovely reader}.

PS. I have zero plans to censor THIS post...many took issue with my DAD post, and it is now so beyond edited, it is unicorns and bullshit and not me at all. So, I hope it at least informed a few of a growing treatment option. Because that is the LAST time I change who I am so as not to offend.

Who's your DADdy?

I recently accepted a {non-salary..volunteer} position as a clinical consultant with a dog breeder that also trains services animals, namely: Diabetes Alert Dogs. I help screen potential clients, and help them grasp who is, and is NOT, a good candidate for a dog. Oh your A1c was last done 2 years ago and was 13%? Ehhhhhhhhhh

For those of you not in the know, a diabetes alert dog is a service animal that has received 1,000+ hours of training to become a service/assistance dog that you're able to take everywhere, and is also trained to detect high and low blood glucoses in a handler. I've seen it happen, and it made me cry. Here is this sweet faced labrador that is telling someone that they need to check their sugar. it gives you goosebumps. What exactly are they smelling? We aren't quite certain. its not neccesarily the actual "sugar", its a shift in hormones that their super noses are able to pick up on (I wonder if they know I skipped my shower last night....). Its best done with a type 1 diabetic, as its somewhat a stunted occurance in type 2s...again, we aren't sure why. We are calling it "Factor X'...sounds like super CIA stuff, right? So any chemists out there that would like to do a study as to exactly WHAT these dogs are getting a whiff of, PLEASE, contact me ASAP.

For those of you with loved ones that suffer from severe hypoglycemia awareness, ya'll are the ones that can benefit the most from these pups. Being able to catch a downward swing long before its seizure time would be a blessing for anyone that has experieinced them in real life. They ain't fun. Seeing my husband seize, realizing I don't have glucagon in the house, and knowing I am at least 30 min away from an ambulance arriving at my house: NOT FUN, and the stuff that nightmares are made from. Imagine if that was your child? Well...I can't..I wouldn't want to. These dogs are beyond what we are even capable of knowing ourselves...and although they may have puppy breath, they will love you no matter what...even if you do look stupid trying to fit into your Spanx and fall over onto the floor. Not that I have ever done that. Ever.

These guys are service animals, they wear a vest, and can go anywhere with their handler. They begin socialization and training at age 4-6 weeks, and some have even been able to alert at the age of 9 weeks. Although, they are not ready to "go live" in a home until closer to 18 months of age. Training involves using saliva samples from a type 1 diabetic, placed in a vented tin that can be hidden anywhere on a person. The dog is then rewarded to recognize and paw (see: alert) when it smells this scent. And they use spit. To train a dog. I felt pretty dumb the first time I was 41 and standing in my kitchen shoving gauze in my mouth to collect a sample. Even stupider when I realized that my mouth was bright pink from the strawberry Jello I had just consumed.

Diabetes isn't sexy. I mean, I'm sexy..and have diabetes..that's different. Diabetes is work. Its a fulltime job on top of a full time life. So anything that is able to help someone live a life that's a little easier....why not??? Well, maybe the price tag. For the cost of a used vehicle, you can purchase a gently used DAD, fresh out of training...to the tune of $25,000.00. But unlike a car, it poops, pees and burps in your face. Dogs need constant care and love, and a DAD is no different. They are there to serve you, not sit in a crate all day long. Some DAD trainers are able to get grants or organize fund raisers to assist in the purchase of these animals. Some (not so nice) trainers sell you a 12 week old puppy that has been "scent imprinted" and youre given a booklet to train the animal. There are not so nice trainers that will assure you your dog has endured hours upon hours of training, only for you to get home with a spazoid dog with ADD that shizzles on your shoe. As in any market, scammers are here. So you best do your research, yo.
And as this growing industry gets rid of some its stretch marks, we will have set standards that dogs must meet to be called a DAD. You wouldn't want a seeing eye dog that only guided 30% of the time when it was distracted. Same with a DAD. We need genetically sound, healthy animals, and non-asshole, smart trainers, that are working towards the greater good of diabetes betterment.

Remember....The Alamo??

I am writing this post from Downtown San Antonio, Texas. Dr. C and I are here attending the annual Texas chapter of the American Association of Clinical Endocrinologists. No lie, we are probably the coolest people here...just don't tell the other nerds..ahem..doctors.
You are probably wondering about the title of my post. Actually very fitting! Funny story: we drove from our home in Southeast Texas (near Houston) to San Antonio, which is in Central Texas (see also: Hill Country). Following our arrival and check in to our hotel, I promptly discovered a packing mistake. I forgot to pack undies. Party FOUL. So yeah...I'm sans panties in San Antonio. That sounds a helluva lot cooler than "sleepless in Seattle".
My epic EPIC fail brings up a good point. Last weekend I was visiting friends and family in Austin (my hometown) and realized I had not packed extra pump supplies or insulin. And my pump (of effing course) started beeping "No Delivery" at bedtime. The wonderful folks at Medtronic offered to overnight me a new pump, and my local rep wanted to drive me a new pump...at midnight! Seriously, how great can a company get??? Love
my MDT-Minimed friends!! In lieu of those two options, I opted to test and inject every 2-3 hours with Novolog. It was super fun and practical...said no one..EVER.
I have always instructed my patients to calculate how many supplies they will need during a trip, and then DOUBLE that amount. Bring a travel letter, keep your insulin cool and have your pump settings written down somewhere (you would be surprised by how many people have zero clue).
So, I'm a big fan of the "do as I say, not as I do" rule...well, obviously because my brain isn't running on all pistons. Speak with your CDE or Endo regarding travel letters, a copy of settings and an action plan in case something goes awry.
I was flying to Boston out of Houston, and TSA pulled me aside and started pilfering through my bag. They weren't sold on my Schmomni Pod not being a weapon of mass destruction. They started ripping open pods, touching syringes and subsequently smashing my vial of Novolog. I was in tears. I began taking pictures of the TSA agents with my phone, which they told me was against the law (it's not). Their search cost me my flight and my pride. I then contacted ADA legal services, and said TSA agent ended up losing his job. Part of me felt bad, part of me felt vindicated. TSA itself says that insulin pump users have the right to request pat downs, and in fact, don't even have to disclose that they are wearing a pump or carrying supplies. I would like to teach incoming TSA agents that touching pumps, telling people it's "fiiine!" to put them through X-ray and to always trust that passengers know what's best for their health and $6,000 pancreases...pancrei..? Hmmmmm.
So..yeah, good talk everyone! I'm headed to the mall to buy some undies.

The wind beneath my wings....

My fellow 'betes bia, Cassie Giesberg, CDE is up to her shenanigans, again. She blew me away with this post she wrote on my behalf. I am so lucky for every single one of you and the endless support I have recieved from the diabetes community.
Yadda yadda yadda, sniffle, sniffle



An Open Letter…



To Whom It May Concern (insert interested party here):


Kelley Crumpler (Mrs. Crump, or “Crump”, as I like to call her) did not ask, goad, or threaten me at gunpoint to write this follow-up. I’m going to do it anyway, because I like Kelley and what she’s about, and I think she deserves to know she’s not alone here.

I “met” Crump after she “friended” me on Facebook a year or two ago. Since that time, I’ve come to know and really like the work that she does. In fact, I admire her for it. I admire her sticking out her tongue at diabetes every day, and saying, “eff you”, and letting others know that it’s okay to do that—as long as you get back on the horse and keep going after you’ve had your moment. I love that because she’s been a card-carrying member of the D-Club, she’s made a life effort into learning the science of diabetes and giving validity to the feelings that go along with having a chronic illness. And I love that she has never given up—even when it’s much easier to do so. She is passionate—a girl after my own heart. And she is not alone.

I, too, am very passionate about diabetes education—particularly with kids and their families. I firmly believe that education equals success. In my three years as a diabetes educator, I’ve seen countless kids and their families take a diagnosis that inspires fear, anger, and other negative emotions, and become empowered; these families are ready to “fight the good fight.” Likewise, I’ve seen kids who’ve given up on themselves—and everyone else has, too—and realize that they can do this. Not everyone is a success story, and I always knew that would be the case, but I definitely do think I gave these families something to think about.

I love being an educator. I love that feeling when I see the proverbial light bulb switch on, and people realize that they can be successful, but they’re also free to have their feelings about this condition—that those feelings are valid. I absolutely believe that with almost 30 years of personalT1 experience under my belt, I had a perspective that many educators don’t have the “advantage” of possessing—and that made me able to connect. Being an educator gave my life a lot of purpose; I realized that I could answer “Why me?” Because these families need someone who’s “been there, done that, bought the t-shirt, and lost it” and come out on the other side. I was happy to be that champion.

Unfortunately, even in the world of chronic conditions, there are politics. These politics are less concerned with education and its benefits, and more concerned with dollar signs. And when that happens, it’s not the providers, the administration, or even me that is directly affected: it’s the patients. This makes me furious.

In my own situation, I had been a devoted educator for almost three years. I don’t think that I, along with a few others, brought a new energy to an environment plentiful on low morale. I wanted to start support groups. I wanted to implement classes. I wanted to help people learn to take charge of their care so that when they entered the big, bad adult world, they would be prepared. I was shut down at almost every turn. It was one excuse after the other: “we don’t have the staff”, “we can’t do _______”, “we can’t bill for that.” The list goes on an on. The focus became such on turning a profit, that my life became a living hell. My health finally succumbed.

Long story short, I finally resigned. When I handed in my resignation, I was thanked for all my hard work, and asked to contact a local agency and let them know that I left of my own volition, “so we can have a working relationship”with said group. I did so with the knowledge that people aren’t stupid.

So I guess Kelley and I aren’t allowed to have any space to express our feelings—either about work or our own trials with diabetes or health issues. It’s not enough that we put in a workday dealing with diabetes, only to go home to deal with diabetes. I don’t say this is a self-pitying way, but only to put some perspective on the issue, and say how ludicrous it is that we can’t have our own space to vent in order to be healthy. What’s even worse is that people who have no idea what we do are more concerned with their own egos than what’s right for the people they serve. And there’s no amount of blood, sweat or tears that Kelley or I put in that can make up for the fact that those people are the ones who lose out in the end. My heart bleeds for them, a) because I feel like I failed them by giving up, and b) because I don’t know what they’re going to do for support.

For what it’s worth, Kelley, I support you. I’m proud to call you a colleague, and more importantly, a friend. I know you’ll keep finding ways to fight the good fight. If you need someone on your team, I’m here.


As you like to say, peace, love, 'betes,

Cassie

Sometimes, it ain't so sweet

Some of you may not know this, but this summer would have been my 6th year working at the camp I also attended as a kiddo, where I learned to give injections and that I could grow up and be "normal". Anyone that knows me knows my love for camp, and I speak of it often...to friends, patients and colleagues. 
So consider me flabbergasted to find out that said camp doesn't want me back this year. They don't want my expertise (there are usually only 1-2 diabetes educators, 1 Endo, and many MANY trainees that know NOTHING about type 1 or pumps) or experience. They don't want the relationships I have formed with campers or families, or the med staff volunteers I recruit. All because of this. My blog. My outlet. My huge branch into the diabetes world. They don't want parents associating me or my views with their camp.
I was heart broken, it was handled piss poor, and I'm also effing pissed. I speak for local clubs to recruit donations for said camp. I hang posters and fill out applications for campers to go. Shit...I had already allotted a percentage of my book deal as a donation for a new infirmary on camp grounds. So. Very. Sad. And the uneducated individuals responsible for these decisions have no idea about me. No one cared to give me explanations , no one went to bat for me, or cared to challenge these decisions, despite positions of power. My heart has a hole the size of Kerrville because of it, and I have truly learned who I can, and can't ever, trust.
The diabetes Gods look out for those who represent, though. Without my blog, I never would have met Cassie Giesberg or been invited to speak at Camp BlueBonnet, near Austin. It was love at first sight, and I can NOT wait to go back next summer to offer my services, expertise and donations. The sugar Gods smiled upon me when they sent me to Camp BlueBonnet!
This brings up another question. Those of us that blog, and dare to say the un-sayable, are we just sitting ducks? Waiting to get shat upon, just for our beliefs and vocabulary? When I worked for Company X (Schmomni Plod, for new readers) I was straight up told that if I posted 1 word on this blog, I could face instant termination and legal implications. WhatThaFructose. Just for preaching the good word?? That was one of the MANY reasons I left Company X, and haven't regretted my departure for one, single, Medtronic loving day.
Why do we put ourselves out here? These are my inner thoughts...these are things I implement in my practice...why do I share them with you? Because...it's the right thing to do, and if I can make one diabetic person laugh on a shitty sugar day, my job is done.
I truly love what I do, and do what I love. I will not quit until everyone knows my name, the true definition of type 1 diabetes, and until we are all walking around with new artificial pancreases, that are covered 100% by insurance. I won't quit until kids and adults stop receiving quack-ass diagnosis and treatment plans, and I definitely won't quit until everyone is an ambassador for their disease state. I want to advocate for those that can't, and educate for those who aren't as fortunate as I have been in the diabetes world.
Ok.
Good talk.
Now...go change someone's life..or recycle or something.

The one about my big toe....

I recently had to undergo a procedure, lovingly referred to as an "EGD", aka "upper GI" scope. Yep, my asshole maintains its status as "EXIT ONLY"...at least for now. I began having waves of stomach acid roll up into mouth at inopportune times, or I would have to, very emergently, puke. It was not cool. Between my Celiac and all of the crap I take for my RA, the Dr wanted to see what was going on and take some biopsies. Seriously? What ELSE. Part of me wanted to cry, part of me was glad she was pretty confidant that I was not dying of yet-to-be-determined disease state. Everything ended up being fine, I have severe esophagitis, a hiatal hernia and had developed an esophageal ring (to which my friends made comparsions to "cock rings"...I need new friends, obviously)...nothing a new, yeat ANOTHER pill couldn't fix.

As my IV was being inserted prior to my procedure, the RN made an observation. He asked why I was wiggling my big toe so anxiously. I had to stop my train of thought and actually look down to witness WTF he was actually referring to. I explained to him that, as a child, being diagnosed with type 1 diabetes, while learning to give myself injections, I had developed this "toe wag". It happens if I'm getting blood drawn, a shot, having an IV placed, BP checked...basically anything medical. Its my "wubbie", if you will. I don't scream, squirm or hold someone's hand tight...I just wag my big toe. Hmmmph..works for me.

Then it made me wonder if others with chronic diseases have developed odd coping mechanisms or nuances assosciated with their diseases. I feel like mine has become exaggerated as I keep adding to my collection of crap that's wrong with me. Not that I go around feeling sorry for myself. That's just no fun. Plus, I'm WAAAAY to heavily medicated for that. I just make fun of others and turn up my smart assedness when I'm feeling down, it usually makes others laugh, and it sure as hell makes me feel better about life. I often say this in my practice: "Sometimes you have to laugh, otherwise you're gunna cry"....and that's ok. In itself, humor and laughter is a type of coping mechanism.

I'm also dealing with a very VERY personal life decision I have recently had to make. So, instead of keeping it all in and being private, I'll blog about it. I have decided not to have anymore children, even though I would love to be pregnant and have another baby. It would just be too dangerous for both baby and me, and my luck, (because we have to do IVF) I would end up with triplet girls. Then ya'll would all have to send me diapers and formula, because I would be too poor from buying bows and ruffled leggings to keep my kid's butt's dry. So, yeah...it sucks...and I wish I could wag my toe until I felt better about this all, but it doesn't work that way. So feel free to send presents.

Hellions, Heathens & Hyperglycemia

In the last 2-3 weeks I have seen a rise in the number of visits I have had with non-compliant tweens and teens. What gives? Its like they are getting friskier with this warmer weather down in Texas. I've been meeting with their harrowed parents, so frustrated that they are pulling their own hair out while trying not to strangle their sweet children.

As a teenager I was BAD. You've seen me mention my A1c of 16% when I was 16, and getting fired by Dr. Pedi Endo for continued non-compliance. My parents didn't know what to do with my ass. I would go weeks without testing, make up sugars in my meter (yes, it can be done)and miss insulin doses all over the place. In High School I was on UltraLente and Humalog..you know, whenever I DID decide to inject. My endo would bring up pumps and I would laugh at him. I couldn't have given less of a shit about my diabetes. My reality was...friends, boys, drinking and my grades, those were my world. Now, had insulin gotten me drunk...I would have walked around wasted face....but with good blood sugars. I was always on some form of activity restriction or grounding with my parents. Limited computer access, no phone, no weekends with my friends = no bueno. And as I reflect back to that point in my life, I really don't know that anyone could have said anything to me to make me change my behavior. Not my Dad, teachers, Dr. Pedi Endo, and least of all, my mom.

Recently, Nurse Cassie did a post about disciplining kiddos with T1 that aren't taking care of their bidness. Many parents feel that a chronic disease is enough of a burden, and that being punished for not checking sugars, omitting insulin or lying about their diabetes, is wrong. Trust Cassie & I: IT'S NOT. Kiddos require close diabetes supervision at least until age 16, and at that time, a few more responsibilities can be handed over to the lad. As a parent, it is your job to prepare your child for adulthood, and that includes taking care of their body. So if your child was lying to you about money..or cleaning..or grades..you would impose punishment, so why NOT for diabetes self management???? Take away that smart phone, turn off texting, deactivate FaceBook or have them sit out from athletics or team sports. Diabetes is serious, ya'll! And allowing one's child to get away with murder will not help prepare them for the long run.

In the words of the great Joe-Slo (Joe Solowiejczyk, RN, MSW): "The message from parents to young people needs to be, “It’s going to be difficult. We, as your parents, understand that you have issues with managing your diabetes and that you don’t like doing it all the time. And, we’re going to insist that you do it anyway. After you’ve done it, we can discuss how you feel about it.”
I think had my family made it THEIR diabetes, and we talked about the level of suckage diabetes is, I would have been much more receptive. A kiddo needs to feel supported, loved and able to come to you with issues...but they must also trust that you will stick to your guns, and in the end, you ARE an authority figure, and if you don't follow MY diabetes rules you will LOSE you age appropriate priveleges.

Make your terms very black and white: You WILL test your glucose no less than 4 times daily, you WILL dose your insulin prior to all carb intake and in return, I will allow you to (insert super fun teen activity). Failing to hold up either end of the agreement, and you will both end up angry, frustrated and with a crappy A1c. Make your home a "No-Nag" zone for diabetes, only ask questions when pertinent to the safety of the child. Have a diabetes round table discussion once or twice a week, where Mom & Dad get to look over meter and/or pump and ask sugar realted questions. All nagging does is piss kids off (Wives, however, are ALWAYS allowed to nag FYI) and further push them away from the bigger picture. Make your kid an appointment with their CDE to discuss WHY they must test, keep their sugars at goal and dose insulin correctly. Let them vent. Being a teenager is sucky, add a chronic disease state on TOP of that = a cluster (insert "F" word).

Also want to give a shout out to Kendall & Jocalyn over at Kendall's Hope, my new favorite blog (I seriously was 30 min late calling my last patient backwhile trying to catch up on Jocalyn's posts!!).

Tick Tock ya Don't Stop...

Hellloooooo there to the diabetes blogosphere and DOC! Yes, I am alive. Work has been nutty and I've been a brittle RA patient. Yeah. I went there. BRITTLE. But its ok because its Rheumatoid, NOT diabetes.
During my absence, I aqcuired a minion of sorts. Ok, not really. I haven't exactly hit her up for any favors or asked that she run any errands for me. Ohhhh but its coming. And by all of my pronouns, youve been able to deduce I met a girl. Her name is Cassie Giesberg, and she's kind of amazing. She was diagnosed with T1 the year I was born, and like your favorite bia, has made work with diabetes her life's passion as a diabetes nurse educator. I asked Cassie to hit me with a guest post, and hopefully this becomes a regular gig for her. So without further adieu....
{I'm playing Color Me Bad RIGHT.THIS.SECOND}

My name is Cassie Giesberg, and I have been a member of the T1 club for almost 29 years. I was diagnosed with T1 when I was 17 months old. My D-day is December 23, 1983. I have been through ups, downs, and some crazy technology (GlucoWatch, anyone?), but that's not the point of my story today.

Another thing that I have experienced is the common barrage of questions. I don't mind it really; I'm pretty open about my diabetes. It's not anything to be ashamed of--it just "is". However, I'm pretty sure some people don't know that personal space also applies to conversation.

I've received some pretty odd questions over time, and I think the strangest one by far is, "How do you have sex?" And what's even crazier is that I've gotten that one more than once. Seriously? Would you ask that to someone who doesn't have diabetes? And how do you answer that? By the way, since I'm married, I can talk about this.

Well, my go to answer is usually, "Well how do you have sex?" You know, it's really strange how many people don't want to answer that. So it's okay for you to ask me how I have sex, but I can't pose the same question back to you? Frankly, I don't really want to know how you have sex, and if you don't know how I do it, then you're probably too young to ask that anyway! And if you're nosy enough to ask that question, then you're also entitled to whatever smart-ass answer I have for you. Hmph!

But I will say this: there are some things that make it difficult and frustrating. For example, when you've had a butt-kicking low blood sugar (of say, 37?), you feel like, well, like you've had your butt kicked. That doesn't do much for the mood--particularly if you don't have any energy after fourteen juice boxes. Or, there's those good times when your infusion site gets ripped out. It's a little painful, a little annoying, but it's not a total deal-breaker. Then, there's the really fun one: when your blood sugar drops at a most inopportune time. Sigh.

There is fun to be had, though, other than the obvious. Sure being low sucks, but that can also be a good thing. You see, I've developed a rating system that makes me feel better because my husband and I can laugh at it--and it helps put the diabetes in the background where it belongs. Diabetes will not crash my party--especially during intimacy!

Its a pretty simple rating system, actually. For example, if you need one juice box afterward, then that means it was pleasant (or you can attach whatever mediocre adjective you find applicable); if you need two juice boxes, then that's pretty good--amazing, even. But if you need three juice boxes, DO NOT LET THAT GO!! Sure, you won't like needing three juice boxes, but you'll realize later on that it was for a good cause.

Now let me be very clear: I am not suggesting you intentionally drive your blood sugar low so you can tell you friends later on that you had three juice box relations. In fact, I try to plan as best as I can so that there are no interruptions. I keep my juice boxes and my Dexcom (if I happen to be wearing it) nearby, and I wait for latest possible time that I can disconnect my pump (so my two-hour window doesn't fall at a bad time).

I'm really just trying to make light of something that can be really be frustrating. For me, it takes the power away from diabetes during such an important time. My "rating system" lets me be just like everyone else. It's a funny story for me to tell later on.

So, to all you nosy people out there--that is how I have sex. Believe it or not, it is possible for people with diabetes to have relationships--awesome ones, even. If you feel uncomfortable hearing that, then imagine how uncomfortable I might feel when you ask me that.

Hit me with your best shot

We are rapidly approaching my birthday season. Many of you laugh, thinking I am hypercelebrating my own day of birth. But I'm not, yo. Not only will I turn 29 on Monday, on March 16, I will celebrate my 20th year with 'betes. Yep. 20 years with a chronic disease and ZERO complications {horn: tooted}. This feat has not been an easy one. Years of trial and error with insulins, shots, pumps, weight, stress, 2 pregnancies and CGM. Effin hard, ya'll. I still learn new things about my disease, and disease state, weekly...and hope to continue to do so throughout my career.

Which brings me to today's post. This weekend I will journey to Austin with 3 of my best friends. We have plans to eat, drink and revel in gluttony. For my non pancreatically challenged friends, all I have heard them express amprehnsion over is weight. Will we gain weight this weekend? Will we look like crap next week from our birthday binge weekend? Where should we eat without being super bad? No, I'm not eating bad today because I'm saving it for this weekend. Must be nice. On top of trying to stay relatively the same weight this weekend, I have to also worry what these activities will be doing to my sugars. Well yeah, that looks awesome...butttt its also 9,000 carbs and my pump only hold 180 units....

In high school and college I drank alcohol {gassspppppsss the audience} and really did so without being too careful. Beer, wine, jello shots, margaritas {Helloooo, I AM in Texas} and good ole whisky. I remember missing insulin injections, not checking my sugar NEAR enough and waking up wondering how I got home. Yeah, pretty dumbsauce. My husband even had one episode of binge drinking in college that landed him in the ICU on a ventilator. Diabetes + alkie-hol is some serious bidness. And if youre going to do it, for the love of little baby Jesus, be smart:
~ Always eat with, or just prior to drinking
~ Check your sugar throughout your occasion
~ Stay away from fruity "girl" drinks {Pina Coladas, Daiquiries, brightly colored drinks}
~ Make sure your drinking buddies know about your 'Betes and the signs, symptoms & treatment of a low sugar
~ Discuss the "rules" with your Endo or CDE...many of us have real life experience with getting shitfaced that we would love to share with you

Alcohol, in spite of containing carbs, will actually lower the blood glucose. That powerhouse of an organ, your liver, has never been told it has diabetes, so it continuously is churning out glucose into your blood stream for energy. Add alcohol to the mix, and it suddenly becomes preoccupied with removing this toxin from your blood...so much so, it forgets to spit out your energy sugar. About half of our basal {long acting} insulin is taken to combat this very sugar. This equals a pretty dangerous scenario. So knowing how to play the game is a must.

So as for my birthday weekend in Austin: I plan on having a great time that includes balancing great food, wonderful friends, a little insulin and some adult bevvies. My poison of choice is Vodka, and if it is Whipped Cream in flavor, SIGN ME UP. I often mix it with diet coke, and avoid calorie laden "shots" as much as possible. A night of shots usually ends with me vomming. No thank you!! So Happy Birthday to me, and more to come on my Diaversary.

Disclaimer: Pinnacle Vodka has not paid me to advertise their insanely good flavored vodkas...but they should.

Bag lady

I hope everyone survived Valentine's day and the influx of chocolate goodies! I managed to keep a safe distance...for most of it...

2 nights ago I was changing out my pump site {6mm, 23 in PAAANK Mio} and reservoir, and I realized the small bag I keep my wallet stuff and diabetes supplies in had a lot of bulk at the bottom. So I decided to clean it out. Wow. Someone needs to turn me in to the show Hoarders. There were 47 USED OneTouch blue test strips, a powdery mess of a leftover grape Dex-4 glucose tab, a half wrapped tootsie roll with 3 pennies stuck to it and now I feel dirty.

I carry a small Betsey Johnson leopard and sequined bag for my supplies.


I have come a long way since the days of my Dia-Pak {Why yes, I AM a trend setter}. I remember the constant shuffle of keeping the gel pack inside *just* cold enough, not sweating and NOT melted. Which was tough in Houston, TX. Now I toss my opened Novolog vial in the bag with my PAAANK OneTouch Ultra Mini, Delica device, strips and an extra reservoir {for those days when I'm feeling not so fresh}. This bag also houses my credit cards, insurance info & license. I often take this places in lieu of a purse. I hate for my diabetes to weigh me down, but also like to be prepared for anything on the fly. I often find myself writing excuse notes for patients at work because they have to leave to go home to get insulin..pump supplies..you get the idea.

You should always be prepared. Whether you are a D-Mom or a D {instead of 'diabetic', can we just start calling ourselves 'D's? Kind of like 'B' means bitch, 'D' can mean 'diabetic'....I personally don't necessarily like to term 'PWD'...I dunno} you should always have a backup plan, a Plan B, if you will. And then a backup plan for the backup plan. Dr. C and I travelled to 'Nawlins for an ADA meeting a few years ago and BOTH ran out of pump sites AND Novolog. Uhhhhhhh. Yeah, we felt like morons. Thankfully we have some awesome ass D reps that hooked us up. I'm a firm believer, now, that you should always plan out the amount of supplies you will need for a trip and then DOUBLE that amount. Having long acting insulin in the fridge {for pump peeps} and a supply of old school syringes is never a bad idea.

And back to my original point, why the eff is it so hard for me to throw away my used strips? I should be reported to OSHA. I have found them in my kid's diaper, in the toilet, in shoes, parking lots I frequent, in my FRIEND's vehicles....I guess its like my calling card. My own little way of hiking my leg on something, marking it as my territory. Yeahhhh. I like that.

That's all I got, D peeps!!

You are loved...sort of

Sometimes I think I need new friends. They hide and jump out of random places in an attempt to make me pee my pants in fear. I'm never allowed to slip up and say something silly without wisecracks from the Peanut Gallery. My hair usually warrants poking fun at, and an opportunity is never lost on them to do so. And heaven forbid I not wear makeup without mention of my "natural beauty".

But. BUT. They have always been there when I need them. Fights with my husband, bad days at work, tough patient cases...and scary health issues. I have 4 autoimmune diseases, some of which are NOT fun. My friends have tested my blood sugar when I drank too much to do so myself. They have read multiple food labels to ascertain the amount of carbs AND gluten a particular item contained. They have accompanied me to doctor's appointments. They have drawn my blood for "further testing". And most importantly, they have made me laugh every step of the way. Through tears, gritted teeth, inflamed joints, high sugars, stomach cramps and bunk thyroid tests...they have always made me laugh. And for this, I will be eternally grateful.

So, on this Valentine's day...D, S & J...will you be mine? Oh, and thanks for being my besties...you are loved.....even though sometimes y'all make it hard to do so. Just kidding. No not really. Ok, maybe.

Love,
Your autoimmunly challenged friend

Mommie Dearest

I wanted to be a mother from the moment I knew I was capable of loving another being. I wanted to be pregnant, feel a baby kick my insides and rock a tiny infant to sleep in my arms. Babies were always in my plan. The movie Steel Magnolias gave me {and many others} warped senses of what it might be like. Kidney failure? Death? Uhhhhhhhhh...... 
Dr. C and I began our journey to become pregnant down an extremely bumpy ass road. Infertility sucks. Way more than diabetes. Trust me. Being told you are unable to become pregnant is one of the single most ultimate feelings of failure a woman could ever experience. The black cloud that moved in over my being was palpable. Yet we pushed on. IVF was no walk in the park, but it worked for us. The huge needles {in the ass} daily. The blood draws 3 times a week, the vagina pills and the weekly ultrasounds. The oversized sized ovaries and whack hormone swings. It was all worth it to see that positive pregnancy test. My life hasn't been the same since.
Pregnancy + Type 1 diabetes = a mofo pain in the ass. Glucose swings and heart burn. Extra Dr appointments and warnings of increased chances of birth defects. Preeclampsia and a numb tongue and lips when my sugar was low. It was not a glowing time in my life. But I did it. For Jack. He was the reason I checked my sugars 20 times a day. He's the reason I bolused 4 times during a meal, to mimic the phases of a working pancreas. HE was the reason my A1c was 4.7%. It was not easy, and walking around with a constant sugar of 65 is not fun. I would be unloading the dishwasher, see stars, and check, only to discover my sugar was in the 20s. It was a fine line I constantly hovered over, always tempting severe hypoglycemia with my excessive insulin habit. My perinatologist constantly urged that I eat more and bolus less. Pssshhhaaaa. What do Drs know {ALWAYS listen to your doctors, y'all}?
Holding my sons in the hospital for the first time is a high that no drug could ever mimic. My preemie boys were both healthy, and didn't require dextrose drips or oxygen masks. I did that. I made that happen. My diligence and research and responsible diabetes management had been rewarded with the {healthy} loves of my life. Jack & Ben. 
This last week I followed through with something that Dr C and I had decided to do before our boys were even conceived: we had the boy's blood drawn through the Type 1 Diabetes TrialNet. Their blood samples will be added to the Natural History screening study for relatives of type 1 diabetics. This sample will prove as a predictor of the boy's risk for developing type 1. I cried and cried before, during and after their blood draws. No mother wants to see their child in distress. Jack, my 4 year old was a champ. He was so brave and watched the entire process with wonder. Ben, my 20 month old {and red head of the bunch} did not appreciate being violated. It required two adults and a phlebotomist to restrain his tiny ass. It truly was a moment of blood, sweat and tears. And now: we wait. Up to 5 weeks before results. 5 weeks. Mofo eternity, yo.
What will I do if one or both predict a future diagnosis? Honestly, I'll cross that bridge when we get to it. But Who better? Who better to care for a child with type 1? Two parents with over 40 years experience, that's who. So, I am trying to be the best mom I can be, and trying not to think about it as much as possible {yeah right, not enough meds in Texas to stop that from happening!}.
So thanks for the thoughts, prayers and love for my little family during this. We worked hard to bring these boys into our lives, and we will continue to work hard to keep them healthy and happy, no matter what that may entail.

Look, Ma! No hands!

D-Moms. For anyone in the know, this term can strike fear into your core, especially members of the DOC {diabetes online community}. D-Moms have street cred, they are the jocks with letterman jackets, and don't you DARE challenge anything they say. They are mama-bears apt to snap an uneducated twit's neck if they suggest their child maybe "shouldn't eat that".

I have always admired these women from the sidelines. Going from a Mom to D-Mom is not something that any mother pines for. Hugging new T1 families in my office often evokes many emotions from me. How did my parents handle this? How did they keep me safe? What if my boys get T1? Will Dr. C and I be able to surf these scary ass waves of diabetes land??

The DOC has opened up many avenues that parents weren't able to access years ago. We now live in a world where we can Google carb counts and ask Facebook how we should DualWave that piece of pizza. We are inundated with blogs filled with helpful...and sometimes not so helpful...information. What someone believes as gospel, another spouts as pure rubbish. I can find 87 different answers to 2 questions in 30 seconds. How do Moms do it? I often wonder what level of basket case I would be worrying about lows, excursions, pump malfunctions...I just know how many little issues I face daily, and then to be in charge of such a Mini-betic??? My kid can barely tell me when he needs to poop, how the HELL is he supposed to carefully articulate the feelings of hypoglycemia??? It's enough to make me batty just considering it.

A deep dark crevice of the DOC lies in parents, even patients, that become martyrs for the disease. That thrive on the drama and turmoil that can so easily consume any one of us on any given day. Blow by blow accounts of "horrible" nurses, "know it all" Endos, "money grubbing" pharmacies, " dumb ass" teachers...some comments and blogs are fueled purely from hatred and depression. At times I've seen DOC members of this caliber become cyber bullies, attacking innocents just looking for more information. These situations must be tread upon lightly, as many times there are much deeper lines that must be examined as a root cause for the behavior. Some parents take their role as sole caretaker of the diabetic too far, and it then defines that person. To the point where conversations can ONLY revolve around their plight. I ache for these people. I want to hug them and say "yes, this DOES suck...you DO matter"...and "PLEASE just be niiiiice!". I've seen some wretched claws let loose in the DOC, and I now avoid many of those known "hang outs" as much as possible.

Being a care taker, whether it be full or part time, is NEVER easy. Your job is NEVER done, and often you do it without pay or recognition. It's from love. I love my husband, and sometimes get angry at him for "making" me take care of his diabetes (only at times), but for the most part I enjoy doing what I can to make his life easier. Do I wish he'd get up and get his own damn juice? Of course, but secretly, I thrive on knowing he's doing better because of my help.

So hats off to ALL diabetes caretakers, not just D-Moms {even though they have bigger balls than any man I will EVER meet}. You are not alone. The DOC is only a click away.....

{The above Keep Calm poster can be found in the Keep Calm Store @ Etsy.com}

Paging Nurse Ratched!!!

Blarrrrrf. That’s the sound of the puking I did this weekend after mixing gluten AND alcohol this weekend. No bueno, ya’ll. I have an inkling that this was also a side effect of mixing the alcohol with the medication given to me by the Rheumatologist. I may never know. All I know is that I was miserable, and had only devoured 2 drinks over 3 hours…so for those of you thinking I was drizzle, WRONG. I even counseled with a pharmacist prior to my GNO to make SURE I wasn’t going to drink and then crap my pants, and I was given the go-ahead to “pace myself”. I thought I was doing a noble job at it, too. Lucky me. I see the Dr this Friday to discuss further medication options.

This brings up an interesting point. I have had MANY questions about the gluten-free diet, and would totally love to chat with a dietitian about the changes I have already made, and the further changes I am open to making. For gluten seems to sneak its way into everything. It’s a sneaky lil bastard. Now. Would I want said dietitian to counsel me on the state of my diabetes. NEGATORY. Carb counting. Check. Fats. Check. Being able to identify fruits & veggies….ehhhh CHECK. Why do we HAVE to meet with a dietitian JUST because we have diabetes? Why can’t a CDE learn you about advanced pump features {typically used with fatty or protein rich foods} just as well as a dietitian? I mean they cross train us educators to do both. Why do you need both? Dietitians do pump starts and teach injections, why can’t nurses teach carb counting & dietary needs???

Growing up, I was part of the Texas Children’s Hospital {TCH} assembly line. Appointments lasted 4-5 hours, we met with a nurse, endo, dietitian, had labs drawn and did a lot of sitting around. I remember loathing my time with the dietitan. Was I exchanging starches? Was I eating fiber and drinking water? Did I ever consume candy or junk food? It made me want to SCREAM. My CDE in college, who was also a dietitian, sent me to the “office dietitian” in charge of carb counting, because she was JUST going to do my pump start. Uhhhhh excuse me? How efficient is that for anyone?

Don’t get me wrong, I can see why a newly diagnosed type 1 could benefit from seeing a dietitian, but what if one isn’t available….like in my office? I think I do a pretty phenomenal job of getting my patients off on the right {dietary} foot. Why would I then, also, waste my patient’s time AND money and send them to a dietitian (who in this area, mostly condone exchange counting and cutting out sweets a la Type 2)?? Now for those in the diabetic community that need assistance with renal diets or putting on weight, then yes, a dietitian consult can help. But for normal, Joe Schmo type 1 diabetes management, I just don’t see the need to see a dietitian ALL THE TIME.

Maybe I just need to lay off the haterade?? Maybe TCH & ADC cultivated this “Debbie Downer” feeling I have against RD/LDs? And don’t GET me started on non-licensed/registered {so-called} Nutritionists. I’m sorry, but the internet does not make you a “nutritionist”, and someone should never pay for services from someone not in the field…so BEWARE. In the state of Texas dietitians must be licensed AND registered, so always look for those letters behind their name!

Now…DJ…please don’t punch me! Love ya!

'Roid Rage in the New Year

I gots the ills, ya'll. Rheumatologist said its RA...but she feels like I will have a positive prognosis. Moderately Neat-O, is what I say. She gave me an order for 8,000 lab tests, X-rays and a prescription for prednisone...DUM DUM DUM. Yes, STEROIDS. I felt funny filling it at the pharmacy. The pharmacist pulled me aside, with a very serious look on her face: "you KNOW...this WILL increase your blood sugar...you should PROBABLY talk to your husband..". Uh...yeah...ok, lady. Thanks.

So this morning, 30 diligent minutes following my Synthroid dose, I administered my first dose of prednisone...with a tasty swish of Cherry Coke Zero (SUGAR FREE, don't worry, for all of you internal med docs out there). Went down easily...and then I waited. Took a good 2 hours for my Revel RTS to buzz at me with "190 mg/dL HIGH"...and that's on a 135% increased temp basal. Yaaaaay! So I cancelled it, and went with a 150% increase, and increased my bolusing by 50%...been between 150-210 mg/dL all day...fun times. I think it will take some more WAG (wild ass guessing) on my part to really nail it. Thank goodness for continuous monitoring! on that note, pretty excited to order my mySentry Remote Glucose Remote from Medtronic!!! It will be SO nice to glance up at my glucose levels in the middle of the night! Especially as we start playing around with my Rheumatoid meds.

I have a temper. A bad one. Coupled with severe depression (treated with drugs, of course). These can lead to random objects flying at my husband's head, broken bones in the hand (Sorry, Douggles) and nast text messages (whaaaaaa?? meeeee??? ugggggly????). It is something I have struggled with for years. My recent troubles with joint pain have really sawed of my last nerve, and I have, at times, yelled a bit more than I would like. Poor J & B....I love them more than anything, but they can only lick each other SO MANY TIMES before mommy SNAPS. So being placed on corticosteroids for 2 weeks has me a bit apprehensive, as I know they can induce anxiety. Great. I'm hoping I can self medicate with alcohol...and cake...don't forget the cake.

So forgive me if my next few posts deal with those of us that have multiple autoimmune disorder...its a small club...very exclusive. Thanks for all of your support and thoughts!

Peace, Love & 'Betes,
Nurse Kelley

Growing pains??

Please excuse my troll tendencies that have rendered me under a bridge for the past few months. I missed ya’ll. And who are we kidding, I KNOW you missed me!
A happy New Year to all of my readers out there in the diabetes blogosphere. My endo office was nuts in November and December, everyone was trying to get things done BEFORE 1/1, and needed it done yesterday. It was good times. Diabetes Awareness Month came and went, and don’t worry, yours truly wore blue (along with her entire practice) every Friday, and raised almost $2,000 for JDRF with walk and shoe donations. Thanks to everyone that helped me achieve my goal! And for those of you that didn’t…I accept all major credit cards and personal checks.
My hope with this blog over the holidays was to have it revamped and redesigned by the New Year in preparation for the launch of my book I have been penning. That obviously didn’t happen, but I have joined forces with a NEW blog designer, Lisa from Scratch, and can’t wait to see what she has in store for me..and the blog..ok, mainly me.

January is National Thyroid Awareness Month, and as a Hashimoto Ho, I encourage you to wear blue paisley for those you love with thyroid disease….like me. Having 3 autoimmune issues (I also struggle with Celiac) can make the day totally suck…if you let it. Some days I eat too much gluten, almost poop my pants, only to realize I forgot my morning dose of Synthroid AND have two arrows up on my CGM. Instead of screaming FML!!!! I contain, triage, do what I can, and tell myself I need to lessen the suckage factor the following day. I hate to think that my readers ever get down about their autoimmune issues. Makes me sad, just know you are NOT alone, and there are many of us in the DOC (diabetes online community) that rally for others with this shitty disease to help make it suck less for you…the greater good.
This post is making me apprehensive, so I should probably come clean. About 4 months ago I started noticing some joint swelling and pain. I brushed it off and started hitting the Advil. But then I noticed they were red. And I couldn’t open things. Or grip my steering wheel. And the throbbing pain sometimes wakes me up. I realized I was emptying all of the pain killer bottles in my house fairly quickly. So, tomorrow I am going to see a local rheumatologist that my husband likes to refer patients to. I’m scared shitless to hear what she has to tell me. What if I have ANOTHER autoimmune disease? Rheumatoid arthritis??? I thought only old, wrinkly people got that? Why is this happening to me? How will it affect my mommy-hood? Will I be able to have more children? Will the drugs for treatment harm me? So, yeah…tomorrow will be interesting. I hope that these aren’t just “growing pains” and this is what it feels like to be old, on the other hand, am I actually wishing something is outright wrong???

So thanks for sticking it out with me, diabetes blogosphere. Follow me on FaceBook and Twitter to stay updated, and to be made privy to my ‘Betes Bia-isms. 2012 has good things in store, no matter what that Dr tells me; tomorrow…I’m just glad you’re along for the ride with me…

Peace, Love, ‘Betes,
Nurse Kelley

PS. Stay tuned as the blog itself is undergoing a few “growing pains” itself!! Gunna look faboo!!