Taking diabetes by storm: Hurricane Harvey 2017

As the one year anniversary of Hurricane Harvey rapidly approaches I am filled with a confetti stream of different emotions that come in waves. Watching the city of my birth fill with water. Seeing the destruction and devastation from Lumberton down to Rockport. Realizing that hundreds of insulin requiring diabetics were now being left in predicaments where their physician offices, pharmacies and local ERs were shut down and without power or filled with water. And knowing that if I didn’t help these people, some....many, would die.

Not long after landfall, the social media posts and texts were already being sent my way. Children and young adults away from their insulin and pump supplies, or entire coolers of insulin being exposed to the brutal Texas heat and humidity, now rendered useless. I began stockpiling insulin and supplies at my home in The Woodlands, a township located 20 miles northwest of downtown Houston. I took items from my clinic and accepted donations from local type 1 families.

I began posting on social media asking for more donations to be utilized in the community, even though I was subscribing to the “no plan, plan”. It wasn’t long before I joined forces with a man that is well recognized by many type 1s, Dr. Stephen Ponder, a pediatric endocrinologist, fellow Aggie and type 1, based in Temple, TX, which is 3 hours North and West of Houston. We both had our spidey senses activated, and knew we were being called to action.

It was also around this time that I was contacted by a representative for both the ADA and AADE in the Houston area, for those not in the know, that’s the American Diabetes Association and American Association of Diabetes Educators. I was asked to promise not to hand out insulin or pump supplies, as this could go against my nursing scope of practice without a current prescription or physician orders to go off of. I was asked to only supply meters and education for using glucose meters when asked to help. As though persons that have gone without insulin for days are concerned with learning how to “properly” use a brand new meter. As though the thousands of people that filled the city shelters wanted me to sashay in there to teach the diabetics how to use meters. It would have been like using a spray bottle of water to put out a bonfire. I frankly was angered and annoyed that I was even asked to ignore such a large call to action by the community. I was sharply warned and reminded that FEMA and the Red Cross had emergent medical needs covered and that it wasn’t my concern.

Later, we would find out that the initial shipment of insulin from Red Cross and supplies from FEMA didn’t arrive until day 9 post landfall. Would you or your child survive 9 days without insulin? I know I wouldn’t. There were pharmacies and clinics and physician offices that stayed closed either permanently or the entire 9 days. Shipments from mail order pharmacies and pump companies were significantly delayed, as the area was shut down to incoming mail. Houston was in a medical crisis. Enter: the DOC. The diabetes online community.

Dr. Ponder, myself and a small group of local type 1 advocates joined forces to make up Type One Team Texas: Diabetes Disaster Relief. We organized one of the largest scale social media swarm that our small diabetes community has ever seen. Remember: Type 1 diabetes accounts for less than 5% of all diabetics. We are essentially the unicorns of the diabetes world. So if you know one of us, we likely know 500 others that we are connected to through JDRF social gatherings and online support groups.

Donations of supplies, insulin and money began pouring in to my clinic. From Alaska, Canada, the UK and even Australia. 37 states were represented by donations, and we had items like contact lens solution, and even a DNA paternity test placed in packages. Lancets. Don’t forget the lancets. So. So many. I am now utterly convinced that the entire DOC hoards these tiny daggers for rainy days like Hurricane Harvey, because about 7,897,345 of them ended up on my front porch.

A detailed Excel spread sheet was created by Anne Imber, one of our team’s integral members, and a T1 D-mom. Our intake form was widely distributed, and once specific needs were ascertained, we would package up shipments to go out with our volunteer “runners”. Many would drive 30 min to deliver supplies, such as insulin, meters and pump and CGM sensors, some even as far as 2-3 hours away. We had packages being delivered to National Guard helicopters, Game Warden command centers and the large city shelters set up around Houston, including the George R Brown convention center, Lakewood Church, NRG stadium and complex and the Toyota Center. Texas Children’s hospital system and their satellite hospitals and clinics relied on our insulin supply and extensive inventory of pump and CGM items to begin seeing patients in their diabetes clinics again. Without the huge shipments of insulin delivered by Insulin For Life in Florida, many of these deliveries would not have been possible.

JDRF Houston/Gulf Coast (juvenile diabetes research foundation) did what they could within their legal scope. They spread the word about our cause and pointed lost families in our direction. Every shipment that went out of mine, Anne’s and Michelle Kallensen’s homes was inside of a JDRF donated bag. Thank you, JDRF Houston. Y’all were there when many were not, or refused to be.

The city of Houston as a diabetic community was unprepared for a natural disaster like Harvey. It caught MANY families off guard. We reached dozens of Type 1s as they entered into DKA (diabetic ketoacidosis), after not having had insulin for 24 hours or more. Not having an exit strategy for something like this for either yourself or your child is, simply put, playing with Fire. Had any of you relied on the government (FEMA, ADA, Red Cross), you would not be with us any longer. Be your own advocate. Keep extra insulin on hand. Have multiple exit routes planned, know where gas stations and family members live along the way. Have a cooler designated for the trip that is both sturdy and reliable against the harsh Texas weather. Pack enough supplies for 2 weeks and then double that when evacuating your home. Double bag everything in brand name Ziplocks, as I saw MANY H-E-B and Kroger generic baggies disintegrate during our work. Know what to do if you or your child experiences a low low or a high high during a time where you can’t reach your endocrinologist. Some people had no access to their cell phones, as they were lost in the rising water. Expect the best, prepare for the worst.

And thank you to the COUNTLESS members of the DOC that made Type One Team Texas a reality. We received over $1.5 million in donated supplies and insulin within the two weeks following Harvey’s land fall. The DOC saved lives.

And special thanks to the companies that donated supplies and time:
Insulin For Life
Pump Peelz
GrifGrips
GlucoLift
Dexcom
Insulet OmniPod
Tandem Diabetes
NovoNordisk specialty diabetes division
Lions Club - Temple & Conroe chapters

The countless volunteers, runners and organizers that made our operation a successful one.

Sister/Sister, part 1

When I was diagnosed I vividly remember the pit in my stomach. The feeling that lived there for days. Diabetes. The word just hung in the air. Needles. Blood. Shots. Sugar. Food. Pit. The pit was that sinking feeling you get sometimes, only it remained for some time. I felt as though I were on auto pilot after my diagnosis. Wake up, prick finger, inject, be force fed breakfast, school, snack, school, lunch, school, snack, prick finger, inject, and bed. For awhile my crazy red headed mother would scare the crap out of me and prick my finger at 2am, something I never got used to. My parents were very matter of fact, very confidant, and never shed a tear or acted upset or stressed in front of their 4th grader who had just been dealt a blow of a lifetime. Yet in all this, in these memories following those first few weeks after my diagnosis....I don’t seem to ever remember where my little sister, Emily, was. 5 years my junior, a spark plug sassy pants of a sister, I assure you she was there, BUT WHERE WAS SHE? It’s often made me wonder what it was like for her, being almost 5 years old, and seeing your older sibling come home and having to give herself shots. Seeing your parents dote on her and make special food, what must’ve been going on in her little brain?

Ask our parents and they will surely tell you: if they had birthed my sister first, she would have been an only child. She was the naked baby, running through the house, sticking her fingers in sockets and jumping off of furniture. While I was the one you could set down anywhere, and I would quietly read a book. Emily was the wild child, and I was the book worm that observed everything. Being 5 years apart we had nothing in common. I was blonde haired and blue eyed, Emily dark complected, with big brown eyes and brown hair. As little girls, we might as well have been from different planets.

I used her when I needed to. I remember needing her blood to trick my glucose meter for my appointments with Dr Ponder. She happily complied. I would teach her how to give me insulin shots if I came home too drunk to do it myself. If I threw a big party when our parents left town, I had her serve beers and light cigarettes, making her swear her allegiance and buying her silence with cash and promises of rides to the mall. And then later on she used me. She would come stay with me when I was in college. Where there were no rules or parents or curfews. And this is when our personalities and bond began to grow.

To see us today, you can still see our physical differences. But to hear us, not even my children or our parents can tell us apart. Our mannerisms, humor, gestures and sarcasm are spot on and identical. Even our handwriting is eerily the same. We have worked side by side at diabetes camp, and Emily has cupped her hand over my swollen pregnant belly for entire seasons of Frasier, feeling her nephews move and kick and be assholes inside of me. She was the first one there to hold my sons, besides their father. And to this day, she’s one of only 3 people that can simply look in my direction and say “BRUH! YOURE LOW!”, and bring me a juice box or glucose tabs. She knows to set down the goods and back away, because touching me during a low is a sure fire way to get bit, hit or yelled at.

My sister also sends me snap chats of test strips I leave in her house or driveway. She loaded her car up with $1,000s of dollars worth of diabetes supplies and came running during Hurricane Harvey. She helped me train Diabetes Alert Dogs and puppy raise. It can’t be easy to be the sibling of a type 1, and they get very little recognition, as they are pushed aside and often forgotten. And we’ve absolutely had our differences through the years, called names, thrown things and had a fist fight or two, but she’s handled being a sibling of a type 1 with grace and might. Thank you, Sissy.

Dr Meanie Pants & the sick girl

Being a teenager is hard. Being a teenager with a life long chronic illness is even harder. I was diagnosed at age 9, and was pretty much on auto pilot with my disease management for several years. My parents were always supportive and helpful, taking me to my Endo appointments and making sure my teachers always knew that I was "special" haha. They never let me feel sorry for myself, and were always so matter of fact about my disease, so I mirrored that attitude. I needed no ones pity or to be constantly promised that a cure was "just 5 years away".

Enter the tumultuous teenage years. Puberty, hormones and everything had to have a drama level of at least epic proportions. I began to blossom socially, and loved running around with my friends...and pretending I wasn't chronically ill. I placed my type 1 on the burner at the back of the very back one. I wouldn't test, I'd miss insulin injections and I ate what I wanted, when I wanted, without making adjustments to my regimen. I was always tired, had headaches and dealt with random infections as a result. My mom was frustrated and sad that I was ignoring my health. She would demand to see my meter once a week, and we would fight constantly. At the time I had no idea how much the yo yo that was my blood sugar was affecting my mood.

Every 3 months, like clockwork, we would travel to Temple or Round Rock, TX from our home in Lakeway, to visit Dr. Stephen Ponder. Yes. The Buddha of Sugar Surfing, the Sultan of Sugar, the Deputy of Diabetesville, Ghandi of Glucose and the Colossus of Camp. Dr Ponder and I never saw eye to eye. I was a teen that knew it all and didn't need some adult telling me how things should be in MY life. I dreaded my appointments, because I knew I would be called out for how irresponsible and wreckless I was acting when it came to my diabetes.

Being a woman, and a teenager, I was proficient in the art of deception and talking my way out of things. I would look my parents straight in the eye and tell them I had been checking my sugars, that I was taking my injections, knowing good and well I was not telling the truth. A day or two before my appointments with Dr Ponder I would sit down with my One Touch meter and change the date and time to reflect the last two weeks of data. I would mix my own blood with the alcohol of a wipe, or with control solution, or even recruit my younger sister or friends to offer up a finger poke. When I was finished, I had a work of art: a completed digital log book that my endo's office could now download and review at my visit. The first time I brought in this BS record keeping I got a rush of adrenaline as I watched the nurse connect my meter to the computer, and my heart raced as I heard the results being printed on the printer. When Dr Ponder reviewed the results, he literally sat there scratching his head. Those 4-6 meter readings per day did NOT reflect the average glucose estimated by my HbA1c. He asked if I ever used control solution with my meter, had I allowed it to get too hot or too cold, how old was it and then asked my mother if there was a family history of any hemoglobin or other blood disorders (there wasn't). I left that appointment with instructions to increase my long acting (Humulin Ultralente) at bed time, and to set my alarm to intermittently check middle of the night blood sugars. SUCCESS! I had fooled the Dr and his staff. Or so I thought.....

At my next visit I strolled in there thinking I was hot stuff. No adrenaline rush, no heart racing, just the confidence that this visit would go as my last one had, and that I would sit there and say yes sir, no sir and I don't know sir, shrug my shoulders and leave. Dr Ponder had a different plan. Little known to me, I was not the first, nor was I the last, patient that had fudged their records. He walked in, sat down and this time looked at me over his glasses and asked how many times per day I was checking my blood sugar: I shrugged and said I'm not sure, maybe 4 times a day or more? He paused and gave me a "mmmmm hmmmmmmm". He then excused himself and said he would return momentarily. He walked back into the exam room with several resident pediatric physicians behind him. He introduced them to my Mother and I. Then he reached out and grabbed my hand, closely studying each finger and my forearms. He cleared his throat and said "Well, these fingers sure are smooth and non calloused for someone that's claiming to test as often as you do......", GULLLLP. "So how about you explain to these doctors and myself exactly how you managed to trick the meter". I looked at him, to the doctors and then darted my eyes to the floor. I said nothing at first while I processed being busted. I then carefully explained what I had done. Painstakingly taking the time and effort and several hours to put together this fairytale logbook within my meter.

I was ashamed and angry. Angry at the world, myself and Dr Ponder. How DARE he. What the hell did this guy know?? Before I left this visit he very carefully explained that I was to send in blood glucose logs, real ones, every two weeks until I saw him again. And should I miss a deadline for sending them, I was out. Finnito. Doneski. So being the difficult teenager I was, I took it as a challenge and said YESSIR!
But there was nothing challenging about NOT changing my destructive behavior. About 6 weeks later my parents received a certified letter in the mail. With a return address of Temple, TX. It was a letter dissolving the physician/patient relationship between Dr Ponder and myself for not sending in my glucose logs. My parents were crushed, I believe I muttered some curse words....and then went about my day.

With Dr Ponder far from my mind, I continued forward with my Sophmore year of highschool. Struggling because I was always sick. So sick, that one morning, close to my 16th birthday, I woke up to vomiting and nausea. An aching headache and weakness accompanied what my parents thought was a stomach bug or food poisoning. My parents quickly made an appointment to see our family physician. As my mid morning work-in appointment approached I began feeling worse and worse. Once the medical assistant called me back to the exam room I was even dizzier and felt like my thoughts were sluggish. It felt as though my feet weighed 500lbs each, as I struggled to follow her to the room on the left. As she showed me in and began to close the door I dropped to me knees and vomited into the trash can. I still remember seeing dots everywhere. I pulled myself up onto the exam table, and tried to call out for someone. My father was in the waiting room, and the nursing staff seemed a million miles away. I stumbled to the door and poked my head out and then the lights all went out. Blackness occurred. Dark, fluid dreams, spattered with bright lights and loud noises floated in and out of my brain. I would hear voices, muffled, as though they were in another room.
According to Dr Butts (yes, that was his name) and my dad, once I opened the door I said "excuse me...." and then collapsed onto the floor. The Dr and my father and a nurse attempted to wake me up. Dr Butts quickly smelled the acetone on my fruity breath and a nurse couldn't get my blood sugar to register on the office meter. Where we lived, 20 miles West of downtown Austin, had no hospitals at the time. Dr Butts had the nurse wheel me To my Dad's Ford Explorer, and I was laid in the back seat. They said my dad would have me to the nearest ER far quicker than an ambulance would. I remember none of this. Dr Butts called the emergency room physician on duty at St David's south and briefed him on my condition. Apparently a stretcher awaited my unconscious self as I was floppy and unable to follow instructions. Once wheeled into a room a brief history was taken and the Drs and nurses went to work. Putting me in a gown, drawing blood, initiating IV fluids and securing ECG leads to my chest and stomach. My heart rate was elevated, my blood pressure was extremely low, and my blood glucose was 680mg/dL. A respiratory therapist arrived with a male nurse to draw my arterial blood gases. And at this point, I awoke. I cursed the men for clutching my arm and wrist so hard. I called them names that would make a sailor blush. I bucked and cursed and I'm sure I was quite lovely in my disheveled state, hair half sticky with drying vomit and eyes ablaze.
The results soon confirmed what everyone suspected: I was in full blown Diabetic Ketoacidosis. I also had a UTI, presenting with a fever and bloody urine. I was admitted to the ICU and placed on an insulin drip, IV antibiotics and monitored with every 4-6 hour blood draws to monitor my glucose levels and anion gap status. The following day, the chief resident for whichever program service had the pleasure of seeing me, stood in the doorway of the small, private ICU room. It was a sunny day and the skies were blue. Austin, TX was a beautiful place to grow up, and exquisite that day. I watched the birds and the people, walking by, parking their cars in the hospital visitors lot. That's when I heard the number. "16...do you hear me? Your hemoglobin A1c came back at 16%...how did this happen? Don't you have an endocrinologist??"....and that's when I laughed and said he didn't care about me.

For many years I believed that. I blamed Dr Ponder for my behaviors. For my week long hospitalization and illness. He was my diabetes scapegoat until one day I decided I was sick of feeling sick. I was leaving for college soon and had to be well, both for myself and for my family. It was as soon as the excess glucose began to dissipate from my teenage brain that I fully began to see the MANY errors in my ways. Dr Ponder was never to blame. He was merely the only one to call me on my bull crap and challenge me. Which made me furious. I can't imagine the level of fun I must've been to treat with an average glucose of 500+ all of the time.

As I made my way through college and then nursing school, I began meeting persons affected by diabetes. Complications and illnesses, disabilities and handicaps. All from uncontrolled diabetes. And the doctors and nurses on the floor would pity these patients. Pity their situation and state of health. It was then I decided I would NEVER be that patient. I wouldn't be the girl in the ICU bed or Dr Ponder's office being pitied or thought less of. I would take ahold of my disease and own every inch. And that I did. At each Endo visit my A1c would register lower and lower. And this is when I decided I wanted to be a diabetes nurse educator.

Working in an endocrine clinic as a type 1 gave me a world of advantages. Patients saw
My experiences as the best "street cred" in the world. I applied one summer to be a nurse at Texas Lions Camp in Kerrvile for children with diabetes. It was the very place I had given my first insulin injection, the summer after my diagnosis. I met dozens of other girls that were also type 1. I was sent a "Welcome" packet and given a packing list. I diligently packed my SUV up, kissed my son, and headed West. The first day on campgrounds are for new Medical Staff to review policies and procedures. We were also welcomed by the camp's medical director, who introduced himself and gave us a background of the camp and the diabetes program. At the first break I walked up to the medical director, who was wearing a hat with a fake chicken on top, and I shook his hand. I said "Hello, my name is Kelley Champ Crumpler, and many years ago....."
He warmly smiled, his brown skin already golden from the summer sun, and said "I do remember you! There aren't many patients that get fired..so I remember you all!..."

And that, my friends, is how a grudge against a World famous pediatric endocrinologist can inspire you to lead a life of serving others with Type 1 diabetes. Diabetes is my ministry, and helping others is my blessing.

Thank you, Dr Ponder. Thank you.

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.

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! 

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. 

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!

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??

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!

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.

That time I went into kidney failure....

Recently I became fed up. I've gained this weight from having kids, being lazy and my RA medications...and it just sucks. So I wanted to try something both fun and challenging. I'm sure many of you have heard of CrossFit, as had I. A legit CrossFit gym had recently opened near mi casa...so I decided to try it out! The first week was free, so I had nothing to lose. Or so I thought.... {dum dum DUMMMMMMM}

My first workout was on a Monday. The prescribed workout was 100 pull ups, 100 push ups, 100 squats and 100 sit ups. Well, there was no way in HELL that MY body was going to be able to do THAT on my first day, so we modified the workout {WOD: Angie...for those of you in the know}. I ended up doing 35 of each, and although I was drenched in sweat and stringing curse words together like a sailor, I got through it all. Pre-workout BG: 94 mg/dL, post: 86 mg/dL, and I removed my pump during the actual workout, and drank water before, during and after. I dropped low later that night, which I promptly over treated with juice and then almond butter & honey...jussssst to make sure I didn't die. As soon as I came home from the gym I was immediately sore in all of the muscles I had just abused. Triceps, abs, quads...all were killing me. I upped my hydration, hit the Magnesium & L-glutamine...and a little Advil so I didn't feel like I was dying. Trainers told me to def come back the following day, that working out again would help with the soreness. Sure, ok...seemed legit..plus I loved the community feel of the gym and workouts, and how positive everyone was. Crossfit was also super appealing to me because of the connection with the Paleo diet, which Dr. C and I have dabbled with and prescribed in our clinic for the past year or so.

2nd day work out consisted of weights...jerks, lifts..and I did some modifications with a 35lb kettle bell. Again, not easy, but I never felt like I was over doing it. BG stayed ~90 again, and I also hydrated. Next day I felt pretty sore, but pushed through and did a run. Which I completed. Again with good sugars and {what I thought was} adequate hydration.

Thursday I took totally off. I was sore. I had also noticed that I was UP 10 lbs since Monday. That was a bit unnerving. I had puffiness around my eyes, in my fingers, my tummy and my ankles. Hmmmmmm. So I reached out to FaceBook....which warned me of a certain condition that I was familiar with because of my nursing background. But, again, STILL didn't feel bad...was still ok in my eyes. My sports medicine Dr suggested getting some blood work done when I came in the following day to see patients in my practice. So I did. About an hour later I get a call from the hospital's stat lab informing me that my muscle breakdown level, a "CK" or "CPK" level, was more than their machine could measure...and that they would be sending my blood to another hospital. Hmmmph. My liver enzymes were also more than quadruple what they normally are, and my creatinine {blood kidney test} was double what it normally runs. SHIT. At this point I'm getting upset. My triceps and quads had also begun to abnormally swell, and my skin in those areas became super tight. FML. Dr. C called over to the hospital, and at that point their machine was also having difficulty running my CK level, but they were guessing it was around 20,000. Ruh Roh. Normal is 60-400.

So by now, Dr. C and I have consulted with my sports med Dr {Hey, Dr. D!!! Love ya!} and an internal medicine doc in our practice. Both were recommending a trip to the hospital for IV fluids. Dr. Google was scaring the crap out of me. When you hear things like "renal failure" and you've had diabetes for 20+ years, you tend to get nervous. So I drove myself to the hospital, Dr. C followed....I turned up the music, LOUD...and cried, because I was scared, y'all.

I get into the ER and my blood pressure is abnormally high. Hmmmph. And my weight is up 15 lbs from Monday {it's now only Friday}...ERMAHGAWD. I get shown to a room, and a physician looks over my blood work. I started hearing things like "acute renal failure" and "rhabdomyolysis". At this point I'm sobbing, and feeling like I'm going to faint. I was given no choice in the matter, I was being admitted to the hospital for intensive IV fluid management and monitoring. WHOA. Seriously, I've been in the hospital for baby-having stuff and for DKA when I was 16. I used to work in a hospital. I KNOW what goes on there, I KNOW how sick the patients can be. I was fuh-rrreaking.

Fast forward. 4 days of intensive IV fluids. Peeing gallons of water and protein out almost hourly. My CK level at admission was around 25,000, and that indicated that my muscles were swelling and dying, and as they are breaking down, releasing proteins. These proteins then are being caught up by the filters in my kidneys, which overloaded them. The ER doc said to think of my kidneys like a swimming pool after a super crazy summer party: my pool filter is now clogged with hair and the pool is getting murky. Uhhhhhhhhhh.
Thankfully I have zero kidney involvement when it comes to my type 1 diabetes. My kidneys took it all in stride and immediately began to improve and heal. I was told I wasn't allowed to leave until my CK levels came down to below 1,000...remember, normal is 60-400. On Monday, my level came back at 4,300...and I whined and complained enough that I was allowed to come home and rest for a few days before returning to work. I was also told no exercise for 1-2 weeks. Y'all. This shit was craaaaaay craaaaay, and I NEVER EVEN FELT THAT BAD.

Dealing with my diabetes in the hospital was easy. After the Dr on call "placed" me on a "sliding scale" with "regular insulin", I informed all Drs that NO ONE was to even THINK about the management of my sugars, insulin or diet. Do you think that stopped them from ordering a "diabetic diet"? Or prescribing bed time snacks of sugar free pudding and cheese to "prevent hypoglycemia"? Bless it. That's all I have to say. My highest sugar there was 136 mg/dL. Funny how basal/bolus Novolog with carb counting works. Like a Champ. Pffffffft.

So now I'm home. Feeling a bit weak, having muscle cramps, and still spending hours of my day peeing. I gained a total of 18 lbs in 7 days from the fluids and swelling. Mofo 18 pounds. My face is round and puffy and I look 5 months preggo. I'm ready for this to be over!

I have spoken with the gym owners and trainers at great length. They have been awesome, and have a prescribed plan just for me, catered to my delicate, flower like self. I am in no way blaming them for what happened, as it was just a random ass shit storm that occurred in my body. I'm also not afraid to work out again. I'm sad that I have to take so much time off, but alas, my body has to heal!

I was also under the assumption that marathon runners, persons taking cholesterol lowering medications and those that experience crush injuries were the ones that were diagnosed with rhabdo. It never occurred to me that I was at risk. Going from my un-gym like status, under hydrated and working out at 5:30 in the hot as Texas heat...I set myself up for the perfect storm of bodily dysfunction.

So now, here I am...a few days after discharge. And I still feel like ass. My muscles are cramping, I'm tired and have only peed off 4-5 lbs of that fluid. My arms and legs are still
a little swollen, so I am hoping all of this will improve in days to come.

How do you prevent rhabdomyolysis? First of all, again, my diabetes status had zero to do with it. It was more like, hey...you haven't lifted weights in 3 years? How about you take it easy instead of going all Chuck Norris style.
-immediate muscle soreness after a workout
-increasing muscle weakness
-fatigue
-red, rust or tea colored pee {I never had this} {you're welcome}
-muscle swelling
-new workout routine you're not accustomed to....and you just ADR {ain't doin right}
-generalized edema
I was lucky I had peeps to ask what the fudge to do. I could have easily ignored my symptoms and blown them off...then done some major ass damage to my kidneys. That ain't cool. So, being an educator, I'm sharing my story with my public. In hopes that you share it with yours. {as in DO IT, or I will beat you}.

Thanks for all of the love, support, thoughts, prayers, food, texts and emails...I'm a blessed lady!

Time!!!

The 'Betes, 101 {Guest Post}

Hey, party people...please welcome my guest poster, none-other than the super famous {well, at least in the DOC} D-Dad with DADs: Frank Wisenski, who blogs over at Blackdogsrule.com
. Please welcome him with sugary, bitchy love!!!

Hi everybody! Welcome to diabetes 101, day 1. Today's topic? Things that can affect blood sugar in a 10 year old girl, that makes managing diabetes so tough, and prevents us from knowing "normal", or having our diabetes (or our children's diabetes) "in control"

1. Food
2. no food
3. drinks
4. exercise
5. no exercise
6. math tests
7. pop quizzes
8. your best friend just got a new "insert cool thing here"
9. cleaning your room
10. horseback riding
11. hormones
12. growing
13. heat
14. cold
15. puppies
16. mom and dad miscalculating carb counts
17. miscalculated carb counts printed on food packaging
18. waking up in the morning
19. not wanting to go to bed at night
20. butterflies
21. going to Costco
22. excitement
23. Disneyland
24. anything school related
25. little brothers
26. when dad says "have you finished your homework?"
27. not washing hands
28. eating more than 1 "free" snack
29. Thursdays
30. playing outside
31. playing inside
32. not playing outside
33. rainy days
34. sunny days
35. Mondays
36. hot showers
37. pizza
38. bananas
39. blue shirts
40. birthday presents
41. Halloween candy
42. going to Nana's house
43. walking down the hall
44. reading a book
45. orange socks
46. car rides
47. crying
48. eating the same lunch today as yesterday
49. laughing
50. kittens
51. breathing
52. stopping to smell the roses
53. Computer games
54. Sunsets

You see, here's the funny thing about diabetes. EVERYTHING can affect blood sugar. Or it won't. Maybe it will. It did last Tuesday. Today? Nope.

They say the definition of insanity is doing the same thing over and over and expecting different results.

The thing about type 1 diabetes that drives us insane? It's doing the same thing over and over and GETTING those different results


Comment below and keep the list going! What affects YOUR sugar????

.

..

Gotta have faith

Faith....in humanity...and in the general public has been challenged here as of late. The tragedies that have transpired over the last week have been heart breaking and gut wrenching, completely senseless and make me ache for those so closely affected.

The trust I have in the public has also been challenged in a "people of Walmart" kind of way, too. My new gig as a clinical trainer for a diabetes alert dog service organization has put me somewhat in the spotlight in my small community. Having a gorgeous dog or puppy, in a vest, as my constant companion has invited some interesting interactions while visiting different establishments.
"Is that your seeing eye dog???" As I'm holding my latte, a new bathing suit and bottle of vitamins at Target.
"Is your DOG diabetic!?" Yep, he also wears a tiny insulin pump.
"If I pet your dog, will it bite me??" Indeed, that's why I brought him here.
"Why can't your dog tell me if I have diabetes?" I'm pretty sure that giant Big Red you're drinking with your gut hanging out tells me you have diabetes.
"Paying that much for a service dog is why our country is in a financial crisis" -_-

Don't get me wrong, any opportunity I have to educate people about diabetes alert dogs is a good thing. But please just consider asking generalized questions.....instead of jumping to conclusions and saying asinine things that in no way make sense, or that possibly offend others.
It very much goes along with the stupid shit that people say about type 1:
"Did your mom feed you too much candy as a kid?"
"You/your kid will grow out of that, right??"
"My grandmother had diabetes, and had her leg cut off, and then she died a horrible death..." {thanks for your story of hope and encouragement, asshat}
"My 17 year old cat has diabetes....you should look at the diet plan I have her on"
"You know...if you ate more kale and came to see my chiropractor, you could totally get off of insulin all together" {yeahhhhh, my chiropractor is definitely on the forefront of type 1 diabetes cure treatments...right, Karly???}
The list goes on and on, and I know each and every one of you has anecdotes of your own. It is ALWAYS my first instinct to be an asshole to these people, but then I take a deep breath, bite down on that Xanax I was hiding in my cheek, and know that God wants me to use my powers for GOOD. Educate. Tell them you're less than 5% of the diabetic population. Tell them that nothing will get you off of insulin, short of a transplant. And tell them that while you're super sorry about their grandmother/cat/aunt/rotted off toe, that you're doing great and hope for a better, healthier future.

Please approach me if I have a dog. I'd love to share the good word of DADs and their super powers. Ask thoughtful questions, rub their chin and admire their awesoemness. Just don't say idiotic things, or I will straight up call you out on my blog!
Ahhhhhh, the power of social media.

Please feel free to share YOUR unfortunate diabetical interactions, below...we all need a good laugh.

Life sentence

Being diagnosed with a chronic disease can be devastating. Whether you're a toddler, tween, teen or almost adult, it can rock your world. Knowing the statistics. Listening to the news, the billions of dollars spent on others with your same disease state. Constantly being screened for potential complications and issues. Having your feet stripped down and examined by the Dr...I think it's just plain humiliating. I mean, sometimes I just can't make it to get a dang pedicure, mmmmk, doc!?

But what happens when you're faced with yet ANOTHER diagnosis. Another blood test that rocks your entire existence. Being told you must take yet another life saving medication just to function daily. Sometimes it's almost too much to bare. But wait...oh wait...life isn't finished with you. Your immune system is in a full on revolt, and launches a destructive war against yet one more bodily system. Why is this happening? Why did I get chosen to bare the burden of this auto-immune hell???

Truth is, once you're diagnosed with one autoimmune disease, you're very much predisposed to others. It's like a genetic lottery. Will your number be picked? And again? What about one more time? Disease grouping is common when we look at autoimmune diagnoses. Crappy part is, all of these disease states are relatively rare, and barely measure as a blip on the public health radar. There are multiple specialists associated with each diagnosis, which means more cash spent on copays, medications and treatments. T1 diabetes has brought most of us here, but how many of you also share your life with an additional AI disease? Rheumatoid Arthritis, Lupus, Hashimoto's Thyroiditis, Graves' Disease, Addison's, Vitiligo, Celiac Disease, Crohn's, Ulcerative Colitis....and these are just the more common.

I personally struggle with my hand basket of random autoimmune issues. Type 1 since the age of 9, Hashimoto's not long after the birth of my first son, Celiac Disease not too far behind that one, and the suckiest by FAR: a rare hybrid of Rheumatoid Arthritis and Ankylosing Spondylitis. I struggle with anti-inflammatories and immunosuppressants trying to treat the pain while also attempting to slow down the damage being done to my body. It ain't fun.

Some days are easier than others. But something as simple as a cold my kids brings home can send me to the hospital..where they want to shoot me full of steroids..which affects my 'betes. So, I feel like this delicate juggling act can disrupt with the tiniest of interferences. There are days I can barely get out of bed, or nights that I sleep for 12 hours straight. It has affected my ability to be the kind of mother to my sons that I wish I could be. That guilt then manifests into a crippling fear that I have passed along my crappy genes to these guys. Yeah he got my amazing dimples and winning personality, but will he also have to face these struggles and burdens as I have? It takes my breath away at times. The only thing that helps is to sneak my fingers to interlace with theirs while they sleep. And listen to their breathing, and know that I am not in control of these things, and all I can do is take this life one day at a time. The advances made in medicine over the last 20 years have been amazing, and I so look forward to what the future holds for me, my husband, my kick ass kids and my patients.

Know the signs and symptoms of other autoimmune disorders. Early detection and treatment is key, just like with T1. We, at the endo's office, routinely screen you for many of the common issues...you may not even realize it. And if you find yourself a sudden collector of suckage, much like myself, seek out the love and support of others! My life and health have been enriched by the thought and care of my husband, friends and family. They can't understand what I'm going through, but they sure know how to make me laugh and which foods make me poop my pants and which aggravate my joint pain. I am beyond a lucky girl.

This week I celebrate my 30th year on this planet, and I am enriched and humbled by all of you, so thank you for your kind words, support and accolades. Being here, now, is pretty damn awesome.

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.