Let's kick some pancreASS!!!

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

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

Not-So-Fertile-Myrtle

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

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

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

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

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

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

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

Love, Nurse Kelley

Friends in low places....

I'm popular. I have lots of friends. Well, sort of. I have lots of FaceBook friends, but only see about 50 of them in any given year. I do, however, have a handful of close friends that I cherish deeply. Most are evil bitches, such as myself, with sick senses of humor and husbands that run the other way when we are all together. To me, my diabetes is an after thought. To some of them, its something unknown and scary at times. This, I find fascinating.
My bestest friend (lovingly referred to as my Nestor) and I attended nursing school together. So she has a medical background, and a pretty decent grasp on the whole 'betes thing. She's tested my sugar and administered insulin while I was in drunken stupors, she makes fun of me when my pump tubing gets hung up on things, and she feeds me when I'm low. It ain't no thang to her.
On another front, I have a newish friend, one whom I get along with like she was my and the Nestor's long lost triplet (scary, huh?). She has a medical-like background, but no experience with the 'betes, other than drawing labs on patients that require testing. I have been very surprised at the level of discomfort I have placed her in when describing a glucose of 32 mg/dL...or 500 mg/dL (I had a bad pump site, NO judging).
I'm an educator...eradicating diabetic ignorance is my thang...so why do I find educating my new friends about my chronic disease so awkward?? Do I sit her ass down and give her "Diabetes 101"? Do I print out info from JDRF? Or do I let her wing it, and learn as we go?? WhyTF am I struggling with this? And how do I assure her that my almost 20 years of experience as a diabetic is legit, and she doesn't have to call Dr. C when I look like I'm about to fall over or puke?
I laugh, because SO many people are diabetically naive, and some of the things that people believe to be true, are total CRAP! Just yesterday, Dr. C and I celebrated the fact that we haven't assassinated one another all week (I've been working as his nurse) with a jumbo cupcake. ANOTHER Dr in our practice passive-aggressively berated us! Said there was something "wrong" with 2 insulin pumpers eating cupcakes, and that it didn't exactly set the right example. I almost flew across the counter. UMMMM oh yeah??? Well my MoFo cupcake was good, and I'll eat another one in front of you, just because I can (please make it red velvet, this time)!!!! But then I get annoyed that my new friend brings me a peach bellini mix with 8,000 carbs in it. How DO I set the right example? How DO I reach this happy medium??
SURE!! I can eat cake and drink alcohol, but No, no thanks...that sushi roll makes my sugar spike so I can't eat it...oh, and that bellini mix, no way...I'll go sky high. Am I making this up as I go along? Does anyone else do this???

Maybe we need to set up a "New Friend Orientation 101 Basics, Version 1.1" for all new peeps in our life? Heck if I know. But if so, I'll bring the cake and margaritas!

Love,
a confuzzled Nurse Kelley

PS. Dr. C just told me I looked "off"...well maybe because my sugar is 49...so YES, I just wrote this ENTIRE post under the influence of hypoglycemia...Yeah, I kind of rock like that.

The sick of it all

So, I'm sick. No, not with diabetes. Diabetes is just that little thing in my life that has given me everything I love in my life. I'm actually sick, with something that does not want to live in my stomach, apparently. RUDE.
So enough about my ass and vom problems. It has just made me think about a little thing us edumacators like to call "sick day management". My sugs have been elevated, I've had ketones...and not really wanted to eat much. At least it's not the herpilie erpolies. Still not fun. I've been hydrating and cranking up the temp basal, and sipping some Vitamin Water Pure, low carb, but has electrolytes and vitamins, and isn't too sweet. Golden Pineapple is my flava fave! In fact, you should buy me a case and send it to me, it's the least you could do.
Are you up on your latest sick day plan? Parents, do you have pedialite, Gatorade, ketone strips? Having these things (and knowing where to find them) could save you a trip to the ER for ketosis. For habitual vommers, I will even give them an Rx for Phenergan suppositories (as in, insert per rectum) to have on hand, and several patients have said they are literally life savers (no, not the candy...the rectum invaders...well, I guess we COULD call em rectum candy...but I digress).
Also, keeping your Endo or educator in the loop is a good idea. I had a mom, cool, calm and collected, shoot me a text about what was going on with her daughter this weekend.....that way I was aware and could intervene if needed. Your endo's office may have a nugget of info that is down right helpful in the event of an illness.
If you aren't familiar with any of what this post is referring to, make it your priority to speak with your Endo and/or educator about it at tour next visit.
Happy hump day!

Peace, love & 'betes, 
Kelley

(PS. I may, or may not, have written this in the bathroom on my iPhone)

Eat Me

Soooo my Book em, Danno post about telling people to shove off in regards to a T1's diet was quite popular. It has also raised some questions and concerns.

Why do we get, essentially, punished for lowering the sugar content in our diet? For instance, say Momma wants a Sno-Cone, why am I charged more for the sugar free variety? So I did a little research. A pint of Bahama Mama syrup (sweetened with sugar) is $6.25, the sugar free variety is $8.25. BULL shit. So my fat ass saves money...for continuing to be fat?? This blows my mind.

Also goes a long with the sweet vs. un-sweet tea. "Unsweetened" implies that a special un-sweetening process has been applied to previously tea sweetened with sugar....no? In the last year, suddenly, I'm served mother effing SWEET-enough carbs to equal TWO pieces of white bread-FUPA causing-TEA. Why is this??? Is America not fat enough??? And some are excusing it as "ohhh hwellll, we are jusssst Souttthherrrrn...", oh yeah? Because 50 years ago we weren't diagnosing type 2 diabetes in tweens and teenagers. So when you are out, with your grossly overweight family, please refrain from ordering your children SWEET tea. Water or milk should suffice...and will wash down those chimichangas just fine.

And DON't get me started on High Fructose Corn Syrup!! Arrrrghhhh!!!

PSA: All diet drinks ARE sugar & carb free, Caffeine free varieties ARE NOT sugar free...why is this so confusing?

WHEW...ok...I should breathe...haha Rant: OVER.

Peace, Love & Diabetes,
Nurse Kelley

Its all fun and games...until somebody gets eaten

So this post is going to address a very serious subject affecting diabetics EVERYWHERE. What is so serious and requires your utmost attention?? Yes. Zombie Apocalypse. Yes, I went there. I'm adressing it. Here and now...finally. Well....sort of.

This summer I have had a high number of insulin pumps malfunction. Mainly Medtronic Revel's and OmniPod pods. The companies don't feel like adressing my concerns, so I guess I will blame it on the heat (I'm in Texas...we've had several weeks in a row of >100 degree heat!! You should visit). Anyshit, I have been inundated with patients having to call the helplines and request new pumps, pods or PDMs. And it is SHOCKING how many of them (95% if my genius ass had to guess) that have NO idea what their settings are. Or have a backup plan. Or even know what to do! C'mon, guys.

1. We went over it in your pump training & follow ups
2. You have RXs for long acting insulin
3. What would you do if you didn't have your educator's cell phone number and could test her anytime of day or night????

Emergency preparedness is a real thang, ya'll. Hurricanes Katrina and Rita was proof of that. Our area was filled with our coastal neighbors, and many of them had been without diabetes medications, testing supplies or pump supplies in days. We donated what we could, but it was shocking how many of these refugees had no idea 1. What medications they were taking, let alone the dose 2. That without these medications, their sugars would run amok 3. That you can't reuse ONE pump site...indefinitely. Some sad shat, yo.

I challenge you, as diabetics, and parents of diabetics, to make sure you have an emergency kit, including all of your pump settings, supplies, and contact information for your healthcare provider, inside. Have it in a central location, that is easy to find, in case of an actual disaster.

Crap happens, and I understand that. Dr. C and I were attending the 2009 Scientific Sessions of the ADA in New Orleans, and discovered we had BOTH run out of Novolog, AND had not packed enough pump supplies. Oops. Good thing there was 1,000 reps i attendance, as well, to bail us out!!!

Try not to have nightmares...and be prepared.
Peace, Love & 'betes, ya'll.

Book 'em, Danno

Sooooo, one day last week I was standing at a counter in my office (that we share with 5 internal medicine docs), and it was early, clinic had just opened. Often times, in lieu of coffee, I will have a diet something-or-another. This morning I was enjoying a Cherry Coke Zero. Now, in efforts to liken it to regular Coke, I think Coca-Cola has changed the print on the can to look more like the "leaded" variety. I was visiting with my administrative assistant when one of the docs walks up and clears his throat, I look up, and then he nods at my can and says "Ummmm, should you be drinking that??", to which I point out the "Zero", and he replies, "Oh..Ok...just checking". WHAT THE FRENCH-TOAST. So what?! What if I HAD been drinking a "regular" Cherry Coke?? I have type ONE diabetes, its my right to eat whatever the flip I want...when I want...and for you to MIND YOUR OWN BUCKING FUISNESS!!!!

Nothing enrages me more than to be given a blanketed opinion regarding my diabetes. Type 1s account for less than 10% of the diabetic population, almost all publications and media releases are targeted for the other 90+%...TYPE 2s. THEY watch their diets, THEY cut out table sugar, THEY take pills....I however, have a gland that doesn't produce ANY insulin, so I do what a pancreas would do: I match my insulin to my carb intake. Does this mean I should be drinking a regualr Coke? Not really...I have enough dimples in my ass. And as most of you know, insulin can, and will, make you fat if you aren't careful. Its my first inclination to become angry, shake my fists and throw things at uneducated people's heads.....when really all they need is a little education.

Hi, My name is Kelley...YES, I can eat that...YES, I took my insulin....YES, my doctor knows about it...and YES, I would like to punch you in the thyroid. I don't need the Food polic, or the blood sugar police....that's what Dr. C is for...he is my endo, and I try to discuss my food and sugar issues with HIM, and him only. Would you walk up to an obese person and ask them if they should be eating that donut? Or a hypertensive patient and ask them if they should be eating that soup? UM no. So why is it that people feel so entitled to call out diabetics? Its mind baffling.

So, sports fans, how do you deal with the food/diabetes/blood sugar police? I'm looking forward to reading these responses!!!