The one about my big toe....

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

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

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

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

Hellions, Heathens & Hyperglycemia

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

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

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

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

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

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

Tick Tock ya Don't Stop...

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

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

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

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

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

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

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

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

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

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

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

Hit me with your best shot

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

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

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

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

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

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

Bag lady

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

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

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


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

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

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

That's all I got, D peeps!!

You are loved...sort of

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

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

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

Love,
Your autoimmunly challenged friend

Mommie Dearest

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