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!