A Type 1 Diabetic's Health Kick

A Meme!

2010-09-12T11:07:00.002-04:00

Feeling a little crap from an overnight basal test of basals that I artifically dropped super low, so instead of a real post, I give you: a meme!

What type of diabetes do you have: Type 1

 When were you diagnosed: January 26, 1997   

What's your current blood sugar: CGM says 176, but probably a bit lower; the Dexcom has been running higher than reality over the last 24 hours, and my BG dropping fast from the heights to which it soared during my overnight basal test.   

What kind of meter do you use: Right now the Omnipod thing, because I'm participating in a study, but once I run out of free freestyle strips I'll be back to the OneTouch Ping.

  How many times a day do you test your blood sugar: 8 ish? Less lately because I have a Dexcom in pretty much continuously.    Depends on the day.

What's a "high" number for you: I pretend to myself that "high" is over 180, but really it's over 200.

 What's do you consider "low": Under 70.   

What's your favorite low blood sugar reaction treater: Tootsie rolls. 5 g carb per roll, hella cheap, available in bulk, resilient to being stored in unfortunate conditions (...in the bottom of my backpack) for long periods of time, and I hate them so I'm not liable to eat them when I'm not low. My ex hated them too, which was also useful.   

(someone should explain to me the appeal of glucose tabs: THEY ARE SO EXPENSIVE OMG.)

Describe your dream endo: Responsive to phone calls about pharmaceutical refills, accepting of the fact that I know more about my disease than she/he does, but not to the point that he/she offers no advice. Honestly, I have little faith in endos: I'd rather a good CDE any day of the week.   

What's your biggest diabetes achievement: 6.8, for 6 months at least.

 What's your biggest diabetes-related fear: Kidneys, I think, followed by a heart attack, follow by limb loss or chronic pain.   

Who's on your support team: My absolutely phenomenal CDE, friends, officemates, sister, parents, boss (surprisingly), the grad student who is currently studying me for her masters...My Dexcom. Not kidding. And the people at various insurance/pharmaceutical companies/doctor's offices/pharmacies who work to get me the things I need, and paid for, in a reasonable amount of time.

 Do you think there will be a cure in your lifetime: No. On the one hand, the advancement in treatment options over the ~15 years I've had it have been remarkable. On the other hand: no.   

What is a "cure" to you: Immunology to fix the immune system problem, and some sort of encouragement to get the beta cells going again, with minimal side effects.

 The most annoying thing people say to you about your diabetes is: "Oh, my [uncle | relative | neighbor | 1st grade teacher] had that, and he didn't take care of himself at all…[enumerates the numerous unpleasant side effects said unfortunate relation experienced before dying tragically young.]" Thank you. That kind of comment is extremely supportive.

Runner up: "Can you eat/do that?" Wait, what? Oh, I have diabetes? Really?! Wow! THANK GOODNESS YOU TOLD ME BECAUSE I DIDN'T KNOW AND THIS CUPCAKE/STRENUOUS PHYSICAL ACTIVITY WOULD HAVE KILLED ME.

  What is the most common misconception about diabetes: I think the biggest misconceptions apply to Type 2, not as much Type 1. When people figure out the difference between the two, they sometimes suggest some sort of moral virtue on my part, because the kind I have isn't associated with behavior, which drives me crazy; Type 2 is a big, undertreated problem, and the public perception of it can't possibly be helping.

 If you could say one thing to your pancreas, what would it be: I feel bad for the pancreas. It gets a bad rap. It's not really it's fault that the immune system went ape and killed the beta cells. Besides, it's still useful, producing other hormones needed for metabolism. So I would tell it that I'm sorry for all the bad press it receives, and that it's doing a stellar job under the circumstances.

An illustration.

2010-09-11T23:21:00.002-04:00

To follow up on my last post...

While on hormonal birth control (as in, for years, up until last Sunday) I averaged something like 45 units of insulin a day. There was a pretty wide spread there, but I very (very) rarely went below 35 (if sick and not eating, or if eating super duper low carb and also exercising like crazy), or above 55. I hate to make claims without the actual numbers in front of me, but that's roughly accurate, and close enough to make the point.

Today is the first day since I didn't start my new pack of pills last Sunday that I didn't get catastrophically, blindingly (literally) low. I probably ran a little higher than I'd like to, but nothing ridiculous.

I took 28.80 units of insulin. That includes a bolus (2.3 units) I took after midnight for food I ate at 9 pm last night, which shouldn't count. I did not eat low carb by any measure (cereal for breakfast, rice with dinner), though in the interest of full disclosure I had a pretty strenuous (but not entirely out of the ordinary) workout this morning.

I keep rechecking my pump to double check that number because it's so absurd.

And that fairly tidily sums up the current ridiculousness in my life.

Hormonal Birth Control + insulin resistance?

2010-09-09T17:58:00.002-04:00

Question for the female blogging public: have you noticed hormonal birth control affecting your insulin needs? Like, in a dramatic way?

I was on the pill for roughly 10 years. I recently stopped taking it in lieu of other methods of BC (story for another post). I would have started my most recent pack on Sunday.

I have been low ever since.

Day 1: low all day. I figure, well, there are days like that.

Day 2: low all day. Well, there are two-day stretches like that.

We're on day 4, now, and it's more than a trend at this point. I'm looking at the 24-hour window on my Dexcom, and I count 8 times that I've been low enough to treat. EIGHT. That's once every three hours. It gets up above 100 from the tootsie rolls and crashes right back down.

It's bizarre. And the only difference in my life is the pill. I assumed that ending hormones would change my needs a bit, but I figured I'd give it all a month to settle down before redoing all my basal tests. I don't really have that luxury, now, though, because at this rate I'll die before a month is out.

Does anyone else have any experience with this? I'm failing in a google search and getting a lot of info on PCOS, which is not helping.

In which the Omnipod makes me cry.

2010-08-26T12:50:00.002-04:00

As I mentioned, I'm currently trying out the Omnipod for a clinical study at the Diabetes Technology Center at UVA. Free strips (!), free sensors (!!), free pump supplies (!!!), and some money (hooray!) serve as reasonable incentive, and I was looking forward to the chance to try out the Omnipod. If I stick with the study, I even get to keep the PDM (the remote thing you need to program the pod).

Oh, Omnipod. I wish I could like you. I almost love you.

Except that I don't. It's kind of the worst of both worlds because now I know both how much I hate the tubing that comes with traditional pumps and also how much I can't use the Omnipod.

It's not just the IOB thing, although that remains ridiculous (yes, I really have been carrying around my Ping for a month to track IOB). No: I've lost 4 pods in just over a week, 3 to unexpectedly kinked canulas. The kinked canulas are bizarre because one of the things I nominally like about the pods is how easy insertion is. The pod inserts the canula for you, very quickly, and automatically retracts the needle. Given my struggles with the Ping sets, this is nice. But somehow, over the course of three-day wear, something keeps going awry, and I never know how or why until my blood sugar is over 400 for no reason at all. Thank heaven for the CGM, or it would be even worse.

(And when I say over 400, I mean it: both yesterday morning and this morning, I essentially took no insulin for breakfast, as far as I can tell. With the introduction of carb counting into my life, I've been able to eat breakfast cereal again, a vice I'd long since given up. I don't eat it every day, but I'm pleased as punch that I can plow through a bowl of frosted mini-wheats and go no higher than 130; wouldn't you eat it too? But when your pod decides to silently fail to bolus the 12 units of insulin I need for it, well...).

And then today. Today, up near 500, I changed out the inexplicably kinked pod for another. And 1 hour later, the PDM gives me some incomprehensible error, tells me to remove the pod, and call customer service.

I'm not a violent person, and I'm not a crier. I do get a little...excited, sometimes, but I don't throw, hit, punch, whatever. But I freely admit that I threw that thing very hard across my car when it did that.

The error signifies some sort of memory corruption problem, according to the guy on the phone. He had no useful understanding of why I lost the other three, nor anything particularly reassuring to say about the ~300 units of insulin I've lost in all this. There are ways to get insulin back out of the pod, but you always lose some, and you're not supposed to, but somehow today with 150 units in this brand-new pod I had to pull, I completely failed to extract more than 20 or so.

So here I am, busted-ass PDM, tons of lost insulin, sky-high. So I do the sensible thing. No, I do two sensible things:

First, I load up and insert the Ping.

Second, I burst into tears.

Like I said, I'm not a crier. And when I cry, it's very typically frustration, which it sort of was this morning. But it's a sad frustration: sad, because my A1C has been 6.8 for 6 months, for the first time in years, and a week of Way Too High will ruin it; sad, because freedom from tubes is amazing; sad, because 500 makes me more emotional than 50 does, somehow, and this is the second day running I feel crappy; sad, because of the fight I'm going to have to have with my insurance to get an extra bottle of insulin when I run out early this month.

I haven't reset the PDM yet, because I'm waiting to hear back from the study people about what they want me to do. I'm so happy for the Ping right now, I can't even tell you.

I wish the Omnipod were not produced and sold by a bunch of amateurs (seriously, you're not on the medical exemption list for devices on airplanes below 10,000 feet?!), because it's so close to being wonderful.

Instead, it manages to morbidly highlight exactly how much this disease sucks while just failing to make it better.

The OmniPod, or How Much Can We Mess up IOB?

2010-08-04T23:02:00.003-04:00

I'm currently participating in a clinical study with the Diabetes Technology Center at UVA (I tried to find a link to them, but apparently they have no web presence. Wtf?). I've done a trial with them in the past, and I've found it very worthwhile: the pay is great, the free supplies are great, and none of the meeting locations are more than 2 miles from my apartment. Effectively, in practice, they pay me to be diabetic and test my blood sugar and take insulin, which I normally do every day for free, so it's a total win.

I just started week one of the current study, which involves wearing an OmniPod. One of the reasons I was enthusiastic about this study was the opportunity to try the OmniPod risk-free (and get a free PDM at the end!). I was a bit averse to switching paradigms (from tubed to tube-free) so hard without a test run, and the little plastic trial pod that doesn't actually inject insulin was not exactly fitting the bill.

First impression: I liked it. I love the insertion. I have no end of problems with the Ping sets (the same problems I had with the Paradigm angled sets, compounded by crappier insertion mechanisms). This is comfortable. It's big, but not ridiculously so. The size is less of a concern than I thought it would be.

Which is why it breaks my heart that their IOB calculation mechanism is so, so, so royally screwed up that I can never switch over, and am considering dropping out of the study because I'm afraid this thing is going to kill me.

For those who haven't followed the drama (which has been going on for years, and users are still screaming about it): the OmniPod doesn't include insulin taken to cover carbohydrate consumption in tracking insulin on board. It only includes insulin you take to correct a high (and maybe insulin you take for no specified reason? Unclear). The "logic" is that the insulin taken to cover carbohydrates are already used up by the carbohydrate and therefore shouldn't be included in the correction.

This is so confusing it's actually hard to argue with. It actually just makes no sense whatsoever. First, it assumes that both insulin and food hit your system at the same time and disappear at the same time. But they don't: this is part of the reason we'll never really get management as perfect as the undiabetic body, and also, more practically, why post-prandials are such a bitch. Injected insulin doesn't hit the system as quickly as native insulin, which begins to be released when your tongue signals that you're eating. This is why problematic post-prandials can't always be solved just by taking more insulin: I tried this, and I used to get wicked low, after going super high first.

This works best with an example. Let's say I eat a banana. The banana hits my blood stream super-quick. I bolus appropriately for the banana, let's say because I have a scale and I know it has exactly 24 grams of carbs (it's a small banana). If I test 1/2 an hour later, I *guarantee* that my blood sugar will be above 120, or whatever other example of a "perfect" blood sugar you want.

Let's pretend I'm having a good day, and it's 160. Let's pretend I tell this to my OmniPod PDM.

Now remember, I've taken insulin to contend with that banana. It's doing it's thing. Humalog works in my system for about 3-4 hours, so it is getting started. But the OmniPod will tell me to correct as though I have no food in my system and no insulin either. In the end, I will bolus 1-2 units extra for that banana.

And I will end up low.

It makes no sense to do it this way. If we could just ignore the insulin we took for food because it was used up for the food...why are we high? It's like there's some weird extraneous third force in the world besides food and insulin that makes your blood sugar go up. If it's high it's because the food is hitting the blood stream and there either is or is not enough insulin to deal, eventually. Ideally I guess we'd be able to track the degradation of glucose in the system along with the insulin ("carb on board", if you will). But we need to know how much insulin there is in the system to figure it out.

I have had enough problems with catastrophic lows in my life that I refuse to risk more for a system that dogmatically refuses to calculate this properly. This is one of the biggest benefits of pumping over shots, in my book (besides super-fine-tunable basal rates. I love basals!). I bitch and moan about bad software and crappy UI and all the rest, but the one thing -- the one thing -- that is really non-negotiable to me is IOB calculation.

At the moment, I have the Ping totally disconnected, pumping saline, bolusing every time I bolus with the OmniPod, to track IOB properly to make sure I don't kill myself with this thing. I'm going to see if I can stick with it.

This is really, really breaking my heart, because I really like the OmniPod, in so many ways. I've been up and down in and out of bed a few times over the last hour, and every time I get up, I reach for my pump site to disconnect, and every time I come back, I reach for the pump end to reconnect, and realize that I don't have to. It's really....liberating.

If only it weren't so fundamentally broken.

Mystified, in a good way

2010-07-23T10:07:00.002-04:00

Dexcom will replace (free of charge) sensors that fail before day 5??

Color me both surprised and delighted.

Things You Don't Realize When You're 12 and They Tell You It's Forever

2010-07-18T23:36:00.002-04:00

There are things you don't realize when you're 12 and your doctor tells you she thinks you have Type 1 diabetes, and then gets on the phone with your parents' insurance and tells them in no uncertain terms that you need to be transferred to a different hospital, a better hospital, with a pediatric ICU, instead of the regular ICU at the hospital with the ER that you've been sent to. So you're transferred.

And the doctors tell you that you do have Type 1 diabetes, and the next day the nurse says she is going to give you a shot of insulin, which you're going to have to learn to do yourself, and she promises it's not going to hurt, and she's right.

And your new doctor, the pediatric endocrinologist, smiles at you that day and tells you you're looking so much better, and while it's true that you're feeling a little better, when you drag the IV tower with you to the bathroom and look at your own ashen, unrecognizable face in the mirror above the sink, you think "This is me looking better?"

But the hot dog they bring you after that shot that actually didn't hurt is the most delicious meal of your life (that you'll remember as such for the rest of it), because you've actually been starving to death for a month.

Your new doctor also tells you not to worry, you can live with this, this problem that isn't going away, and you can still do just about anything you could have done without it, don't worry. You'll be fine.

And you, being 12, you think about how sick you felt when you went to the doctor, that you thought that you had cancer, and that comparatively diabetes sounds like a relief, because you think of Stacy from The Babysitter's Club, and how she didn't die, and how she was still the coolest babysitter, so it looks like you're not going to die either.

They tell you that it's for the rest of your life, and it's serious, but really, at 12, you just think, OK, they won't let me leave until I give myself a shot, well, pass over that needle, then, I can't sleep here anyway and the food is awful, might as well clear out ASAP, I have a ski trip to go on next week, and so much homework to catch up on...

And you do it. And you set a hospital record for the (short!) length of your stay, relative to the pH of your blood when you were checked in.

And you do go on that ski trip. Because your parents are amazing.

They tell you it's forever, but that you can do it. And you believe them, because you're 12, and you want to.

But there are so many things they don't tell you.

Some of those things are actually pretty good, like the awesomeness of living right near a 24 hour pharmacy. And how when you go to that pharmacy, always after 10:30 pm because it's just so much faster than going during the day because you're the only one there, that after a while the night staff will greet you by name, and they will know how to pronounce your last name properly even though your own freshman year roommates didn't know how for like 8 months.

But some things are not good, even though they're really just stupid, like the fact that brand-name prescriptions will be $30 while generic prescriptions are $10, which is supposed to encourage you to use generics whenever possible. But they also don't tell you that there's no such thing as generic insulin. Or Symlin. Or any host of other things. And even $10 a piece is a lot when you're 25 and a graduate student and you have Type 1 diabetes, no matter how good your student insurance happens to be.

And that's how I ended up sitting at the second of the 4 stoplights on the mile and a half between the pharmacy and my apartment, at 11:15 pm, mulling over the two $30 prescription copays I just gave over to CVS, and realized: I will have to do this every month for the rest of my life.

The thought of forever is somehow just so much more exhausting, when put that way.

A collection of diabetes-technology-and-endo-related thoughts...

2010-07-16T19:32:00.000-04:00

1) Has anyone else noticed a substantial drop-off in customer service quality at Minimed? One of their prime Points of Awesome has always been phone support, but over the last few months it's been murder to get a human on the phone. More than once I've called during business hours (in the middle of them, mind) and been told that no one was available to take my call, but I should call back during business hours. Thanks. Now I'm trying to talk to the returns department to get a shipping label for the Extension of Therapy pump I used after my old Paradigm died and before I started on a Ping and, after 3 transfers, I have been on hold now for...20:34 minutes. Not cute, guys. I don't know if they're having money problems or what.

2) Went to the endo today. This was my first appointment in many, many months, something that was not actually my fault - the clinic kept rescheduling me for days/times that didn't work (what do you expect when you reschedule without asking me when I'm free?). And then the doctor I was seeing, a fellow at the clinic/university, graduated, and now I have to have a new one. Grumble.

She seems...young, I guess. I have been thinking more and more lately that being a doctor must be really, really boring, because as far as I can tell, they test your blood, they mentally compare the numbers they get back to the cutoffs they have learned, and then they tell you that X is too low/high and, if applicable, you should take Y pill. This does not seem very fun to me, as a career.

Case in point/allow me to rant: My TSH level is apparently a teensy bit higher than expected, suggesting hypothyroidism, so they want to test it again to determine if I have this problem and then, I don't know, start me on drugs for it? I figured it was not worth explaining at that particular juncture that there is no way in hell I'm taking drugs for a condition for which I have literally no symptoms whatsoever, especially drugs that affect my hormones and especially for a condition that can't kill me except in the extremes. And I am not kidding when I say no symptoms: look over at google health for the symptoms of hypothyroidism, and the only thing you can check off for me is slightly-elevated TSH levels. Guys, I'm clinically hyperactive. The last thing on earth I need is to take drugs that will increase my energy levels. I'll stop sleeping altogether. Hellz. No.

I digress.

My larger point is, I have always been left a little frustrated at the level of advice/support I have gotten from endocrinologists. I've had very nice, knowledgeable, and even helpful endos in the past, but the amount of time they have with you and their lack of training in the factors that actually affect my life/blood sugars (basal testing/adjustment, site irritation issues, etc etc) mean that they're not equipped to do much beyond writing prescriptions/ordering lab work. This is one of those things I never noticed (well, I had noticed the latent frustration, just not the real cause) until I started seeing a really stellar CDE, who helped me understand, test, and adjust my basals and then start carb counting effectively, who tracked down a good solution for my adhesive allergies, who helped me try out and then use a new type of infusion set to deal with site issues, to name a few off the top of my head, at which point my A1C dropped by 0.5 and I realized that my endo appointments are pretty useless. I can actually just call for prescription refills.

Moreover, it's clear that my clinic sees far, far more Type 2s than Type 1s, meaning that my endocrinologists know substantially less about the techniques and technology I use to treat my disease than I do.

I did hear words that I never hear, however: "Your last A1C was good. [Ed: 6.9. Huzzah!]" Say what?! I didn't realize endos were allowed to use that sentence. Maybe it's because she's young.

3) In anticipation of my appointment, I downloaded data. This was probably the first time I had ever done such a thing for an endo, and she didn't look at it, but it was good to do anyway. I have not used the ezManagerMax! software since my first post on the subject. Needless to say, time has not alleviated the absurdity of The Balancing, but I managed to get it all downloaded without any serious nonsense.

ezManagerMax! remains useless, but the DexCom DM3 software basically blew my mind my when I compared my weekend and weekday numbers over the last two months. Doing so was incredibly illuminating. Guys, my weekend blood sugars are so much worse than my weekday blood sugars!

Why? Don't know. But it just goes to show that more data is not better (there are only so many pie charts I can look at in a day): different data is better. Which has been my point all along.

Animas, I'm Embarassed for You.

2010-06-23T00:33:00.020-04:00

There is simply no rational explanation for the Animas EZ Manager Max! program/system/catastrophe. I'm about to say something pretty inflammatory, and it may be premature, but: it's worse than Carelink.

Remember: I loathe Carelink. I experience animosity towards Carelink that goes beyond what is normal in human-software relations. Here is a subset of the reasons that Carelink is a disaster: it's slow; it only runs on Windows in Internet Explorer (this one's particularly baffling, given that it's web-based); it has zero flexibility in terms of the data it displays; it doesn't answer basic questions about trends; its UI is embarrassing, by 1997 standards; and half the time it doesn't actually work.

Clearly I was setting my standards too high. Animas dispenses with the web-based thing, and EZ Manager Max! nominally works on both OS X and Windows (this point is moot since I couldn't actually get the Ping to connect in OS X). As it is not web-based, it is unable to fail to load PDFs from the internet. It makes up for this in spades.

For example: to download pump data, Carelink requires that one plug in a USB key and put one's pump somewhere in its vicinity. Because, you know, it's wireless/bluetooth. By contrast, the Animas USB "dongle" looks like this:

In order to use it, you need to line up this little blue box, on the back of the Ping:
With the infrared (!! Seriously?!*) sensor on the end of the dongle. Note that "the end of the dongle" is not where the flashing light is on top. Ignore the flashing light. It's only there to confuse you.

In order to line up the little box with the IR, you need to balance one on the other, much like so:

(photo taken of the instruction pamphlet that came with the dongle. Please forgive my terrible iPhone photos. Higher resolution does not make this whole thing any better anyway.)

You must put your pump in suspend mode before engaging in The Balancing (Carelink actually suspends the MM pump for you, and then unsuspends it, trivial functionality that I clearly just did not appreciate enough at the time), and then! Then! You must make sure that the pump does not go to sleep.

This is harder than it sounds. The maximum possible timeout on the pump display is 60 seconds which, yes, is longer than it takes to download less than a week of data. So you have to keep pressing buttons every 55 seconds or so. But remember, the apparatus you're dealing with looks like this:
The Balance is precarious. The components must not be moved, because if they are, the connection will be lost, you will have to start over, and you will want to kill yourself.

After all that, EZ Manager Max! displays exactly the same reports as Carelink does. I reiterate my question: how is this week's average blood sugar compared to last week's? I still have no idea (not strictly true: the Dexcom software actually does answer this question). As with Carelink, there does seem to be a way to export the logbook/data from EZ Manager Max! to a straightforward format (.csv), so that those of us who can write our own damned software can deal with it ourselves, which I guess is a relief? Maybe? It's sort of on my list of "summer projects", but who has the time? And really, I shouldn't have to...

The most astonishing part is that the EZ Manager Max! software actually provides the ability to customize the pump's alarm tunes with little music files. This is actually neat, except that it means that EZ Manager Max! includes, and I am not kidding because there is no way I could possibly be making this up because it is simply too insane for me to fabricate, a little composing program for writing alarm tunes. It is bizarrely fully-featured. The fact that someone made the choice to write a keyboard program (that works pretty well, to my profound irritation) but ignored...everything else, is so absurd that I will leave it without further comment.

Animas, this may sound harsh, but I only say it because I care: I don't know who you paid to create this crap for you, but you need to go demand a refund. I am very happy that I did not pay for this crap, or I *would* demand a refund, as a matter of principle.

I suppose you get what you pay for, but there is a point to all this ranting which might actually be relevant to someone in the diabetes equipment business: I would pay money for good diabetes management software. I would give you, Diabetes Equipment Company, money, for software that doesn't suck. I bet I'm not the only one. You hear that? MONEY. You like money, right?

In other news, I'm off on a 10.5-day trip with my sister, so there will be little-to-no posting, as I will be too busy trying to navigate driving on the left. See you in July!

* The craziest thing about the fact that the Ping uses infrared to communicate with a computer, besides the fact that it hasn't been 1985 for almost 25 years, is that the Ping pump and the Ping "remote" communicate via Bluetooth (I think; if it's not Bluetooth it's something close/similar) from up to a distance of just under 10 feet. This means that the pump has reasonable wireless capability built-in. You don't need to precisely line anything up to transfer data between the pump and the remote. The IR is additional to the other wireless protocol that is built into the pump to function with the glucose meter/remote. It's bewildering.

Dexcom, week 3.

2010-06-18T14:29:00.003-04:00

You can tell that this is working far better for me than the MM system ever did. Here's how: as soon as the sensor expires/falls off (curse you, adhesive!), I'm raring to put on another.

It's a simple but important difference. My MM sensors would die and I would deliberately take a couple of days off, mostly to let my skin recover from the many band-aids required to keep the thing in place. I'm massively allergic to the adhesive, especially after a couple of days. I finally got a prescription-strength steroid cream to supplement my hydrocortisone usage, and I have to say, it really, really helps (thank you, CDE!), but still. The hassle and discomfort of the MM, the constant alerts, and the accuracy issues, coupled with the fact that you had to start over every 3 days, meant that, although I would draw it out as far as I could (up to 6 days, often, but again, accuracy!), I would always give myself at least 3 days off before putting in another. Sometimes I would go weeks, and dread it, a little; it just wasn't really worth it to me, something I didn't notice until I got a device where the trade-offs *are* worth it. The insertion was uncomfortable, the needle was uncomfortable, the band-aids were uncomfortable…

To be fair, I don't like the Dexcom receiver. It's needlessly huge. If they just made it rectangular and made the buttons a little smaller, they could shave at least an inch off of the length. And also, I keep losing it/leaving it places, dropping it (wtf with the really crappy clip it comes with?), forgetting it in the cup holder of my car…there's something to be said for a pump with tubing. At least you'll never lose it.

Despite that, though, I just started my third sensor. As soon as both previous sensors were kaput, I replaced them. Within a half-hour. It's so much more comfortable, the alarms can wake me (making it really genuinely useful in that respect), the alarms aren't continuous/annoying (maybe because it doesn't complain all the time if it's out of range/if you tell it to snooze). And, given that it has always taken 12 hours for any sensor of mine to start giving really sensible, trustworthy data, if you can only count on wearing it for 3 days, it's barely worth it. A half day startup for almost guaranteed 7 day wear is great.

Of course, after day 5 or so, the adhesive starts to go, and I'm back to tape, but there's still less of it than needed for the Minilink. And it doesn't move around.

And the software isn't miserable.

Moral? LOVE.

And the Ping is in business.

2010-06-17T15:28:00.005-04:00

I got my new Animas Ping in the mail today. OMG IT IS SO COMPLICATED I LOVE IT. I don't quite understand why the Minimed Silhouette inserter spring-loaded thing doesn't seem to fit the Animas infusion sets which otherwise look IDENTICAL, but whatever.

It's interesting, though: I feel a mild anxiety with a new pump. I've never used anything but a Minimed pump, and so there's definitely a learning curve. The thing with the Paradigm is that I know how to use it so naturally that I don't even think about it. On the Ping, taking a bolus requires some serious thought, like, OK, how do I dual-wave? I *can* dual-wave, right? Right, of course. I haven't even gotten into the "food library" or using the software yet, for reasons mostly related to my MacBook's stupidity w.r.t. its interaction with the USB CD drive...but there's a lot of complexity added, both in terms of functionality and in terms of learning to use an absolutely integral device (that I (normally) use all the time, without thinking) with basically a totally different UI.

I find it most interesting how the instruction book, which is huuuuuge, has all these warnings about "advanced features", not pumping till you've been trained, etc etc. I ignored these, of course. Goes to show first, how much pump companies' literature and sales pitch is geared towards bringing pumping to non-pumpers (instead of converting pumpers from another company), and second, how much more complex pumping has become in the 9 years I've been doing it. My little 508 could like, do basals, and bolus as much as you told it to.

Now they have food libraries built-in.

Certainly, I complain about the backwards-ness of modern diabetes technology, but there has certainly been a lot of progress, just as evidenced by the giant "pumping workbook" complete with exercises to help tune basal rates/sensitivity factors, the glucometer that can bolus from afar, the food libraries. The mere idea of a combo-bolus was certainly a novelty at the time, and one that I think the medical and pump professionals didn't know what to do with when it first arrived. It's like we're learning how to use the tools as they're handed to us. It's interesting to live through medical progress, and to watch it happen.

Sometimes, complexity is overwhelming, and too much. All this technology/gadgets (I'm looking at you, Dexcom), can make diabetes something you think about too much, something overwhelming.

But sometimes it's actually just really cool.

Apparently I'm cured.

2010-06-11T13:10:00.004-04:00

I just downloaded my first week of Dexcom 7+ data. My first thought was "Hey, this software doesn't suck beyond all rational comprehension!" My second thought was "Hey, I'm cured!"

Seriously, folks, I think I just had the best week of my diabetic life. I know it's tacky to brag, but whatever, I doubt this has happened before and it'll probably never happen again, so I will post my screen cap and admire that lovely almost-flat line and wonder vaguely about what on earth happened.

Goddess of Insurance Wisdom

2010-06-09T22:16:00.004-04:00

My Animas Ping was approved today.

First things first, I did nothing fancy to get the Dexcom. My system was shipped FOUR DAYS after I made the phone call. Apparently it's on Aetna's student health plan (Chickering)'s precertified list. I was flummoxed.

(especially after the multi-month ordeal that was getting the Minilink covered, remember that? I should link to the blog posts but I'd have to find them first).

The Ping, on the other hand, is apparently too new to be on the precertified list, and Aetna was being somewhat difficult. My Animas rep left 2 messages on the precertification answering machine, which evidently includes a message about how expected response time should be within 48 hours. No luck.

So I called.

At first, the Aetna rep who picked up was very aurally wary of my sob story. "I need a new pump, I have type 1 diabetes, this is extremely important to my health..." She originally offered to transfer me to the answering machine, but I pleaded. Was there no one I could speak to? Was there nothing I could do? It's really really important, and it should be covered no problem, it's not a wacky request...etc etc.

My Aetna phone person, bless her, took pity on me. She eventually offered to just fax the request paperwork to my Animas rep for me (saying "I actually don't know why we don't do this more regularly!"). She also told me what to tell him to put on it to get it expediently processed (note that he had made the request a week previous and that it should be given top priority given the necessity), and offered to send an internal email to help me get things processed. This was last Friday.

Upshot: she called me today, personally, 8:30 pm Eastern time (her time too, by the area code) to tell me it's approved.

I wish I had a direct line to call and thank her. I might just ask for her to do so at the main customer service line. I love when people at call centers treat you like a human.

Moral of the story: I'm damn good on the phone. I should contract, or something.

Revenge Snacking.

2010-06-09T19:04:00.004-04:00

I love the term "Rage Bolus", which I learned from the DOC. Today I engaged in what I realized is pretty much the exact opposite behavior, the dual of rage bolusing, if you will: revenge eating (revenge snacking? A revenge snack? Hm).

Have you ever had those days where you're just low low low for 12 hours for no reason? I don't have them often, naturally (high high high for no reason is more common), but today was one of those days, starting last night at midnight. The good news? The Dexcom alarm is loud enough to wake me. The bad news? It did so approximately once every 3 hours. And kept doing so once I was awake, and on, and on, until 10:30 am. I spent the morning clumsy and confused and tired, an entire mug of coffee not once but twice, dropped egg on the floor, and generally was frustrated and anxious and a mess.

Subsequently, at the coffee shop (to replace dropped coffee #2), I got a strawberry and cream cheese croissant (how are those things so awful and yet so delicious?) and I ate it, dammit, even though I'd had breakfast and wasn't really hungry, and had eaten my sensible portions of 15 carbs in tootsie rolls (6 times over). It was exactly that feeling one has when rage bolusing: GODDAMMIT JUST GO UP ALREADY BADDECISIONTIME. It's like I'm getting revenge on my blood sugar: Oh, you think you're boss? BITE ME.

Then I spent the afternoon riding a high, of course, as you do. To be honest, it was a bit of a relief.

Dexcom vs. Minilink, hour 1.

2010-06-04T23:49:00.003-04:00

Got the Dexcom today. Still no new pump, but that's a story for another day.

I cannot resist a new toy, especially when it's technology, so despite the fact that I'm still wearing my (loaner) Paradigm and am in possession of Minilink sensors etc, I charged the receiver and loaded up a sensor.

I haven't even calibrated yet, but still:

1) The receiver is larger than I expected, and I don't like having two pieces of hardware. Maybe I'll wear the Ping in my bra or something.

BUT

(capitalized but, because it's important)

2) OMG the sensor/transmitter is so comfortable compared to the Minilink it's embarrassing and Minimed should give us all refunds and take its toys and go home.

WOW.

First, the transmitter actually clips into the sensor in a stable and sensible way! I don't need to use 40 bandaids that keep slipping and peeling and ITCHINGITCHINGITCHING to keep it in place! The needle doesn't wiggle and dig and bleed!

Second, the transmitter is noticeably lighter and smaller than the Minilink transmitter, which helps with stability and comfort.

Third, I don't actually know how long the needle is since they hide it (probably a win, actually; even my battle-hardened self finds the Minilink sensor needles intimidating) in that complex one-use plunger (no spring, sadly) thing (the environmentalist in me doesn't approve, but whatever), but I actually placed it in my abdomen, following orders, for once (I never put pump or sensor sites in my abdomen, it's always really uncomfortable) (this is a lot of parentheticals for one sentence) and it's...fine. Totally fine. Comfortable, even.

Fourth, the alarms do sound louder than the Minilink's. We'll see if they actually wake me, but they actually have a chance, unlike my poor Paradigm.

I still don't love the giant additional hardware, but this is shaping up to having been a really, really good idea.

Diabetes Equipment Makers' Software Problem

2010-06-01T18:53:00.008-04:00

Or: Why I'm Glad My Financial Software Is Nothing Like My Pump Software

(yes, I haven't posted in like, 1.5 years. I think I may start up again, though. It's fun, and I've missed the DOC.)

I'm in the market for a new pump, and I'm finding the whole process infuriating. I think I've finally figured out the ultimate source of my rage: diabetes equipment makers (referred to as "they" and "them" for the purposes of this rant) have a serious software problem.

On the one hand, this is understandable. For years, the hardware really was the big concern. Pumps are relatively modern devices, and until recently, there remained call for major hardware changes and upgrades. Minimed really hit it home for me back in 2005-2006, when they released the Paradigm system with Minilink capabilities before they had FDA approval for the Minilink system, which allowed a seamless transition to a fully-integrated CGM system as soon as they got that approval (modulo the multi-month insurance approval process, of course). The Paradigm was impressive. At the time.

Now? Not so much. In many respects, the insulin-pump hardware problem has been solved. It's a screw and a reservoir. They can make the screw a little more precise - enabling smaller basal increments, for example - but really, that's it. It's a giant pre-filled syringe on a string.

(I guess OmniPod is an exception to all this - the pod thing is pretty cool. But really, it's not very novel either - it's a giant pre-filled syringe in a round piece of plastic, with bluetooth capability. Which is much like my Paradigm, a giant pre-filled syringe in a rectangular piece of plastic, with bluetooth capability).

They (and by "they" I really do mean "everyone"; I'm looking at you, makers of glucose meters) do not seem to get it: I want ways to evaluate my overall treatment plan. The current approach is just all wrong, and focuses on keeping me hyper-posted on individual blood sugar events. This is relevant in the low-blood sugar arena - in which case, by the way, Minimed, MAKE THE ALARMS LOUDER. I do want a system that will keep me alive overnight. But not dying during individual hypoglycemic episodes is honestly a very small portion of my overall diabetic concerns. Most of my treatment decisions are not emergency-in-the-moment-must-rapidly-consume-Tootsie-rolls decisions (frankly, I retain a fair amount of hypo sensitivity, so I don't even really need the CGM for that). No, the difficult questions concern *trends*: are my basal rates accurate? How does Wednesday night practice affect my overnight blood sugars? Does my carb ratio change over the course of the day? How do my weekends compare to my weekdays? If I change my overnight basal, how does my morning blood sugar change, on average? What is my average blood sugar on a Thursday? What's the standard deviation of my blood sugar? Has it gone up or down over the last 6 months?

(Those questions all ignore even simpler things, though these complaints are very Paradigm-specific: how much active insulin is in my system right now? I can answer this if I go through the rigamarole of pretending to take a bolus, but I can't just answer the damned question. Or this: I eat pretty much the same thing for breakfast every day of my life, and every day of my life, I have to key in the number of carbs to the bolus wizard. Or this: I enter a glucose reading into my pump. Both readings are entered into CareLink to compute the average.)

I challenge you to answer the above questions easily using any of the tools at your disposal. The difficulty of this task should infuriate you. It infuriates me, because all that data is here, ON MY PERSON AT ALL TIMES, between my glucose meter, my pump, and my CGM. But hell if I can do what I want with it. They do not need to dramatically change the way the pump operates or tracks information to allow us to answer any of these questions, they just need to write software for the pump/the data that doesn't, pardon my French, totally fucking blow.

Allow me to diverge briefly to complain: CareLink is a catastrophic joke that would be funny if it weren't serious. True story: I once made the mistake of managing my blood glucose data and my financial history in the same hour, going from CareLink (which requires, I AM NOT KIDDING, booting up Windows XP in a VM and using Internet Explorer) to mint.com. I have been tragically depressed about this whole software situation ever since. The current approach for managing diabetes health is equivalent to a world in which the only tools we had to track our finances were a proprietary PDA device (and not a sexy iPhone-like PDA device. Does it bother anyone else how much smarter your cell phone is than your glucose meter?) that gave us two abilities: 1) we could ask our bank how much money was in the account whenever we wanted, and 2) we could receive warnings if it looked like we were spending too much or too little (fine, 3) we could look at tiny graphs of our spending over the last 3 or 24 hours, so long as we didn't mind that they could be totally wrong, and 4) we could check out averages over a predefined period). But wait, how does my weekend spending vary? How much money did I spend in March vs. April, when I started cutting coupons? I can trivially answer these questions in mint, complete with lovely dynamic 3D graphics. I cannot answer anything approaching analogous questions using any combination of my CGM, pump, CareLink, and/or glucose meter, without serious programming gymnastics (and by that I mean: without writing a program that does it), which is stupid beyond words, because the data is there, if only they would bother to organize it for me.

So Minimed, why are you still trying to sell me the hardware? I'm trying very hard to find out what makes the Revel so nifty, and you simply do not want to tell me. You have a > 4 minute video up on your website on the subject of the Revel that explains the whole screw-syringe thing, and you know what? I got that. I've gotten that since 2001, when I was 16 and started on the 508. I'm not saying that the Paradigm is not notably better than the 508, but its improvements have remarkably little to do with the whole syringe/screw combination, which I now trust pretty much any big pump maker to sell me. In fact, my old 508 injected insulin just fine. Hell, I can inject insulin into myself just fine. I can also test my blood sugar 46 times a day; I don't need the Minilink's help for that. The Revel frankly looks just like the Paradigm. It apparently has some awesome new features related to the CGM software, but I can not for the life of me figure out what they are (maybe they're listed on the Minimed site somewhere, but really, I don't care -- if they're not front and center, that's Minimed's problem, not mine). It seems that the major new innovation in the Revel is "warning" alarms. Hooray, more alarms that I can't hear at night and that annoy the hell out of me during the day. COLOR ME EXCITED.

Look: I don't need more warning that my blood sugar is going high or low. I check the stupid CGM compulsively enough to notice without you telling me all the damned time. And honestly, while it would be disingenuous to say that I always know where my blood sugar is going, first, I'm not always exactly surprised when my blood sugar goes above 200, and second, being told at 150 that my blood sugar is going to go above 200 will have pretty much zero impact on my behavior, because presumably I bolused for that meal. Maybe I'll watch a little more closely, but I'm watching compulsively anyway, so you add no useful data into my life by warning me earlier that my blood sugar is rising, as though I didn't notice that I just ate lunch.

I noticed. I was there.

(If you could allow me to figure out what sort of dual-wave bolus/Symlin combination would prevent that 200 next time, then we'd be in business.)

Practical upshot: I think I'm getting an Animas Ping and a Dexcom 7. Not that I have good reason to believe that they're dramatically better about all this than the Paradigm/Revel/Minilink, but there are enough benefits there both hard- and soft-ware-wise to justify a switch, including memory for meals/common foods, sensors/transmitters that don't flop around stupidly/require 4000 band-aids to hold in place and that last longer than 3 days. I'm a little sad about this, not least because I have to pay out of pocket the 20% of the Dexcom system cost, and because I really love having an integrated pump/CGM system. However, my current issues with the Minilink system -- sensors are wonky half the time, it takes half a day to a day for a sensor to settle in and behave usefully, and they're just physically so uncomfortable, especially with all the tape necessary to keep them in place -- lead me to rarely wear it, dramatically limiting its utility anyway. Moreover, I have had SO MANY PARADIGMS die with "button errors" that Minimed's (pretty awesome, no sarcasm) customer service is no longer cute. So we'll see. It's probably a "grass is greener" thing - I'm sure there's just as much to hate - but a girl can dream.

But seriously? I'm trying to figure out my carb ratios right now, and it is so, so hard. I will drop any pump, any CGM, any blood glucose meter, and pay out of pocket for any system that helps me with both the individual data points, and the trends. Bank of America and Quicken both do me better, and my life doesn't depend on them.

Cheese fries.

2008-12-17T12:20:00.003-05:00

We went to Outback for my birthday last night, since it can seat a bunch of people and the food isn't bad for a chain. I announced my intended birthday dinner of cheese fries, chicken wings and beer, because it was my birthday, and that's what I wanted.

J, my very conscientious friend/co-worker (who sits next to me in the office), was perusing the nutritional information online (he tracks his salt and saturated fat content like an old person), and noted that they have special "menus", or lists of stuff from their regular menu, for various health concerns, like "heart healthy," "low-fat," "low-carb" and, of course "diabetic."

The following exchange was tongue-in-cheek:

J: "Look, they have a diabetic menu! How convenient for you."

*beat*

J: "You know, I don't think that beer, chicken wings, *or* cheese fries are on this, Claire. You may be SOL on this one..."

I got them all anyway, and it was magical.

New Symlin Annoyance

2008-12-16T10:07:00.002-05:00

Man, the female population annoys the hell out of me.

A common conversation:

Generic Female Friend/Family Member/Acquaintance: "What's that?"
Claire: "This is Symlin."
GFFFMA: "What's Symlin?"
Claire: *this is Symlin*
GFFFMA: "Oh! Are you OK? Are there any side effects?"
Claire: "Well, it can make you nauseous. And it really slays my appetite."
GFFFMA: *wistful sigh* "Oh, I wonder how *I* could get some of that!"

Wtf, folks? Really? Like, I'm kind of happy because I have a new injectable that adds a very minor amount of control to my uncontrollable disease, and you're thinking about the size of your ass?

I have started calling people on this, slightly more aggressively than I normally would:

Claire: "Well, we can trade if you want. You get the diabetes, and you can also have the Symlin."

...that tends to stop that train of conversation right there.

Also, today is my birthday. 24!

Crap.

2008-11-20T14:14:00.001-05:00

I do hate the OneTouch ultra.

But its logbook feature is illuminating.

I thought my blood sugar has been decent that past week or so, but, actually, no. Not at all. Wicked high average. And I don't think it's as bad as the single average implies (since the "averages broken down by time" aren't as alarming), but the big graph of blood sugars looks like a random-ass scatterplot. It's Not Good.

I should use it to track insulin and symlin intake and stuff, but I haven't been, and my weight isn't moving much. I guess I actually do have to pay a little more attention. *sigh*

Finances, mostly.

2008-11-19T12:16:00.003-05:00

I got my newly-approved sensors. HUZZAH. Hooray for not blowing (an additional) several hundred dollars a month on sensing supplies!

This took forever. Months. Months and months and months. And then the University of Virginia forgot to tell their student insurance provider which students were still enrolled, and Aetna canceled everyone's insurance.

That, friends, is a 30,000 person problem.

Moreover, they closed out my appeal process.

*steams*

They've fixed it, apparently. The insurance thing, I mean.

Kudos to my rep at minimed who, as far as I can tell, found this out and proceeded to flip a shit on the phone with my insurance company. Two weeks later? My new box of sensors is here.

*squee*

I'm holding off on putting it in, though. I'm on a massive hydrocortisone-moisturizer kick in an effort to get the skin on my ass looking human, again. I'm massively allergic to basically any kind of bandage adhesive: so it's not the actual needles or injection, but the tape/bandaids that cause me to rash and itch like crazy. In addition to being tremendously unattractive, it's really uncomfortable. I'll give it a couple more days and sensor it up for my vacation week in Boston/NY.

I was thinking today, not quite unrelatedly, about the intersection of being diabetic and living on a graduate student stipend. I was driving around trying to track down a new phone charger, debating with myself about lunch. "I want McDonalds...." *internal whine* (that's a rare desire, I'll have you know). "NO. NO MCDONALDS." "I want sushi..." "NO. NO SUSHI." Not that sushi is bad, but just, you know, $10-15, and I don't have my Symlin in the car with me, and I'm going to eat out a lot this weekend and it's not a lot of money, but it's almost a tank of gas, and I'm driving to Boston on Friday, and and...it seems silly, to obsess about such small sums, but there you have it. Since The Break Up I've had to pay the full rent once paid by two people alone, and I assure you my salary has stayed the same. I pay well over $100 in copays a month, I can make my own damn lunch. And I would have felt crappy all afternoon without Symlin to save me from the french fries.

So I came home and looked in the fridge for something to make. Ah, the fridge of a graduate student T1 diabetic. Scrambled eggs and mini tortilla peanut-butter-and-jelly sandwiches. I didn't get through all of them (the hormone seems to either make me nauseus or make me not hungry; it was the latter, at lunch). And some nuts. Maybe some carrot sticks for a snack. *sigh* It's a funny intersection, balancing a budget with carb-control. It certainly leads to some strange meals.

I saw the Brian Williams MSNBC clip on a cure. If I'm still poor, and I get cured, I'm going to eat nothing but ramen for a week, on principle.

Invisibility

2008-11-09T11:36:00.002-05:00

I mentioned previously that one of the reasons for my disappearance over the last several months is that I broke my wrist. While hiking, I fell onto some rocks. I threw out my hands to stop myself, and broke both bones in my right wrist, right below the joint. Fortunately, I'm left-handed.

To make a long story short, it hurt like hell. I had to hike an hour back to the car, sit for an hour on the way to the hospital (where they saw me right away, bless them), suffer through having them set it, the whole nine yards. I don't recommend it.

What I thought was fascinating, however, was the General Public's reaction to my cast. The world is full of really nice people. I knew this before I broke my wrist; it's especially true in the South, where I have been consistently amazed at how pleasant the cashiers, automotive technicians, policemen, etc etc are (not to say people in Massachusetts are mean, but the people down here are beyond friendly. I miss it when I go visit my parents in NY). But a broken wrist unlocks whole new arenas of friendliness in total strangers, who rush ahead of you to get the door, offer to carry your bags to your car, help you through the airport (thank you, Anonymous Soldier, both for being a soldier and for carrying my bags through the Richmond airport), and so on.

This is particularly noticeable after the first few weeks, when it's mostly stopped hurting. For the first few weeks, you're pretty much in pain all the time (and I couldn't tolerate the percoset, so I mostly sucked it up, with the help of some Aleve) which means that A) you depend on the kindness of strangers, so you don't notice it as much and B) your friends are falling all over themselves to help you out anyway. But after the first couple of weeks, when it still hurts but isn't unbearable, you really begin to notice. The girl at Starbucks who replaced the coffee I knocked over for free and also poured in the milk for me (...that was mostly because I'm clumsy, not because of my wrist, but she wouldn't hear of it), for example.

I thought it was interesting because the reaction of the public at large was in response to something visible, namely, my sticker-covered cast. I never said anything, and I certainly never asked, but people saw the cast and immediately rushed to my aid. It was a weird feeling because I live with an invisible malady every day, and have for the past 12 years, and it's far worse, really, than a broken wrist. A broken wrist will heal itself, and after the first 3 weeks it doesn't hurt as much anymore, it's just kind of a hassle and prevents one from showering properly. I have a whole-body malady. I have two wrists, after all, but only one broken body.

Now granted, my diabetes does not preclude me from carrying my groceries to my car. But we often talk about this invsible illness we live with, and I never really got it. I mean, sure, it's invisible, I thought, but isn't that a good thing? I can't say I'm complaining; I'm not looking for help, daily. But the whole experience really drove home how visual we, as humans, are, and how compassionate we can be, but how limited our capacity for empathy really is to what we can both observe and imagine. I like that I can pass for a non-diabetic but, having been a beneficiary of the kindness and sympathy of strangers, I more viscerally understand what it means to have a disease that is so powerfully invisible. Sometimes, on my weaker days, I wish the girl at Starbucks would know, and feel sorry for me, even though nothing obvious is casted.

The bad, so far.

2008-11-06T18:24:00.003-05:00

Funny, the nausea side-effect seems to have hit me late. It's worse in the morning, unpleasant at lunch, and barely noticeable at dinner, but it's definitely new. How strange. I'm assuming it will pass.

The bad part is the total lack of appetite, surprisingly. I mean, on the one hand, it's nice not to feel like a compulsive eater (...something I've always kind of suspected of myself), but on the other, it would also be nice to be able to get through a meal without forcing myself. I took my Symlin halfway through dinner today with this exact purpose in mind, and I think it was a good idea. I've been in a bit of a mood all day, and I definitely, definitely felt better after eating dinner, meaning it was either the food, or the company. And the company was good, but I think I may be pegging this one on the food. Perhaps I'm just not eating enough.

It's not a question of feeling full, per se: it's a question of never feeling inclined to eat. I may play with when/how often I take it in order to address the problem. I mean, I have a few pounds to lose, but never eating again is certainly not the way I was going to go about dealing with it.

But damn, damn, my blood sugar has been good. The line on the cgm has been flat.

In other news, the pharmacist, of all people, called me the other day to ask how the prescription is treating me. How's that for customer service? I was so surprised.

New love.

2008-11-03T13:18:00.000-05:00

OK, I may actually love Symlin.

I confess I haven't quite gotten the hang of it yet. It's clear that my blood sugar rises more slowly to a lower peak on it. I've tended to panic-bolus somewhere near the top, only to crash like crazy after 3.5 hours, exactly. So I need to figure it out. I can take the full 5 units no problem. It made me a little woozy yesterday evening, but I hadn't eaten all day, so I don't know if it was the hormone or the long day or what. My only real complaint is that it kind of stings like a bitch going in.

But onto actual usage. I've been trying the square-wave bolus, but it still climbs a bit more than I'd like. Today, instead, for breakfast, I did the dual-wave: I halved my normal breakfast dose of insulin and took half of that right away and the other half over an hour. This, miraculously, seems to have worked. And not just a little bit - I mean, the trend line on my cgm was almost flat. Flat flat flat. Between 88 and 101. IT'S AWESOME.

Lunch was a more challenging circumstance: pizza. I only had one slice (see below re: appetite), and just square-waved. It unfortunately coincided with the moment after the morning bolus where my blood sugar dips, so I clearly haven't totally gotten it yet. But we're closer...

The interesting bit for me is how much it has slain my appetite. I don't think I realized exactly how hungry I am all the damned time until I wasn't, anymore. I've been teased, gently, by friends for what they've dubbed "THE HUNGER." I mentioned it to The Professor, who said "Yeah, I'd noticed that. Most people don't decimate the world's string cheese supply with quite your level of enthusiasm." But on Symlin, much less so. I find myself less hungry between meals, and less compulsive during them. I find it strange to think my eating habits might have been a chemical imbalance instead of like, a normal feature of my existence. I dunno.

Anyway, yes, I love the stuff. I'm all about it. More, please.

One-Touch UltraSmart.

2008-11-02T07:46:00.004-05:00

Apparently the clocks change today. I had no idea, of course, so I spent an hour running around like a crazy lady trying to get ready for our competition before sitting down at my computer and realizing it was only 7:12 am.

Damn.

By that time, my Symlin injection had left me totally disinterested in breakfast, so I kind of had to force it down.

It's not making me sick at all, though, and I've already upped the dose. We'll see what it ends up doing for my post-prandials; I put a sensor in yesterday so I'd have an easier time of it.

But that's not today's post. Today's post is me bitching about the One-Touch Ultra Smart.

I have used a Freestyle Flash for so long that the paint on the buttons has worn off. It's tiny and adorable and I love it, and it uses very little blood. Sure, it doesn't have any fancy memory features, but it's reliable and painless.

However, I'm participating in a clinical study (about which I will write, when I'm not about to go dance) that includes a new glucometer and free test strips for a year. This is, independently, awesome. We have to use their meter, which makes sense, because they download the data once a month.

News for the free (diabetic) world: the One-Touch sucks.

Not only does it use far more blood than it claims to in the user manual ("real size!" LIE), it starts counting down before it has enough blood. This drives me craaaaaaaazy. The Freestyle won't start counting until is has a large enough sample, so you know when it's going to be happy. This thing sucks up halfway and starts, and then complains that it doesn't have enough blood. I have wasted so many strips. It's infuriating. The only good thing about the situation is that I'm not paying for them, but it could honestly be a deal-breaker for me in terms of the study. My poor fingers are being sucked dry.

(It's funny, but it reminds me of the Old Days. My Glucometer Elites did the same thing - only they didn't error when they didn't have enough blood, they just gave you a lower reading. Which was a useful trick to know.)

I do like the electronic logbook features, however. I'm so bad at logging that it's nice to have it all in one place, and I can enter in boluses and stuff whenever I have time to kill, like in the car. Now if only I could convince myself to count carbs...

First post since April

2008-11-01T12:34:00.003-04:00

Yeah, so I vanished there. For six months.

What happened?

First, I broke my wrist. In two places. While hiking. Jesus Ayche Christ, that really hurts. So that threw me. Then I broke up with my boyfriend, and he had to move out, and really, that was miserable. So I had a good 4 or 5 months of drama, resulting in substandard diabetes care, a 15 pound weight gain, a broken gym habit, and on, and on....

But I'm back. My wrist is better, my apartment is back in order, I've replaced all the lamps (...why did he take everything that wasn't bolted to the floor, you ask? I couldn't tell you). I just had my A1C done for the first time in 6 months yesterday, and I am not hopeful about it. But!

A) I've started going back to the gym, and

B) I started on Symlin.

Yesterday.

So this post is about Symlin.

I have been asking doctors about this stuff since I first heard of it, no joke. For years I have been asking about this stuff. I have a horrific time with post-prandials, and I always have. This is why eating low-carb is so important for me, because there is no way, no way for me to eat carbs of any significant variety and keep a blood sugar below 250. 300 or 350 is more like it. Pasta is completely out of the question.

And no one has ever given me any reasonable advice on the subject. I keep asking doctors about Symlin, and they keep saying "Weeeeeeeell....." and then saying something useless. "Have you tried taking your insulin a half hour before you eat?" Yes, you nimwits. That was the first thing I tried. "Have you tried taking more insulin?" I've tried taking 20 units at a time. Then it just goes low after going up to 350. "Have you tried eating your dinner while standing on your head and yodeling?"

...

Anyway, the doctor yesterday was massively reticent, but I pushed. He said he didn't think it did much, he never prescribes it, I'm at risk for lows, have I tried taking insulin a half-hour before I eat? I glared. He pressed. I glared some more.

They wrote the prescription.

My argument was more or less, listen. Nothing I have ever tried has ever worked. Nothing. This may also not work. But it's something I haven't tried, and it's supposed to take care of exactly the problem I have, and I'll be careful, and wear a sensor (...insurance battles continue, but that's a post for another day), and please? I'm just so frustrated. It's not like I want to eat like a regular human, but I ate a chicken salad on spinach and a pretentious, minuscule cup of butternut squash soup yesterday, and took plenty of insulin, and my blood sugar was 429 two hours later. I'm at my wits end.

I took a tiny dose last night, and didn't feel much different. I dropped my insulin intake by so much I don't think I could really look at it properly. Lunch, just now, I ate some Kraft Mac 'n' Cheese for the first time this decade. I took 3 units of Symlin, and a square bolus (after some much needed internet research on how to take use it. Thanks, Scott and Bernard!), and I'll test compulsively and see what it does. I feel a little...off, like, not quite nauseous, but a little strange. I kind of had to force down the last of my lunch, which is weird, because usually I can't get enough of the stuff, so clearly it's having some effect.

Anyway, I'll keep my tootsie rolls on hand, and y'all posted.

Another post for another day? The clinical trial I'm participating in.

Off to finish my new ballroom costume for tomorrow before hiking...

Small Victories

2008-04-17T09:59:00.002-04:00

I am stressed. Grad school is stressful.

Around 1:30 am last night, I was still slogging away, tired, and kind of panicking over my workload. I am an emotional eater - it's like clockwork, stress goes up, and all I want is comfort food. And usually I eat it, because it's really hard not to.

But last night? All I wanted was some frozen cherries and milk, which is pretty benign, but I didn't eat them. Why? Because I managed to actually convince myself of the truth: it might make me feel better for 15 minutes, but I'm crap and taking the correct amount of insulin for a bedtime snack of greater than a trivial number of carbs, which is why I never eat them anymore. And if I messed up, which I would, I'd awaken at 250. And if I woke up at 250, I would feel like utter crap for at least several hours which, given the lack of sleep, would certainly not help the work situation and, accordingly, the stress situation.

I went to bed at 90, got low at 4 am, and woke up at 110. And I'm very happy for it.

Also, I've finally found logging software I can live with: Diabetes LogbookX. Free! (Darn, I can't find the link at the moment. I'll keep looking...) I always have a problem with logging because I've never been satisfied with the tools - the little booklets, so simple and perfect back when I ate on a 2-shot a day schedule uh, a decade ago, are totally insufficient, and I can never get a format in excel that I like. And even when I get a format in excel that I like, I'm too lazy to set it up to give me useful stats, so all I have are lists of numbers and, if I'm lucky, some averages. But this is good stuff - easy to use once you get used to the rather busy UI (...clearly written by a computer geek and not a UI geek. I'm both, fortunately, so I can figure out pretty complicated stuff, but I'm lucky), and it prints lots of pretty pictures for you. I'm much happier. Logging only takes a few seconds a day, now that I have it set up. I think I may be able to stick with it.

It's amazing how much influence the process of logging - merely the act of paying attention - has on one's blood sugars.

Bra Revelations

2008-04-13T12:09:00.001-04:00

I fell off the wagon. Again.

But what is there to do but try again? Back to logging, back to blogging, back to going to the gym...

It started slowly. "Oh, one cookie won't kill me..." and before you know it, you're eating whatever ends up in front of your face and looks good. And it doesn't work like that, unfortunately. I understand that, in theory, I could learn to count carbs and blah blah, but even when I get my bolus right, there's just no way for the insulin to act fast enough to prevent the Swing. I was on the roller coaster, up and down. *sigh* Until one day, I was walking to the bus stop feeling exhausted, and I realized "Hey, I used to feel like this all the time. IT SUCKS."

So I'm back. Going to the gym, logging my blood sugars, being mindful of what I put in my mouth, remembering how nice it feels to be a diabetic In Control. Because for all I was ignoring it, it hasn't miraculously gone away yet (...I do still fantasize about that, for the record. Like, "what if I could be THE MEDICAL MIRACLE?"), and I'm happier and perkier this way.

Anyway.

The only other news is that the Boy has gotten almost as good at Diabetic Spotting as I have. He glimpsed one at a dance we went to last week - she had her pump in her bra, tucked under her arm.

I've always been so confused about the Bra Pump Storage technique - more than one person has referenced hiding their pumps in their cleavage when wearing a dress. I, unfortunately, am wee - and my B-cup chest just can't hide the pump. So I suffered through makeshift Thigh Things and just sticking it in my underwear to the side - but that ruins plenty a good line in a dress, and the Thigh Thing is just so not comfortable. But! Today! In my cute Gap shift dress thing, I have put my pump under my left armpit in my bra, and it is like, a complete revelation. Totally comfortable, 95% invisible.

11 years, and I still have more to learn.

Back to homework.

Loooooooow

2008-03-14T13:39:00.004-04:00

Haven't gotten that low in a while.

My usual plan of tootsie rolls + cgm keeps me from getting those panicky, irrational lows, except sometimes in the middle of the night. I know exactly how many tootsie rolls to eat when the CGM beeps, and so I sometimes feel a little fuzzy, but never crazy, scared, panicky, or brutally desperate for food.

I ran out of tootsie rolls yesterday, and the sensor is getting old.

I managed to give the lecture to the class I TA this morning anyway; I only began to search for words near the end. Afterwards, it was clear I needed to eat, but I thought, in that irrational, "my blood sugar is low" kind of way, "Well, I need to get lunch anyway; I'll go get food and deal with it then."

"Maybe I should walk over to the undergrad dining hall; I can eat there, right?"

Never mind the coffee shop through which I walked on the way. Never mind the convenience store on the first floor. No: I was fixed on the dining hall, and the dining hall it was going to be.

The thing is, I've been in food courts at UVa before, but never in the dining hall, so I wasn't even sure I was going to be allowed in. The dining hall is remarkably like the Harvard dining halls, but bigger, brighter, prettier, shinier, and newer. It's kind of like all the Harvard dining halls smushed together and made shiny, with better ingredients and more options. This bounty spread before me as I climbed the stairs and approached the lady at the card reader.

"I'm a graduate student. Can I eat here?"

"Sure thing, hon."

She swipes my ID card.

"Oh! You're not showing up!"

Swipes again.

The manager approaches. I'm practically salivating at this point, and losing rationality.

"What's the issue, ladies?"

We explain.

"Let's try it on this one."

Sir, I'm about ready to eat your card reader.

"Hmm. Are you on the meal plan?"

"Um, no. Can I please eat anyway? I'm so hungry."

"Of course. You can pay with Cav or with cash or a credit card..."

Sir, I'm going to eat your card reader.

I focused on not bursting into tears or otherwise making a scene. Calm. Calm. Pay the gentleman. There's tons of food. You're not going to die.

Then there's the question of choice. When you're that low, everything sounds so, so, so good, and so, in the land of UVa dining, it's water water everywhere, and I can't for the life of me decide what to drink.

I should have just rationally gotten some juice, sat the hell down, and waited. No. I finally settled on black forest cake, which I ate first, and then hot dogs, for some reason. And some fruit. I wolfed down the hot dogs, still passionately low despite the cake frosting.

I need to go to Sam's club. I need more tootsie rolls. I forgot how much lows like that suck.

Back from Spring Break.

2008-03-12T11:14:00.004-04:00

I had a very enjoyable Spring Break with Boy, dancing and visiting family and friends up in the Great White North. The downside, of course, was the diabetes control, which kind of fell by the wayside. Between my parents' houses, which are remarkably (given their health consciousness) devoid of anything simultaneously low-carb, edible, and satisfying and the numerous meals either eaten out or prepared by other people (...and I love my friends, but they love their spaghetti. And pizza), things kind of sucked from a diabetes perspective. Not only were the numbers bad (yes, bad. Not "too high." Not "out of range." Bad.), but eating that much carby food leaves me ravenous. It takes me a couple of days to sort it out and ease back into my usual lifestyle. Confession: I kind of binged on some yogurt-covered pretzels the other day, though I think my ravenous carb-hunger is back under control. Side note: why are they so delicious? And why do we pretend they're covered in yogurt when they're really covered in frosting? Needless to say, it's nice to be home again, where the easy choices happen to be the healthy ones. And I put in a precious sensor, to help myself get a grip.

Today, for lunch: an egg salad! With vegetables!

(and no pizza whatsoever)

My weight also bumped up a couple of pounds, of course.

...The crazy neighbors, or at least some portion of them, appear to have TAKEN UP THE RECORDER, and have been practicing all morning.

Weight loss and Banana boat

2008-02-22T09:29:00.003-05:00

First: the weight loss.

I'm kind of back on the weight loss wagon. Me, and everyone else in the OC, right? It's nice to be doing it at the same time as everyone else whose blogs I follow faithfully, even though I'm not a Weight Watchers kind of girl. Well, I suppose I have a similar system, only my daily insulin intake is my points. It's a bit more complicated, really, since it's not the case that I just eat eat eat and don't take insulin (...I don't know how people do that, btw, I feel so awful once I hit 240), but rather that I low-carb it enough to keep my insulin amount below a certain amount. It's a useful heuristic and it works like a charm, and now that I've read Good Calories, Bad Calories, I understand why.

Anyway, I had dipped into the 120's for the first time since high school back in September, but bounced back up a few pounds and never made it back down. I chimed in at 134.5 after the holidays (oh, the holidays!), and as of today (today!), I made it back down to 129.5.

So hooray! For that.

(Power the rest of the d-OC who struggle similarly. )

It's weird to be losing weight now that I'm not, strictly speaking, fat anymore. I know I'm towards the high end of normal for my height (...yeah, I stopped growing in the 8th grade), but I've noticed that the thinner I get, the easier the diabetes management gets, so I'll keep at it for a bit. I'm certainly not starving (I'm serious about this low-carb thing: I eat almonds by the handful, just no bread), and it really helps my control anyway, so I see no harm.

I do need to go back to going to the gym every day, though. It's so good for me: I have more energy, my control is better, I can focus better...I'm only managing a couple of days a week for whatever reason (I can't go this morning: homework, and I'll sweat off my tanner. But maybe this afternoon), but the workouts I'm getting are good. It doesn't help my gym routine that Boy and I practice ballroom for longer now than we used to (I think because I've gotten better?), but I'll claim that that's exercise (because it is), and not feel bad about it.

Speaking of ballroom (because life isn't all scales and glucometers, you know): as I've mentioned, Boy and I ballroom dance (latin, though we're moving into standard) competitively. This means lots of silly costumes (I have a new one! It's red. And backless. I made it. I'm very, very proud of it), eye shadow, rhinestones, and hair gel. And, of course, tanner.

Boy and I are both very, very white. I am the child of a red-head - the thought of the sun makes me burn. I convincingly do the red-hair-pale-skin thing, I think, in my daily life, but on the dance floor it just doesn't work. Under bright lights and compared to the other tackily-tan latin dancers, I look like a zombie. Who cha-chas. If anything, Boy is even paler. Translucent, almost. *sigh*

The pros on Dancing With the Stars get those fun spray-on booths. I do not have that luxury, so we regularly go out and try to figure out the best way to get that Brazilian latin-dancer tan with minimal effort. I have to say, I like the spray-on stuff, even if aerosol is terrible, but I end up having to use a whole can and still wind up looking like I just got a little sun. In late spring. At Wal-mart last night, while Boy reached for the Neutrogena his sister swears by, I had a revelation: we were going about this completely the wrong way. See, the more you pay for tanner, the better it is: the more natural, the more blended, etc, etc. We don't want natural. We want tan. Tan tan.

So we got the $5 Banana Boat instead. It promised me "super dark." And you know what? I'm impressed.

(Did you know that tanning powder was originally developed as an artificial sweetener? In testing they noticed that it was turning peoples' lips brown. And there's your link to diabetes.)

(also, at the endo two weeks ago, she asked to look at my pump sites, as I'd been having some reaction to them and she wanted to make sure my skin wasn't going to fall off my body. The tanner from the last competition was fading, so I looked jaundiced, and the pump site hadn't gotten tanned at all because, duh, the site had been there when I had done it. Anyway, I looked diseased, in a scary, contagious way, and her eyebrows about shot off her face when she saw me.)

Back to basals

2008-02-19T10:00:00.000-05:00

My shiny new pump has arrived. It's just like the old one, only not all scratched up.

Of course, the old one died in such a way that I can't get out any of my settings. Fortunately, I remember most of them, except for the basals. *sigh* I'm close to being right, though, and random basals are so much nicer than no basals. It's funny what half a unit of insulin an hour does for you - it's the difference between waking up at 80 and waking up at 250.

I missed it.

Well, back to work. Crazy busy week: grading, homework, reading, and frantically trying to finish my costume for this weekend (hard, with a temperamental sewing machine). But it's easier when I'm not injecting every two hours, that's for sure.

Pump. Dead. Sad. And happy kidneys!

2008-02-16T14:04:00.000-05:00

My pump died. *sigh*

It had been behaving somewhat wonkily for awhile, actually. It was absolutely chewing through batteries, for example. But the end of last week, my blood sugar was sky high and just wouldn't come down, until I woke up the other night at 354 (having gone to bed at 134, and not having eaten a thing).

I did what one does - stumbled out of bed, used the backlight on the 722 to dig up a syringe from the closet, drew some insulin by the light of the fridge, went back to bed. In the morning, it had come down from totally-ridiculously-high to too-high-for-the-morning-but-I'm-feeling-fine high (197). Fine. Bolused, ate my usual breakfast, tested two hours later...

414.

Well. Maybe it's the site?

Didn't look it when I pulled it out. When I went to prime, though, is when things all went to hell. The minimed has a plastic screw in it that does the business of injecting. To prime, you hold the button to prime and, when the screw hits the top of the reservoir, it asks you to hold the ACT button until the tubing is full. I don't know how it senses the top of the reservoir; it is part of the black voodoo magic.

Black voodoo magic which has, alas, abandoned my poor pump. It never noticed the top of the reservoir, even when it started spraying insulin all over the room. Now it's stuck on the prime screen and I'm stuck sans pump.

(Side note: this also means I can't get my basals or bolus wizard settings or sensor configuration out of it because, for whatever reason, you can't do anything with a pump that's only half primed. Who came up with that brilliant piece of UI, I wonder?)

Why, oh why, do they always die on a Saturday? Why does no one deliver anything on Sundays? Now it's coming tomorrow morning, when I will very much *not* be here. *grumble*

At least I didn't have a sensor in; that would have made me mad.

So, shots it is. It's actually been OK, given: I don't have any lente or anything, so I'm winging it with the humalog (which is what I did last time) for a couple of days. Suboptimal, of course, but it's not worth the trouble to go down to the clinic to talk to a bunch of GPs who know nothing about my disease to maybe wrangle a prescription for an insulin I don't know how to use. It involves waking up in the night at 250 to bolus a bit. The real problem is how low I've been getting, with the winging it - without basals, or any idea how much insulin is still in my system, I'm kind of flying blind.

I also feel really naked without that thing. I mean, I'm fully clothed, but when you're on a plastic leash every day for 6-7 years, you grow a bit accustomed. It's like, Stockholm Syndrome, only maybe a bit more explicable.

Anyway. I made blintzes this morning anyway, and now I'm slave to homework. But that's my story.

Oh! In other news: A1C was up, to no one's surprise, given the holidays, (7.1), but still lower than the 7.4 it was for like, 3 straight years. It'll be better next time. AND AND AND, the microalbumin level was fine, so I don't have to start taking the blood pressure medication of doom, death, and unhappiness.

Here's to ignoring one's doctors until one receives confirmation of one's test results! Huzzah!

I would have taken it if this test had also come back elevated. The problem, though, is if you start taking it, there's no coming off of it - you take it, the numbers go down, everyone's happy. Given how sick the family of medicines made me last time, and my aversion to pharmaceuticals, I'm glad I waited for confirmation before beginning the medication.

Gosh Darnit AARGH

2008-02-15T09:33:00.000-05:00

Slept like the dead last night. Seriously. At one point, Boy and I woke up and we had switched places in bed, which is really confusing, for the record. I finally woke to the sound of the blender going, but I was convinced it was a power drill. Confused, I got up to see what the hell he was doing in the kitchen with a drill at 8:30 in the morning. I swing my legs out of bed and-

CRUNCH.

Yup. Those were my glasses.

They're not broken, actually. Blissfully. Just bent really seriously out of shape, and one of the lenses popped out. I think I can get them fixed. But that's a morning spent, after digging up the one pair of contact lenses I have left, when what I wanted to do was laze around the house and finish my homework. Ack.

Anyway. I'm annoyed.

Valentine's day was wholly unexciting. Boy and I aren't really into it, because it's a silly holiday, though we are going to a movie tonight. More because we want to, and less because of institutionally-forced consumerism in the name of love. So it was a normal day for me, only with a High School Musical Valentine from a friend at school (the kind we used to get in the 3rd grade). It made me smile.

I had a dream last night that he proposed, and the ring was way too big and really ugly. I mentioned this to him, and he stared for a second, and said, "I have no worries about finding you a ring that fits. You sleep so soundly, I could bring the jeweler in with me to measure you one morning and you'd never know the difference."

I suppose I can't argue with that.

Food surprises

2008-02-12T19:41:00.000-05:00

I voted this morning. I got a sticker, like I used to at the doctor's office when I was little, for being brave. It's on my laptop, now. Hooray!

It's a day of funny food surprises.

I ran across some blood sugar logs from several years ago while organizing my documents folder today in class. It's kind of a trip to read them. First, because I'm craptastic at keeping them, so they each keep up for like a week...or two. Second, because my blood sugar was actually pretty good, which is nice to see. Most amazing, though, are the logs with my food intake. HOT DAMN, I used to eat a lot. It's remarkable. I don't think I physically *can* put away that much food in a day anymore. No wonder I was fat.

Speaking of food, we've been chased out of our apartment by a massive power outage, so Boy and I got Chipotle for dinner. I always thought of burritos as kind of benign, but since I'm feeling virtuous today, for the first time I got the bol instead of the burrito (it's a burrito, only in a bowl and not in a tortilla). I get mine without rice and with peppers and onions, because rice is boring and full of carbs. It's good this way. In a bol, I mean. And then I looked up the carb count for the tortilla on calorie king, and HOLY HELL, there are 55 grams of carbs in those things! It's like, a can of Sprite! And they're so thin. I mean, I guess it's not a lot in the grand scheme of things, but given that I eat like, 100 grams of carbs on a normal day, it was a surprisingly big number.

Well, the bol is delicious, and much less messy.

Back to the gym.

2008-02-11T12:29:00.000-05:00

Went back to the gym today, for the first time in a week. Our last ballroom competition really threw me off track for some reason. I really didn't want to go, but now that I'm done, I'm glad I did - it's really not that hard, and it does make one feel good. Now I'm procrastinating on my homework. Shocker.

In other news, the apartment is hella clean. Boy and I have a new tidiness policy, that involves - *gasp!* - putting stuff away when we're done, and doing a quick clean up before bed. It's lovely and spotless, and I don't lose everything I own. It's wonderful.

I wore my sensor for the aforementioned competition, which is another habit I'm going to stick with. At our first comp in January I wasn't wearing it, causing me to freak out between heats and chow down on tootsie rolls like the world was ending. The stress makes me loopy to start, and the high blood sugar that results from overtreating a mild low makes me dance like shit, so actually knowing what my actual blood sugar is at all times and what direction it's heading in seems like a blindingly intuitive way of dealing with it.

Saw the endo last week. Retested the ****ing microalbumin. Am waiting on results. I expect my A1C to go up what with the Christmas fun, but I'm hoping for something closer to 6 when I go back in May. Also am hard on the heath plan to pay for more sensors. *sigh*

Anyway, back to work, and sewing. Am hard at work on my costumes for next week. Things have just been so busy, hence my neglecting of the blogging. I'm still reading, though!

EDIT: back to work, while eating a big bowl of cooked kale. God, I am a food nerd.

Crying over the blender.

2008-01-23T15:59:00.000-05:00

I'm in that phase of virtuous low-carbiness that causes my daily insulin needs to drop precipitously. This means that my incidence of hypoglycemia has increased precipitously. I have been low all day.

To wit: I wake up at 40, eat some tootsie rolls, go about the preparation of my breakfast. Smoothie, naturally. I pull out my favorite new toy, the hand stick blender, and get to mixing. I get nothing but an unnatural grinding and a really loud noise and, notably, no blending.

My new toy! Broken already!

Naturally, I burst into tears.

Poor Boy. Looking at me from up over his work, leaping over to the kitchen to hug me and ask what's wrong, looking at me a bit incredulously when I indicate the blender. I was in full-on irrationality mode at this point.

"Sweetheart, it's fine! It's under warranty. You can get a new one."

"But what am I going to eaaaaattttt....?"

"Here, I'll make you eggs."

"I took too much insulin for eeeeeggggggggsss....."

"Here, love, please eat something, you're low."

"I don't want to eeeeaaaattt a clementiiiiinnnneee I want my smoooooooothie..."

Anyway. Apparently, it is possible to make a smoothie in a food processor, which is what I ended up doing. And it can be fixed/replaced. But darn, I hope these lows even out. I feel like I've been hit by a truck. And I'm crying over kitchen appliances. *sigh*

Phew.

2008-01-19T10:14:00.000-05:00

Wha! A whole month!

Christmas kind of knocked me off the blogging wagon, as you may have noticed. The diabetes wagon is doing fine, but the blogging wagon...not so much.

I find it much easier to keep it up when I'm in school and have a quasi-regular (if completely insane) schedule - then, I know I have a weekly half an hour or whatever to sit down and share my thoughts. I had a good three weeks off of school, and between the weekend trips to Boston, the family gatherings, the long long drive from Virginia, and so on, I just let this whole thing fall by the wayside.

Back, now, though.

Ahem.

I'm actually in NY at the moment, for a ballroom competition, which is why I have time - my makeup is done, and I'm waiting for the gel on my hair to dry. I'm very (fake) tan. Wish us luck, today!

Blood sugar has been...decidedly OK. Not great, not terrible. *sigh* I'm not even sure why...

I'm trying to figure out the best way to do competitions, actually. Yesterday I panicked and over-pre-treated, ending up high on the floor. I don't dance well when high. We'll try...something else? today.

Read Good Calories, Bad Calories. Found that the science seems to support what I've observed, namely: if I each such that I can take fewer than 30 unites of insulin a day, I lose weight (low carb). And that's the only rule that matters.

It's been so long, I don't know what to say! It's easier when it's being done regularly. Consider this my "I'm back!" disjointed post, and in the future, I'll hopefully have something a little more substantive to say...

Done.

2007-12-17T08:44:00.000-05:00

Done done done. Not really, of course, as I have reading and such to do, but finals are over.

Now, CLEANING. The poor apartment; we have been dreadfully neglectful. I've already loaded the dishwasher this morning, after a truly epic visit to the recycling center yesterday. (whew)

As for blood sugar, yesterday was awful, for no reason. I scarcely ate. Soared after dinner, and stayed high through the night. I remember the high alarm, I remember cleaning it, and I also remember bolusing for it - unfortunately, only the first two actually took place. *sigh*

So I'm loading the dishwasher and drinking my coffee and waiting.

Oh! It was my birthday yesterday. I am 23. I find this fact surprising, for some reason.

Also, all I've been doing, besides kind of studying, for 4 days, is watching The Office. We blew through Season 2 in well under a week. Yes, that's 22 episodes. Yes, we're sad.

I went out and got Season 3 as a 23rd birthday present to myself. And I'm not sorry. I only hope the writer's strike resolves by the time we catch up...

Don't Feel Like Going

2007-12-13T08:52:00.000-05:00

Don't want to go to the gym.

Don't want. To go. To. The Gym.

Don't want to go. To the gym.

I have the (messy) apartment to myself, while Boy takes a final. I am to study for several hours (exam, Saturday! Architecture, ugh. The computer kind, not the building kind. The latter might be interesting. Though I'd be more likely to fail), and then drive to Maryland for a dance lesson this afternoon. I'm enjoying the aloneness, with some coffee, the internet. The Office.

(Oh goodness, The Office. Just discovered it. Totally obsessed.)

And I do not want to go to the gym. I don't really want to study, either, but I see that happening a bit more easily. I'd rather sit here with the coffee, or clean the kitchen/living room/dining room/vanity, or, really, watch more of The Office. Anything but.

In times like these, I resort to mind games. I get up for just a few minutes, to get dressed. I have to get dressed; I don't study well in pajamas. Besides, I can't wear pajamas all day. Must wear clothes. The fact that I am putting on gym clothes is completely inconsequential. I'm just getting dressed.

Soon, we will get to shoes. I'm already wearing gym clothes, which is why I'm going to have to put on running shoes. They go with the outfit. No choice.

And then, *sigh*, out the door I'll go. But I'm not happy about it. And I'll tell myself "it's only for a few minutes" every few minutes, until I'm done, and home, and in the shower.

I haven't been so good about going this week; I think it's because I'm off the usual wake-breakfast-gym-class schedule. But I'll trick myself into going today, and then studying.

But first, a few more minutes of The Office. Because I can.

End of the Semester

2007-12-12T09:17:00.000-05:00

Phew! It's finals period here in graduate land, and so the apartment is a mess and life is a little stressful. Things have calmed down on my end (only one more exam, and piles and piles of grading), but Boy is in the throes of 1L exams and is, thus, freaking out.

We did get the Christmas tree up, though. Hooray!

Anyway, that's why I've been MIA, and probably will be for another few days. Things are just too crazy.

I will pause to say, though, that my newfound obsession = spaghetti squash. I. Love. Spaghetti. Squash. Wow. I love me my pasta, but I don't really eat it any more, what with the carbs and all, but I've started roasting squash and eating it as a substitute (with real spaghetti for Boy, who usually goes along with my crazy food schemes but just wasn't able to get behind this one) in my usual pasta dishes. So good. And the chirpy little cgm stays all but flat when I do it.

Numbers have been good; still a bit on the chubby side. Trying to log again, as it usually helps.

Back to work.

Tagged!

2007-11-22T10:34:00.000-05:00

Bad Decision Maker tagged me! I know I'm a bit late, but Thanksgiving travel/family time/celebration have interfered with my computer usage. Anyway, better late than never, no?

Seven things about me that you don't yet know:

(this was harder than I expected it to be)

1. I played the Pauper in my 6th grade production of The Prince and the Pauper. The prince was played by a boy (we were about the same height, so it worked). I had waist-length hair at the time that we had to tie up and pin under my hats. This was the pinnacle of my musical theater career. I like to think I did a good job. Yes, there is VHS evidence of this spectacle. No, you may not see it. I still remember some of my songs; I sing them in the shower.

2. I wear Clinique Happy every day. This one's diabetes related: I don't much like scent, and I swore I would never wear perfume, until one day about 5 years ago I broke a bottle of insulin around my boyfriend. He came in, said "What's that smell?" I told him, and he looked puzzled for a second and said "That's what you smell like! I've always wondered..." He didn't mean it badly, but I was so horrified that I bought the only perfume I've ever been able to stand and have worn it every day since.

3. I can walk on stilts and jump on a pogo stick. I cannot juggle to save my life.

4. I have been a nail biter for as long as I have had teeth. I'm currently trying to quit (again). It's going oddly well.

5. If you google my full name, most of what you will find are archives of high school Lincoln-Douglas debate results from around 2000-2002. I was pretty good. In fact, I wanted to go to law school for years and years, until I actually started studying social theory in college and realized it made me want to die. I switched to computer science and have been much happier since, though I still took the LSAT, and a huge proportion of my social circle is in law school/are now practicing the law. In fact, all of my ex-boyfriends are/will be lawyers, my current boyfriend is a 1L, and the one non-lawyer works as a technology consultant to, you guessed it, lawyers.

I apparently have a thing.

6. My favorite TV shows as a child were Batman and the Teenage Mutant Ninja Turtles.

7. I speak French fluently. My parents are immigrants. My mom came here 25 years ago to get a Masters degree in Material Sciences at Carnegie Mellon and stayed for her PhD; my dad came with her. (They're divorced now, but still friends.) I actually have a very large extended family out in the mother country, and I used to visit for months at a time over the summer as a child/young adult. It's funny to think that my mother used to put me on a plane to France with a connection in Reykjavik all by myself at 11, 12, 13...Perhaps she was just very liberal with me (she was quite a bit more protective with my younger sister); perhaps the mid-90's were just very different.

So there you go. Some tidbits about my life.

Rules:

1. Link to the person’s blog who tagged you.
2. Post these rules on your blog.
3. List seven random and/or weird facts about yourself.
4. Tag seven random people at the end of your post and include links to their blogs.
5. Let each person know that they have been tagged by posting a comment on their blog.

Breakthrough

2007-11-19T10:33:00.000-05:00

I am not a medical professional, blah blah blah.

But seriously, this whole intervals thing is pure genius. Everyone should do it. No joke.

Before last November, I had never run a mile in my life. As of 3 weeks ago, I didn't have a huge amount of time to work out, so my daily run looked something like: warm up at an incline, 5 minutes. Run, 0% incline, 6.4 mph, 20 minutes, cool down, incline, 5 minutes.

The last couple of minutes of that 20 minute bit was always quite difficult.

For the past two weeks, I have been on the treadmill for 20 minutes a day. Total. 3 minute warm up, 2 minute run-like-hell, 2-minute recover, repeat for 3 more sets, 3 minute cool down.

Today, I was in the mood for something a little longer, so I thought I'd try a variation on my usual run, to see if the intervals really had helped.

Holy running, Batman! 5 minute warm up, 15 minutes at 7.0 mph, and then 5 more minutes at 7.5 mph and a 2.0% incline.

...

...

And the kicker is, it wasn't even that hard. The last couple of minutes were difficult, but mostly because my legs were sore at that point. I was breathing hard, but not as hard as I have breathed before.

I'm completely amazed at myself.

Break time, almost.

2007-11-18T11:28:00.000-05:00

Well, I'm not updating every day for a month, yet, but I have been better about it. *pats back* And, I've been responding to comments! In a timely fashion!

(maybe I'm finally getting a hang of this whole blogging thing)

It has been a rough couple of days. I've been going catastrophically low, repeatedly. I think it just wore me out, because I feel kind of ... sick? I don't know. Headachey and exhausted and sore. A bit better today. I hope it's just a "your body is freaking out because of the swings and will feel better tomorrow" thing, instead of a "FLU!" thing, because that would certainly ruin Thanksgiving.

Excited about Thanksgiving, though. I haven't been back to NY to see my parents since I moved, in August. I have seen most of my family since then, since they all came to visit, but it's not quite the same. When I lived in Boston, I would usually drive down every six weeks or so to visit, so this is a long time to not have been back.

I'm looking forward to the break from school, and a change of scenery. Sad to be leaving Boy for 6 days, of course. But I love Thanksgiving. It's my mom's favorite holiday (which is funny, since she's an immigrant), and so it's always a big do at her house. That, and my dad and stepmom and I have a full day in NYC planned for Tuesday - Christmas Spectacular, windows, Christmas tree, ice skating, dinner - like we used to do when I was a kid. And yes, I'm very excited.

I could use the break.

A Rough Couple of Days

2007-11-15T17:07:00.000-05:00

Yeah.

Yesterday was already shaping up to be mediocre, diabetes-wise - you know, there are leftover stacks of Halloween chocolate around the department, I overslept and missed the gym, and so on- when I got a message from the New Doctor.* New Doctor had already called to tell me that the blood work was peachy keen (remember the A1C? Hooray!), but this message was a bit different. My microalbumin is up to 30 in whatever units they use to measure these things, which is right at the cut-off of what they consider acceptable, and she'd like me to go on an ace inhibitor or some such to head the problem off at the pass and reverse any damage.

This is in a message, mind. So I call back, and I get her on the phone within two minutes (...love...). She's very matter of fact, a little excessively so, as I'm kind of freaking out. Not on the phone, of course, just in my head. On the phone, I am polite and put together. In my head, I'm having a breakdown.

Seriously. A year of diabetes reformation. A year of exercise, of low-carb, of testing. Of continuous monitoring. A year of no longer being fat, of wearing shorts again. The first A1C under 7% in longer than I can remember. And now this? So I'm internally hyperventilating. It's only been 11 years, I can't have problems yet! And this problem, above all of them, scares me to death. Eyes, they can fix with lasers. Neuropathy sucks, I'm sure, but...there's nothing to be done about kidneys. Nothing, but dialysis and pain and jaundice and a slow, painful death. 11 years! I'm only 22, I have decades more of this, and problems, already?

This is what is running through my mind as I talk to her.

She's being very rational about it, since that's the way she is. In truth, there is no problem. Yet. I'm right at the cut off of what is considered problematic, and if I take medication, any damage can easily be stopped and/or reversed. She is sending me a prescription.

And that caused me to panic, silently, for the rest of the day, as I tried to focus on the paper we're submitting, and classes, and all the rest. I overbolused like mad, freaking over the high numbers that the stress and the chocolate produced, crumbling madly as I came home in the evening. Home to Boy, who listened, and let me cry, and fed me tootsie rolls, and told me that everything was going to be fine, and that he had plenty of kidneys, and I could have one of his if I needed it.

I feel a bit better now. Points of note:
1) I don't know how I feel about the medication. Not because I'm intrinsically averse to medication, but because this is the stuff that made me feel like death the last time (the stuff that spurred the health-kick). She is aware of this problem and is giving me a different type of drug, and told me to take it at night, when low-blood-pressure-induced exhaustion is less of a concern. I'm taking a very, very low dose, since I really don't have a problem yet at all. I'll take it, but I'm not happy about it.

2) I don't really have a problem yet. The number is still in the acceptable range. I am not dying. I need to calm down.

3) I'd like to get retested, actually. My microalbumin has always been fine (excellent, even, according to the notes my previous doctor gave me when I left him), and it seems fishy to me that, in the one three-month period I finally get my A1C down below 7 again, it goes up to almost-alarming levels. I intend to call MGH to figure out the last result before insisting, but I'd like to be sure before taking the death pills again.

The moral of the story: I had one of the worst blood sugar days I've had in months. Under 250 all day, but up and down and up and down. The kicker is that the sensor claims an average of 117, which is laughable, because the only time I went through the low hundreds was when I was cruising up or down. Quickly. Finally settled around bed time.

Of course, now I'm on a renewed kick. To the point that I called minimed and plopped down the credit card for a new box of sensors. I will get the new insurance to pay for the rest of them, and hopefully reimburse me for this one. I figure my tax break will pay for it. Or something. *sigh*

Anyway, today, the insulin just stopped working. I finally got home and pulled/changed the set, and that old bottle was done anyway, but seriously, this is out of control. Fortunately, I barely ate a carb all day (salad and lunchmeat-spinach wraps for lunch), so it climbed slowly to the high 100's, and flirted gently with the 200's, by the time I changed it. Site looked fine, no kinked canula, but perhaps a bit more inflamed than usual. *double sigh*

In happy news, it looks like the cortisone cream is helping my skin problems. Looking on the bright side.

Boy's home soon, then off to the gym. I hope everyone else is having a slightly better week.

* Side note: I like the New Doctor. She talks a bit too much, which says something, coming from me, but she's smart and involved and not too pushy, and listened to me. Which is nice.

The Verdict

2007-11-13T08:29:00.000-05:00

6.7

Not terrible. Not terrific, in my book, but not terrible. Better, notably. Now, to the low 6's!

(The ADA would think it's spectacular, my new doctor - whom I like, incidentally - sounded pleased).

Here's the important bit, though: my most recent, pre-CGM A1C? 7.4. It was 7.4 for years.

.7% drop!

Bite me, Kahn.

Support diabetes technology!

Tidbits

2007-11-09T09:47:00.000-05:00

Mired in research work, but taking a quick break to update. To wit:

1) Meeting the (potential!) new endocrinologist today. Am prepared to dump said endocrinologist immediately if I don't like him/her. UVa medical center has, apparently, one of the top 10 diabetes centers in the country (as does MGH). We'll see how that pans out.

2) MGH, speaking of which, is not returning my phone calls pleading for help with the CGM coverage issue. Aargh. May have to dip into savings for another box. Very unhappy. In an effort to conserve supplies, have gone without CGM for a week with little fanfare, but miss it terribly.

3) Seem to have lost my taste for sweets and much of the crap that made me fat. This is both good and bad. Good, because Cheetos at 3 in the afternoon are a negative habit that made me fat and contributed to some outrageous A1Cs. Bad because, when hungry at 3 in the afternoon and without pre-packed snacks, the vending machine has become useless. I actually had a bowl of Go-Lean yesterday morning because I woke up feeling mildly unwell and it was the only thing that seemed palatable, and I didn't enjoy it as much as I remembered. Huh.

4) Still like chocolate, however. Very sad about having finished the Trader Joe's dark-chocolate-covered-dried cherries that my dad brought down for me. Post-halloween mini-kit-kats are a sad and sorry substitute. Must restock over Thanskgiving. Miss Trader Joe's and the northeast.

5) Want to lose 8 more lbs by Christmas, due to pending birthday shopping extravaganza my mother has promised. This plateau is fun and all, and I'm very proud of myself, but come on. New skinny jeans would be fun.

6) Intervals no longer painful theo day after. Now, just difficult. Am enjoying new fitness plan; intend to work resistance back into my life starting this week (I think that the lack of resistance is contributing to aforementioned plateau, not to mention general feelings of weakness. I miss my muscles! And, I'm going climbing with my sister over Thanksgiving, and want to minimize feelings of uselessness).

7) Introduced some friends to lentils last night. Am on a massive legume kick. Delicious, nutritious, and cheap! What else could a girl look for in a foodstuff? Oh, right, a preparation time of < 8 hours. Well, they still make me happy.

Back to slave labor. Happy D-blog day, everyone.

Intervals

2007-11-03T16:45:00.000-04:00

Good Lord.

Boy's mom, a crunchy-alternative-medicine type, recommended a fitness book by some fellow crunchy-alterna doctor type. I'm loathe to follow health advice from books that claim to be able to make me thin in just 12 Minutes a Day!(TM), but Boy was reading solemnly and claiming that some of the claims were "interesting."

Well, we all know my gym routine has been tortuous of late, so I figure, why not give it a go? Boy never joins me at the gym, and I thought company for a day would be nice, and any exercise is better than none, right?

Crunchy-alterna's recommendations can be basically summarized thusly: intervals. I'm too lazy to recount his theories, but the idea is that you warm up for 3 minutes, run like hell for 2, recover for 2, and so on. He's not the first health person to recommend a strategy like that. And OHMYGOD, it is so hard. Never has two minutes seemed so long and brutal before. In a good way, I mean. I worked out for about 20 minutes and feel like I was going for an hour.

It was amazing. And awful, naturally. But also amazing.

Grumble grumble blergh, and an accomplishment

2007-11-02T08:26:00.000-04:00

Overindulged a bit at a dinner party last night. Corrected before bed, which almost universally does the trick (what with the taking insulin, and all), and still woke up a 233.

The Reese's peanut butter cup was A) not as good as I remembered and B), so not worth it.

Now I feel like I've been hit by a truck, which is probably why it took me a full hour to get out of bed after Boy did. Even with the alluring scent of coffee. As he kissed me good-bye on my perch on the couch, I whined "You can't go to schooooool, I don't feeeeeel goooood."

He pointed out, gently, that he had to go to class, and that there wouldn't be much he could do but wait for the insulin to do its business.

True enough. But still.

Anyway, the kitchen is a disaster, as is the rest of the apartment, so cleaning the blender by hand to make my morning smoothie seemed like an insurmountable task. We're out of frozen blueberries, so I couldn't use my typical easy default (cereal-like in its convenience! Ice-cream like in its deliciousness!). Fatalistically contemplating never eating again, I came to the sudden, lovely realization: YES! We do have eggs! Cage free, even.

For the first time in my life, I made a decent omelet. A *good* omelet, even. I have a hex thing with omelets: while I'm a pretty good cook, if I do say so myself, just something about the folding over never went well for me. But the gods of the kitchen were feeling generous, and so omelet it was, with mushrooms and onions and a smidgen of cream cheese (some Jewish traditon of Boy's family, though he tends to stick half a block in there. It's oddly delicious, and I wanted to save the last of the spinach for lunch...). That, and a new pot of coffee (the first one was oddly weak), and I'm beginning to perk up.

The only problem is that I bolused thinking I would have my usual smoothie, which is probably too much for omelet + gym. Hum. Don't want to go low, need to go run...

Oh well. I'll go back to my blasted NSF essays first and obsess about *that* particular habit later. I think I'm beginning to feel better.

I love Friday mornings. I don't have to go in before 11. It's downright decadent.

Motivation.

2007-11-01T11:47:00.000-04:00

I am having the hardest time getting myself to the gym these days.

It's not a time thing. I mean, I don't have time to do anything, so I just go, and that's the end of it. But walking up the hill to that little fitness room in my apartment complex is just so, so hard. Every step, I think "Gods, I don't want to run today." Every step is a mental bargain with myself "Just get on for 5 minutes, then you can stop." While running, every 30 seconds is a mental encouragement: "Come on, only 14 minutes left. Only 13:30 minutes left. Only 13 minutes left..." I've never liked to run, and of course there have always been days that I didn't want to go, but this is a more consistent rut than I can remember. Looking at it in a different way, maybe I'm just noticing this rut more than I would a previous one, because perhaps in the past I would have just not gone running, whereas now I'm going, I'm just not very happy about it.

Of course, I still think it's a good idea to go: my blood sugar is better and I feel better when I've run. Maybe I just need to change up the music on my iPod, or something.

(For some reason, the Intense Runner Guy, who beat me to the gym this morning and was doing his usual full tilt at like a 97% incline, or whatever it is, was watching infomercials for exercise equipment targeted at 30-something women. Explain that one to me).

I have to go, though. My first appointment with my new endo is next week, and diabetic guilt is in full swing. Besides, I'm going to have to convince a whole new fleet of medical professionals that I really don't want to take a blood pressure medication (because my BP is quite good, and because the medication makes it impossible to get out of bed in the morning because, shockingly, it causes my blood pressure to drop too low) or a cholesterol medication (because, frankly, my cholesterol is fine, and I am unconvinced of the benefits of artificially lowering it, particularly when I still have weight to lose). That will all be easier to do if I maintain my healthy lifestyle in the week leading up to the appointment.

(speaking of which, I need to get back to the pharmacy and pick up the rest of my test strips. Hm...)

So I'll keep running, but I don't promise to be happy about it. I do take slight pleasure in the fact that I've been pushing my abilities a bit - upping the speed, starting to run up a teensy, insignificant (but still present!) incline, and so on. Maybe it'll help me get out of my rut. Maybe it will make my heart explode.

More likely, I'll keep hating it, it'll keep being good for me, and I'll keep doing it.

Oh! Unrelated note: I resisted pizza for lunch yesterday. Go me!

*Claire putters off to eat her salad and finish her NSF fellowship application*

Unawareness

2007-10-20T10:38:00.000-04:00

In the grand scheme of things, I haven't had diabetes that long. I mean, compared to a lot of people, 10 years is nothing. But how long does it take before hypo unawareness kicks in?

I'm beginning to worry, actually. Boy commented that he worried that the sensor was making me unable to feel my own lows, because lately, more often than not, the sensor chimes that I'm low and I quite literally haven't felt a thing.

Maybe it's because my control has been so much better lately that I'm having a hard time feeling the lower numbers? I theorize that it may be that the sensor gives me better control, so the low numbers don't feel as low any more - it's definitely the case that I feel high at far lower numbers than I used to feel it before.

Then again, I haven't had any really dangerous, confused, scary-need-help lows in a while. I think it may be the better control I've found in the last year or so (Bernstein's law of small numbers is really true - if you're not eating as many carbs you don't need very much insulin, so it's rare that you make a drastic mistake and drop catastrophically. At least for me). Additionally, the sensor chimes before I get really low. It's set to 70, so I'm usually actually about 60 when it goes off.

I've been off the sensor for a couple of days now (I'm trying to conserve them, since I don't know when/how I'll be getting a new box. Moreover, the skin on my backside could really, really use a break...), and I've been low a couple of times. Sometimes I've caught them just because I've tested at the right time, but most times I feel them and then test. The problem is just that, by the time I feel it, it's down in the low-50's or high-40's, which is not only scarily low, but also harder to treat accurately (I know how many tootsie rolls to eat when I'm in the 60's) and lower than I used to be able to feel them. I also know that it takes a lower number to wake me than it used to.

*sigh* I suppose I'd rather have better control overall and less ability to feel my lows than the opposite, so long as I have Boy around to wake me if things get bad (it hasn't come to that in many months), and so long as I have a sensor to chip in most days. But the tradeoffs offered by this disease are frustrating. It's as though it was designed by someone with a very unpleasant sense of humor...

Experiment

2007-10-17T12:05:00.001-04:00

Look! I'm blogging again!

This month is an experiment month. We all know that I've given up statins and ACE-inhibitors. However, for many years, I have also been taking birth control pills, as we discovered very quickly at the age of 13 that my menstrual cycle wrecked complete and total havoc on my blood sugars. The pill eliminated this problem (though not my cramps, for whatever reason), and so I haven't thought twice about it for 10 years or so.

However, I've been noticing a "cycle", of sorts, of my insulin needs. Namely, in the week off the pill, I need much, much less insulin. I don't know if this is a true correlation or if it's just luck or chance or whatever, so I'm taking a month or two off to see what happens with my sugars.

(It'll probably take a couple of months to figure out if it's the pill or just dumb luck).

Does anyone else (of the female persuasion, naturally) have experience with this? I never really thought about it until recently, and it's been so long since I started that I don't really have any point of comparison...

Anyway, it's not a life-threatening experiment in any way, so I'm looking forward to figuring the mystery out.

In other news, I'm sitting outside, working on fellowship applications, with a cup of coffee. It's a good life. Also, I'm planning to get in on this Diabetes365 action, I just haven't had the chance yet. It's not usually my kind of thing, but I find it appealing in this case, and I have a pretty little digital camera that I want an excuse to use. Be warned, I'll end up taking a lot of pictures of my meals...

Another Friday Afternoon

2007-10-12T17:46:00.000-04:00

*sigh*

Well, I'm inclined to blame the insulin bottle, this time around.

There really just isn't any other explanation. Breakfast of mango smoothie. Remember the mango smoothie? The mango smoothie consists of frozen mango, full fat yogurt, two ice cubes, and enough whole milk to get the blender going. And a consistent 3.5 units of insulin.

Well, today was the same, only with 2.5 units of insulin and a half-hour run. And a climb up to well over 250, for whatever reason.

OK. Let's change the sensor, in any case, because the old one was getting really jumpy and had been in for a week.

Lunchtime: 146, according to the Freestyle. I calibrate. I bolus 4 units, which should be a lot for the meal that follows. I eat the 4 chicken strips, nugget style. This is less than a full breast, each strip dipped in flour, then egg, then a thin layer of corn meal, and pan-fried in olive oil. Plus, my fun asparagus, tomato, and yogurt/dijon salad, and two kiwis.

I HAVE EATEN THIS SALAD BEFORE. And yeah, OK, chicken pan friend *not* in cornmeal might have been better, but we're not talking heavy-duty breading here. I've eaten *that* before two.

Was it the kiwis?

What, dear reader, among those meal choices, could have justified a climb to 350 after lunch? I bolused repeatedly, to no avail.

I give up. I really do. I came home, I changed my (perfectly normal-looking) set, and I used a different bottle of insulin. I bolused fairly heavily for the ridiculous blood sugar. I climbed in bed for a half an hour, because really, what else am I going to do?

And now we've crashed comfortably down to below 70. FINALLY. I don't think I've ever been so happy to be low.

Was it the insulin swap, or did my afternoon rage-bolusing finally catch up? I think it was the insulin swap, because if it was the rage-boluses, I'd be much, much lower than 70 (I took over 16 units for that lunch, in the end, before the post-set-change correction).

I skipped afternoon tea at school today. There was a cake bake-off among my fellow grad students, and we were to eat the results, but I just couldn't do it. Yes, I was sad to miss the social event, but there was no way I could justify it with the readings from the sensor.

And I'm happy for it, really. I'm feeling better now, and I just treated myself to a snack of some coffee and the last of the crepes my dad brought me from France, with some butter and a little dusting of real sugar. Oh, and a couple of dark-chocolate-covered dried cherries, from Trader Joe's, because I love them and I'm fighting off a low, of course.

*sigh*

I hope it *was* the insulin causing the mess over the last couple of days, because otherwise, I'm at a loss. It would make sense, though, because those spikes were nonsensical. The past couple of days I could kind of explain them with my questionable food choices, but today, there was really no other reason for it. In my wrath, I turned up my basal rates super-high this afternoon, but I'm thinking it was probably unnecessary. I'll go turn them down, now...

Another Friday Morning

2007-10-12T08:58:00.000-04:00

I'm about to go to the gym, but I like having time on Friday mornings to update, so here I am. Not that I can't update other days, but at least one day a week, I have the time. And besides, it has finally, finally, finally gotten cold down here (hooray for fall weather!), so I'm waiting for the coffee to finish.

(Boy made very good coffee this morning, and then promptly drank 85% of it. Ergh.)

I promised a State Fair update! Actually, the flickr set is more eloquent on the subject than I could ever be. I particularly like the photos of the demolition derby, which I think actually came out fairly well. I'm not much of a photographer, but the camera I got for Paris is very nice, and I'm certainly enthusiastic. Most interesting from a diabetes perspective is the food, which was mostly fried. Oddly, I had a very good blood sugar day: apparently all that fat really does slow the absorption of the sugar/carbs.

(I didn't even eat that many carbs, if you exclude the large limeade, which you can't, of course).

And the deep fried oreos. Oh, the deep fried oreos! Actually, one of my friends got a deep-fried pepsi, just to try it. I did venture a taste, but found it pretty unappealing. The D-community is not missing out, I can assure you. The oreos were a different story altogether: I don't even like the little chemical cookies that much, but fried, they are balls of heaven and happiness. We split a couple of orders between the 5 of us, which cut back on the gluttony, but oooh boy I'm glad I have a *modicum* of self-control, or I would have eaten the fair out of them.

Diabetes aside, it was a really fun day. Lots of strange performances (a whip guy, an alligator wrestler, a pig race. Demolition derby. Kids on sheep) and animals (prize winning piglets, for one). Beautiful weather. Games. And so forth. I highly recommend it. I was there with some new friends from my department. It's strange, to have to develop a whole new social circle after having had such a steady one for 5 years. I was worried for a bit, for some reason, but really, the people I've begun to spend time with are just as funny and inappropriate and entertaining as my other friends, and I'm perking up about graduate school in general.

Since we've been settled in a for a few weeks now, it was really very nice to get out of the house and have an adventure. The first month was really consumed with unpacking and orientation and figuring out where the grocery store is. Now, I'm looking forward to clearing some time in my life for something besides homework and research and fellowship applications. Boy was gone this past weekend, but this weekend, we're off to DC for a day trip to take a dance lesson and see the Smithsonian. (I haven't been since a trip in the 8th grade. Hooray, adventures!) Anyway, I think such things are good for my mental health. I won't have the time or the money for the same level of adventure we used to have while I was employed, but there's still no reason to sit around at home every day.

This entry is getting long.

The diabetes...has not been going super well. I'm having sort of an existential crisis, or something. I'm just really struggling for control. I'm also feeling highly apathetic - like, why bother obsessing today when A) it's probably going to suck anyway and B) I'm only going to have to keep obsessing tomorrow? I know this attitude is unhelpful, of course, but...I did go to the gym every day while Boy was gone, and while I took a couple of days off, I'm going back now. I think some of it may have been the kind of lonely frustration I got into being home alone for 6 days doing nothing but homework, because I'm feeling rather better today - I'm up early, I ate a positive breakfast, and so forth. We began dancing the samba at practice last night, and I'm excited for our first competition (in November!). So I'm sure it's just a phase. I also intend to ask the endocrinologist, if I can ever see him, about Symlin. I know I'm not supposed to compare myself to others in the OC, but it seems like I have such a hard time compared to some people - even when I eat a low low carb breakfast, like full fat yogurt and low-glycemic fruit, my blood sugar shoots up 100 mg/dl before it even starts to think about responding to the insulin. *sigh* I'm just tired of trying so hard, just to end up with the same A1C of 7.4, month in and month out.

I *do* still love me my CGMS, however. I'm sad that I'll probably have to shell out my own hard-earned $350 for another box, but it shows you how much I love it that I'm willing to do it. Also, I'm on day seven of this sensor, and it's still ticking. Huzzah!

Anyway, after all that griping, I really do need to get to the gym. Happy Friday, and happy fall weather, to all.

VA State Fair

2007-10-06T21:58:00.000-04:00

For my first real out-of-Charlottesville adventure, I went with several fellow students to the VA State Fair in Richmond. Needless to say, I was not disappointed.

I will write about my adventures tomorrow, however. I just wanted to check in with the fact that apparently, fair food is really great for my blood sugar (...all that fat). Very odd.

Now, though, I 'm going to rehydrate, eat a small piece of steak and some concord grapes (I'm hungry but am too lazy to prepare a salad and really, desperately want to eat something that's not fried) and learn some new things.

Happy Saturday.

Recovery Weekend

2007-10-05T22:40:00.000-04:00

I never really recovered from this morning's 200+ glucose reading. *sigh* A poor choice at the Chinese place for lunch just shot me to hell for the afternoon in a really really serious way, and then the decision that it would be a good idea to eat toast and way, way too many grapes (...sometimes I eat compulsively, a realization I definitely had today), led to just a waste of an evening. I napped. I just can't handle it when I feel that way.

I finally dragged myself out of bed, into the shower, and to the gym, around 8. I rarely work out in the evenings, first because I don't have time*, and second because it can keep me awake, but it was just the thing I needed. It was also the only thing, all day, that managed to get my sugars down. They're climbing again, for no reason, but at least they're under 200. I don't even want to look at today's average.

Anyway, moral of the story is, today kind of sucked. To be honest, I haven't really felt like myself for the past week or two, and I think some of it has to do with my physical well-being. I've also been completely swamped with work and crazed for time, which hasn't helped. As I have off from school until Wednesday, and as I'm home alone until then, I'm going to use this weekend as something of a recovery period - time to catch up on my work, relax, clean around the house, take care of what needs to be taken care of, have a little fun, and really focus on my physical and mental well-being. I'm going to go the gym every day, begin to stretch a little more, regularly (I'm monumentally inflexible and I don't have time for yoga, and it's beginning to interfere with the rumba...), and eat properly.

(The big caveat to that last clause, of course, is tomorrow afternoon - a bunch of people from my graduate program are going to the VA State Fair. My attendance is, of course, necessary, if only to take care of the "mental well-being" part of my plan. I mean, I can't stay home all weekend and not speak to anyone, now can I? And besides, with all my work, I need to have *some* fun. I'll take it easy on the greasy food, though I may be forced to at least take a bite out of a deep-fried snickers bar...)

(But just one, I promise!)

Anyway, I think I just need to focus on a little personal rejuvenation. Fortunately, I have a long weekend that I can devote exactly to that cause.

* I actually usually run in the morning and practice ballroom in the evenings with Boy; ballroom is quite physically intensive, but it's nothing like running, so it works out well.

[EDIT: I just did look at the sensor average for today. It's funny, it's the same as my A1C average glucose equivalent was back when I was all not in control, freshman year of college. I can't believe I used to be this way all the time.]

2007-10-05T09:47:00.000-04:00

Today got off to an inauspicious beginning, as I woke up at 201, feeling groggy and scratchy and sick. Blergh. So I skipped my morning gym trip in lieu of sleeping until 8, let Boy make the coffee, and took it easy over my breakfast smoothie. *sigh* He's leaving for fall break today to visit his family, so I'll have time to run this evening instead. My mini-goal for the break is to run every day...

But anyway, things are better now. Nothing like insulin to get a girl feeling good again. :-P I finished up the research work I was supposed to finish by today, and am back to being productive. Fellowship essays! Unloading the dishwasher!

And so on.

I'm a little nervous about sleeping alone for 6 nights, but I'm sure my trusty sensors will keep me going...I'm beginning the arduous process of convincing my new insurance to pay for more of the accursed things. *sigh* It's annoying that being a grad student involves quitting a job not only with superlative health benefits (...that included free sensors) but also with a high salary (...that could have covered the sensors even if the insurance didn't). Is it weird to ask for them for Christmas from my family, you think?

I've been kind of struggling with the diabetes the last couple of weeks. I had a couple of really excellent weeks there in September, but now, no matter what I do, I'm eating too much, bolusing too little, bolusing too much, bursting into irrational-low-help-me-Boy-tears...it's exhausting. I'm hoping my little break from school (and from teaching hours and hours and hours of lab - huzzah!) will get me back on track.

Now, to call Minimed. Wish me luck.

It has been...

2007-09-28T08:30:00.001-04:00

...a long, long time. Thank you to Manaically Monday for prodding me back into blogging. I realize I've been totally MIA, and I suck. I hope to be back now, regularly.

So. Where have I been? Well, there was the packing and the moving, and the going to Paris (! I want to move there), and the whirlwind 4 days at home, and the 10 hour (!) drive to Virginia (editor's note: it's not supposed to be a 10 hour drive. We got lost), and the orientation, and the moving in, and the unpacking unpacking unpacking for a month, and so on. Only recently has life settled into enough of a rhythm that I feel like I can sit down and breathe, let alone blog. *sigh*

I've been keeping up with the headlines, though, in my defense.

Things have settled down quite a bit. Grad school is insanely busy - so much more so than work ever was. I expect it will calm down, too, by my third semester, at which point I will not longer be expected to TA. I'm enjoying it so far, however. My classes are interesting, I've started to research, and I even enjoy teaching, for what it's worth.

(speaking of which, I really should be grading)

Friday mornings are nice because I don't have to be anywhere before 11 am. Usually I go to the gym (I've been so good!), but I banged up my ankle yesterday and can scarcely walk today, let alone run. This means I have the time to free-associate a bit online.

The diabetes has been back and forth. The first couple of weeks were a mess. The next couple of weeks were perfect. This week has been mediocre. After the first orientation weeks, where we got free (carby) food almost every day, I got back into the habit of eating well and carb-free. And going to the gym. Almost every day. At 8 am. Can you believe grad school is turning me into a morning person? This is helped by the fact that boy gets up at 7 am almost every morning for law school, but whatever. This week, for some reason, I slipped a bit. In any case, I'm back on the wagon, again, and I put a new sensor in last night, and things should be better from here.

My weight even dipped into the 120's last week, for the first time in years! It's back up again, now, but I see the light!

I haven't sorted out new sensors, yet. I'm trying to get an appointment at Student Health, which involves a referral (annoying, but hey, it's their money, not mine). I thought the meeting with the GP went well - we covered just my history, briefly - until I got a phone message from a nurse at the diabetes clinic saying something like "we received a referral about you wanting help with your pump and overnight hypoglycemia."

...

Thank you, for not listening to me.

(I haven't had problems with overnight hypoglycemia since 2003.)

*sigh*

I need help getting new sensors, people. My grad student salary is hardly going to cover them, and I really can't live without this thing.

Anyway, I'm really just babbling. Checking in to say that I'm still here, Virginia is nice enough (it's not Cambridge, and I miss the north east, but given that I spend 10 hours a day running around anyway...), and I'm going to get back to this regularly.

Hopefully with a bit more structure next time.

Stress Effects

2007-07-31T14:27:00.000-04:00

I had somehow managed to convince myself that I was one of those people on whose blood sugar stress had no effect. I am immune to adrenaline, cortisol, whatever whatever.

Not so much, though. Last week was a whirlwind of moving-induced panic attacks, and my blood sugar was through the roof, repeatedly, inexplicably. I finally took a much-needed deep breath this weekend, and, despite eating the exact same meals, more or less, my blood sugar has halved. It's pretty amazing.

Things are pretty desperate on the food front. Lunch, today: 6 frozen spanakopita and 3 huge pieces of watermelon (...impulse buy...). Dinner, today: frozen chicken tacos, frozen peas of some variety. Probably some more watermelon.

Looking forward to having my life, apartment, kitchen, groceries, everything, back.

Also, I'm not weighing myself again until after we move. It's freaking me out.

Back to work!

New Goals

2007-07-26T13:52:00.001-04:00

I was gone for a week because I was avoiding the internet; I didn't want the end of Harry Potter and the Deathly Hallows ruined for me.

There, I admitted it.

Endo appointment on Monday. A mixed bag. I don't think I've ever seen a doctor glow and effuse as much as mine did over my weight loss: apparently, the way to an endocrinologist's heart is to lose more than 10% of your body weight and admit that you've taken up running. I did ask what a good target weight would be. He answered first by saying that I could stay where I am forever ("You're perfect exactly as you are."), but that, at 5'3", the mean "normal" female weight is 115 lbs.

The internet lacks emoticons that would allow me to express my reaction to that news (most recent weigh-in for me: 131.5 lbs. I haven't been this thin since the 10th grade.), but all I can say is that I still have my work cut out for me. Fortunately, it's become such routine by now, that I think all I need is patience.

Blood pressure and cholesterol still a bit higher than he would like. I explained my feelings on the medication for both of these, and he agreed fairly easily that, given my exercise and weight-loss regimen and my previous reaction to the ACE inhibitor (uh...bad), I could stay off the blood pressure stuff for now. As for cholesterol, he admitted first that the goals prescribed by whomever prescribes such things (LDL < 100) is actually impossible to achieve through diet alone. I found that really interesting, for some reason. He also said that, although he would prefer that I take the cholesterol drugs, I am young and healthy and can probably do fine without it for a couple of years if I insist.

I haven't decided if I'm insisting. I suppose I could cut back on the full-fat dairy (he also conceded that a low-cholesterol and a low-blood sugar diet are mutually exclusive), but I haven't decided. The prescription will sit on my dining room table for the time being.

And...the A1C. I confess disappointment with a 7.4 that hasn't really budged in years.

I do think that, had I gotten it checked, say, at the beginning of May, it would have been a bit lower. I had several really rough weekends this summer. Moreover, I've had far fewer really rough lows than I've had in past years. The new CGMS will be helpful, I hope, particularly when I finally figure out the basals. Although I love that it'll wake me for a low, I also, unexpectedly, love that it'll wake me for a high - waking up at 250 sucks, and I don't really have to anymore. It's undeniable, though, that I've gotten a bit complacent, particularly with my carb consumption. I don't really want to cut them out entirely - my pump is supposed to be good at this kind of thing - I just need to be scientific about it.

So! That leads me to my New Goals:
1) An A1C under 6.5 Yes, it's a big drop. But I'm a big perfectionist, and I have a machine clipped to my pants that can give me my true average blood sugar 24 hours a day. This can be done.

2) 115 lbs. It's less weight to lose than I've already lost, so let's just keep on trucking...

3) Running a marathon.

Well, that one came out of left field, no?

Specifically, there's a marathon in Charlottesville in March that I'd like to do. It's evidently quite hilly, but I have a ton of time. I'm in better shape, running-wise, than any of the online beginner-to-marathon training schedules expect you to be, I just need to sort out the diabetes too.

I realize, to many, that this is not a very novel goal. What you need to understand, though, is exactly how foreign this idea should be to me. Before November, I had probably run a mile in my life. Yesterday, I did just over 2 at 6.6 mph - my fastest ever - and I think a real, concrete, totally insane thing like a marathon would be a tremendous personal accomplishment.

Besides, there's clearly not enough going on in my life as is.

Health Insurance Changes and a Bit More History

2007-07-19T12:06:00.000-04:00

As I've mentioned before, I'm moving. Not only am I moving, but I'm quitting my job as a software engineer with pretty exemplary insurance and starting a PhD in computer science at the University of Virginia. Along with requiring a lot of paperwork, planning, packing, and strange lunch combinations* (the result of trying to clear out my kitchen), this forces me to plan more serious things, like the transition from my current (exemplary - thanks for the cgms, guys) insurance to whatever the university throws at (and pays for) me.

Fortunately, I've gotten very good on the phone.

It all works out. CORBA will save me if I need it to, everything will be covered continuously - no gaps in insurance between leaving work (August 3rd) and starting my school insurance (August 15th). My work insurance continues to the end of the pay period, which is also August 15th. Moreover, if I want to pay huge sums of money, I can actually keep my current insurance for up to 18 months. Huzzah! This makes me feel better, because it allows me to keep the current plan for at least a little while while I get used to navigating the new system and learn how to get the new plan to pay for more sensors. I'm sure it'll be too expensive to keep for the full 18 months, but I feel much more comfortable being able to keep it for at least a little while.

They've been good to me, after all.

This whole palaver also involves submitting proof of immunization and a new TB test. I didn't realize until today, of course, that I need the latter, but it turns out that I can get it done at the diabetes center when I go for my endo appointment on Monday (apparently they have those things lying around everywhere. Who knew?). It's good, because I never so much bothered to get a new GP when I graduated...everything I need is diabetes-related anyway, so I basically just have a bunch of specialists. I'm going to correct this oversight when I move - it's helpful to have someone to help out in the case of strep throat or for a referral - I've just been too lazy.

As for the rest, I have my old medical records from Harvard's health center in a big envelope that I insisted on getting as soon as I graduated. This was oddly smart of me (I'm really, really glad I did it so promptly), because now I *do* have my immunization records, and I can just send those along (thank you, UVA). End of brief panic. It's a very thick packet, to put it mildly. I didn't read through all the patient notes and stuff from the numerous doctor's visits, because that would just depress me: everything is there, back to my seizures freshman year, and my weight gain, and some pretty horrific A1C's that I don't remember ever receiving. I realize that that's impossible - I mean, I remember getting the blood drawn - but I really don't ever recall hearing some of these numbers (I'm leaving them out of this post in case my mother ever discovers it. I'm serious). My weight is also there, climbing steadily, and all the excuses I ever gave - pasta, late-night snacking, and so forth...Good gracious, I was *such* a mess. I know that I covered some of my previous messiness in my Origins of the Health Kick post, but it's clear that I was glossing over the memory, even with myself. Well, now it's all spread out in a pile on my living room floor in its full glory. 40 lbs packed on, average blood sugars well above 200, seizures left and right...

Who was I, then? Even before the current Health Kick, I had improved so much. Who was this strange college freshman who only tested once or twice a day and ate pasta for every meal? I don't remember being her, I don't remember thinking like she did. Hell, I don't remember ever receiving those lab results. I never realized how far I'd come until I looked over the lab sheets with this sinking horror: Who was this person? Didn't she notice she was killing herself? That she was killing me?!

There's nothing I can do now, of course, but chalk it up to the indiscretions of a college freshman who handled all the new freedom/responsibility very, very badly. I know a number of diabetics who had the same problem when they got to college - more than one took time off to get a grip - but I'd conveniently forgotten how badly I was doing, too. I guess the change has been so, so gradual that it only became dramatically noticeable now, several years later. It's a scary thing to see first thing in the morning. But a small part of me looks over that disaster and is gently pleased with how far I've come.

* Today: 3 frozen spanokopita from Trader Joe's, a mini can of V8, some Camembert and crackers. Also, Camembert + V8 = very peculiar, mostly unpleasant flavor combination. Tonight I'll cook up the snap peas and hopefully will have something a little more normal for the next couple of days.

Clearing Out the Kitchen

2007-07-16T20:09:00.000-04:00

In preparation for The Move (3 weeks and counting), I'm trying to clear out all the food from my fridge/cupboards. It's not really movable, and I hate to waste it, so I've put a moratorium on visits to the supermarket for everything but breakfast supplies (yogurt and milk) and am focusing on eating everything. This is good for a number of reasons: 3 meals a day from my kitchen means I am eating much more healthfully than I do when I eat out a lot (...as I did all last week), it saves money like whoa, and it means that I plan carefully to avoid waste (yeah, there's a lot of it, but it needs to last three weeks, so I had best avoid having to throw away anything because it's gone bad...in other news, its' a good thing I noticed that asparagus today...).

The salmon is on the stove, happily sauteeing away. This should be an interesting experiment. If nothing else, it should be pretty good for me, at least until we get down to the wire.

Still obsessed with the CGM. It's interesting all that I was missing without it: sure, I'm at 94 pre-run, but did I know how high it spiked post-lunch? Nope. I'm also fascinated with watching the food and the insulin race to affect the numbers, and I have to restrain myself rather significantly to keep from overbolusing: it just climbs and climbs and climbs! And just when I begin to panic, the insulin kicks in really obviously, and back down it slides.

It's an everyday drama.

The First Solitary Insertion

2007-07-15T20:33:00.000-04:00

I'm staring at this thing, this thing I fought so hard to get, that's sitting all cocked and pretty in the little blue inserter, and all I can think is:

Damn, that is a big needle.

I am not scared of needles. I can insert my pump sets by hand (...I have a thing about losing the Quick-serters, or whatever they're called. I got another one though, as a treat!). I took shots for years, I can test, I can take vaccinations, I can take novocaine in my gums, whatever.

But the needles on the Minilink sensors are really alarming.

I shared that thought with the guy who trained me, who inserted the first one. He assured me it wouldn't hurt, of course, and thunk! in it went, and it didn't hurt, of course. But that was the first one, which lasted 4 days until I rather stupidly caught it on my pants getting into the shower (...yes, despite the tape), and now I'm facing doing it alone, in my empty apartment, with my pump beeping periodically about "lost sensors" and the prospect of a night without my new best friend to keep me going in case of a low. I'm going to the clinic tomorrow for blood work, I could just wait till then and have someone help me...

So I did what seemed natural. I called my mother.

My mother is not a diabetic, and she generally has left the care of my disease to me for the last 10 years. At the beginning, of course, she helped a lot, but I was a pretty independent 12-year old (I started going to France to visit my family for months at a time over the summer, alone, at 11), and so I've been doing my own shots and the like since a month after my diagnosis. So of course, she doesn't really understand, but it's nice to have her tell me that she knows I can do it, and I'm very tough, and she's very impressed with me, and so on.

So I get off the phone, line the thing up on my thigh, close my eyes, and squeeze.

Nothing.

Turns out the inserter is not very sensitive. I give it a couple of trial clicks, to figure out what kind of pressure I'm looking for. I'm desperately afraid of doing it wrong, of wasting one of these impossibly expensive things with my own fear.

One more time: line up, close eyes, squeeze. Thunk!

Bled a bit, but didn't hurt. I think I did it right. Pulled out the needle, held some toilet paper there, updated the blog, and am about to reconnect the poor sensor and slap some tape on so I can sleep easily.

That said, though: I like it.

I like it a lot.

It's taken a few days to undergo the full paradigm shift from watching individual data points to watching the trends - and yes, I did angrily over bolus when the stupid thing beeped during a particularly challenging climbing route last week - but it's...frankly brilliant.

EDIT: I just realized I hadn't pushed the transmitter all the way into the sensor. Whoops. Pushpushpush click! I think I have it all under control...this may take some getting used to...

All hooked up

2007-07-12T14:42:00.000-04:00

And the cyborgization of Claire continues.

My minilink is all in and hooked up and sending readings! I'm totally transfixed. I can't work. My productivity is shot. I just keep pressing Esc: 98. Esc: 100. Esc: 96. Esc: 103. Esc: 106.

I just ate lunch, so let's see where it goes...

Mysteries of Exercise

2007-07-10T17:16:00.000-04:00

I would like to know: why is it that the exact same workout can feel so breezy and simple some days and so excruciating and impossible others?

Yesterday was rough. I hadn't run since the previous Tuesday, which is long for me. One of the things I like about running is that it has a nice learning curve: your ability ramps up quickly. On the other hand, however, you lose it just as quickly, and a 6-day break really feels like hell. I did the same workout yesterday that I was doing last week (5 minutes warm up and cool down, 30 minutes at 6.3 mph), and I struggled.

Today, I figured that things will be better. I know I can do it, I have done it, so I will do it again, today (this is actual a remarkable mental trick I can play on myself. More than once, I have shot up a very difficult climb at the rock gym because somebody - usually a nefarious friend - has convinced me that I've done it before, just two weeks ago, only to admit when I get back down that they were lying, just to see if I could do it. I usually can, but if I'm not lied to first, I probably won't. It's bizarre, but very reproducible). Oh, but Lord help me, it was just as hard as yesterday, only today I was sore.

*grumble*

Some days, I can sing along (in my head) to my iPod, or think about what needs to be done in my life or at work, or fantasize about my Paris vacation in August. Some days, I literally count the seconds.

CGM, Dancing, Long Weekend

2007-07-10T14:28:00.000-04:00

I took Thursday and Friday off from work, so Tuesday night I drove down to NY to commence my 5.5-day vacation with Boy. This included my great Public Foolishness (dance competition), among other things, and was generally very enjoyable and relaxing. Of course, I ignored the hell out of my computer for almost a week: catching up on the Diabetes Headlines has been quite the daunting task!

The Public Foolishness went quite well. I'm trying to muster up some photographic evidence of this event, but I think the best I have right now are the fuzzy images on my old old digital camera. I'll have to upload them at some point. We did well, though! For the ballroom nerds out there, I danced American rumba, cha-cha, swing, and mambo: in the newcomer division we took second place in everything but mambo, in which we took third, and in the pre-bronze division, we made it to finals in everything (they only announced places for the top three, so I don't know where we were relative to everyone else). And yes, there were more than three couples competing. I have answered that question numerous times over the last week. And the fake tan (to answer a question in the comments, which I have been ignoring, and I'm sorry about that, I faked it with the spray on stuff, instead of a bed or the actual sun. I'm very fair).

Regarding the elusive CGM - or "my new toy," as I've been calling it to anyone who will listen to me - I got it, in the mail, before I left on Tuesday. It comes, rather conspicuously, actually, without any instruction whatsoever. The user manuals are online, and I'm relatively certain I could figure it out, but the things are so expensive that I really don't want to risk it. I made an appointment with someone at my diabetes center for Thursday morning, so after that, I'll be all hooked up...and yes, I'm excited. What's the point of having a chronic illness if you can't geek out over all the technology? I think they also sent me a bill for my portion of the payment, but I'm ignoring it until I at least get the thing in. I mean, can't I have a couple of days of blissful excitement? I think I can.

I hate that I ignore my health when I go away for the weekend - I put on at least a pound, and my numbers were everywhere. What's more infuriating is that my control over the last six months has been good, with the exception of this month, which is the month before my A1C will be taken. Of course. *sigh* Climb back on the horse, keep going...

I did learn something useful about myself, however. Actually, I think I already knew, but it was certainly verified: I have no impulse control. This is useful knowledge, and supports my decision to not bring cookies or chips or whatever into my apartment. I'm more lazy than I am impulsive, so I'll never go out to buy such things, but the cookies in my mother's house really don't stand a chance. At least I know, though, right? There are benefits to being self-aware.

Anyway, work has gone back to being insane. I'm trying to plan the move and the vacation while meeting my deadlines and tending to my health, which is proving complicated. I'm still squeezing in my exercise, though, even if I haven't been cooking or cleaning my apartment as much as I should.

Oh! And on the subject of shorts, I wore a pair at home this weekend. My mother's eyes nearly popped out of her head: "Oh my! You're wearing shorts!" She turned to Boy: "I don't think she's worn shorts since 1999."

I'll get back to responding to comments soon, I promise.

Tanning...?

2007-07-01T15:29:00.001-04:00

Things have improved dramatically since last night, and today, despite (or because of?) having slept until 11:30, I am back to being productive and cheerful.

I started the day with a field trip to Boston and through Cambridge, trying to find a certain article of clothing...I failed, naturally, but it was a good long walk, and so I felt good about it. I swung by the super market on the way home, to pick up fruit (I know: fructose is glucose is sugar. But it's so hard to resist peaches in the summer! I've definitely noticed a hit to my vegetable intake with all this fun summer fruit being in season) and some pork chops. I realized last night, pondering what had led me to the high 400's, that my two weeks of Crazy at work had had a detrimental effect on my eating habits. Sure, I lost another pound (down to 132, for the record; 30 lbs lost from my heaviest!), and my blood sugar hasn't been embarassing, and I didn't eat out very much, but I focused more on "easy" foods and less on vegetable intake and general healthfulness. So tonight, I break the trend and make myself some okra and pork chops in dijon sauce, and I'll have leftovers for the week, and everything will be right, provided I don't fall into the habit of eating bagels again (can you believe I ate a bagel yesterday?!).

In other news, I've been slowly preparing for my dancing debut this week...painting my nails, altering my dress (it's a little...short, to put it mildly), "dyeing" my shoes (coloring them with black permanent marker). And today, one of the last great frontiers: fake tanning.

I am very, very, very white. And, under stage lights, I will look like a ghost. A mambo-ing ghost, but a ghost all the same. *sigh* So, I exfoliated, and I'm taking the plunge...here's hoping for something approaching a natural-looking tan, at least...

Tubing Kinks

2007-06-30T21:58:00.001-04:00

Found myself lying in bed at 7, unable to get up, motivate myself to do any of the numerous things I kept on my mental to-do list, convinced my lethargy was a result of my two weeks of Work Insanity...fell asleep...tested 2 hours later, coming in at near 500, due to a canula kink that probably came when I hooked on my clothes earlier today...

So I forced myself out of bed, took a shot, refilled and reinserted the pump, took a shower, and slowly started to force my way through the to-do list, until I get to the point that I feel well enough to enjoy being industrious.

*sigh*

Rejoining the Land of People Who Wear Shorts

2007-06-21T15:43:00.000-04:00

I haven't been a shorts person in a long time.

Mostly, I have not regretted this decision from oh, about 5 years ago now. Shorts have not been a good look for me for quite a while. On really hot days, I might revert to capris, but I'm not very tall, so I have a hard time finding capris that don't look silly on me.

I try to dress in a way that is generally flattering to my figure, and so I've avoided shorts, except in tropical situations (I owned one (1) pair of shorts for these circumstances; they're quite rare). Even at my fattest, I've been a very normal shape - I actually carry extra weight quite well. But I couldn't really get over my upper thighs, and in the super-short-short styles that were so in vogue 5 years ago, they were not to be avoided.

However! I have moved on! My thighs are still larger than I'd like, but they're far from grotesque (not that they were ever grotesque, but you know what I mean). And you know what? Boston is hot in the summer, and I'm sure Virginia is too. I have decided that my unnatural fear of the Tiny Pants must be overcome, so I went to Banana Republic today, and I bought two (2!) pairs of shorts. They're a little smaller than they should be, but I'm happy to note that the super-short appears to be out, and a slightly-more-flattering length in safari-like khaki styles appear to be in. And in five more pounds, they'll fit perfectly.

I'm proud of myself.

And I intend to wear them.

(Parenthetically, the mall is a really difficult place to find a snack while trying to lose weight. It's all like "EAT DONUTS! DONUTS!," while all I really want are some carrot sticks and almond butter. *sigh* I settled on a little bit of vegetarian minestrone from ABP. I'd bring in snacks to work, but I don't often snack in the afternoon, and so food tends to go to waste in the fridge waiting for that one day every 3 weeks that I'm absolutely famished at 3pm.

I don't know if you've noticed, but my life is very difficult.)

Workity Worky Work

2007-06-21T11:03:00.000-04:00

Work has been insane.

It's insane right now, in fact, but I'm waiting on a compilation, so I can blog a bit while I take a mental breather from the truly enormous code refactor I'm in the middle of and that really needs to be done today.

It's invigorating, really, in kind of a stressful way.

It's OK, though, because I've been ruminating about work in the context of health, and so taking a break to blog while I wait on work stuff seems like a good reason to write about it.

I remain mystified by my workplace's attitude towards health. I work in software engineering, at a big tech company. So I overwhelmingly work with a bunch of 30-something male geeks. This means I work in a very "male" culture, if you will - not "male" in the "macho football player" sense, but male all the same. I am certainly an anomaly, being young, and female. Anyway, I don't think about it much, as I've always been very comfortable in male-dominated environments; I'll sometimes ponder the societal implications of the fact that something as important and pervasive as technology is designed, created, and controlled by such a small segment of society, and I'm happy to debate the Women-In-Science question until your ears bleed, but in the day to day it doesn't bother me much. What I have been thinking about lately, however, is how this culture manifests itself vis a vis health and food and exercise choices.

I'm overgeneralizing, of course. I don't know if it's a "male" thing at all. But it sure feels like it: eating a huge burrito (or two) for lunch, teasing me for my salads and packed lunches when my coworkers are going to the Chinese truck ("Right right, you have to eat your rabbit food...that stuff'll kill you, you know..."), teasing me for running regularly ("You'll give yourself a heart attack!"), teasing me for asking for a smaller piece of cake at an office party (I won that one, actually, with: "Oh, it's just because I'm a diabetic...HA HA, look at the look on your face!" Fastest way to make the health-haters feel bad...), and so on. It's all in good fun, really, so it's not like I'm bothered by it personally, but it's just so...strange. Are all workplaces like this? Is it unique to tech guys, who stay up till 4 pumped up on Diet Coke and pizza? There's definitely a respect held for the hard-core habits of some coders who do just that ("Man, you checked in a 5 am last night! Do you ever sleep?!").

There are a couple of guys who I sometimes spot in the gym, lifting, or on the treadmill, but by and large, everyone's at least a little round about the middle. Even my trim female coworker regularly skips breakfast and makes her lunch of diet soda and Cheez-Its. Is this an adult thing? Does everyone eat/behave this way?

It does feel like a male-geek thing, though, in a lot of ways: "Screw health, I'm HACKING." I'm more puzzled by it than anything. Especially since my company has excellent benefits, flexible hours, and a number of incentives to practice healthy habits - a fitness room in the building with showers and a locker room (and a willingness to let employees take time out of the day to use it), a cafeteria with a good salad bar and other healthy choices, and a reasonable attitude towards the work-life balance. I'm not perfect, by any means, but I'm way healthier than most of my engineering coworkers.

*sigh* Fortunately, I'm also difficult to offend.

Busy.

2007-06-20T22:08:00.000-04:00

Things have been...busy. Not bad busy, just busy, with two weekends in a row back to my parents' in NY, some crazy time at work, and planning for Paris and moving to Virginia and starting at school (forms! forms!) and various other projects going on all at once.

Things are going well on those fronts, really; Boy and I scrapped plans to go down to Charlottesville (we were to go this weekend - while I'm most unhappy that I don't get to see him this weekend, I cannot begin to explain how overjoyed I am that we don't have to go down there. Stress!) and just signed a lease on a decently-sized place in a nice-enough looking apartment complex. I have finalized a hotel reservation for Paris. So now, the actual Move needs planning, but I swore off thinking about it for at least a day...

The diabetes management was relegated to the back burner for the past couple of weeks. I've been feeling very anti-diabetes lately. Well, I'm always anti-diabetes, but not usually very adamantly or consciously. Usually, it's just a fact of life. The past week or so, however, I've been in Bitter Diabetic mode, angry at every bolus and every tootsie roll and every high. I think it's passing, but it's funny how it just pops up sometimes...I realized today, though, that I really need to get back to strict control, because I've devolved to the point that I'm having inexplicable blood sugars almost every day ("Why am I low?? I took the same amount of insulin for the same breakfast yesterday and was at 250 at lunch, and now I'm 57?!" etc, etc). I allowed myself a moment of "I hate this disease! Why is it so unpredictable?!" before chastising myself. While I know that it's often the case that the unpredictable happens in diabetes management, so much of it is actually predictable. I just don't like to admit it. I haven't been exercising as much, I had cake, of all things, yesterday afternoon, and so on. So, back to careful management for me, and hopefully the averages will drift downwards accordingly.

The weight has been a bit higher than I'd love, but my pants are fitting better, so I'm declaring it muscle mass (I climbed a 5.10d yesterday, for fellow climbing nerds out there...) and not worrying about it. Ooh, and speaking of parenthetical athletic accomplishments, I ran 30 minutes at 6.3 mph this afternoon! New record!

So this post is kind of everywhere, but I'm just trying to catch up while I wait for the iron to heat (doing some sewing - my pants are universally too long). I've been kind of chilling tonight, and I intend to take the next couple of days/weeks a little easier, before my dance competition. Relaxing is good for the soul.

I have some contentful-posts swirling around in my head, so I expect I'll be back to posting regularly. If nothing else, I need some averages!

Routines/Medicine and the FDA

2007-06-07T14:14:00.000-04:00

As I've been on a bit of a spending spree this month, I committed this week to frugality: I've packed my lunch and eaten dinner (and breakfast, obviously, but I was already doing that) at home every day, I've taken public transportation to work instead of my car all days except Monday (when I needed it for my dance lesson), and I've generally been staying home to work and take it easy instead of going out.

It's been good to relax a little bit - sometimes life feels a little too frenzied for me, socially, and my apartment tends to suffer. It gets messy, dirty, dishes pile up...this week, everything is more or less tidy. I've swiffered. I've done all the laundry (and put most of it away), and I'm feeling very calm.

I wonder, sometimes, if my mildly compulsive, habit-loving tendencies are a result of my ten years of diabetes or just a convenient corollary. There's no doubt that when I'm sticking to my routines, compulsively logging, planning my meals, etc, that the diabetes takes care of itself - and I must say, I love my routines. Given that I was one of those kids who would take afternoons organizing her sock drawer by color and pattern, however, I'm figuring that it's just in my nature to like having all my ducks in a row, and that this just has happy benefits for the diabetes management. Weeks like this, it's so much easier to maintain rigid control when for instance, I've packed a lunch - sure, by 1 pm, I'm starving and want nothing more than either a Twix or a big thing of Pad Thai (...or both), but when I settle down to my marinated salad, it's really delicious, and afterwards I feel fine. All cravings gone. Fancy that.

In other news.

The more I read about this FDA/Avandia debacle, the happier I am that I took the entirely medically unsanctioned step of quitting Lipitor. Since that fateful decision, I've been doing a lot of reading - it seems that the benefits of artificially low cholesterol have never been really demonstrated in clinical trials. Half of all people who have heart attacks have normal cholesterol levels. In fact, it seems that the only factor that they've really successfully linked to heart disease risk is blood glucose - so I'm glad I'm focusing on that, to put it mildly. Moreover, it seems like every two months there's some big scandal when research surfaces that, for instance, a wildly popular diabetes medication causes heart attacks. Just to, you know, pick an example out of nowhere. Not that I don't generally trust statins, but it's true that they can have some pretty egregious side effects - neurological problems, severe muscle damage, liver damage. And, for all that millions and millions of people are taking these drugs, rates of heart disease in this country keep increasing.

So I'm glad I've taken the serious "lifestyle" approach. It's really remarkable the difference it makes - I just noticed the other day, for instance, that it looks like my insulin sensitivity has sky-rocketed since I went on my weight-loss-exercise-restricted-carb kick. I mean, I knew that I was taking less insulin, and I guess I knew that I've been gradually adjusting the ratios on my pump the past few months, but I assumed the former was due to eating fewer carbs and didn't really register the latter until I looked at my settings today - it has, quite literally, almost doubled, from a 1:25 ratio to a 1:47 ratio. I don't know if it's the diet or the weight loss or the exercise or what, but I'm digging it.

Screw Lipitor. So few drugs that purport to treat our current collective metabolic woes can boast improvements in risk factors that even approach those offered by a nutrient-dense, restricted-carbohydrate diet with plenty of exercise. Maybe I'll eat my words come blood-test time, but I would be surprised.

I'll be back to accountability with some posted numbers in a week or two, once I have enough logging stuff to make it worthwhile. I'm also trying to figure out if it's unreasonable to call Minimed every day until my new toy shows up. I don't think it is, but I'm not sure that that's about to stop me.

Even More CGM News

2007-06-06T13:40:00.001-04:00

I called my care coordinator at the insurance company today - this is my actual nurse, not the woman with whom I spoke last week, who was filling it while this nurse was on vacation - to confirm the authorization for the CGM system from Minimed. She confirmed that yes, I have been officially authorized as of Monday. My copay would be based on whatever the plan charges for durable medical goods, which I don't know offhand - it might be up to 20% of the cost, but whatever, it's less than the $1500 or whatever I would have had to pay without it.

Confirmation fresh in my mind, I called Minimed, who confirmed that they received a prescription on Monday from my doctor's office (quick praise for those guys, who can sometimes be slow; they're really on the ball on this one). The woman put in an order for me, and said she's not sure when I'll get it but I'll receive a follow up phone call soon to set up an appointment for training. She sounded pleasantly surprised that my insurance company went for it, even saying "Yeah, they usually just reject it immediately."

I'm feeling particularly special this week. I'm not sure why I'm special - Empire Blue Cross has apparently been really bad about approving this thing, to the point that, at my doctor's office, they hadn't approved anyone before me. I don't know if I got lucky with the women who were assigned to manage my case, if my doctor put out a really good explanation as to why I need one, or if my ridiculous persistence simply impressed the medical manager, but I'm not complaining. Maybe it's all three. Either way, I'm learning that persistence really is the key to getting anything done, in medicine and in life - for instance, even though Minimed received the prescription, they wouldn't have ordered it for me unless I had called back. I doubt my care coordinators/helpers at the diabetes center would have been so quick if I hadn't sent nagging emails/made nagging phone calls 3 times a day last week.

(I've noticed the same is true when dealing with banks.)

I think, overall, that this is a good sign for CGM systems in general. As I was saying to my mother last week, it would have been frustrating if they hadn't paid for it, because in 6 months or a year or 10, everyone will have one, and not paying for it would be unreasonable insurance behavior. But for now, I'll say I got lucky, and I look forward to receiving my new toy.

And finally being able to sleep through the night.

More on CGM, Happy Ravioli

2007-06-05T19:32:00.001-04:00

In response to requests for more info from the last post, I thought it worth mentioning that I'm not entirely clear on the details for my insurance approval from last week. The story, in brief, goes as follows:

First, I asked my NP at my diabetes center to get a preapproval from my insurance company. She faxed them a letter of medical need and some recent blood sugar records and told me not to hold my breath.

Next, I started getting phone calls from an administrative assistant at my diabetes center. I found this vaguely annoying, because she had no idea what I was talking about - as in, what a CGM system is, what its components are, etc - but seemed genuinely committed to helping me get it. She started talking to a care coordinator at my insurance company.

Mid-last week, I got phone calls from both the assistant and the care coordinator. The CC told me that the request had been rejected, but that she really wanted to help me. She explained that the insurance company didn't pay for experimental therapies and, as the Minilink lacked FDA approval, I couldn't expect them to pony up the cash.

"Wait," I interjected, "the Minilink system was approved in March."

She then said that their databases may not have been updated yet, but if we could get proof of the FDA approval, she would go back to her medical director right away, skipping all the extra paperwork, to see if she could get a reversal of the rejection. If not, I had about 15 opportunities to appeal the decision, which actually sounded pretty good, if time-consuming.

My assistant at the diabetes center wasn't too optimistic, at this point, since, despite the approval, the Minilink system still lacks some sort of code thing that the FDA gives therapies, and they don't expect to receive those codes until January of next year.

Well, fuck. Regardless, a bit put out, I got on the intarwebs, went to fda.org, and searched for the Minilink approval letter.

(for the record, finding it took about 35 seconds. I wish I didn't have to do other peoples' jobs for them, but what can you do?)

Moral of the story is, I faxed the letter to the care coordinator (trying hard not to sound smug when I let her know I had found it a mere half-hour after our original conversation), and I didn't hold my breath.

Friday, I got a phone call from the assistant. She sounded very somber when I picked up the phone, which caused me to say "Uh oh, that doesn't sound good." She responded "What do you mean? They approved you."

Nifty.

So Minimed faxed a prescription request to my doctor's office, and now I'm waiting on that. They say it'll take a week or two to get everything together.

Also, I had a nice plate of ravioli for dinner, and I am full and happy. And, I ran 25 minutes at 6.3 mph today. It's amazing how much harder it is at a mere tenth of a mph faster.

I've been kind of a Lazy Diabetic lately, but I think I'm getting over that phase, so I'm not going to obsess.

And those are the updates.

Insurance and CGMS

2007-06-01T16:20:00.000-04:00

*HAPPY DANCE*

They approved me they approved me they approved me they approved me!!!

*Claire sings and skips around her cubicle*

I assume I'll be seeing my new transmitters sometime next week or the week after...

Remind me never to say anything mean about my insurance ever again.

Sick

2007-05-29T16:18:00.000-04:00

I suppose I should at least be grateful that I didn't get sick until after the long weekend had passed. I hate being sick when I could be having fun.

Oh, but good God I am sick. I don't know if I ate something funny, or what. Boy has had some weird throat thing (strep? I hope not. I'm prone to catching it), but he was certainly not throwing up while he was here. Which is basically all I'm doing. I can hardly keep anything down, which means trouble in blood-sugar land.

Actually, that's not entirely true. Although I couldn't keep down my first bowl of cereal (finally eaten around noon), I managed to swallow a much smaller half-mug of it half an hour later. I just had another bowl, and that feels all right - maybe it's a 24-hour thing, and I'm getting better.

*grumble*

Thoughts on Weight Loss

2007-05-25T14:50:00.001-04:00

Hungry.

I'm on kind of a low-calorie day to make up for yesterday's ridiculous splurge: I was a bit low post-run so I munched on cherries while cooking, consuming like, at least a pound of them, and then my girlfriends came over for a potluck, which involved grotesque amounts of cheese and fruit and other delicious things. Nothing processed or unhealthy, but a lot of food nonetheless. And I've been hitting the candy bowl at work really hard this week, so I need to chill out for a couple of days to get back on track.

Only now, of course, I'm famished, and inexplicably a little high, and getting grumpy.

So, do I eat something from the vending machine? Or do I suck it up?

I think I'm sucking it up, and running, later. A little hunger never killed anyone, and I need to get the blood sugar in range anyway.

Sometimes dieting is truly tedious. I don't believe in crash dieting, I believe in making gradual lifestyle changes. However, it's true that I'm more conscious of everything I eat now than I am when I'm maintaining or gaining weight. The fact that I'm not particularly chubby means that the margin of error for weight loss is really low, so while I can maintain pretty painlessly, losing takes more effort. Sucks.

This is the part about my weight loss that I don't like: being so aware of food and my body. When I was fat, I did understand, intellectually, that I was fat, but I was never really bothered by it until it became a point of medical concern. Then, my fitness began to concern me, so I altered my eating habits and took up exercise. However, whereas before, I would run around wearing whatever and think I looked fine, I now sometimes catch myself in the mirror and think "Aaack! Thighs!" or "Aack! Lovehandles!" Which sucks. Since when do I give a shit what my thighs look like? Since when do I go a little hungry a day after overeating? Who cares?!

Well, I care. I care about my cholesterol and my cardiovascular health. And, having gone shopping since losing 25 lbs, I've kind of developed a sensitivity about how I look. On the one hand, this means I delight in a new pair of pants that I think looks hot (or my new ballroom outfit! Huzzah!), but on the other, I despair a little more over a pair that doesn't. And there's not much to be done about it. I think, so long as my real joy is about my blood pressure and energy levels (which they are), I'm willing to take some of the less psychologically-healthy aspects of the whole journey for the more tangible, and important, benefits.

More of the Same

2007-05-25T11:09:00.001-04:00

Got my numbers out of my meter for the past 5 days and emailed them to the NP. They're oddly good, actually, and I think it's going to get me back to logging: it's no secret that my control is better when I'm writing everything down, and I'm so close to decent control as it is that a little push would go a long way.

I think I've gotten used to waking up at 3:30 am every morning. *sigh* Every night I think "well, things are fine, I can probably just skip the 3:30 am check..." And then I get a series of morbid images of what it would be like if I died of a hypoglycemic incident in my sleep, my super breaking in, my boyfriend freaking out, my parents driving up, and how sad it would be...and I set the alarm. Actually, it's probably been good mostly for the opposite reason: I eat a carby dinner that doesn't hit until after I go to sleep, so I get to take a correction in the middle of the night (though now I've been waking up low...exercise affecting my glucose ratio? Maybe). It's also helped me adjust my overnight basal.

Goodness, I can't wait until I get that continuous monitoring and can actually sleep again. I'm kind of staring into space at the moment, trying to perk up.

CGMS Update?

2007-05-24T19:13:00.001-04:00

Got an email from my NP today, saying my insurance needs to know how many times a day I test and that it wants my numbers for the last 5 days. Of course, they ask during a week when I'm not logging (I swear, they always know. I log for 3 straight months, they don't want to see the numbers. I stop logging for two weeks, they want them...). I'll scrounge something together.

Is this a good sign? I have no idea...It's stressful to deal with, because Boy and I are also trying to buy a condo down in Va, and I have no idea what I'm doing. I'm so busy dealing with mortgage lenders that I can scarcely think about insurance. I'm just hoping that this means that they have one more box to check off (evidence of regular testing: check) and then they'll ship me my sensors...

Kitchen Misadventures

2007-05-21T22:35:00.000-04:00

So the dishwasher exploded yesterday.

By "exploded," I don't mean "burst into flames" (though that would have sucked); I really just mean that it filled up with dirty dishwater and then poured it all over the counter, the drawers full of clean dishes, the floor, and me. We have one of those counter-top dishwashers that hooks up to the sink (I think they're intended for office break rooms, or something), and it is A) one of the best things to ever happened to me and B) at least 10% of the reason I let Boy move in. I'm only kind of kidding. However, it's getting old and...massive mess.

I think I fixed it. Needless to say, I'm glad that I've spent so much time at the climbing gym; even a counter-top dishwasher is heavy when it's full of dishes and dirty water. I could not have dealt with it alone six months ago. Huzzah for being a strong, independent woman!

(that's not to say that I didn't call Boy at 11:30 pm last night and burst into tears, or anything).

In other kitchen news, I made pasta tonight for the first time in ages. I'm sure it was not the most intelligent blood-sugar decision ever, but I had a big thing of little pearl tomatoes that were just begging to be made into a sauce with the mushrooms on the shelf below, and who am I to argue with my produce? And ooooh, it was sooooo gooooood...and I have leftovers for lunch. I can run off tomorrow's blood sugar on the treadmill, but we'll have to see how tonight goes.

In answer to a comment, I actually haven't tried out soy milk for its blood sugar effects, because I don't like the taste. I have tried rice milk, which is all that Boy will drink, but I find I need a lot more insulin to cover it because it's really sweet and low-fat. I think that the fat in whole milk is really helpful in tempering the lactose (and the sugar in the fruit I throw into my morning smoothie), and it wouldn't surprise me if this gave it a leg up over soy in terms of blood-sugar effects. Again, though, I haven't tried it. I would be interested to find out the difference.

And finally, my dance coach has taken it into his head that I should compete pro-am with him at a competition in July. While I think he's crazy, I thought "well hell, why not?" Nothing like an impending ballroom competition to keep a girl on her diet. Speaking of which, 136!

Over a Week!

2007-05-17T10:09:00.001-04:00

Oh my, I haven't been very good about this over the past week. The blogging thing, I mean.

It's annoying to go so long, actually, because little thoughts I have that would warrant posts kind of get jumbled. So I'll try to keep this vaguely coherent, and resolve to suck less in the future.

First, I've been slacking, hard. I mean, some habits have definitely stuck - I don't eat cereal for breakfast anymore, I don't freak out and eat two donuts in the afternoon for no reason. To snack, I sometimes freak out and get like, a packet of Chex Mix or something, which is still carby and nutritionally vacant, but is certainly an improvement. Instead, my diabetic crimes are taking place at lunch and dinner, in the way of huge pasta dishes (hello, pad thai!), for instance. My fear of sleeping has led to some super-high morning blood sugars. I have still been exercising, so again, I'm not totally a lost cause, but I need to refocus my efforts. And go back to regular logging.

It's interesting how it comes in phases - some weeks I'm golden all week, some weeks I test three times a day and ignore everything. It's also interesting that some habits really can become ingrained, such that my diabetic bender is much better than they have been in the past. That's encouraging, but I'm really annoyed at myself.

It's also interesting how much my weekly dance lessons give me kind of a mental shove to go back to being healthy and focusing on weight loss. It's amazing how superficial I can be - I'm actually not a terrible dance student, but I sometimes catch glimpses of myself in the mirror and think "No! Thighs!" I'm such a woman, sometimes, it's a little embarrassing to admit it publicly. It's strange how I can have thoughts that I actively recognize as superficial and silly - I mean, who cares how much I weigh, so long as I'm healthy? - and yet still have those thoughts.

Second, weird tidbit - I went home to visit Boy and my parents this weekend and was feeling a little ill, so I hopped in the bath. My mother has this kind of funny habit of checking on me in the bath after about 20 minutes, to make sure I haven't drowned...she's a little silly. She's aware of that, however, as she went back to the living room and commented to Boy about how she has to remember that her daughters are no longer two years old, and that we are capable of bathing without dying. They then segued into a conversation about worrying about me overnight - Boy has developed the habit of calling/texting me in the morning to check on me and beginning to freak out if I don't immediately respond (I've started texting him in the morning when I wake up, actually). I thought this was a sadly morbid conversation for my mother and boyfriend to have to have.

I wish this weren't a conversation anyone ever had to have.

But hey, at least I'm still alive, right?

Third, I ran for 30 minutes at 6.2 mph this week, and didn't even keel over afterwards. That's my accomplishment for the week.

Now, to work!

A Multi-Parted Post

2007-05-08T11:02:00.000-04:00

Part 1: I've decided that I can no longer ignore the fact that I'm totally, 100% inflexible, a problem that seems to have gotten worse since I started running. Moreover, my only-adequate ab muscles are interfering with both my climbing and my dancing, and thus must be improved. Accordingly, I hereby resolve to stretch/do crunches every morning before work, and to stretch before and after running.

Part 2: Sleeping. I've decided my best bet with the sleeping is to just set an alarm at 3:30 am. I've stopped eating a snack before bed, and eating a sensible (read: low-carb) dinner also helps, but the best way to console myself that I'm not going to die is to know that I'm going to wake up every night and check. Good thing I did, too: despite climbing gently for several hours to 153 before bed last night, it had tanked to 74 by the time I woke up. Apparently the basals need adjusting, again (...and I'd just adjusted them up last week!). I think the peace of mind more than overrides the sleep interruption, so I'll take it.

Part 3: I've been slacking on the diabetes front. Again, my habits have improved greatly over the past months/years, so this slacking isn't as bad as some slacking can get/my slacking has ever gotten, but still. Boy leaving has led me to eat out a lot, so I haven't been eating very well. Moreover, my fears of sleeping alone have caused me to allow my sugars to run high overnight, which means they're in the high 100's, low 200's in the morning, and it's hard to recover from that. This whole thing has made me vaguely fatalistic, eating more stuff I don't really want/shouldn't really be eating, so I need to get back to my home-cooked, low-carb standards. I think the new sleep plan (see Part 2) should help on this front.

Part 4 (Random Edition): Why didn't we learn anything useful in home economics? The only genuinely useful thing I remember learning is how to do laundry, and that totally stuck with me (that, and an abiding fear of the lint trap catching fire and burning down my house, as it did the house of Miss Brill's close friends in the story she told us to scare the hell out of us). Other than that, we stitched a lot of stuffed animals. But how about learning to sew on a button? Or hem pants (because really, the tailor charges an arm and a leg for it, and it's really easy to do)? Or plan meals and manage leftovers? Or cook dinner in under half an hour? Or stock a kitchen and grocery shop, at maximum, once a week, without an overabundance of your fresh produce rotting in the fridge? Or get that weird gross gunk off the stovetop when even steel wool fails you (answer: butter knife)? Or how to get a human on the line at your health insurance company (answer: press and hold 0. Sometimes it's 9. In my case, it's 0)? Instead, we basically participated in glorified arts and crafts, which was fun, but being a grown-up has all sorts of challenges associated with it that I've been having to sort out on my own. Given how effectively Miss Brill implanted knowledge of how to do the wash, I'm pretty sure they could have driven home how to balance a checkbook fairly effectively.

I suppose I'll just have to keep learning as I go, but I feel like it was a wasted opportunity all around.

No More Meat and Patterns of Eating

2007-05-07T15:41:00.000-04:00

I think I'm going to cut more dramatically back on my meat consumption, particularly out of the house. I was going to swear it off entirely, but I think I was overreacting, slightly. But if I cook it myself, I know where it came from, which is my primary concern. I don't like supporting the meat industry, so I'll be looking to shop organic more consistently as well. The whole thing is just...gross.

My big question of the day: why is it so much harder to eat well on a day that you started off eating badly? I had cereal for breakfast and a bagel for a snack later in the morning (...I got up at 5:30 to drive to work from LI), and my sugars have been fine, but I've had the munchies all. Day. I ate a very sensible lunch but just found myself getting up to go to the vending machine, thinking "mmmm, Chex Mix" before I realized what I was doing and stopped myself. Hello, I'm not hungry, I'm just bored and fidgety, and dealing with it by getting crap to eat. I find this happens more on days that I start off badly - with cereal or a bagel. I've mentioned my proclivity for this before - I have difficulty stopping bad behavior once I've started, and I wonder if it's some commonly understood Diet Fact or if I'm some sort of Diet Freak. Who knows?

In other news, I finally got some clothes that fit, by spending too much money in East Hampton this weekend (shocker, I know). I also slept properly for the first time in a week, what with being around Boy. I actually crashed really hard on Saturday and napped like a napping monster-beast, because I've been so tired and unable to rest properly. Hooray for supervision! Also, I ran for about 5-6 miles, and Boy even commented on how much faster I've gotten. Hooray for fitness!

So those are my random updates: less meat, behavior questions, and finally, some sleep. Glucose readings have been unexciting, though I haven't been as good about it as I'd like. I'm too lazy to deal with updating my log right now, as the internet is being hellishly slow. Maybe when I get some more sleep I'll feel a little more excited about the whole thing.

Mini, Pre-weekend Update

2007-05-04T10:22:00.000-04:00

Things are better. I've been more careful, except for a little incident with some Chex Mix yesterday, and the numbers reflect it, more or less. I'm still scared to sleep, and trying to keep the numbers in the mid-100's through the night. When not sleeping alone, I aim for between 85 and 100, but I just don't want to risk it. No news from the NP about the cgm, except to say that she had my letter of medical necessity ready for the doctor's signature, so let's hope.

No, really, the diabetes was uninteresting this week, once I stopped eating out. My friends eat out a lot, mostly because few of them cook (Seriously. One couple I hang out with just moved into an apartment with a little cubby for a kitchen that contains, no exaggeration, no counter space. None.), and the ones who do aren't as anal about it as I. That's probably because they're not diabetics. But I think my eating-out experiment from the beginning of the week kind of proves that my policy of cooking at least 5 nights a week is a good one, because the more food I eat that is prepared by someone/something else (in a restaurant, or heavily processed. I'm looking at you, Chex Mix), the higher and more unstable the numbers go. It's lame, because I really like eating out, but it's better for the waistline, and it's cheaper, so I think I'll try to keep the number of times I go out for dinner/lunch down to a couple of times a week. It's worth a try, even if I do have to go out today for lunch. Hmmm. I really should eat a salad, but can I resist tacos? Tune in next week...

By that token, in preparation for my Weekend Adventure with Boy (we're meeting at my parent's beach condo on Long Island), I have cooked up a storm. We like to take long (or even regular-length) weekends going places, but we're also thrifty/health nuts, so we tend to bring a lot of food wherever we go so as to avoid paying a ton of money for unhealthy stuff. I have a whole food-bag of tupperware containing vegetables in various preparations as well as fruit, yogurt, cereal and rice milk (for him. I think rice milk is weird, and I defend that position): the whole nine yards. For at least a few days, I can keep the overnight numbers a little lower, which is exciting. And, there will be fun! And sun! And beach! And lounging around, reading!

(Can you tell I'm excited? Right, that's because I'm excited. It's hard to care that much about diabetes when a Weekend Adventure is planned...besides, I have to go figure out how to get to the ferry departure point from here, and try to get some work done today. Hooray for pumps!)

ADDENDUM: This amazed me so much, I had to add it. So much for the mini update.

I caved and got my tacos for lunch. The Taco Bell is right next to the Burger King in that particular food court (the lines are always longest at them, too; I always feel vaguely sheepish standing in line at Taco Bell, for some reason. It's some kind of bourgeois guilt that I need to get over), and there, on the Burger King menu, is a new offering: Cheesy Tots. Like Tater Tots, only filled with melted cheese. A medium order costs less than a thing of fries, which I found confusing- I mean, they sure sound more complicated than fries do- and- and-

Sorry, I'm overwhelmed by the gooey. As I've mentioned, I don't really blame the fast food industry for catering to its customers' desires, but sometimes they just so baldly ignore good health and sense that I have to stare in awe.

At least until the grumpy woman at the register of the Taco Bell says, "HELLO?!"

And yeah, I got the tacos. Some weeks are better than others but, with Boy gone, I'm eating so much less at home that I think I can splurge a little. No popcorn or toast or cereal or whatever other carby thing he likes to snack on in the evening, so I'm generally eating very well (and not very much). Sometimes, a girl needs a taco.

It's strange how I can go a week without touching anything carby or processed and then I have two days in a row with Chex Mix one day and tacos the next. I hope this means I'm about to kick off another week of straight vegetables.

A Double-Post Day, Oh My!

2007-05-02T17:07:00.000-04:00

I need to take a moment to brag.

My "easy" workout, for days when I'm unwell or my knees hurt or whatever, is 5 minutes of a quick walk to warm up, 20 minutes at 6 miles per hour, and 5 minutes of quick walk to cool down.

My "standard" workout is 5 minutes warm up, 25 minutes at 6 mph, and 5 minutes of cool down.

My "challenge" workout is 5 minutes warm up, 30 minutes at 6 mph (a flat 3 miles) and 5 minutes of cool down.

Lately, I've been pushing myself, trying to make "challenge" into "standard."

The moral of the story, though, is that I'm fairly consistent, but I'm also, in the world of running, pretty slow.

But today, today, I did something I have never ever done in my entire life. I had, in point of fact, run a mile in ten minutes before (for gym class, once, maybe?). But TODAY, I ran 2.583 miles at 6.2 miles per hour.
That's a 9:40 mile, for 25 minutes.

And I ring in the post run at a 93 mg/dl. I think the powers that be are apologizing for the last two days, or something.

/End brag.

(Sorry about that, folks. I'm just really, really proud of myself. This goes to show that any lazy computer programmer can train herself to run, no matter what she thinks of herself.)

Can't Sleep, Hypos Will Get Me

2007-05-02T10:45:00.001-04:00

Ever since Saturday night's low incident, I haven't been able to sleep. I mean, 36? Seriously? Don't people fall into comas before that? So I've been paranoid, sending frantic emails to my RN about getting a continuous monitor, testing way more than usual (...conservation, dammit!) and being wholly unable to get to sleep. Last night, facing exhaustion and a pretty big correction bolus (sushi rice. I need to stop eating out, I'm totally failing the last few days), I finally caved and set an alarm for 3:30 am, and could rest easy. I mean, hell, even my mom is worried. Boy is paranoid as hell. And I can't sleep.

I therefore slept in this morning after my 3:30 am check indicated that I was still in the land of the living. This has to stop, though. I need to go back to not eating any carbs, because the ups and downs of the last three days are more than I can handle. Moreover, uncertainty about dinner boluses is one of the reasons I'm scared to sleep, so I need to take that out of the equation. While getting up at 3:30 in the morning is a viable solution, I think it might actually kill me after a couple of days. Or maybe not. We'll see.

At least today, I'm mostly awake. Back to low-carb living and test-strip conservation.

The Origins of a Health Kick

2007-05-01T10:00:00.000-04:00

I've already kind of covered the progress of my health kick since about September, and, given the hints I've dropped here and there (overnight seizures), my loyal followers can get kind of a picture of how things have gone for the last ten years. Not a complete picture, of course, but an idea. So this is kind of out of order, but I thought it would be worth documenting the cause of my recent foray into healthfulness. (warning: this is unreasonably lengthy. I tried to cut it down, I swear...)

My diabetes has gone up and down. When I was first diagnosed at the ripe old age of 12, I honeymooned pretty hard. The first couple of years were smooth as buttah, as they say around here. I don't remember it being much of a problem through high school, either; I got a pump, everything was rosy. I got a little chubby, but so is everyone in my family.

Then, I went to college, which did horrific things for the diabetes. My mom prepares well balanced, healthful meals on a nightly basis, in addition to being a VP of a large corporation. She's superwoman. She wasn't at school with me, however, and the dining services, while comprehensive, left much to be desired. Mostly, I ate pasta. The freshman 15 looked more like the freshman 25, and my blood sugars could have been anywhere. I wouldn't know; I only tested once or twice a day. Really, no one should have been surprised when I started having overnight hypoglycemic seizures.

Now, that's a story I'll save for another day, however much fun it is (needless to say, not only do I have a well-documented problem with authority, but authority definitely developed a problem with me. Oh, and I can also go into my adventures in university health care. It's a good time). Regardless, sometime sophomore year, some sense snapped into me and I resolved to test more frequently, to the tune of 4-8 times a day, sometimes more. Unsurprisingly, the blood sugars came back under some semblance of control. Not tight control, but control.

I kept eating, though. Mozzarella sticks are fine for blood sugar, but spring of sophomore year rolled around and I hit my highest weight: 162 lbs on 5'3" of human. 35 lbs since junior year of high school.

Realizing, vaguely, that mozz sticks on a nightly basis were a questionable nutritional approach, I cut back, and dropped about ten pounds in six months. I'm visiting an endocrinologist, I'm testing nicely, sometimes I'm logging, and I'm generally being a Decent Diabetic. My cholesterol levels were a little iffy, my blood pressure was a bit higher than we'd like, so I swallowed my pills like I was told. I cruised through the rest of college with little further diabetic ado.

Now, on the subject of the medication: I am not averse to medication per se. In fact, I took those pills for years without complaining. But it always, frankly, bugged me a little to be on such powerful drugs at such a young age. If I was taking an ace inhibitor at 19, what would I have to take at 40? I understood then, as I do now, that a diabetic is at much greater risk for heart disease than the average member of the population. I understood that my numbers were higher than what was considered acceptable. So I took my medicine. But in the back of my mind, I questioned...

Cut to September '06. I originally started on the ace inhibitor with my doctor from high school, and my current endocrinologist thought that a longer-acting drug would be more effective (I was on short-acting stuff once a day, which seemed pretty pointless). I like him, and I trust him, so I allowed him to alter the prescription without complaint.

I started complaining pretty quickly, though. In all honesty, my blood pressure had never been that high - I swear it only bumped above 120/80 because the damned machine makes me nervous. The prevailing theory as to what happened is that the medicine just worked too well, dropping my blood pressure ridiculously low. While medical practitioners generally agree that no number is too low, so long as you're still breathing, there is apparently a level at which you're still breathing, but feel like crap. I could hardly drag myself out of bed. By the time I lugged myself up the hill from the T-stop to my doctor's office, I could barely stand. He told me he assumed that I could stop the medicine and feel better, but that I should get some blood tests, "to rule out any major toxicity."

For some reason, that phrase has stuck in my mind. It hit me like a sack of bricks at the time. "Major toxicity"?! MAJOR TOXICITY? I was, for whatever reason, totally offended at the possibility. Long story short, my liver was still functioning fine, and everyone concluded that my blood pressure was close enough to an acceptable number that I should just try to go a couple of months without the medicine, to see if I could go without long-term.

But, for whatever reason, my brush with Major Toxicity really got me thinking. And it got me to look at my lifestyle, and see how I was doing. And I realized something that should have been obvious: those drugs weren't treating a medical condition. They were treating the symptoms of a problem, caused by certain circumstances in my life. Namely, I was 25 lbs overweight and totally sedentary. I am very well paid to sit in front of a computer for 9 hours a day. Of course my blood pressure and cholesterol were high. The more I thought about it, the more those drugs bothered me: why was I putting myself at risk for major toxicity by employing a method of treatment that wouldn't actually solve the problem?

So I quit the Lipitor and took up running.

I realize that the practice of flatly ignoring one's doctors is not necessarily the best way to ensure a long, happy life, and I don't intend to make a policy of it. In fact, when I get my blood done, if either my cholesterol or my blood pressure are in unhappy ranges, I will cheerfully start swallowing my pills again. I just figured that there was no better time than my early twenties to try and deal with the root problem, my fatness, my sedentaryness (to make up some words). I'm sure I'll have to take many powerful drugs as I age, and I don't have a problem with that. I just have a problem with a medical practice that ignores lifestyle as a factor in health. As a caveat, I think that my doctor (and most doctors) is actually prescribing the best course of action, at least from his (the medical industry's) perspective: it is unlikely that any given patient will adopt any major lifestyle changes, and so he (and they) prescribes the course that is more likely to be effective in dealing with the problem (cholesterol, blood pressure). While I think that our medical system ignores preventative medicine to a dangerous degree, I don't really fault them in this instance, because their experience probably shows that they're more likely to reduce cholesterol by prescribing a pill than by insisting on better diet and exercise habits. That, I think, is a function of our collective cultural insistence that we can do, and have, and eat, whatever we want (I've talked about this somewhere - the effect the capitalist mindset has on our willingness to modulate our desires...).

But that is not for me, necessarily. I'll try my hand with the running shoes before I put myself at risk for the major toxicity and liver shutdown.

That, in a nutshell, is what got me started.

...Update to the Update

2007-04-30T22:28:00.000-04:00

Bleargh. Totally untrue. Bounced up and down all day and generally felt like crap until at least 5 pm; had to leave work to hydrate and nap. Am hoping to start tomorrow off someplace reasonable, since it's so hard to recover from a busted morning...

Also, why does blogger think I live on the West coast?

Another Weekend Update

2007-04-30T10:53:00.000-04:00

(a real "thinking" post at some point, but for now...)

Fell off the wagon this morning.

This was precipitated by my waking up at 3:00 am on Saturday night (well, Sunday morning, I guess) at 36, despite being perfectly in control all day. This freaked me out, naturally, being home alone and seeing no good reason for the precipitous drop. I suppose I wasn't as strict with the eating on Friday night, but I really just ate something sensible and corrected properly and was fine before bed, so I don't know what happened.

Then, for some reason, I just ignored The Rules on Sunday. I wasn't outrageous (no donuts), but I also wasn't careful, shooting up in the afternoon and coming in the in the mid-200's post dinner. I'd had too much wine (never a good idea), and was scared to overcorrect, knowing that alcohol makes me drop and that tipsyness makes me stupid. So I woke up this morning at 284.

I forgot how much that sucks. Yes, just forgot. I know there was a time in my life that I regularly woke up high - mostly because, following the seizure phase of my life, I was scared to drop overnight and just let myself run high (...I got over that). But the last three weeks have been so perfect that the contrast between how I usually feel in the morning at 90 and how I feel in the morning at 280 was marked; it's taken me quite a while to recover.

But, proving that the wagon hasn't left without me, I had my smoothie and coasted downwards from my morning high with ease. Previously, I'd have eaten cereal for breakfast and freaked out about how it wouldn't come down, regardless of how much insulin I took. So I won't panic too much.

The very peculiar thing about all this is that my insulin sensitivity seems to have shot upwards in the last couple of weeks - previously, I had a 1 unit/35 mg/dl ratio that worked pretty well. I corrected, using that ratio, this morning, and catapulted downwards (...I don't think that that phrase even makes sense, but whatever) to 75 at 11:00 am, which means that my ratio is something more in the range of 70-85 mg/dl per unit of insulin (depending on how conservative I'm being with my calculations). This seems unlikely. I guess it's another thing to add to the list of "stuff to experiment with."

Also, I got new running shoes, which should be better for my back.

New Resolution, a Confession, and Random Tidbits

2007-04-27T14:30:00.000-04:00

I somehow started three independent blog posts last night, and didn't manage to finish any of them. Argh. Maybe that explains why this one is so long.

Well, Day 1 of Long Distance Lovin' (Boy is gone; I'm sad) has passed without major catastrophe. I overslept, of course, waking a good hour after I had intended, feeling a little woozy from hunger. I panicked, as much as I can when I first wake up: Why did I oversleep? I'm hungry. Oh, no, I'm low! Scramble for the little Freestyle, which cheerily informs me that my blood glucose is ringing in the morning at 99 mg/dl. I'm hungry because I barely ate dinner last night, and I overslept because I'm lazy. Right.

I dealt with the emptiness of my apartment by cleaning the hell out of it, and cooking up a storm, making the biggest pot of zucchini-chickpea stew you have ever seen in your life. Trust me. It's huge. I had to transfer it from the pan in which I normally make it into the big soup pot. That's how much stew I made. I have the idea of not having to cook every night by virtue of having stuff pre-prepared, so making a huge amount of stew is a good start.* I actually froze the remainder of the soup we had the other night** and ate half of it for dinner yesterday, and the convenience cannot be denied (my big lunch yesterday meant that I wasn't really hungry, though I probably should have eaten something besides a tiny bowl of soup, a piece of toast, and some strawberries for dinner...). I intend to take the stew to work for lunch for as long as it lasts, actually, which is my new resolution- up until recently, I had been packing my lunch for work every day. While I am sufficiently well-paid that I can afford to buy lunch, it seems like a tremendous waste of money. My recent lapse is mostly related to my new control push; I simply cannot match the power of the salad bar from my own fridge. However, I do have the power to produce many packable delights of similar nutritional quality, so I hereby resolve to try.

One thing about me that differentiates me somewhat from many other people my age is my enjoyment of cooking. I think it mostly stems from the fact that I really like to eat good food, and the only way to really eat well is to learn to cook well. So I did. And I really like it - it's kind of cathartic to come home from work and go into the kitchen and prepare something delicious. The act of creation is a basic human pleasure, and playing with sharp knives and flame is an added bonus. There's mess involved, and mess is good. Moreover, one has much better control over one's nutrition and health this way. With time, I've gotten better, too - I can now put together a real meal in under a half-hour, which can be really important.

That leads me to my Confession: I don't count carbs.

I'm relatively certain that that confession is something of a pump-using Type 1 heresy: everyone counts carbs. You count the carbs you ate and then you calculate your bolus and then you move along. That's how it works. I do use my insulin/blood sugar ratio to calculate correction boluses, but I just ignore the carbs and guess.

Why don't I count carbs? A number of reasons. The most basic is that, frankly, no one ever taught me to. I was late getting a pump that calculates one's bolus based on the carb/insulin ratio, and while I'm perfectly capable of doing basic math myself, no one had ever suggested that I might want to try. For a while after I got my 722 Paradigm, I tried it, experimenting with ratios and coming up with some that more or less work. But...it seems kind of unnecessarily complicated to me. While I do like to eat, it's rare that I ever eat anything that I haven't eaten/corrected for before. I also have a really intuitive sense of my own insulin needs based on what I've eaten, for some reason. This is particularly true now that I'm avoiding starch like the plague, and it's one of the reasons I like the low-carb approach, actually- because the individual doses of insulin are so small (on a good low-carb day, I rarely take more than three units of insulin at a time), it's hard to be off by enough to really incapacitate oneself in either direction.

Moreover, and this is perhaps more important (and more related to my cooking habits), I find it almost impossible to accurately guess how many carbs are in most things I eat. I believe that I should eat as much Real Food as possible and, as a result, it's rare that I eat anything that comes with nutrition facts printed on it in a remotely useful way - even if fruit does come with nutrition facts printed on it, the time of year, level of ripeness, etc can vastly change the amount of sugar in any given serving. Cooking just causes the carb-counting system to break down. My stew, for instance, consists of some amount of chickpeas, some canned tomatoes, zucchini, onions...and so on. Although I could probably loosely calculate the number of carbs in the whole pot, I don't know how many chickpeas are in the arbitrary amount of food I put into my tupperware for lunch. I figure, if I'm guessing the carbs and I'm mostly approximating the ratio, I might as well just guess the insulin needs, since I'm good at that and it removes a level of indirection. I simply try to maintain some consistency in my day-to-day diet, throw in a little guesswork, fine-tune the hell out of my basal rates, and move along. And it's been working pretty well for me, to tell the truth.

Of course, tonight my sister comes to town and we're going out to Thai, so I'm going to violate all kinds of personal rules with their spicy pad thai. Mmmmmmm...

And finally, some Random Bits of News from the Life of Claire:

1) I clocked in both this and yesterday morning at 137 lbs. Hooray!
2) Anyone who lives in Cambridge should go to the Finish Line at the Cambridgeside Galleria, because they're having an outrageous sale. $15 for two sports bras! $10 for workout dance pants!
3) The ballroom lesson was unembarrassing. My teacher is so excited to get a real beginner (rather than someone who's learned everything all wrong in a group class first) that he's focusing almost entirely on technique from the beginning, so I spent a good 30 minutes learning how to stand. Last night, I practiced standing, and moving my hips without moving my shoulders. I'll tell you, it's much harder than it looks.

* This tactic doesn't work as well when Boy is around, because he tends to just eat everything until it's all gone, no matter how much stew is made.

** Boy complained bitterly because he couldn't find the leftover soup the next morning. He had intended to finish it for breakfast.

More Random Thoughts

2007-04-25T16:50:00.000-04:00

Thought 1: *grumble grumble* Google Docs refuses to load my blood sugar spreadsheet. I want to update my blood sugars! *grumble* Web 2.0 fails me this afternoon.

Thought 2: I don't know what fit of insanity prompted me to schedule a ballroom dance lesson, with a ballroom dance coach, this evening. I'm not graceful. I'm not skinny. I'm not tall. I'm kind of stubby and graceless, actually. I've kind of lost my mind, I think.

Thought 3: Performance testing is really boring.

Thought 4: I need to run tomorrow. I have even less attention span than usual when I don't.

New Favorite Treat

2007-04-25T15:17:00.000-04:00

My new favorite sweet discovery is definitely a steamed milk with sugar-free hazelnut syrup from any generic coffee shop. I realize it's silly to pay $2 for a glass of milk, but it really hits the sweet-tooth spot and does gentle things to the blood sugar, if it does anything at all. It's a pretty glaring exception to my aversion to the artificially sweetened, but sometimes, you just need something ridiculously, stupidly sweet, and it's certainly better than the Sour Patch Kids I might get instead.

The only challenge is to convince the average barista to give me whole milk instead of non-fat. The skim stuff tastes like milk-flavored water, which isn't nearly as good...

Also, I'm compulsively searching for/fantasizing about apartments in Charlottesville. I think we can get a two-bedroom and have an office for working, which will be good. I'm so excited! We can decorate!

Changing Image

2007-04-24T12:42:00.000-04:00

You know, weight loss and its incumbent lifestyle changes are peculiar things.

Until about October, and I'm being remarkably generous with myself here (I pick October because it's when I started seriously rock-climbing), I was not a physically active person. I've always seen life as broken down into two realms: the physical and the mental. My activities universally took place in the latter realm. With the exception of physical affection, I have never been, in my entire life, a remotely physical person. My sport in high school was debate. I was a computer science major. I never budged. I also didn't eat many vegetables, and I've been somewhere between chubby and fat for the last 6 or 7 years of my life.

I'd gotten used to it. I've never been hideous, in my opinion, and it just seemed to be the way I was built - not a mover. I think my apathy may have just been an entrenched mindset, that some people are physical people and some people are not, and I'm inevitably in the latter category. And it was fine, because I like being a thinker, a programmer, an arguer.

Apparently, though, it wasn't inevitable, or genetic, or whatever. People can change. And, slowly, steadily, I did. I owe a lot of that to Tyler, who believes strongly in remaining fit and taking good care of one's body: I took up rock climbing because he introduced me, and it turns out I loved it. I sucked, naturally, but I loved it.

Slowly, I got stronger. This was cool.

Next, I started taking some salsa lessons. He's a ballroom dancer, and I thought that a girl gets the chance to be with a man who actually wants to take her dancing once in her life, maximum, so I should take advantage while I had the chance. Turns out, I really like to dance, and I'm not as much of a catastrophe as I'd thought I'd be. In fact, I'm not bad: I pick up new steps faster than he does.

I don't know who decided we should take up running. I know he was complaining that he got winded three-quarters of the way through his jive routine and wanted to improve his cardiovascular health, and I was thinking of my disastrous run-in with blood-pressure medication and my desire to reduce my numbers naturally. So we took up running, at first together, but then, as it got colder, I tried to stick to it on the treadmill at work. I cannot overstate exactly how much I sucked when I started. I couldn't go a mile; I stopped three times; I could barely walk the next day. But I kept at it, thinking about my blood pressure and cholesterol and the fact that it was pathetic that I couldn't run a mile, and now I can run three.

So in January, I realized all these changes had been slowly accruing, and thought it was high time to deal with the fact that I was fat. I started watching what I was eating, and realized that, the more I watched, the better my sugars. And slowly, it all built, and now I've lost another 11 lbs and my average is the best it's been in years. I'm no longer clinically fat, even. I'm not yet where I want to be, but I'm getting there.

This all leads us to today, in the cafeteria.

I was filling up my second coffee cup of the day (one of the things I did in the fall was give up diet sodas, but now I'm ramping up my caffeine consumption again: up to two cups of coffee. Remind me to deal with that), and found that the milk and skim milk containers were both empty. As I was fumbling around, a guy who works on my floor commented on it, saying the half and half was still full, and saying "Why, are you watching your weight?" I said, well, yeah, basically, and he looked astonished: "But aren't you a crazy fitness freak? You work out all the time!"

At this point, Little Evil Claire sitting on my right shoulder bursts into laughter, cackling like a maniac, at the very idea. Me? A fitness freak? Me?! Lazy, lazy Claire? I mean, I only work out at the office 3 or 4 times a week, so I think he was overstating a little bit, but...

Apparently, yeah. I eat a lot of vegetables. I run regularly (far, far more regularly than anyone else around here does). I engage in regular strength-training activities.

I guess that means that people can change. Myself included. How odd.

Moral: I Suck At Weekends

2007-04-23T10:09:00.001-04:00

It's annoying. The week is so easy, comparatively: my big decision is whether I'll be good and have the same salad I have every other day, and that decision doesn't challenge me much. The weekend is sooooo hard: I'm out with my friends, or in the city, walking around, passing restaurants, at a friend's house when the pizza arrives...

Confession time: I ate four (!) slices of pizza for dinner last night. FOUR. Why four? I'm 5'3" tall. I am not a big woman, and I was not hungry enough to justify four slices of pizza. Maybe, maybe I was hungry to justify three, but the fourth one was gratuitous.

I used to eat like that all the time, actually; it's what got me so fat in the first place. It's weird to do it now, when I'm so much more conscious of what I eat and of my nutrition. It's like I'm standing a few feet away, watching myself, going "What the hell is she doing?" But I ate them anyway. I still lack impulse control, to my chagrin.

It is interesting to see how much I've changed, however, from a person who could consume that much food and not think twice about it.

Of course, then the blood sugar shot up, because there's nothing you can do to stop it when you eat four freaking slices of pizza. It's back down to more reasonable levels now, but my pizza-induced guilt will hopefully keep me well-behaved for at least a couple of days.

In other carby news, we went for dinner at a friend's apartment on Saturday night, and they made risotto. I happen to love risotto, so it was nice. I was a little worried about what it would do to the blood sugars, but it ended up being fine. My theory is that, when done carefully and every once in a while (and not in increments of four slices of pizza), a dinner of risotto is not a problem: I think it's the compounding of massive amount of carbohydrates that really leads to ridiculously impossible blood sugars. In that sense, I don't really mind that weekends are less strictly controlled than weekdays, because I don't think that the occasional meal of risotto (it was delicious, by the way) is all that bad (that, and my blood sugars were great, before and after). That being said, there is such thing as profound overkill, and four slices of pizza falls into that category.

I'm a little annoyed at myself, if you haven't noticed.

More Misadventures in Cafeteria Atkins Eating

2007-04-20T12:17:00.000-04:00

I examined my pump this morning and noticed that the tubing looked as though it was disconnecting from the round bit that comes out of the reservoir. I tried pumping 0.5 u, and, noticing that an air bubble at that point in the tubing was failing to move, I assumed it qualified as busted and changed the set, bolusing my full breakfast bolus (despite the additional 0.5). Um, apparently that was a bad idea...

I'm sitting in my boss's office for an impromptu meeting, discussing the performance numbers on the code I'd just written, the status of my project, grad school, and so on, and I am dropping, slowly, steadily, and the words take longer and longer to resolve into sentences, and I cannot wait to get out of there. I rush back to my office and fail to convince my meter to do anything, wasting two strips in the process. Fortunately, the fact that I am low is obvious, so I chow my three tootsie rolls and start to feel a bit better.

I'd dropped rather lower than I normally do before treating, however, and had developed that ravenous low hunger monster that grips you even when you're fine and climbing and at a totally normal number again...increasingly rational as the candy does its magic, I decide that the best way to deal with this is just to eat lunch early and be done with it.

So I do. The prospect of a salad is totally unappealing at this point, and I'd been craving something hideously unhealthy all day (what I was craving was non-specific: I'd go from donuts to bagels to cinnamon rolls to a Big n Tasty with fries...), so I turned to the burger counter, where the special of the day was - I am not making this up - blue-cheese stuffed burgers. Like, two thin patties, blue cheese in the middle.

Well, that'll certainly do the trick.

I ordered it without a bun, which got me the standard set of raised eyebrows from the guy manning the grill. He seemed worried about me: "Shall I give you extra fries? No? You sure?" I turned down the fries, but decided that the onion rings wouldn't kill me. They were probably a bad idea, but comparatively...anyway. I made him pile on the vegetables, and got some A1 sauce (3 grams of carb per tablespoon! Who knew?!), and dug in.

I really wish they didn't insist on grilling the burgers to death down there, but it did satisfy my junk-food cravings. He didn't even put in too many onion rings, though looking at the nutrition information on calorie-count.com, it clearly wasn't the best choice I could have made (actually, I just compared the onion ring info to the french fry info, and the onions rings were the better choice by far. I'm feeling a little better about the whole thing). I ate the veggies he put in for me: tomatoes, lettuce, peppers, onions, mushrooms. It totally violated my quasi-ban on red meat, as well as my ban on Shit That Is Obviously Bad For Me, but as far as bad choices go, I suppose I could have done worse.

Now if only they'd stop staring at me when I ask them to leave out the bread. I realize the Atkins craze is over, but are we so culturally amnesiac that we can't remember it? Stop looking at me funny!

Then again, I found the whole thing reassuring - apparently it's possible to satisfy an overwhelming craving for crappy food without overloading on the carbs.

And now, of course, I'm in that post-low sleepy fuzzy state where all I want to do is naaaaaaaaaaaaaaaap...more free bad coffee? More free bad coffee!

EDIT: 4:20 pm: 260. Fuckity fucky fuck fuck. I should know better. I do know better. *grumble* Can you imagine what it would have been with the bread and the fries?! Salads, henceforth! SALADS!

Loooooooooooow.

2007-04-19T10:09:00.000-04:00

Goodness, I have been low for like, days. Low low low low low. Like, high 50's low. And they've all been very gentle, so I have been totally capable of dealing, but it's getting a little exhausting. I lowered my overnight basals again, and my daytime basals too, since I woke up below 60 for the third day in a row. I'll have to look over my records and remind myself not to give as much at meals as I'm inclined to, since I've been eating nothing but tootsie rolls for days and days.

I also can't get low, because I'm trying to conserve test strips after last week's binge. I only tested 4 times yesterday, and was really unnecessarily proud of myself for it. I'm wondering if I can get away with not testing before lunch today, since I ate the same thing for breakfast today as yesterday and took the same amount of insulin...

God, it's easy to get caught up in pointless minutiae in dealing with this disease.

I'm trying to get it all under control over the next few days, though, because Boy is going back to NY to work for a couple of months this summer before we move south together for grad/professional school in the fall. I haven't had any serious overnight low incidents (and I define "serious" as "requiring hospitalization and the intervention of Freshman Deans") since freshman year in college, but I have still woken up and required assistance a couple of times since Tyler moved in. The fact that I'll be sleeping alone again for basically the first time since last August makes me a little nervous. I know that I've slept alone before (I had singles in college), but that was mostly in a context where I had suitemates nearby who would notice if I didn't get up in the morning. I only really slept alone, in my apartment, for a month or so last summer, and while it didn't bother me then, I think I've been really subconsciously reassured by Boy's presence all these months, to the point that I didn't realize how much I appreciated it until it became clear that he'd be gone during the week for the next couple of months. I guess it just means I need to be especially rigid in my eating and insulin habits for the summer, but I'd like to be waking up above 65 for a couple of days before he goes, just to get started on the right foot.

In other, unrelated, but happy news: I got to work at 9:40 this morning. And, more importantly, the sun just came out. I think I had forgotten that the sky is actually blue under all those clouds.

Accountability!

2007-04-18T16:17:00.000-04:00

I ostensibly started my diabetes blog in the interest of maintaining some accountability for my health and control, so I think it's time for some number-crunching.

So far, my new diet experiment has been remarkably successful. I looked over my Google bloodsugar spreadsheet and did some averages and such. My crunch for the last 12 days looks like:
# recorded blood sugars*: 50
# blood sugars over 200: 6
Average daily insulin intake**: 40.47
Average blood sugar: 130.23

I think these numbers will improve, because most of the highs (with the exception of last Saturday) were from the early part of the month, before the implementation of my improvement plan. I'd like to see how it progresses.

I'm actually kind of surprised with myself. I'm really hard on myself, control-wise, and I think it may be a holdover from that period in my life when I wasn't responsible and didn't make much of an effort to control my blood sugars, let alone test them regularly. God, freshmen in college are stupid. I still think of myself as being wildly out of control, when really, I'm not as bad as I think I am. I think there's definitely room for improvement, of course, but I found this rundown to be heartening, more than anything. That's especially true in light of the fact that I haven't lost any weight in two weeks (damn you, plateau!). At least the important numbers aren't a total mess, right?

* not all tests, because there are days that I test like 17 times and there isn't room for all those results on the spreadsheet

** this can vary wildly from day to day. On "good" days it's in the low 30's, generally...

Whoops.

2007-04-17T17:40:00.000-04:00

Went on a tiny Tootsie-Roll spree this afternoon, consuming a serving size (6) in a go. I don't know why. I think I was just hungry, actually...I should try to get some decent snacks around my office. I don't usually snack at work, I run instead, which is what I did today- but the lunch was kind of small, I guess. Oh well. That doesn't explain why I went on something of a cake binge after dinner, but the sugars have been good all day and I didn't pig out otherwise, so I suppose I'll have to forgive myself.

Remind me...

2007-04-17T10:33:00.001-04:00

...never to complain about a diabetic's eating restrictions again.

I got full fat organic yogurt from Trader Joe's this weekend, and used it to make my breakfast smoothie. I need to be careful when I do that, because it is so magically, indescribably delicious that I'm liable to lose it and eat myself to death, which is ironic, because half the reason I got the full fat stuff is that it's more satisfying (and, thus, I don't need to eat as much). So, yogurt and peaches and ice and milk and I'm in creamy blissful frozen breakfast heaven.

I continue to be mystified by our society's relationship to food. Like, real food. Real, delicious, magical food, like full-fat plain organic yogurt. I understand that donuts and low-fat Cherry Garcia frozen yogurt are delicious, but I don't understand why we put such a premium on them at the expense of other, arguably more delicious foods. Like full-fat plain organic yogurt. I started buying milk and yogurt in the full-fat versions about a month ago, after reading an article that details how low- and no- fat dairy products are made (which of course I can no longer find. Damn you, intarwebs), and I'm so much happier. In the end, I eat less than I would of the low-fat versions (so the calories even out), because there's only so much whole milk you can consume in one sitting, and it's so much more satisfying.

I suppose this brings me back to an earlier post about our society's fixation with sugar. We'd rather eat a pint of low-fat fro-yo than a half a cup of real, plain yogurt with a little fruit, and I fail to understand why. I mean, I understand that Cherry Garcia is delicious, but I don't know why I think it's delicious. I also understand that, for breakfast, I'd rather my smoothie, which is just tastier, not to mention a hell of a lot healthier.

And that's what it comes down to, of course. All this corn-syrup crap is terrible and not nearly as good. So...why, America? Or, why, humans? It's a bizarre twist of evolution that would cause us to gorge ourselves on all this crap that's killing us and is objectively not as good as the alternative. The low-fat craze is an embarrassment to real cuisine. And it's so ingrained! When I went to the Nutrisystem website to figure out yesterday's calories (I gave up, by the way), I couldn't enter in the whole milk I used in yesterday's smoothie because it wasn't an option on their otherwise very comprehensive food list. That's a list that's been originally provided by the makers of the site and then expanded by users, and not a single person involved in its creation has seen a reason to add whole milk (note: it has less sugar and is metabolized slower, so it's better for blood sugar. Thank you, Dr. Bernstein).

Regardless, this is perhaps the first food combination I've ever consumed that makes me feel like I should be taking a lot of insulin, even though I don't have to. It's that decadent.

Monday, Again.

2007-04-16T13:49:00.000-04:00

A decidedly mediocre weekend, from the diabetes perspective. On the bright side, I kind of managed to offset my bad behavior on both days: while I normally respond to bad behavior with a "fuck it, I might as well pig out because I already did," this weekend it was more "well, I messed up, but no reason to eat another bagel just because I already ate one."

So Saturday morning was a high-carb plethora of bagel slices and a donut, of all horrible things, followed by a totally sensible dinner at a nice restaurant of seafood, a broth-based soup, and a cheese plate, and no popcorn at the movies. Sunday was a little better, though still higher-carb than necessary (well, depending on your definition of necessary: we had absolutely no food besides bread and almond butter and a little yogurt): breakfast of yogurt and grapes and a few cheerios, but then a lunch of rice cake/toast with almond butter. Not horrific, but not great. Dinner wasn't awesome either: we were going to a friend's place where pizza was to be served, so I had a dinner of scrambled eggs and some broccoli beforehand, knowing that if I didn't, I'd eat 4 slices of pizza. On that front, I succeeded: I only had one slice, but that was in addition to several handfuls of Cool-Ranch Doritos (which I love way more passionately than I should, which my friend knows, which is why he got them. Dammit).

So Saturday I shot up, naturally, but once I corrected sufficiently, the numbers for the weekend weren't terrible. I find this new eating plan much more difficult to follow when I'm not in a controlled environment (ie my office, or my apartment with a full fridge). Again, though, I feel like I made better choices than I would have in the past, so I need to continue looking at this as a gradual change.

Today was great, on the other hand. Despite my smoothie struggles this morning (never having made one, I put in too much ice and not enough milk), breakfast ended up being really good: plain yogurt, milk, ice, some frozen peach slices: like ice cream! For breakfast! Without added sugar! I wish that food makers would make those drinkable yogurt things without high-fructose corn syrup because, as my (slightly messy) breakfast experiment indicated, it's possible to make a cold delicious frozen yogurt drink without piling on the sweetener (I didn't add any). As Tyler said: sweetened stuff all tastes the same. Shame on you, food producers, for destroying the delicious. Lunch: big salad. Stable blood sugars all around.

On the CGM front, I found a fax number for my NP to use to harass the insurance company, and felt very virtuous.

Shall I run today? Hopefully...

Exploring Continuous Glucose Monitoring: Part 1

2007-04-13T15:22:00.000-04:00

I forget which d-blog I was reading, chronicling the writer's forays into CGM therapy. To put it mildly, it picqued my interest. I've been resistant in the past, looking at the clunky transmitters, thinking that I'm already attached to a monster device all day, I don't need another one...but the new Minilink system, released in March, is so tiny and adorable! I can get behind that. And I really think it's the next step to upping my control.

So, I started making phone calls.

The Minimed guy assures me that, with "aggressive patient work," it is possible to get an insurance company to underwrite some of the cost of the new therapy, which is no longer considered experimental. That, or they take any credit or debit card with a Visa, Mastercard, or American Express logo. Good to know. Also, it's tiny, watertight, comfortable...and works with the pump I already have.

(side note: I'm glad I dallied so long in getting my old 508 replaced: I got the 722 two weeks after it was released, mostly because I was so slow in getting all my paperwork in. I should have gotten it months previously, but, well, I'm lazy, and now it's paying off because I won't need to pay to upgrade.)

Next, insurance company. Oh. My. Sweet. Lord. Getting a human on the phone through their menu system was flatly impossible, so I called my employer's special help line, and asked the woman to transfer me to a human at BC/BS. She did. New Woman was very friendly (and told me the secret voodoo for getting a human directly next time I call), explaining how to get them to do a predetermination, which basically involves getting as much proof of medical need as possible and shipping it off to them to let them decide your fate. Then I can get a claim denied and appeal, if necessary. I forsee many long phone calls in my future.

OK, time for phone call #3 (yes, I do have a job, but this is my health we're talking about): doctor's office. I had to miss my last appointment to fly to Virginia, and of course, he's booked through July. Damn. Well, I made an appointment for July (!) and left a message for his NP asking to talk to her about it. I then wrote him a plaintive email, begging him to help me ASAP, before I go to grad school and have to live with shitty insurance.

So, the wheels are in motion. I'm pretty good at getting what I want when I'm really dedicated, so I'll be making more phone calls.

Barring that, I think this may be something I'm willing to spend money on. I'm getting a pretty big tax refund this year, and, since I'm going to be a Poor Student (TM) starting in the fall, I need to do it now, rather than later. I won't use it constantly if this is the route I go, because $350 every three months is a lot for testing, but I feel strongly enough about it that Minimed just may be able to talk me out of some cash. We'll see how my Forays into Insuranceland go.

EDIT: 5:30 pm. Got a call from the NP at the doctor's office. She said they haven't had much luck getting insurance plans to pay for it (they just got their first approval this week, in fact), but she's happy to try for me. I made sure she knew about my numerous freshman year overnight hypoglycemic seizures, since I think that that's the best way to convince them. I just emailed her all my info...here's hoping.