Going to the Carnival…

The DSMA Blog Carnival, that is.  The prompt for July (OK, so I’m waiting until the last minute!) reads:

Blood glucose.  It’s front and center when it comes to diabetes.  It is how we get diagnosed and it is what we are trying to manage.  An important tool we use to manage our blood glucose is our meter and its strips.  But what happens if our meters aren’t giving reliable information?  Let’s explore that this month as we discuss a topic from the June 26th chat Fill in the Blank.  Weigh in on the following statement:

Test strip accuracy is important to me because______.

As type 1 diabetics we rely so much on numbers.  Our a1c, how many units of insulin we take, insulin sensitivity factor, Insulin to Carb ratio, but the number we rely on the most is our current blood glucose level.  This number is instrumental in telling us how we are going to proceed with our next diabetes decision – do I need a snack?  Insulin?  Should I wait a bit to eat dinner?  Am I at a safe level to exercise?

We test our blood glucose 4, 5, 10 or more times per day.  It is a constant “tattle tale” of how we are managing our diabetes.  Yes, our a1c gives us our overall diabetes “grade” for the past 3 months, but our blood glucose…that is the number we rely on to make these multiple daily decisions which, in turn, account the most for our overall care and management.

There has been a lot of talk lately about test strip accuracy (or inaccuracy if you want to look at it that way).  Our trusty little meters aren’t quite as great as we thought.  Some may read too high, some too low.  The general rule is that a meter is within about 20% accuracy.  This is a big deal.  Say my meter tells me my average BG is about 140.  I think I’m doing pretty darn good at this whole diabetes thing – this would translate to an a1c of about 6.5, not too shabby.  But what if my actual average is closer to 168 (an increase of 20%)?  That brings my a1c up to 7.5, which, not as great as 6.5, especially when you are planning a pregnancy and trying really, really hard to get your a1c to 7.0 or lower.

A person without diabetes may think, “What’s the big deal?  The difference between 140 and 168 isn’t THAT huge.”  But over time, as you can see above, it makes a pretty big difference.  If my meter is telling me 140, I’m giving myself less insulin than if I’m 168, thus remaining a little elevated.  And vice versa.  If my meter tells me I’m 168 but I’m actually 140, I may give myself too much insulin and thus cause a blood glucose drop later on.

Luckily, with the advent of CGMs, we have yet another tool to make our treatment decisions.  However, not every person with diabetes is able to benefit from this technology due to various reasons, so the core issue remains the same.  We need accurate meters and test strips.  Diabetes management is a series of small decisions that lead to an overall result.  Shouldn’t we have the best tools available to make the best decisions possible?

SS-LOGO-STACK-SM

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Doomsday Preppers – Type 1 Diabetes Style

The other day my husband was poking around on the interwebs and came across a forum where someone was discussing “Prepping” with Type 1.  This prompted him to ask me if I had ever thought about it, which lead me to say I’d be screwed and he has permission to eat me should he ever need to.  We used to live in a hurricane prone area, so one would think that I’d be prepared but the great thing about hurricanes is…you usually know they are coming.  Of course, since the husband kinda digs me, he decided to come up with a plan should the crap hit the fan due to a fire, blizzard, alien invasion.  So, without further ado, here it is…

A Guest Post by Laura’s Husband

The funny title and all joking aside, I wanted to try to make an informative guest post about “prepping” – an often sensationalized topic in this day and age.  I wouldn’t say that Laura and I are “preppers” in the sense of the pop culture stigma.  However, I was a Boy Scout when I was a kid and as the motto goes – I like to “Be Prepared”.

In case you’ve seen it, please know that I don’t like the TV show “Doomsday Preppers”.  I think they highlight more of the eccentric personalities of prepping more than providing any useful real world education.  I am however a big fan of TV shows like “Lost, “Revolution” and movies like “Castaway”.   So I ask – What have you done to help prepare yourself or your loved ones for any real life emergencies related to the treatment of diabetes?  How about a situation like one that may come up on TV or in the movies?  Those are obviously the extreme and if you think about everything up to that extreme – you’ll be prepared for anything in between.

Preppers often organize their preparedness into a number of different “bags”.  I thought it would be good to create a quick primer on these different types of bags and some of the situations where you might like to have them with you.

Day Bag
This is most often your purse, a small backpack, or a laptop case – something that you have with you at all times.  Men – this is not a “man purse”, it’s a satchel.  Indiana Jones wears one.

Most T1 diabetics are already great at keeping their “Day Bag” stocked out of necessity.  Obviously you’d keep your daily insulin, meter & test strips, syringes, alcohol swabs, pens, tips, and glucose tablets here.  Laura likes to keep some small snack foods in her purse, such as a granola bar or a rice crispy treat.  Maybe some small candies like Smarties.  Not ideal ways to treat lows, but there if you need them.

Get Home Bag

I like to think of this bag as the bag that gets you through the 12 hours you get trapped in your car on the interstate during an ice storm.  This isn’t something that happens often where we live, but when it does happen every few years it is crippling.  This is a bag that is kept in the trunk of your car.

Related to the D, this bag might have a reservoir, an infusion set, more syringes, lancets, more pens and tips, some extra pump batteries, maybe a spare meter and test strips.  If you’re not carrying your Glucagon in your Day Bag, one would be here and you would tell everyone that its there.  This would also be a good place to have more snacks and maybe a few bottles of Coca-Cola and obviously bottled water.  This is an area where some extra care is needed, especially in the dog days of summer where a soda might explode due to the intense heat.  I don’t care what Mythbusters said, it is totally possible.

Since folks may not be used to having a bag like this in their car, this bag might also have some things like comfortable shoes, extra layers of clothes, gloves, hat, sunscreen, headlamp / flashlight, knife / multitool, dust mask / handkerchiefs, matches / lighter, extra money (around $100 recommended), etc, etc, etc.  Laura currently works about 9 miles from our house.  This bag should have the supplies needed to literally walk those 9 miles home if needed.

Bug Out Bag
The one that gets made fun of the most… but be honest – if your house caught fire, do you have a bag ready to go at a moments notice that will help you survive the next 48 to 72 hours related to T1D?

One of the best things you can have in this bag is a copy of all your prescriptions and a thumb USB drive with your health insurance and medical information.  Next is some cash and a credit card to begin replacing anything you might need, refilling those prescriptions, etc.  In this bag are also more infusion sets, extra sensors for your CGM, an extra charger for your CGM if you have one, more batteries, more Glucose tablets, more syringes and most importantly – Insulin.  Unfortunately insulin is the biggest challenge with prepping for someone with T1D.  It’s recommended to stay cold, has an expiration date, and once opened needs to be used in a month or so.  This bag should have a small cooler or something like an insulated lunch box for your insulin.

The exit plan from your house is completely dependent on the situation at hand, but if time allows there are 3 stops that are made and all can be done in less than a few seconds.

1) Grab the B.O.B. (obviously the bag, not the fun times B.O.B., but hey, I’m not one to judge your priorities)

2) Grab insulin from the fridge and ice packs from freezer.

3) Grab important papers from the safe such as passports / birth certificates.

In a fire, I might be able to make those 3 stops… maybe not.  Obviously, get yourself and loved ones out if the situation is dire.  But if I didn’t have that bag prepared, there would be many more than 3 stops and probably no chance at making them.

Long Term / Permanency
It’s obviously not likely that something like “Revolution” will ever really develop… but if it did, there would be some significant challenges related to T1D.  Test strips run out, there is no way to keep insulin cool, it also runs out, etc.  Unfortunately, we don’t have the means to buy a ~1 year supply of T1D treatment supplies to keep a stockpile… but it might make sense to try to stockpile expired insulin or those old test strips and meters from the brands you didn’t like or the insurance company stopped covering.  If you find an expired vial, don’t throw it away… clearly mark it and save it.  It may not be as potent as fresh stuff, but if you’re at the end of the rope and your life depended on it – wouldn’t it be better to try than nothing?

For many reasons, I used to think about getting Laura a diabetes alert dog.  Though now that she has a CGM, I don’t really think about it.  Again – it’s extreme from a prepping perspective, but without test strips an alert dog might be a way to help monitor blood sugar.  Unfortunately, you then run into the challenge of needing to prep for your dog!  This won’t be something we really explore as we don’t have the funds to properly train a service animal and with the price and availability of CGM it simply doesn’t make much sense financially.

We’ll save the discussion of burying a cache of insulin somewhere out in the woods for next time.  Just kidding about that last part, but as you can see – being prepared never ends.  You don’t need to be a Doomsday Prepper, but any step you can take to make sure you can take care of yourself in an emergency is a positive step to being prepared!

If anyone has suggestions on better T1D preps, please leave a comment below.  Insulin is by far the area where more thought and consideration is needed.

Until next time…

Laura’s Husband

So, as you can see, my husband is definitely the planner in the relationship.  I even ran out of insulin the other day, so should the crap hit the fan, I’d likely panic or forget something of major importance.  I think it’s a great idea to have a bag ready to go with a week’s worth of supplies that you can just grab and go.  This is something I’ll be organizing in the coming weeks.

Flat tires, dead sensors, and clueless people…

Oh my!

This past weekend the husband and I traveled to our hometown for a bridal shower and bachelor/bachelorette parties for a wedding we are both in.  The 7 hour car ride up was pretty un-eventful, my blood sugar behaved for the most part.  However, once we arrived my one day old sensor started misbehaving.  It wasn’t giving me a trend arrow and was telling me I was in the 40s when actually I was 184.  I was hoping it’d come back to life, but after an hour or so of this naughty behavior, I got the question marks of death so I yanked it.  Kind of a bummer because I didn’t want to have to deal with the first 24 hours of sensor inaccuracy during the shower and bachelorette party, but, such is a Diabetic’s life.

The shower was lovely, however when I went out to my car to leave, I noticed a flat tire.  Oh boy.  Luckily my in-laws live only a few miles from where the shower was held so I was able to get my car there and they went out of their way to get a new tire for me.  I am so grateful for them for doing this and giving up their entire Saturday afternoon to solve my problem.  They are wonderful!

The bachelorette party was fun – we went to dinner at a Hibachi style restaurant.  However, we did a lot more walking than I anticipated so I was low for a good hour.  This led to one of the women making a comment about me eating a couple of cookies.  Something along the lines of “I can’t believe you’re eating.  Aren’t you full???”  ARGH.  I said that my blood sugar was low and rather than pass out, I had to force a few cookies down my throat even though we just ate.

This same woman also told me her grandfather “died of diabetes”, so as you can imagine my patience with her was wearing thin.  I will never understand why people think that in order to relate to your disease they have to tell a horror story of someone who died from complications or lost a foot or whatever.  These stories are NOT helpful.

I did face a few D-related decisions over the weekend.  To prevent my CGM alarm from going off at the shower since I knew I’d be eating a lot and it would be a guessing game as to how much to bolus, I turned the high alert off.  I stayed in the low to mid 200s pretty much all day, which, not good.  But, it is what it is.  Hindsight is telling me I probably should have done a temp basal, but live and learn!

While getting ready to head out for the bachelorette party I had to decide if I should bring my meter or CGM as both did not fit in my small, going-out purse.  I chose my meter since I was still within the first 24 hours of my sensor and, well, I trust my meter more.

All-in-all it was a good weekend.  Traveling is just tough with diabetes.  This weekend I’m going to visit my dear friend in NYC and I am determined to have a good blood sugar weekend.  I think it will be much easier since I’m obviously much more comfortable with her than I am with a group of women I’ve only met once.  I have my endo appointment on the 14th and I don’t want last weekend and this coming weekend to mess up my a1c!

I have a special guest blog post coming tomorrow, written by the husband.  Stay tuned!

Friday Fives: July 26, 2013

Five things that are annoying about traveling with diabetes:

1.  The amount of space diabetes stuff takes up in your bag – Pump supplies, snacks, batteries, extra test strips, CGM sensors, Insulin.  This is valuable clothes-packing real estate!

2.  The wonky blood sugar levels that always seem to happen with long car rides.

3.  Feeling guilty about not bringing copies of your Rxs like every good travelling diabetic should.

4.  Attempting to test your blood sugar in the car – why is it that we always hit a bump just as I’m about to prick my finger?

5.  Being out of your diabetes comfort zone.

Have a great weekend, everyone!

 

Rookie Mistake.

The other day I made a rookie diabetes mistake.  I woke up in the morning, checked my pump and realized I had 22 units left to last me until I got home from work.  My daytime basal rates vary from 1.0 to 1.275, so quick, just awake math…8 hours = 10ish units.  And, there’s no way I’ll bolus more than 8 units for lunch, since my average lunchtime bolus is about 5.5 – 6.0 units.  Breakfast is usually about 3-4 units, so, I’ll be just fine until I get home from work!

Mistake number one: A wise diabetic would’ve thrown a vial of insulin in her purse, along with a new cartridge and inset.  I never claimed to be wise.  

Off to work I go, excited for the D-girls gathering that evening and I notice that my morning numbers are running a little higher than normal.  I try to limit my rage boluses to when I’m 200+, instead I rock a temp basal.  So I set my temp basal at +50% for 90 minutes.  Mistake number two.  (Although, D-friends, it’s never a mistake to try to lower your blood sugar, amiright?)

Lunch time rolls around and I have my standard I’m-too-lazy-to-make-lunch Lean Cuisine.  Attempting to be healthy-ish, I had grabbed a banana to have along with it, rather than the Sunchips I have in my desk drawer.  My Ping tells me to bolus 7.55 units so I do because it is way better at math than me.

Literally as my bolus is being administered at warp-Animas-Speed, I remember that I’m low on insulin.  However, the Ping delivers it’s bolus in like, 0.00004 seconds so by the time I realized, it was too late.  Mistake number three – should have checked the amount of insulin I had in my pump before bolusing and deciding to eat that banana!

At this point I had 3 units left.  I thought about setting a temp basal of 60-70% so that even though I’d probably run a little high, it was better than getting no insulin at all.  However, I decided that this wasn’t that dire of a situation.  I work 20 minutes from home and I have a decent amount of sick time.  So, I figured I’d leave when I got down to 1 unit (to spare my coworkers the annoying “You’re out of Insulin!” song) and take a couple of hours of sick time.  I told my supervisor that I miscalculated my insulin in my pump and she, I think, thought death was imminent.  “Ohmygod, LEAVE!” was her reaction.  I told her I still had a couple hour’s worth of insulin in my pump and I’d leave when needed, which was about 2 hours later.

Rookie mistake(s).  Lessons learned – if you are borderline making it through the day, bring your supplies to work.  Better safe than sorry.  Check the amount of remaining units in your pump before deciding to eat the banana/bolus/set an increased temp basal.

And most importantly, don’t attempt to do math before having your coffee.

Wordless Wednesday 7/24: Just a spoonful of sugar…

Is probably all that’s missing from my Mary Poppins Bag Purse…

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The contents:
-Wallet
-2 Checkbooks
-Coupon Wallet
-Keys
-3 Smashed Granola Bars
-5 Pens
-5 Syringes
-1 Dead Apidra Pen
-HUGE bottle of Aleve
-Pepto
-Eye Drops
-Glucometer
-Statement from Endo’s office
-2 packs of gum
-CGM
-Glucose Tabs
-2 lip glosses
-Chap Stick
-Concealer
-Compact
-Brush
-2 hair ties
and the thing I am most proud of…
-Only ONE random test strip!

What’s missing?  The only thing that jumps out at me is a backup infusion set and batteries for my pump.

The day I lost it at the grocery store…

Yesterday I had a little bit of excitement at the grocery store.  As I was on my way there, I was chatting with my sister on my phone and we were mid-convo when I arrived so I hung out in the car for a bit to finish up our conversation.  Went into Kroger and after about 20 minutes, my sister texts me that my nephew had received the picture I drew for him (he sent my husband and I a picture in the mail so of course I had to draw him one, because what 5-year-old kid doesn’t love getting mail!?)  Anyway, according to my nephew, my picture was “Impressive”.  Ha!  Want to know what’s not so impressive?  Going to check your CGM and realizing, shit.  It’s not there.

Commence Panic.

OK, maybe it’s in my purse? I actually had the thought to throw it in my purse while I was on the phone with my sister.  I dump out the contents of my purse (which, as any D Lady knows, we don’t carry purses.  We carry Mary Poppins’ bag.  Picture a panicking lady dumping her purse into her shopping cart.  Yeah.)  Not there.

Shit.

I retraced my steps all while freaking out… OMG, we can’t afford to pay full price for a new one.  What if someone sees it and thinks it’s an iPod and swipes it?  WHY have I been dragging my feet on making a label to put on it, explaining that it’s a medical device, reward if found, OMG I suck at life.  Ohmygod, Ohmygod, Ohmygod.

My heart was racing.  After not seeing it in the spots I had been, I go to the customer service counter, nearly crying, asking if it had been turned in and if they will make an announcement.  The woman does, but of course her announcement makes zero sense.  (Really how do you explain what a CGM is to someone who has no idea?).

I’m freaking the hell out.  Texting with my husband and panicking.  I said about 9,000 prayers to St. Anthony (who usually is listening when I lose stuff!).  As a last-ditch effort I think that maybe it fell off while I was walking into the store, maybe, just maybe the Diabetes-Gods will smile upon me and it wasn’t run over.  I ditch my half full cart in the produce section and head out to my car.

Don’t see it in the parking lot.  Fuuuuuuuuu……dge.   Maybe it’s in my car??  Please, please, please, let it be there.  I open the door…and….

FOUND IT.  It was in between my seat and my door.

Biggest sigh of relief ever.

I sent my husband a text that said “FOU D IT”, which he was able to decipher as “FOUND IT” (he’s so smart).  He wrote back that he was in his truck on his way to the store.  (I should’ve made him come and finish up the grocery shopping, cuz man, I needed a beer or something at this point!).

Friends, I was freaked the hell out for a good 30 minutes.  I rely so much on this device and should I lose it and can’t get it replaced under warranty, right now it just wouldn’t be in the cards to replace.  My heart is still racing.

Lesson learned.  Unless I am at home or at work, my Dexcom will stay securely IN something.  In my purse, my boxing bag, cup holder of my car.  The clip it comes with really just isn’t the best and I really do not want to have to have a panic attack at Kroger again.

Laura Fun Fact – I played Jane Banks in my Kindergarten production of Mary Poppins.  On video, there is a shot of me on stage , butt to the crowd, picking a massive wedgie.  I was a classy little kid.

Happy Diabetes Blog Check-In Day, everyone!