Hello, yeah it’s been a while. Not much, how ’bout you?

Hello, DOC!  I’ve missed you!  I know it’s been a while since you’ve heard from me.  My excuses/reasons for not blogging are kind of lame – busy at work, need a break from focusing on the D, busy getting busy, holidays, etc., etc.  I miss blogging, I just haven’t had the motivation to make it a priority right now.  But, I have some down time at work and thought I’d post an update on life.

Update #1.  Not pregnant.  Still trying to get a baby up in there, but no luck so far.  Not sweating it, yet, but I gotta say, it can be frustrating to do everything “right” and not get the results you want.  Kind of like how our blood sugars can behave one way one day and another way the next, despite doing the same thing.  I keep reminding myself that even with “perfectly timed” sex a healthy couple has a 20% chance of conceiving any given month.  Hopefully it’ll happen soon!

Update #2.  Holidays were not as hard with new robot parts.  Last Christmas I was still on MDIs, CGM-less, and felt like crap.  Between traveling 7+ hours to get to our hometown, eating dinner around 10pm on Christmas eve, and not having handy gadgets, I was nauseous most of the holiday last year.  This year was much better with my CGM and pump.  It was easier to make adjustments and I’m happy to say that I felt good and enjoyed myself!

Update #3.  Endo-conundrum.  I received a letter a few months ago that my beloved endo is reducing her hours and therefore will only be in the clinic on Thursdays.  Commence Panic.  How is this going to work?  Especially when I’m pregnant and have many more appointments?  After chatting with a few other patients of her’s I decided to see how it goes at my next appointment with the nurse practitioner before deciding if I wanted to change practices or stick with my current doc, despite her limited availability.  I had heard that the NP isn’t the greatest and rubs many people the wrong way, but I liked her.  So, for now, I’ve decided to stay with my current practice.  Hopefully when I do get pregnant, I will still receive excellent care.  If not, I’ll cross that bridge when I come to it.

Update #4.  A1c!!! My A1c has dropped from 6.8 to 6.7.  Woohoo!  I’m happy I stayed under 7.0.  My next goal is 6.5!

Update #5.  I have an annoying as eff coworker.  My cubicle neighbor has serious issues with his bodily functions.  He’s constantly snorting, snarfling, neighing like a horse, talking to himself, etc.  He drives me slightly insane.  There is going to be a day when I have the perfect storm of low blood sugar, PMS, and am having a shitty day where I go apeshit on him.  Thank goodness for headphones, but damn, he bugs.  Other than him, I love my job (Except for the whole keeping me away from the DOC thing).

Have a great week, everyone!

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Wordy Wednesday

I’ll get back to Wordless Wednesday next week.

Today I had my much-anticipated endocrinologist appointment.  This was the first appointment in which I’d get my a1c since going back on the pump and starting with my Dexcom CGM.

I was called back by the nurse and she took my vitals.  I told her that I was super excited about getting my a1c and was hoping it’d be around 7.0.  After doing her thing, my a1c still wasn’t ready so she sent me back to the waiting room and told me she’d come out and let me know what it was.  A few minutes later she came out with a huge smile on her face and whispered in my ear….

….

what do you think?

Did I do it?

……

Did I hit 7.0?

Well, I didn’t hit 7.0.  I knocked it out of the freaking park!  6.8!!!!!  Sixpointfreakingeight!  I haven’t had an a1c that low since…never.  I honestly can’t remember having an a1c in the sixes throughout my 14 1/2 years with diabetes.  I may have when I was first diagnosed, but not in the last 8-10 years, I know that much.

I almost started crying.

I am so happy that my a1c has shown all of my efforts.  And, I was texting with my friend and made the realization.  It has been tough, sure, but it’s not like I’ve stopped living my life in order to reach this goal.  I’ve made small adjustments and just made my diabetes management a priority.  The Dexcom has helped tremendously.  I no longer fear going low as I have faith that it will alert me if I need to take action.  And when it tells me I’m higher than I’d like to be, I adjust.  The constant contact with my CDE and her feedback have also been an enormous help.

So, back to the appointment.  My endo walked in and also had a big smile on her face.  She asked me if I wanted to hear the good news.  I said, “6.8!!!”  She was bummed that the nurse told me, haha.  She said that she is so proud of me.  When I first started with her last June, I was 8.9.  My last a1c in April, I was 7.9.  I’ve made diabetes my bitch.

I had a long list of questions for her regarding a (hopeful) upcoming pregnancy.  Here’s a rundown:

  • Given my current numbers/a1c, when can I start TTC?

    • NOW!

  • What are my pre/post meal BG goals during pregnancy?

    • Pre – 60-90

    • 1 hour post – below 140

    • 2 hours post – 100-120

  • When should I start taking pre-natal vitamins?

    • Now.  (I already did.  I win)

  • Vytorin – when should I stop taking it?

    • NOW!  She was adamant about this.  Guess I gotta lay off the steak and other cholesterol-y foods from now on.

  • What about synthroid?

    • Keep taking and call her AS SOON AS I have a positive pregnancy test.  (She said, “don’t even tell your husband, CALL ME!”)  Haha.  I guess as soon as I find out I’m pregnant, I need to take extra synthroid that week and adjust my dosage.

  • How long before we start trying should I stop taking pills?

    • She said that although “they” say it takes about 3 months, it can happen the first month so she suggested a month or two before, but “Be ready” for a positive result!

  • Caffeine/artificial sweetener intake during pregnancy?  What is safe?  When should I give it up/start limiting it?

    • She is OK with small amounts of caffeine – in her words a cup of coffee with stevia and half and half is OK.  She said one additional drink with artificial sweetener is OK.  I think I’ll switch to half caf and possibly go to decaf.

  • How often will I have to go to the DR?

    • Endo appointments – monthly.  Email BGs weekly.

    • OBGyn – probably about twice/month, more towards the end (obviously)

    • CDE – communicate via email, appointments as needed.

  • If BG is high/low, what is the best way to correct?  does the 15-15-15 rule still apply?  Bolus or increased temp basal?

    • 15-15-15 rule still applies.

    • She said most women bolus but if they remain high, then they will do a temp basal.

  • What is my carb intake goal at meals?

    • She was telling me something about the rule of nines – 2/9 of my carbs will be at each meal (so 6/9 total) and 1/9 at 3 snacks.  Although she didn’t give me my daily carb intake.  But did say that I will be meeting with a nutritionist.

  • Daily calorie range?  How much weight gain is expected/realistic?

    • 300 additional calories per day.  25-35 pounds is normal, but since I’m fat already (my words), I’ll have to be careful and shouldn’t gain as much.

  • Any foods I should stay away from other than the usual for pregnant ladies?

    • She didn’t say anything specific.

She wants me to make an eye doctor appointment within the next few months.  We also made some adjustments to my I:C ratios – lunch went from 1:9 to 1:8 and dinner went from 1:8 to 1:6 to prevent some of those mid afternoon and post-dinner spikes.

Soooo, there you have it.  As soon as the hubs and I are ready, we can get down to business.  Eeeeeeek!  I’m so excited/nervous/scared/happy/about to poop my pants!

Here’s your picture for WW – my “Oh shit!” face!

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Happy Monday!

Usually I curse Mondays.  I mean, really, weekends should be five days, work weeks two.  AmIright?

The husband has been out-of-town on a men’s fishing trip, and it’s kind of a running joke with us that whenever he’s out-of-town, I always get overnight lows (which is kind of scary, but we won’t go there) and I don’t really miss him until the lows start kicking in.  Of course they have the past three nights every night since he’s been away.  Duh.  I’ve been over-treating and then spending the following morning chasing down elevated BGs.

Until last night.  I OWNED my overnight low.  I was 60 on my meter, 53 on my Dexcom.  Drank 6 oz of OJ, spoonful of PB and woke up to a nice steady-ish line this morning.  Definitely perked me up for a Monday!

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I also have changed my high alert from 170 to 160.  Hopefully I don’t annoy my coworkers too much with the awesome tunes the Dexcom plays.  I really wish the high alerts were in increments of 5 so I could take even smaller “baby” steps (pun intended) towards better control.  Endo appointment is on Wednesday – my first a1c since I’ve rejoined the land of pumping and started on a CGM!  I’m excited and crossing everything that I’m 7.0 or lower!!!

Friday Fives: August 9, 2013

Five things that (irrationally?) worry me about a future pregnancy with Type 1

1.  What the heck am I going to drink?  This makes me sound like a lush, ha.  Seriously, though.  My CDE said I can have 2 artificial sweeteners per day.  I use Stevia, which, according to my reliable resources on the interwebs, is safe during pregnancy.  Awesome.  I can have brewed Iced Tea sweetened with Stevia (right?).  Of course I don’t want my future baby born with 3 eyes or anything, so I will do my very best to eliminate/strictly limit all artificial sweeteners and caffeine.  *gasp*.  Bye bye coffee.  Hello….water?  Milk?  What else is there?  Should I ween myself now?  I have no problems with giving up wine and beer (although, nachos just don’t taste the same with water!), but I fear that giving up coffee will make me a nightmare to live with.  It’s going to be a long 40 weeks!  Sorry in advance for the crankiness, husband.  ♥ you.

2.  Is my job going to hate me with the 900 million doctors appointments I will have?  My Endo’s and future OBgyn’s offices are a good 30-40 minutes away and as far as I know, do not offer evening appointments.  However, I’m not willing to change because I love my endocrinologist and her team and I especially love my CDE.  Luckily my CDE is very responsive via email so I am hoping that maybe, possibly, she will continue to help me adjust my rates and answer my questions via email when I am pregnant.  Taking a lot of time from work to go to the doctor is something I already feel self-conscious of.  I really am nervous that my coworkers will be frustrated when the time comes and I have so many more doctor’s appointments.  However, I think that my direct supervisors will be more than understanding, as one of them recently herself had a high risk pregnancy.  But still, I don’t want people to think I’m a slacker.

3.  Working, period.  Diabetes is a full-time job.  My job is a full-time job.  Being pregnant will be a full-time job.  I’m tired.

4.  Keeping the secret.  The hubs and I have agreed that we don’t want to tell anyone until I’m 12-16 weeks along, however this may prove difficult.  I imagine I will tell my sister sooner since she lives close by and I see her frequently.  And I was the first to know (after her husband, of course!) with all of her pregnancies.  (Neener, neener Mom! Haha!)  But there are going to be challenges, depending on when we conceive.  It could be a non-issue, in that we wouldn’t see our parents for the first 12 to 16 weeks due to schedules, when holidays fall, etc.  Or there could be lots of time spent with parents in which I’ll have to lie my tender boobies off.  It is pretty important to me that we don’t tell anyone until after the first trimester so we will just have to do our best.  I’m looking forward to having a little secret with the husband.  ♥

5.  Guilt.  I’ve read about this on so many different blogs of D-mommies/mommies-to-be.  The guilt they feel when their BGs aren’t in range.  I really want to enjoy my future pregnancy and be as laid back as a pregnant PWD can be, but knowing myself and how much I already love our future baby, I just have a feeling I will be super hard on myself if I am out of range.  I hope I can find a good balance.

6. Judgement from others.  (OK, it’s friday fives plus a bonus!).  I’ve never been pregnant.  I am scared, nervous, excited for that day when I see two lines on the pee stick.  I have no idea what it will be like, how it will feel to hear my baby’s heartbeat for the first time, to feel the flutter of movement, etc.  I am researching pregnancy with type 1 as much as I possibly can in an effort to educate myself so I can kind of know what to expect.  I know that it’s going to be hard.  I know I’ll have to make sacrifices (see #1).  I know that there’s a decent chance I’ll have to have a Cesarean section.  I just worry that people will judge me based on their experiences and what they think is right.  I know my husband will have my back and I will just remind the judgey McJudgersons that although they may have been pregnant, they’ve never been pregnant with type 1 and I’m doing the best that I can for my unborn child.  And if all else fails, I’ll break out some kickboxing moves and show them who’s boss.

I am thinking about this stuff more and more lately as the day when we start “trying” doesn’t seem as far off as it did a few months ago.  I am so inspired by the type 1 women who have had successful pregnancies and know that my pre-worrying is a bit on the cuckoo side.  But I also know it’s normal as we PWD can’t just throw caution to the wind and have to actually really plan and work hard for our pregnancies.  In the end when I hold that little life, it’ll all be worth it.

Not a week goes by….

… without fighting with my insurance company.

Warning: this post is rather venty and may contain some adult language.  Parental Guidance Suggested.

For the past few months I’ve been in one battle after another with my insurance and/or pharmacy benefits company.  Luckily, everything went smoothly with obtaining my insulin pump and CGM.  However, there have been a few headaches that I’ve had to deal with that are really starting to piss me off.  As if we PWDs don’t have enough to deal with, but insurance makes us jump through hoops (of fire, it seems) to get things done.

Test Strips – My blood sugar meter “talks” to my pump.  Yay, Animas!  It’s a One touch meter, not some fancy unique brand that no one has ever heard of.  Well, my strips cost $95/month.  I’ve reached my out-of-pocket max for this benefits year (a perk to making major cyborg-living purchases!) so since they are classified as Durable Medical Equipment, they should be covered 100% for the rest of my benefit year.  Of course they weren’t so I called and was told they aren’t the preferred brand so if I want them covered 100%, I need to switch meters.  Pisses me off.  My pump supplies (remember, my meter “talks” to my pump) are covered, no questions asked.  So, fine.  I’ll switch meters and only use my meter remote when I will need to bolus from it (wearing a dress).  Worth it to save $$ and not a huge deal since I bolus from my Ping 99.7% of the time anyway.  I call to order my new meter (Verio IQ) and they are back ordered/recalled/they don’t like me so they won’t send me one/something.  So, guess who is on her last pack of strips and has to order more at $95 for a month?  THIS GIRL.  I am tempted to call and argue that they should cover this month’s worth of strips since it’s not exactly my fault that I don’t have my new meter yet.  But, I really doubt I’ll win that fight and frankly, I’m tired and don’t even feel like putting forth the effort.
Insulin – Previously, I used Humalog.  Was always covered with no problems.  Well, my doc switched me to  Apidra.  However, when I first got back on pump therapy, my pharmacy didn’t have any Apidra in stock so I used a vial of Humalog that I had to get started.  Worked fabulously.  But, my Endo wanted me to try Apidra so once the vial of Humalog was empty, I switched to it.  I feel like I’m not reacting to it as well as I did with the Humalog, so I asked to be switched back to see if this is the case.  This is all within the last 6 months.  Endo says, no problem, writes me a script for a 90 day supply of Humalog.  I mail it in to my mail order pharmacy and now my pharmacy benefits people are saying it’s not covered.  Something about the “formulary changed”.  Oh, I can get it, I just have to pay out-of-pocket.  So now I have to use a sub-par (for me) insulin because some higher up in some office decided that they weren’t going to cover my insulin.   Granted, it’s not like my control with Apidra is all over the place (if it was I’d be sure to appeal!), but I wanted to see if I’d do better with Humalog, like I think I would.
Dealing with insurance shit makes me rage.  I don’t expect anything to be free, but I’d at least like reasonable options when it comes to my diabetes management.  $1200/year just to test my blood sugar is outrageous.  Telling me what insulin I can and cannot use??  What the French is up with that?!
I don’t often get diabetes burnout.  Sure I’ll have a day here or there where I’m temper-tantruming against the disease.  But, man.  Insurance company burnout?  I have that 24/7.  I just don’t understand why it has to be so hard to make dealing with diabetes or any other chronic illness just a little bit easier with maybe a few more choices so we can make the best decisions for ourselves to manage this disease that we live with every day.
Maybe some day, this will be me.
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My CDE is my BFF.

I had an appointment with my CDE on Friday and let me just say she is quickly becoming my new BFF of my Diabetes Team.  Like, I want to make her a friendship bracelet, ’90s summer camp style.

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I was never able to master the swirly ones!
Image from the Google.

Her awesomeness does not only stem from her coming to my Endo/PA appointment last week and giving me a hug, but she has been instrumental with determining my pump rates over the past 2 months since I’ve resumed cyborg living.  I’ve emailed her reports almost weekly and we make tweeks as needed to get me where I need to be to grow a human.  She is also totally relate-able and “gets it” as a PWD.  She makes me laugh and is super supportive when I’m annoyed with myself for not being a perfect diabetic.  I know I totally sound like I have a girl crush (my girl crushes are Megan Hilty and Jessica Simpson, TYVM), but I’d say it’s safe to say I have a definite favorite on my Diabetes Team.  Don’t tell my PA or Endo.  I know I’m supposed to love them all equally, and they can believe that I do, lest I’ll be subject to more finger pricks when I’m in the office.  (Seriously, am I the only one who hates when other people prick my finger?)

So, the appointment.  My graphs look goooood.  She pulled up some of my old graphs and the change in just a couple of months is remarkable.  Definitely happy that I’m back on the pump even after having the pump-cation blues.  For the first time since starting this “get body ready for baby” journey, I feel like I can actually do this.  It’s a good feeling friends.  And it’s motivating me to keep on trying my best to get myself in the best D-shape possible before growing our future little one.

We She noticed some patterns that we are working to correct.  I tend to go higher and stay higher with meals that are more than 60 grams of carbs.  So that means that I will try to limit my meals to less than that amount of carbs.  Easy peasy, mostly.  But if I do have the weekly occasional bowl of spaghetti, I’ll bolus as usual but try a temp basal of +20-40ish%, (depending on pre-meal BG) for 60-120 miutes post meal.  Trial and error.

Another trend is that I tend to stay higher throughout the morning if I eat breakfast earlier in the day.  So we changed my I:C ratio from 1:10 to 1:9 before 9 am and 1:10 after 9am (weekends).  I would’ve never noticed this – so happy for her trained eyes to see!

I do awesome overnight.  I average 147 from 11pm – 7am.  Good-ish number.  Would like it to be a smidge lower, but the thing I am most pleased with is that my overnight lines are typically pretty steady.  No real drops or jumps.  Sweet dreams for me.  This means naptime at work, no?  I have been pretty pro-active with setting temp basals at night when I go to bed on the higher end.  And I swear, it has nothing to do with me not wanting to hear my Dexcom all night.  It has everything to do with wanting to be all I can be with the D.  Or something.

We also changed my I:C ratio for dinner from 1:9 to 1:8.  My CDE was a little reluctant to do this because sometimes after dinner my numbers are great, however, I want them to be great most, if not all, of the time.  So I figure it’s worth a shot.

The best part of the appointment however was when she said that by looking at my graphs, she thinks my A1c is/will be very close to 7 if I keep this up.  This certainly motivates me to keep fighting the good fight.  High Five!

I kinda want to take her out for a beer.

Endo Appointment Round Up

Today I had an appointment with my Endo’s Physician’s Assistant.  Honestly, I kinda like him more than my endo (although she’s pretty awesome too!).  He’s young, very thorough, and never seems rushed.  In fact, he spent an hour with me today, which is just unheard of.  Unfortunately I wasn’t due for an A1c test (WAH!) as I had one within the last 3 months.  Kind of a bummer because I wanted to see how my new cyborg life has affected things.  But, I go back in August so I don’t have to wait too long.

We made some adjustments to my evening basal rate so my rates are now:

12 MN – 1.0
8 am – 1.2
2 pm – 1.0
8 pm – 1.6

Insulin to Carb ratios stayed the same:
12 MN – 1:15
7 am – 1:10
11:30 am – 1:9
5:30 pm – 1:9
9:30 pm – 1:15

Insulin sensitivity factor remains at 40 with my goal BG remaining at 120 +/- 10.

So, all in all, decent appointment.  I had emailed my CDE my CGM and Animas reports yesterday and told her about my nephew and that may account for some of the wonky sugars I’ve had over the past week or so.  She asked me when my appointment was and came over today to give me a hug and chat for a few minutes.  So nice.  I am really liking Duke!  My CDE and I have been in pretty close contact since I re-started pumping, I cannot say enough good things about her.  She’s awesome.

I had the PA write me a script for AccuChek test strips and he gave me a present of a shiny new AccuChek Nano.  I’m going to be calling my insurance company to determine exactly what I need to do to get my strips for free now that all of my out-of-pocket expenses have been met.  Hopefully what they told me last month about Accuchek strips being covered 100% is true.  And I have a good supply of one touch strips so should I ever need to use that meter for remote bolusing, I can.

On a personal note, I am muddling through with everything.  Staying busy helps.  My friends and coworkers have been so kind to me and I’m very happy that my sister and her family have such a strong community of friends supporting them.