Arm Site Review

I’ve been wanting to try using the backs of my arms for a CGM site for quite some time now.  My High Risk OB told me that once I get pregnant (I’m not yet!) I shouldn’t wear my sensor on my thighs for some reason or other.  I forget what the reason was as it was an information-overload type of appointment, but anyway, I remembered she said that!  So when I got a mild rash from my last site, I decided it’d be time to give my thighs a break and try the back of my arms.  Sadly, I don’t have Cameron Diaz guns, so there is a lot of fleshy area to choose from.

I wanted to have my husband insert it (hehe, see what I did there?) but he seemed a little apprehensive, so I took matters into my own hands.  (You could go so dirty with that last sentence, but I’m going to assume that the kind readers of my blog will be keeping their minds out of the gutter.)  So, using a mirror, I put a sensor in the back of my left arm.  It wasn’t easy, but it was do-able.  I’ve been wearing this sensor for almost 2 weeks and had my husband reinforce it with some OpSite FlexiFix for me a few days in.  So far, it’s been sticking like a champ.  Probably better than it sticks to my thighs.

A few things I don’t like about the arm site – I seem to meet so many more door frames.  I swear, I’m constantly bumping it. Visibly, it is definitely more noticeable than thigh sites.  Also, I’ve noticed that overnight it doesn’t seem as accurate.  Maybe because I am a side sleeper and my sensor doesn’t have clear access to my receiver?  Regardless, I’ve woken up a few times with it pretty far off.  This morning I tested at 168 and my Dexcom said 102.  On Thanksgiving morning, it said I was 144 and I was 222.  I haven’t yanked it due to this inaccuracy just yet, as it only seems to happen over night.

Also, it’s really nice to not have to remember to be careful of my sensor every time I go to the bathroom.  I think the arm is definitely the way to go as far as out-of-way-ness, (as long as I miss those door frames!), but accuracy-wise, my thighs seem to work a little bit better.  But, it is great to know that my arms may be a good Dexcom spot for a future pregnancy!

 

Blue and organization!

Slacking on my Diabetes Month Photo-a-Day posts!

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I may not always wear blue on Fridays (I really try though!) but I always make sure I sport my “Cure Type 1 Diabetes” bracelet! Thanks JDRF!

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My pump supplies cubbie. Don’t worry, I just placed an order today!

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My test strips/extra Rxs/Random D stuff drawer. Anyone want to have a BG testing party?

Sadly, I don’t have a fun spot for my Dexcom supplies.  They just stay in their box in the bottom of my closet.  I feel I need a cute (blue) basket for them!

“That is so cool.”

In a meeting the other day, a coworker noticed my CGM receiver (which I still rock in the Dexcom provided 1990s business-person themed leather snappy case thing).

“What is that?  A MP3 player?”

“Oh, it’s my continuous glucose monitor.  It tells me what my blood sugar is.  See?  Right now I’m 98 and steady.”  (I wanted him to high-five me for my awesome reading, but alas, he did not.)

“But….how?”

“See this lump on my leg?  It’s a sensor that’s reading my blood sugar level.”

“So, does it alert you if you go out of range?  Is that what those lines are?”

(Dude. He must be brilliant.)

“Yup!  It beeps and vibrates and acts like a jerk if I go too high or too low.”

“That.is.so.cool.”

And to think, a couple of months ago I was all sorts of nervous about starting a new job and explaining diabetes and stuff.  Now I’m clearly the coolest kid on the block!

 

Artificial Pancreas? Say what now?!

***Note, I’m not a tech guru.  I panic when I have to update my iPhone and can’t find my apps on the correct screen.  My husband manages the DVR because I don’t understand why we can’t record 200 shows at once and having to pick only two overwhelms me.  And, as always, I’m not a doctor so this isn’t medical advice and all that stuff.***

In case you haven’t heard the news, Medtronic has developed an artificial pancreas.  AND, even better, the FDA has approved it!  HUZZAH!  So this means that I can slap on a pump and CGM sensor, leave it there, and not have to think about diabetes for a few days until it’s time to change my site?  Right?  Like, that’s it?!?!  The days of finger pricks, bolusing, temp basaling are over?  Freakin’ awesome, man.

Scrreeeeeeech.  Wait a hot second.  According to this article by The Wall Street Journal, “the U.S. Food and Drug Administration has approved a pump designed to automatically stop insulin delivery in diabetes patients when blood-sugar levels are too low, the first “artificial pancreas” to be approved in the U.S.”.  Heh?  I mean, that’s cool and all, but is that an artificial pancreas?

“Medtronic’s MiniMed 530G, which includes a sensor, sends out an alert if (blood sugar) levels are too low, and if the individual is sleeping, unconscious or unable to react, the pump will shut off for two hours.”  Oooook.  But what does it do if my blood sugar is creeping up?  Does it automatically bolus insulin or set a temp basal?  What about if I eat a bowl of pasta?  Will it sense my blood sugar rising and do what needs to be done to keep me in that 100-130 zone?

To me, this sounds like a pump with a shut-off feature.  Definitely an added security measure that I am sure many people will be happy to have for themselves, their spouses, their children.  Hell, I dropped to 40 the other night and didn’t hear my CGM beeping at me.  (Thank you to the husband for waking me up so I could treat and clip coupons!)  A shutoff feature would’ve been great in this situation!

Another thing that concerns me is that according to the interwebs and other rumor mills, the Medtronic CGM isn’t quite as accurate as the Dexcom.  I wonder how many false shutoffs occur?  And if they do and your body is getting zero insulin for two hours while you’re blissfully unaware in dreamland…well, that’s not really a good thing.

Also, I don’t know about anyone else, but when I have those pesky middle-of-the-night lows, I’m not quite fully awake.  I stumble to the kitchen, pretend I’m only consuming 15g carbs, wait (half-asleep) for 15 minutes, test again, and stumble back to bed.  I can guarantee that I’d forget to turn my pump back on and would not be getting insulin to cover all those carbs (Because we all know, it’s more than 15g) I just consumed.  Of course from the sound of it, this device is geared more towards when the wearer is incapable of treating their low, but still.  I’m forgetful.

So while I think that this new device is a step in the right direction towards the artificial pancreas, I think it’s more of a baby step than the giant leap it’s being made out to be.  Artificial, to me, means I don’t have to think about it.  I want a device that I just wear on my hip and it does all the work for me – it knows when I’m exercising and to give me less insulin, when I’m stressed to give me more insulin, or when I’m indulging in a plate of nachos and may need an extended bolus.  Sure, I’ll change out my insulin/glucagon and change the site every few days, check my sugar for calibration purposes, but, other than that, I want something that is mindless.  To me, artificial pancreas does not = pump with a shutoff feature.

Invisible Illness Awareness Week 2013

Did you know that this week is Invisible Illness Week? I didn’t either until this blog post came across my reader. Thanks Rose!  I used to love filling out the old email surveys way back in the day, so why not? Here’s an easy chance to learn a little more about me and my diabetes. Don’t worry, there won’t be a quiz at the end.

30 Things About My Invisible Illness You May Not Know

1. The illness I live with is: Type 1 Diabetes

2. I was diagnosed with it in the year: 1998, 4 days after my 18th birthday!

3. But I had symptoms since: Not long before diagnosis. Maybe a month before? I lost weight (Yay!) and was peeing a lot (Non-yay when there wasn’t a bathroom on my floor in the dorms!) but I didn’t think anything of it.

4. The biggest adjustment I’ve had to make is: Testing my blood sugar, injecting insulin/wearing a pump, and carrying all the crap ever around – wherever I go.

5. Most people assume: That diabetes is just having to test my BG and taking insulin before meals. I don’t think people realize how serious it is and how I am constantly aware of what my BG is/how my body feels/how my actions affect my numbers.
Or, that my foot is going to fall off.

6. The hardest part about mornings are: Giving up cereal. My BG hates it. No matter how I try to bolus. I miss you Cocoa Puffs.

7. My favorite medical TV show is: Grey’s Anatomy. I’m one of the 4 people who still watch it.

8. A gadget I couldn’t live without is: My Dexcom CGM. Seriously my most favorite Diabetes device ever! I credit it for helping me get my a1c down to 6.8 and I always say I’ll give up my pump before I give up my Dexcom. It has given me a sense of security and much more awareness of my diabetes.

9. The hardest part about nights are: Deciding if I need a snack before bed. Seriously. Food is hard.

10. Each day I take __ pills & vitamins: 2 Pills – Sythroid and Vitamin. I’m usually on Vytorin but my doc took me off of it in preparation for baby making. Also, continuous insulin via the pump.

11. Regarding alternative treatments I: Think they have their place. Although, with T1D there really aren’t any alternatives to insulin. But I think there is nothing wrong with seeking out a natural treatment for more common ailments like the common cold if that’s what you choose.

12. If I had to choose between an invisible illness or visible I would choose: Invisible. I don’t like my diabetes being made a huge deal of and I imagine if I had a visible illness I would feel uncomfortable much more often.

13. Regarding working and career: I’ve been working in some capacity of another since before my diagnosis. I don’t think that Diabetes has affected my ability to get and keep a job. I’ve really only missed maybe 3 or 4 days of work because of wonky blood sugars. In 14 years, that’s not too bad. I do feel guilty sometimes for having to miss time for doctor’s appointments, but I supposed that is what PTO is for!

14. People would be surprised to know: We really don’t want to hear stories about how your best friend’s cat has diabetes, or that your uncle “died from diabetes” or that your former boss’s mother’s sister lost her foot because she was diabetic. Really. Not helpful.

15. The hardest thing to accept about my new reality has been: My reality isn’t really “new” but back in college, the toughest thing to accept was that this is permanent. At least for the next 5-7 years until there’s a cure, right?

16. Something I never thought I could do with my illness that I did was: I got nothing. Ask me again in a year or so and hopefully my answer will be “Have a baby.”

17. The commercials about my illness: Annoy me.

18. Something I really miss doing since I was diagnosed is: Eating without thought. I miss not having to test, figure out my insulin, not having to wonder how this meal/snack will make me feel in the next 15 minutes, hour, 3 hours, etc.

19. It was really hard to have to give up: One piece bathing suits and low cut dresses. Female pumpers will understand.  Oh, and cereal.  And money.  Diabetes is expensive, yo.

20. A new hobby I have taken up since my diagnosis is: Blogging. This is a really new hobby!

21. If I could have one day of feeling normal again I would: Eat all the pasta without a worry in the world.

22. My illness has taught me: A lot of stuff.

23. Want to know a secret? One thing people say that gets under my skin is: See number 14.

24. But I love it when people: Ask questions and actually listen when I explain what I live with, my pump and CGM, etc.

25. My favorite motto, scripture, quote that gets me through tough times is: Tomorrow will be a better day.

26. When someone is diagnosed I’d like to tell them: Diabetes is a pain in the ass, there’s no sense sugar coating it (Pun intended). But it is manageable and even though it seems like you are being inundated with information right now, in just a short amount of time, all of this will become second nature. You can do this. And if you feel like you can’t there are tons of people both online and in real life who are happy to support you, answer your questions, or listen if you need to vent.

27. Something that has surprised me about living with an illness is: That even though there are people around for support, it can be very isolating. That’s why I am so grateful for the DOC and IRL D-friends I have. They “get it”.

28. The nicest thing someone did for me when I wasn’t feeling well was: My college roommate took me to the hospital and sat with me for hours in the ER on what was a pretty useless ER visit (Something I could/should have handled on my own, another blog for another day). Also, my husband does nice things all the time – getting my meter for me, checking my CGM receiver when he thinks I’m not looking, grabbing me some juice, starting dinner when he’s not hungry yet so I can eat/won’t go low, etc. I’ll keep him.

29. I’m involved with Invisible Illness Week because: My blog isn’t so invisible, so why not?

30. The fact that you read this list makes me feel: Happy and hopeful that you weren’t terribly bored.

 

Have a great weekend, everyone!

He ate it anyway.

Got home from work today and the Hubs (who works from home) was still on a conference call.  He popped his head out of his office and told me he has another call until 6:30 and if I don’t want to wait until then to eat to go ahead and start dinner.  (He usually cooks.  He rocks.)  I make the executive decision to make a gourmet meal of brinner (bacon and cheddar omelets, hash browns, toast, and some more bacon).  Yum.

My sister called me and since it seems like I haven’t talked to her in forever (really, it’s been like 2 days, but that’s a super long time for us!) I took the call while attempting to make my awesome, I-can’t-believe-she-works-full-time-and-puts-meals-like-this-on-the-table, meal.  Maybe that’s why I didn’t notice that I was in the middle of an out of nowhere, Shelby-style low.  “This one hit her (me) fast”.  My trusty Dexcom was in my bag, on vibrate.  D’oops.

Hung up with the sis and check my BG in anticipation of pre-bolusing.  40.  YIKES.  In my low fog I thought it was a good idea to finish making dinner, which, of course, dumb idea.  I am not so good at cooking meals in which there are many components (casseroles are my specialty).  I can never get the timing down.  So my lame cooking skills in addition to my low BG made for tonight’s dinner prep to be more of an extreme sport than I anticipated.

So as you can imagine, dinner got nasty burnt, but my husband ate it anyway.  And also lectured me to turn off the stove and step out of the kitchen next time while I treat.  I think I will listen to him.

 

 

Up and down and all around.

Man, I am dizzy from the diabetes roller coaster I rode all weekend.  Good, steady D-Days were a thing I could only dream about.  This resulted in frustration, belly aches, annoyance, and a little more frustration.

The only culprit I can think of is that I had pizza and beer on Friday night.  Even after commenting on Katy’s Combo Bolus Victory that if I make it 8 hours without a spike after eating high fat foods, I’m usually in the clear, I woke up Saturday morning with a BG in the 250s.  My dexcom, it appears, was a liar.  And made me eat my words. Saturday

I yanked it Saturday morning since it was off by over 100 (and was almost 3 weeks old, so…) and as you can see above, I was up and down all day.

The roller coaster continued on Sunday:

Sunday

Up and down with a few good hours in the early morning while I was sleeping (and hadn’t eaten!).  Just looking at food caused a BG spike this weekend.

Finally the last day of the holiday weekend was pretty normal and much prettier:

Monday

Phew.  What a weekend.  I don’t know if it was the pizza or diabetes just being a jerk as diabetes often is but it seemed like a constant game of cat and mouse.  My pump was smoking from all the rage bolus and temp basal action.  I’m starting to think that maybe eating the naughty foods just isn’t worth it any more.  (Does this mean I’m an adult?)

And I am annoyed that according to my Dexcom, my average BG has gone up by 1 over the weekend.  Lame.

I confess…

I’ve been cheating on the DOC with Reddit.  Does anyone else read the Diabetes sub-reddit?  I really enjoy it.  Check it out!

After my awesome A1c results last week I, of course, had to share with my Reddit friends.  One person asked me to list 10 changes I’ve made to make such an improvement in my A1c (I went from 7.9 in April to 6.8 now, however a year ago, I was 8.7!)  Of course the first thing I thought when this person asked was: “Blog Post!”  I love to make lists.  If you ask the hubs, I make them for him pretty frequently – 10 Reasons why I miss him while he’s away (there’s no one around to kill spiders!), 10 reasons why I am excited for the weekend (Sitting on my butt is better than working, duh!), etc.  The lists.  I make them.

So, without further ado, here are 10 changes I made to improve my A1c:

1. I switched to sugar-free flavored creamer. When I first got my CGM I noticed that I was spiking big time after breakfast, even if I was bolusing to cover the carbs. Not willing to give up coffee, I switched to SF creamer and that has helped a lot.

2. I also gave up cereal. I eat a bagel and cream cheese for breakfast most mornings. I should have more protein but so far I’m doing OK, blood sugar-wise.

3. Getting the CGM period. It’s been amazing to know what my BG is doing at any given moment. I’ve been very attentive to it and adjusting my insulin when needed to keep me in range.

4. Baby-stepping my high alert on the CGM down. It started at 200 and I’ve gradually gotten it down to 160.  I think if I started with a high alert of 160 right out of the gate, I would have gotten frustrated with all the beeping.  If Bob can do it, so can I.

5. Communicating with my CDE a lot! I’m lucky in that she is very receptive to emails. I send her my reports every couple of weeks and she makes small tweaks. She’s noticed patterns I never would have noticed before.  She has quickly become my diabetes care BFF.

6. Getting back on the pump, in general.  For me, it’s much easier to correct those pesky high numbers with a couple mini boluses or temp basal.  A little more difficult and time-consuming to do on MDI.

7. Pre-bolusing for meals. It takes me about 30 minutes to get ready in the morning and halfway through I bolus for breakfast. Since I eat the same thing every day, it makes it easy.  I also pre-bolus for lunch and dinner too and I think it really helps prevent those after meal spikes.

8. Using combo boluses when I eat high fat meals.  I will master you, pizza.  I will.

9. Trying (although not always successful) to cut back on processed foods.

10. Really paying attention to the 15-15-15 rule when I’m low. Although this doesn’t always work (especially over night!).

It honestly hasn’t been a huge lifestyle adjustment or anything. I’ve just made diabetes a priority.  I know that I feel better physically and emotionally when I’m in better control of my blood sugars.

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!!!