You’re not the boss of me!

Argh.  I have a love/hate relationship with insurance.  Love it because w/out it, well, I’d be selling my kidney and firstborn to pay for my diabetes care.  However, that being said, even with insurance, diabetes is expensive, man.

One of the perks for buying my new pump and CGM early on in the year and all at once was that I have met my out-of-pocket max for the year.  Hello, 7 months of lower diabetes costs!  Woohoo!  I called my insurance company to see what exactly was now covered at 100% and was told “all diabetes supplies.”  I clarified with her, “So, pump supplies, CGM sensors, test strips, correct?”.  It was confirmed, yes, these things are covered.  Parrrrrrty!

Imagine my surprise when I went to the pharmacy today and I was asked to pay for my test strips.  Now, this isn’t a $20 co-pay, it’s close to $100 for a one month supply.  The young lady at the pharmacy assured me that they ran it through my insurance/prescription coverage so I paid and told her I’d take it up with them.

I called my insurance company first who connected me with the prescription folks and told me yes, my strips are covered at 100% if I use Accuchek.  I use OneTouch, and they are not covered at 100% under my plan and despite meeting my out-of-pocket expenses, I still have to pay the $100/month.  The way she made it sound was that Accuchek strips are covered 100% all the time, no matter if the out-of-pocket max has been met.

I told her this is ridiculous and she needs to give me the phone number of whomever I need to speak to regarding this.  I have left a voicemail and am looking forward to receiving a call back.  It just makes no sense to me that my pump supplies are covered yet the test strips for the meter that talks to my pump are not.  Does.not.compute.

It makes me pretty angry that some random person gets to decide what is covered and what is not and make decisions about MY medical care.

Wish me luck when dealing with the insurance company!

A quick note to my (Moody) CGM Sensor

Dear Sensor,

I know, I know.  You are on day 9 of 24/7 work and you’re tired.  Believe me, I get it.  Your fatigue lead to a non-reading of “???” right at bed time last night.  When, I just happened to be running in the 300s (Damn you Cookout milkshake and your heavenly goodness).  I decided to see if perhaps you just needed a nap and would resurrect yourself as I have heard rumors of this happening.  I, being the responsible nervous diabetic (Hey, I just read a story about a 29 year old’s dead in bed death), set my alarm for 1:30 am to check my sugar.  Imagine my surprise when you not only resurrected, but you resurrected accurately!  Only off by 18, woot!  It lives!

But, sensor pal, you seem to have quite the case of the Mondays today (I do too – I am really angry that I didn’t win the powerball and am here, at the j.o.b). You, without consulting me, have decided that last night’s break wasn’t enough and you needed another nap this morning.  Seriously, how tired can you be?  Fine, nap, because, well, I’m at work and don’t have one of your pals around to replace you (mental note, throw spare sensor into my work bag).  You nap, you snore, and all of a sudden !buzz!, you are alive and ready to take on the world!

Or maybe not.  After your miraculous second resurrection, you informed me that my sugar was 274, when in reality it was 199.  That’s it; you are out of the circle of trust today, Sensor!  I will not be trusting your readings until I can replace you.

Wait just a minute.  I just checked my sugar and it’s 139, but you are telling me I’m 144.  Could it be?  Are you back and back for good?  Or are you just going to continue to drive me nuts like a pms-ing 16 year old girl going through a breakup?

What’s it going to be sensor?  Huh?

Fondly,
Your Master

A sillly poem

Diabetes Blog Week – Day 6.

This year Diabetes Art moves up from the Wildcard choices as we all channel our creativity with art in the broadest sense. Do some “traditional” art like drawing, painting, collage or any other craft you enjoy. Or look to the literary arts and perhaps write a d-poem or share and discuss a favorite quote. Groove to some musical arts by sharing a song that inspires you diabetes-wise, reworking some song lyrics with a d-twist, or even writing your own song. Don’t forget dramatic arts too, perhaps you can create a diabetes reality show or play. These are just a starting point today – there are no right or wrong ways to get creative!

A Dia-Poem.
By: Laura

Diabetes you are so dumb.
Making me chew sugarless gum.
All the finger pricks, make me bleed.
But I sure do love all the DBlogs I read!

I was diagnosed as a college freshman.
Immediately, I started putting needles through my skin.
The burning insulin after the poke,
Man, Diabetes, you are no joke!

Diabetes, you make me stand out.
But I refuse to sit around and pout.
Sure you offer extra challenges and work.
Especially when my blood sugar’s being a jerk!

But there is one thing that I need to say,
Without you I wouldn’t be the woman I am today.
You’ve shown me I’m stronger than I think I am.
But seriously, any time you want to, feel free to SCRAM.

Freaky Friday!

Diabetes Blog Week, Day 5.dblogweek

Just like in the movie, today we’re doing a swap. If you could switch chronic diseases, which one would you choose to deal with instead of diabetes? And while we’re considering other chronic conditions, do you think your participation in the DOC has affected how you treat friends and acquaintances with other medical conditions?

I am selfish – I don’t know much about other chronic diseases.  I have friends who suffer from Crohn’s Disease, Asthma, Celiacs, Allergies.  I’d love to trade places with them to see the struggles they deal with on a daily basis so I can better understand and be a more supportive friend.

However, in answer to this prompt, I would like to temporarily trade places with someone who is paralyzed.  I believe this would help me appreciate the amazing things that my body can do and to serve as a reminder that even though I may be tired, may be feeling lazy, and just may not be in the mood to exercise, I am lucky to have this body and lucky that other than a dead pancreas, it’s functioning and functioning well.  I need to celebrate this with more movement!

Yay, team!

Diabetes Blog Week, Day 4.

We don’t always realize it, but each one of us had come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years, you’ve done something outstanding diabetes-wise. So today let’s share the greatest accomplishment you’ve made in terms of dealing with your (or your loved one’s) diabetes. No accomplishment is too big or too small – think about self-acceptance, something you’ve mastered (pump / exercise / diet / etc.), making a tough care decision (finding a new endo or support group / choosing to use or not use a technology / etc.)dblogweek

Hmmmmm, good question!  I feel like I haven’t mastered anything when it comes to my diabetes care.  I mean, I have mastered the motions, testing my sugar when needed, changing my pump sites, bolusing, etc.  But I am still, 14 1/2 years in, not 100% confident to say “Yes! I kick ass at diabetes!”  My sugars are not perfect, I don’t exercise every day, I still enjoy a carb or 20, and I have days where I’m crying out of frustration that I have to live with this crap for the rest of my life.  Sometimes my blood sugar is just a real jerk for no reason (like last night for example – for about 4 hours I was cruising between 43 and 80 despite 20 oz of OJ and two not-so-small spoonfuls of peanut butter).  Is there anyone out there who really has mastered diabetes?  Who can go to their endo every three months and know that their A1c is going to be 6.0?  Who has the perfect attitude when it comes to living with this?

But, the question wasn’t if you’ve mastered diabetes.  It’s about diabetes-related accomplishments.  Recently I made some pretty darn important care decisions.  As the Hubs and I want to have a small human in the next year or two, I knew that the time had come where I need to get serious and get as close as I can to mastering diabetes.  I decided to end my months-long pump holiday and resume pump therapy with the help of a CGM.  This was something I thought about for weeks months before finally accepting that I’m going to have to become a cyborg again.

You see, in theory, I love the pump.  Don’t have to carry around syringes or pens, your meal schedule can be more varied, and it offers better management for most people than multiple daily injections.  Blah, blah, blah.

But in reality, the pump is a pain in the butt.  Site changes, being connected all the time, it’s expensive, it beeps at you, it’s bulky and gets in the way, and it makes wearing dresses a headache!  My pump-cation had been glorious!  However, knowing all of the negatives that come with wearing a pump, I decided the best thing for my health and the health of a future pregnancy would be to get back on the pump and to get a CGM.  So the research began.

I googled, I youtubed, I blog-stalked.  Wow, there are a lot of people online sharing their experiences with various pumps and CGM setups.  The doctors and manufacturer’s’ sites will only tell you so much, these blogs were so helpful in sharing real-world experiences and opinions.  I especially found blogs written by women who are in similar life stages as me to be very helpful and was so happy to find their sites (Texting my Pancreas and SixUntilMe especially).   With the help of my new blogger buddies and the fabulous interwebs, I decided on the Dexcom G4 Platinum CGM and Animas Ping pump.  In black and silver – stylin’.

Change is scary and although I had previously been on the MiniMed Paradigm pump, I was pretty nervous about going back on pump therapy.  I had a breakdown one night about the fears of the unknown and how much it sucks that I have to do this and think about these things a year before we even want to start trying for a baby.  He, however, reassured me that there are other ways to start a family and if I absolutely did not want to do this, I didn’t have to.  He also made the great point that if I hate it, I can quit.  He’s so smart.

Fast forward to today and I’m almost 2 weeks into my new cyborg life.  Have I mastered it?  Nope, not quite.  I’m still aware of the pump clipped to my pants and the CGM sensor and transmitter taped to my body.  I still feel dorky about my “diabetes tool belt”.  My sugars aren’t perfect and I definitely miss the freedom of not being attached.  But one thing I have mastered is my attitude that I’m just doing what I have to do.  And knowing that diabetes care is something that can be adjusted and modified to fit my needs at the time.  Not everyone needs to be on pump therapy.  It’s not the best course for every.single.person with a dead pancreas.  But for me, right now, it’s the best choice in regards to my goal of becoming a mother, and I’m cool with that.  Will it be my choice 5 years from now?  Who knows.  All we can really do in regards to our care is to make the best decision with the knowledge we have at the time.  I think a series of making the right decision and small accomplishments will lead me closer and closer to that whole mastering diabetes thing.  But for now, I feel like I’ve accomplished the right attitude.

Memories, sweetened through the ages just like wine…

Diabetes Blog Week, Day 3.dblogweek

Today we’re going to share our most memorable diabetes day. You can take this anywhere…. your or your loved one’s diagnosis, a bad low, a bad high, a big success, any day that you’d like to share.

I would be willing to bet that most people feel that their most memorable diabetes day is the day they were diagnosed.  At least for me, that was absolutely the most significant day in my diabetes life.  But, I won’t bore you with the details because you can read about it already.

I would like to share a more recent memorable “diabetes day”, and that is my wedding day.  The Hubs and I have been married for almost 7 months now and leading up to the wedding I was pretty nervous about how my diabetes would behave.  It always seems to be naughty at the worst times.  Seriously, it’s like a toddler throwing a tantrum in church.  I had a horrible fear that I’d have a low or high blood sugar during the ceremony or toasts at the reception, or that my diabetes would be a major focus of the evening and I wouldn’t be able to relax and enjoy myself.  I really didn’t want this, all I wanted was to be a “normal bride”, enjoying her wedding day and being surrounded by her favorite people.

To accomplish this normalcy, I decided to go off the pump a few months before the wedding.  I figured it’d be easier to just take injections rather than figuring out where I was going to put my pump on my dress (although I had a little bit lot of poof to work with!), and plus when you’re unattached, you can almost forget about diabetes.  I didn’t want to have to think about it any more than the bare minimum on my wedding day.  I wanted to focus on my new husband, my friends and family, and the dance floor!  (OK, and a glass or two of wine as well.  Oh, and the CAKE!)

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You wanna fight, diabetes??
(Note. There were no fights at my wedding. However, there was one kick-ass dance off, pictured above).

Mission accomplished.  My sugars were great throughout my wedding day, despite having a horrible cold and a case of nerves.  I tested when needed but wasn’t consumed by it and honestly can’t even remember when I tested (but I know I did, in case you’re reading this my wonderful doctor).  Although this wasn’t a dramatically memorable “diabetes” day, it was absolutely memorable in the sense that I had an uneventful wedding in the diabetes aspect.  I managed my disease and did not allow it to detract from my day.  It was pretty eventful otherwise, because, you know, I got to marry my best buddy.  Even on the best days of our lives, diabetes is still around.  But it doesn’t have to be the memory we take away from these days.

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We, the undersigned…

dblogweekDiabetes blog week, Day 2.

Recently various petitions have been circulating the Diabetes Online Community, so today let’s pretend to write our own. Tell us who you would write the petition to – a person, an organization, even an object (animate or inanimate) – get creative!! What are you trying to change and what have you experienced that makes you want this change?

Dear Carbohydrates,

I, the undersigned, hereby request that you stop tasting so darn good.  Upon my years of diabetic research, I have determined that you, carbohydrates, are the reason why I am not the perfect diabetic.  You make my blood sugar go up and don’t help my A1c come down.  I have concluded that this is because you taste delicious.  Sweets, pasta, nachos, breads, potatoes…please heed my petition and stop tasting so wonderful.  I blame the sensory pleasure you provide to my taste buds for blood sugar readings that spike into the 200s (or higher) despite my feeble attempts to counteract with insulin.  And why, carbohydrates, must you so often be paired with alcohol?  Pasta and wine, Nachos and beer…please, please, stop with the yumminess!

I am a reasonable woman.  I am fully aware that I could just say no when you end up on my plate, but I have never met one of you whom I didn’t like.  I am weak.  You’re just too appetizing.  I implore you to start tasting like something disgusting…let’s say liver…so that I can better manage my diabetes.

I thank you in advance for your cooperation in this matter.

Regards,
A1-Conceive.

Diabetes Blog week – Day 1. Dear Doctor…

dblogweekBeing a new blogger I decided a great way to get more involved in the Diabetes Online Community was to participate in this year’s Diabetes Blog week.  What a neat idea!  I am looking forward to being challenged and to really have to think about the topics.  I am excited to become more connected with my fellow d-bloggers.  Let’s get started!

Day 1
Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see? 

This is a tough one for me.  I am generally a pretty open and honest person, including with my medical team (sometimes to their great dismay).  And, I really like my endocrinologist.  I am lucky that I live in an area that has some of the best medical facilities in the country and I have gotten in with an endocrinologist’s office that has a wonderful team approach.  I love this.  I love that everything is in the same office and every person I see knows my history.  I have had some not so nice endocrinologists in the past – whether they lack bedside manner or a personality.  I would try to crack jokes with my last endo and it was like talking to a brick wall.  I hated going to see her because she expected perfection and would get frustrated with me when my A1c wasn’t a perfect 5.8, or my fasting blood sugars were over 100.  She would act as if I wasn’t trying, when I was trying my best with the knowledge I had and really was looking to her to say “OK, we’re doing XY&Z and it’s not really working how we want it to, so let’s try AB&C and see how that goes.”  I got none of this with her, instead I received lectures about my blood sugars and weight, deep sighs, and I swear I saw her roll her eyes a time or two.  Let’s just say I was not heartbroken when we moved and I left her.

I think some endocrinologists think that in theory, diabetes should be easy to manage – it’s just a numbers game.  I understand you are a doctor and “science-y” and this is the stuff that you enjoy.  But, living with diabetes is much different than numbers on a paper.  With diabetes 2+2 does not always = 4.  I think it’s important for doctors to know how many variables go into caring for yourself.  How sometimes your sugar just does not want stay above 80 and how frustrating this can be.  How you can do one workout one day and your sugar will drop, while the next day it will go sky-high.  A lot of the care for diabetes is instinct.  Sometimes our instinct is correct, sometimes it isn’t.  We, as patients, know our body’s best and we know when something isn’t right.  Please don’t dismiss us if we have concerns.

Like I said before, I’m very happy with my current diabetes team.  I’ve never felt bad about having an A1c in the 7s (heck, it was 8.7 when I started there).  I like that they listen to me when I have concerns and ask me what I think we should do to improve my numbers and overall health.  I am an active participant in my healthcare.  I’m not perfect and they don’t get angry at me because of this.

I think that if I could send a message to all of the endocrinologists I would encourage them to let their patients be involved.  Don’t bark orders at us, don’t get angry at us, work with us, not for us.  Remember that there is much more to this disease than insulin to carb ratios, taking shots every day, testing blood sugars.  Diabetes is a 24/7 job and it continues for us in between those quarterly appointments.  And, for Pete’s sake, laugh at our corny jokes.

Ping!

I wanted to write this blog earlier this week, but I’ve actually (gasp!) been fairly busy at work.  What the what?!  Today is my 4th full day on the Ping.  So far, so good.  I had my appointment with my CDE on Monday afternoon and we set up my basals to be much lower than they were previously on the Paradigm.  When on the Paradigm, I seemed to go low if I didn’t eat and as someone who’s trying to shed a few lbs, this is no bueno.  Right now I’m on the following basal rates:

Midnight – 8:00 am – 1.0 Unit Per Hour
8:00 am – Midnight – 1.2 Unit Per Hour

Very complicated and complex, right?  For those non-Diabetics who may read my blog, the basal rate is the continuous stream of insulin my pump is programmed to give me.

My bolus rates are dependent on my Insulin to Carb ratios, Blood Glucose, Insulin on Board, and Insulin sensitivity factor.  Learning Time!  (I will quiz you later)

  • Insulin to Carb Ratios: Number of units of insulin I need for X number of grams of carbs I’m eating.  Mine are 1 unit per 12 grams of carbs for breakfast and lunch, and 1 unit for 10 grams of carbs for dinner.
  • Blood Glucose: Amount of Glucose (Sugar) present in my blood.  Vampires dig it.
  • Insulin on Board: The amount of insulin still present in my bloodstream based on my last bolus and current basal rate.  The pump figures this out.  It is much smarter than me.
  • Insulin Sensitivity Factor: This is the amount your blood glucose is lowered by 1 unit of insulin.  Mine is currently set to 40.

So far with these settings I think my readings are OK but there is definite room for improvement.  I’d like to be in the green as much as possible.

DailyTrends

Seeing as the spikes are generally post meal, I imagine my Insulin to Carb Ratios will change.  Especially after breakfast because coffee seems to hate me  but that is to be determined by my CDE, hopefully by the end of the day!  I’m excited to get tighter and tighter control.

Even though it’s been a while since I’ve pumped, I have noticed some things about the Ping that are different from the Minimed Paradigm:

  • There is a lot more button pushing.  You have to dial in your blood sugar as it doesn’t automatically display on the pump like it did with Minimed’s (MM) equipment.  I think this is a copyright issue with Medtronic a safety feature.  Not a huge deal but something to get used to.  I like bolusing right from my pump, but maybe I’ll have to train myself to bolus from the meter remote so I can skip the step of having to input my BG.  Those extra 10 seconds at every meal add up!  (Sarcasm)
  • Filling the Reservoir is more cumbersome.  The transfer guard that MM has is pretty slick.  Again, not a big deal just takes a few more minutes when I’m changing my site.
  • The infusion/insert seems to be smaller.  I like this.  I am using the 9mm Insert.  I was using the Silhouette with MM.  The size difference may very well be due to the fact that I’m now using a straight set rather than an angled, but so far I like it.  It makes me more eager to try different sites.
  • The all-in-one inserter has its pros and cons.  I’ve only done one site change without the watchful eye of my CDE so I am sure that it will get easier as I get used to it.  It seems a little more awkward than the MM, but at the same time I like that it’s all-in-one.  Makes travelling easier and I always would lose those inserters that MM provided.  MM does have the Mio which looks comparable to the Insert, but I have no experience in using it.
  • The display and menus are different.  This is just something that takes getting used to.
  • It’s so pretty.  Really.  The Animas Ping is just prettier than the Paradigm, in my opinion.  I love the silver.

So this is my review of the first few days.  I continue to be a work in progress.

Is it time to say goodbye to coffee?

I love coffee.  Coffee, however, does not seem to love me.  I have noticed in the 2 and a half weeks that I’ve been wearing my Dexcom that I seem to have a very high blood sugar spike after breakfast.  Despite taking my BG, Insulin to Carb ratio, and Insulin Sensitivity factor into account when I bolus, I am always spiking about 2-3 hours after breakfast, which I eat around 7:30 am.  Breakfast is usually a bowl of cereal (measured, 1 cup of multi grain Cheerios or corn flakes) and skim milk (3/4 cup), and my to-go coffee with flavored creamer (3 Tbs  – hey I drink a BIG cup!).  I usually drink my coffee over the course of 2 hours, finishing it around 9:30 am.  My blood sugar spikes seem to hit between 9:30 and 10:30 am.  However without taking a correction dose, I’m almost always back in normal range by lunchtime.  Take this morning for example:

  • Woke up with BG of 204
  • My new Ping told me to take 6.6 units for my BG, amount of carbs I was consuming, and correction factor.  My CDE wants me to do what the Ping says for the next few days as we figure out my basal rates and fine tune my Insulin:Carb ratio.
  • I spiked at about 9:30 am with a BG of 320.  Blech.  However, on the direction of my CDE, I did not take a correction dose and am now coming down, about 45 minutes before lunch.
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Who wants to go skiing on that peak?

 

This leads me to wonder if I need a different Insulin:Carb ratio or a higher basal rate.  Or, dare I say it, I should knock it off with the coffee.  I have read on the interwebs that caffeine can cause blood sugars to rise by blocking insulin or something medical like that.  But, it’s my coffeeeeee.  What is worse?  Blood sugar spike or crazy, cranky, half-asleep Laura?  My coworkers probably have a different answer than I do.

My thoughts are that perhaps I should increase my basal in the mornings to account for my coffee.  Or maybe set a square bolus (Or a “Combo Bolus” in Ping-speak) to account for my 2 hour long coffee drinkage.  Or change my Insulin:Carb ratio for breakfast so my bolus is higher, although this concerns me that I will drop by lunchtime.  Maybe next week I will try sugar-free creamer to see if that helps.  Perhaps all the sugars in the creamer are hitting me in a different way than other carbs?  Maybe I need a higher protein, lower carb breakfast in general?  Who wants to be my personal omelette chef?

I really don’t want to have to surrender my coffee to the D.  It’s warm.  It’s tasty.  It wakes me up and it makes me (and my coworkers) happy.

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This diabetes stuff is a tricky thing.