Tag Archives: insulin pump

Why going to the endo is like math class

D E B U T S I N G L ERemember when you used to take tests or quizzes in math class and the teacher would tell you that “you have to show your work or else you’ll only receive half the credit”? First of all, I should be allowed to do math in my head, even though I get it, they wanted to cut the cheating out. Secondly, I hated getting the answer right but the “steps in getting to the answer” wrong. Isn’t there more than one way?

Yesterday, I had a visit with my endocrinologist who I hadn’t seen in a year. This was due to being laid off my job a year ago and finding health insurance again. Going to see a world-renowned endo is pricey! Along with getting to see all my doctors again (yay!), I get my supplies, insulin and everything else I need to get my a1c back down (it was a 7.9). It’s not terrible, but I was doing much better this time last year. I actually thought it was going to be higher!

With that said, I took the time to tell my doctor about the issues I’ve been faced with and really, nothing has changed since the last time I was there– besides the fact that I wasn’t checking myself enough due to a shortage of supply. I feel like most of the time, it doesn’t matter if you have diabetes or not, doctor’s advice is usually the same: Do more exercise, lose more weight, you’re doing fine, at least you’re alive. We’ve all heard it.

This time though, I was scolded about not wearing my CGMS, which I admit slipped to the wayside, again due to shortage of supply. But, not to fear! I’m back on it.

As I was sitting there with the doc, reviewing the printout of history from my pump, what I call my diary because, well, they know EVERYTHING just from looking at a few numbers on paper… and graphs, and charts, and totals, I saw the scatter of numbers throughout the pages. Most notably were the days where I checked only once or not at all.

**[If you know anything about diabetes and this isn’t the first time you’ve heard of this situation, you know how important it is to check yourself. I’ve written about it here. The doctor refers to not checking as the “dangerous road.”]**

This is when the guilt sets in. There are days when you wake up and you just don’t want to deal, so, putting your health at risk, you don’t. It’s not to say that it is the right thing to do, but it happens. For those who don’t have diabetes, let me just say, it gets exhausting. Always thinking about what you’re eating, the amount of sugar, carbs, counting, shots, boluses, double checking how you feel, checking blood sugar, making sure you’re on top of your life! Numbers– all numbers, all the time. So even though it sounded like a good idea to skip on checking out where you were and how you were doing in terms of blood sugar levels, it’s not in the long run and you look like a bad student at the doctor’s office.

At this point, I’m too old to shout out, “But my a1c was a 7.9! That’s still pretty good!” But that’s how I felt. It was a sigh of relief, it was a way to loosen the hook I’d always be on with my diabetes. But you know what? I didn’t show my work.

When the doctor downloads all the information that my purple insulin pump stores in its computer system, he sees what’s going on like when I drop and when I’m too high and all that jazz– my personal life and what my insides are doing. The graphs and charts are only possible with data, but if I’m not checking myself or wearing my CGMS there is no data. The data here is the long division work I did in my head and didn’t show on paper. The a1c result is the answer that I got kinda right. The only reason it isn’t in the “correct” spectrum is because I didn’t show my work, thus slipping up in the end.

Because I didn’t do the work, my doctor couldn’t tell me how to fix it. As much as this is about pricking your finger and sampling some blood, NOT doing actual facts and figures in your head, you’d think it’d be easier, right? Well, besides my need to ration supplies, it’s easy to forget to check. I’m running to work, I’m busy at work, I’m running home, I’m running around, living life, doing things and then, “Oh, shit! I have to check myself!” Does that not happen to you? It happens to me all the time, which is why the CGMS is good for me. It’s stuck there and that’s it. It tells me when to check and I’m good. For the most part. Technology has been known to fail.

So based off of what he knew for sure, he changed my basal rate, changed my carb ratio and sent me on my way for blood tests.

Usually, when I leave the doctor’s office, I’m known to dwell too long on the whole ordeal. I cry most of the time as a release of energy, anxiety and stress that living with diabetes brings about. I’m reminded of everything I have to do to not die a slow and miserable death, and at the same time, I swear that I’m going to change. The difference this time was that I had company and I had to explain things. He told me that I wasn’t perfect, that I’m human and that he was going to support my habits that I intended to build on. I didn’t cry but instead I accepted the fact that I do what I can and sometimes, things don’t just go the way you want them to.

Life is a tumultuous rollercoaster on its own. Sprinkling in some much needed care adds a little anxiety, but more, it adds the motivation needed to feel better and more in control. In the end, I’ve realized that in order to take control of my diabetes, I’m going to have to do the work and hopefully the more corrections I make on my process, the better my results will be.

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Reality Check: How long is forever?

Today I decided to take a day off. I’m always doing something, always going somewhere, but today, I wanted to spend time at home, clean and go grocery shopping. It’s the simple things in life sometimes that make the rest worthwhile, right? It could also be that I needed a mental health day because yesterday I was so distracted and all over the place.

I walked into the fiscal department at work yesterday only to see Tish Parker in her corner. Tish and I met at our new employee orientation and since then she makes the effort to occasionally stop by my closet of an office to say hi, I return the gesture. I found out that she, too, is a writer although of the fictitious genre. When I walked in, she said hi, always greeting me with a beautiful smile and called me over. She pointed to my pump and asked what it was. Apparently her sister-in-law is also diabetic and uses a pump but she didn’t put two and two together until I explained it to her. She thought it was an MP3 player of some sort and I said, well, at least you didn’t think it was a throwback and call it a pager.

I started explaining how the pump is used and how it works to a point when she asked, “So it’s forever?” And when she said that, I didn’t know how to take it and said, “Well, I change it every three days, but yes, I’m most likely going to have to use it forever.” Which put my mind into a whirlwind. Forever.

Or until there’s a cure, but at this point, I feel that I will not live to see one. The fact of the matter is, I will be connected to this contraption for the rest of my life, something I didn’t fully wrap my head around until she said it. I knew I would have to take shots forever, that was easy to come by, yet thinking about it now, the pump does feel temporary although it isn’t. It’s forever.

It took me back to the day that I found out I was actually diabetic. My mom called me over to check my blood sugar, which at the time, I didn’t understand. I knew I had to do it because the doctors said so, but the significance behind it, I didn’t quite comprehend yet. We were about to have dinner when my mom pricked my pointer finger to squeeze out some blood. “Mom,” I said looking up at her, “am I going to have to do this for the rest of my life?” I think the question broke her heart.

What did that mean? FOR THE REST OF MY LIFE. As a grew up, I looked into what the rest of my life was going to be like. It went something like this: Over time you will lose your eyesight, be at risk for cardiac problems, get amputations and die. Fun, huh? Well, everyone dies, right? I already knew that part. But dying prematurely is what gets everyone. As a diabetic, five years is already cut off my life span. So if I was going to live until 100, I’d die at 95. That’s cool. I’ll take it.

The issue is that throughout my younger years, no one told me straight out what being diabetic meant. No one explained the repercussions, the decisions I’d have to make, the consequences. It was just, “If you don’t stop…” or “If you don’t cut back…” Doctors didn’t try to make living with the disorder easier, they were just trying to make me stop living.

Now it’s, “If you don’t control…” or “If you don’t lower your A1c…” The same tactics that are used today were used with me back then, as a child. Awful. They scared me into being healthy, they didn’t teach me how it all worked. They were passing down the stresses of having a diabetic child to my parents who thought they had done something wrong. They didn’t try to expand on my forever, they scared me into thinking about forever and living a terrible, terrible life of pain agony and losing my legs. It was also the 90s. I’d like to think times have changed.

But yes, to my dismay, I’m going to be connected to this little purple machine for the rest of my life. At this point, I can only think of having something smaller but never not having anything at all. I see it as a benefit. We’ve transitioned from a pump that you had to carry around in a backpack to a little thing that looks like a pager. Brilliant. Let’s see where life leads us next. What does your FOREVER look like?

 

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Diabetes Melodies

So the other day, my boyfriend was looking up videos about diabetes and came up with a few good ones. I want to share them here because I’m being lazy and really, I have nothing to write about just yet. I plan on getting my HbA1c tested next Saturday and I’m still writing down everything I’m eating and calculating the appropriate carbohydrates.

Yesterday I woke up with a blood glucose of 491. Pump fail. I should have known something was up when I first put the pump on because it said I had less than I really did. Not mention the night before last my blood sugar wouldn’t come down. It was scary to say the least and I slept a lot while constantly checking my blood sugar, drinking water and taking insulin. I checked my ketone level, of which the strip said I only had a trace so I was ok with that. But man, it was scary. I didn’t know what to do and I wanted to rip the pump out and give myself a shot. I changed the pump and it all worked out, thank God.

Anyway, moving on. My sugar reading for dinner was 75. Slightly low, but I had been getting hungry and didn’t eat much in the morning. Needless to say, I definitely enjoyed my dinner.

So here are the two videos that my boyfriend found that I thought were hilariously awesome and decided I should share with you, my fabulous readers. Let me know what you think, si?

My favorite line: “I’m a Type 1, son!”

This one is more for the Type 2 kats out there but nonetheless, still good information to know. I don’t have a favorite line for this one, but loved exaggerated corniness of it!

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Pump up the insulin!

Beryl Larson and I at the Diabetic Treatment Center

It’s been about a month now since I’ve gotten my purple Minimed and I can’t say I loved it from the start. Like anything, it takes a lot of getting used to and sheesh, the first time I had it on was a nightmare.

I didn’t expect it to be as nerve-wrecking as it was. I’m a patient at Mercy Hospital in Chicago and the diabetic nurse who’s been helping me through this whole process is Beryl Larson. She’s a great woman; patient, understanding and encouraging. Anyway, I got it put in on Nov. 20. Beryl and my doctor, Dr. Uy, told me not to take insulin the night before.

Let’s step back a minute so you can possibly understand what I was going through. If you’re diabetic, you will. So before the pump, I was taking two types of insulin. The first, that I would take in the morning and in the evening before bed, was called Lantus. This insulin is a slow-acting insulin. You take it, most of the time, once and it slows the rate of glucose that your liver produces. Because, yes, your liver produces glucose (or sugar). Now, take another step back and look at it from a “normal” experience.

Your pancreas makes a hormone called insulin (which is what I was taking through injection). The hormone allows for your cells to use the food you eat and convert it into energy. When your pancreas makes too much insulin, your liver intervenes and makes glucose, so it balances your body out. Unlike diabetics who have to calculate everything, in “normal” bodies everything is taken care of. The cause behind why sometimes “normal” people feel weak or shaky is due to too much insulin and not enough food or sugar. See? Easy as pie!

Now let’s go back to my insulins. The Lantus is slow-acting and does not peak, which means using it will result in less cases of low blood sugar (hypoglycemia) and would work throughout the day, up to 26 hours in my body. Humolog, is a fast-acting insulin and started working a half hour after taking it. I would take this when I ate to compensate for all the carbohydrates and food I was eating. I was acting as my own pancreas, which is weird and takes a lot of time and practice.

The Purple Minimed. Should I name it?

Basically, after all of that, I wanted to explain just how often I was on insulin (all the time!) and what it was like not to have it. Since I was used to taking Lantus the night before to help me out while I slept (my blood sugars used to run really high at night for some reason and result in a high blood sugar in the morning) my sugar was running on the high side. I didn’t have any insulin at all running through me.

I showed up at the hospital and I went through the whole process of changing and putting on the pump myself. Then we started it as the doctor had prescribed. Two units every hour, one unit for every 12 carbohydrates that I ate and that was it. Now, instead of taking two insulins, I am now only using one called Apidra. This insulin is another rapid acting insulin like Humolog, except that it works in half the time (15 min) after injection.

After starting up my little purple pump, I went to eat breakfast. I counted out my carbs and gave myself the appropriate dose, which by the way, the pump calculates for you. No more counting out unit to carbohydrate ratios! I then walked around the hospital and I could feel my blood sugar going up. This is when I begin to freak out.

I checked my blood sugar and it had gone up to the 300 range. A half our later it went up to the 400 range. Now, since I was used to just giving myself injections to control this up and down thing, that’s all I wanted to do. When you see yourself hitting those numbers, the first thing that comes to mind is, “Holy hell! Where’s my insulin pen!” The feeling is horrendous. I start getting headaches, my mouth goes try, I have to start peeing every 10 minutes and I get nervous. Mind you, the stress only adds to all of this.

So Beryl calls Dr. Uy. Dr. Uy says to just wait the two and a half hours for the insulin to be fully working. Beryl also reminded me that technically my body was catching up from the lack of insulin those hours before. After about five hours from when we first arrived, my blood sugar dropped to 245. Although it was high, I was never so happy to see a number like that before. “Ok, good,” said Beryl. “It’s dropping.”

From there on, I downloaded an app for my phone that allows me to keep track of carbs, medication, blood sugar readings and basically anything else I want. I’ve been back to see Dr. Uy and she changed my doses from what I started off with, which, I have to say, have worked a lot better.

From midnight to 9 a.m. I’m on a 1.7 unit basal rate.
From 9 a.m. to 7 p.m. I’m on a 2.0 unit basal rate.
And from 7 p.m. to midnight, I’m on a 2.1 basal rate.
I’m on a 12:1 carb ratio with a sensitivity of 40. Although I’m not always between 100-110, I may be at 120 or somewhere in the 90s which is exciting to see.

After getting used to it, I feel like I’m now at a new point of taking care of my diabetes and using this new (ok, new to me, old to a lot of other folks) is awesome.

Please let me know if you have any questions.

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It’s a No Go.

I woke up early this morning a tad bit nervous, to say the least. I had to do a lot before noon. A phone meeting, going to the bank, a doctor appointment. No, not a doctor, a nutritionist. A dietician if you will. I literally prepared for this appointment. Had my blood sugars listed and ready, had my machine, had my fear. What was this going to bring? Was this lady going to be like my new endocrinologist or would she be nicer?

My mind started to wander about in different places. I ended up canceling the phone meeting, not going to the bank and taking deep breaths to prepare my mind. What was going to come of this meeting?

I got to the hospital on time. It was the fact that I had to wander through the winding maze of the hospital, find where to check in and all that hot jazz that made me late. They were nice about it. Also, I was in the elevator with the dietician.

As I checked in, I believe the receptionist felt I was nervous. Not too sure though. I sat down and sure enough, the dietician came to get me with her student shadow (like those residents I despise) but I actually liked her. When we first got to talking, she explained to me that getting the pump was not going to solve all of my problems. I knew that right off the bat. She asked me questions about meals, diet and what I knew about carb counting, which is just taking the proper amount of insulin for the grams of carbohydrates consumed.

The one situation that I did have a question about was my carb ratio. I asked about this because when I took the right amount of insulin, sometimes it wouldn’t bring my sugar down after a meal. My carb to insulin ration was 1:15 meaning one unit of insulin for every 15 grams of carbohydrates. They told me to change it to 1:12 and see what would happen with that. Keeping track, even if it’s in your head, is very important. I realize that only I will know what’s going on and how it all works, even if it’s just from memory, remember to always ask questions.

After we settled everything and I explained what I did in certain situations, she thought that I was right on track. I was doing what I was supposed to be doing and doing it right. Rock on! The fact that I used my problem solving skills to balance myself out also played an important role in her decision to agree on an insulin pump for me.

I wasn’t ready for one before since I had just begun learning about how to take care of myself “manually” if you will. When the diabetic nurse came in she said I was exactly the kind of person that should be on a pump since I was doing everything that it entailed anyway. She said it would save me a lot of poking since I take insulin through injection. The bruises and marks sometimes are ghastly (I just really wanted to use that word).

The pump is a small beeper-sized device that is connected to my side with a catheter which is changed every three days. The insulin goes in and I set it up for the amount I’m supposed to get and when. It also remembers the previous amounts and calculates carb intake as well as anything else I program into it. I’m also supposed to be trying out these classes online to see what it’s all about even before I get my hands on an actual pump. Of course, there’s always the question of insurance, which is scary, but for now, I’ll take a deep breath.

When it came down to it, the nurse explained the Medtronic pump to me, with a basic explanation of how it worked with pictures and an example pump. I didn’t have to be put on the CGM again, which was cool. But the visit only inspired me to do more and continue on with my good habits, finding ways to control my diabetes even more.

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