Still my hero…
I published this post almost one year ago, when I first started this blog, because this kid is just awesome. Since it’s Friday and we all deserve a laugh, I’m re-posting this masterpiece to bring a smile to your face. Happy Friday folks – have a safe and healthy weekend.
“I Business Trip on Insulin” too…
Alarm goes off.
3am California time.
Alarm off.
Click DexCom. 223. WTF?
Oh. The steak dinner last night.
Calibrate.
Bolus.
Shower.
Check blackberry.
Hair. Makeup. Presentation ready.
Where do I put my CGM?
Buffet breakfast.
Runny eggs, sausage.
Test. 189.
No bolus.
Coffee.
More coffee.
5am California time.
Head to the stage.
Presentation. Bright lights.
Back to my seat.
Take notes.
Check Blackberry.
Test. 61.
Candy bar.
More coffee.
Answer rep questions.
Head to lunch.
Discard bread from sandwich, add more lettuce. Create salad.
Test. 390. **SIGH**
6 units.
Eat. Water. Refill coffee.
Sit all afternoon, take notes, answer questions, learn.
Step out for conference call. Back in.
5:30. Time to workout. Co-worker:“Got a minute?”
“You bet.”
6:40. Hotel room. Answer emails.
6:59. Shit.
Race to reception.
Wine? Beer? Cocktail?
Test. 150.
Wine. Red.
Buffet dinner.
Top steak with nacho cheese sauce. Add lettuce. Create salad.
Bolus 1 unit.
Cheesecake.
4 units.
Back to room.
Emails.
Summary.
Call family.
Check flight for tomorrow.
Arrange for cab.
Test.
CNN.
Bed.
Nope. I’m still the captain…
“You still have to check?” My coworker says, glancing at my open meter case. He’s referring to the fact that next to the case is my continuous glucose monitor. I work for a pharmaceutical company that makes diabetes drugs, so its no surprise that folks at the sales meeting I’m working are familiar with the ‘betes gear. But never quite friendly enough.
I look up at my colleague. “Yes. CGM doesn’t eliminate the need for finger stick testing. You still have to back up your readings so you can make an accurate management decision, and you also have to calibrate the CGM by entering finger stick results. It doesn’t replace testing.”
“Oh” he nods, and turns his attention back to the high-science presentation we’re being schooled on. I can’t help but notice the irony of the fact that the cohort in the study we’re discussing happens to be people with Type 1 diabetes using “insulin delivered via subcutaneous delivery. Dude, just say “pump.” Digression. Ahem.
People without diabetes make many assumptions about what it’s like to live with the disease, and often the somewhat-informed-guesses are worse than the flat-out misinformation. By that, I mean the folks that think insulin pumps are a replacement pancreas, no thinking required. Or that a CGM means never having to draw blood again. Even the most recent issue of Oprah Magazine touted “100 Things That Are Actually Getting Better” on the cover, and included “Diabetes Management” as one of the items. The blurb cited that sensors under the skin “improved on the pincushion approach.” True, but they haven’t replaced it.
The bottom line is that although pumps, basal insulins, CGMs, and all the other awesome gadgets have definitely improved diabetes care, nothing has replaced the fact that every management decision requires brainpower and decision making. I decide how much insulin my pump gives me. I decide to what to do with the arrows and numbers on my CGM. So far, there isn’t anything out there that takes the mental aspect out of diabetes management. It’s important for folks without diabetes, especially the “Type 3s” in our lives, to know that diabetes is always a 24/7 job, no matter what hardware we’re rocking.
Technology makes the ship easier to steer, but it can’t plot the course.
Dude, get it together.
DexCom, I love you, but really? REALLY? WTF? Get it together man…
Babies and the ‘betes…
I’v always wanted kids. Not now!! Definitely not now, I have too many places to travel/irresponsible things to do/selfish ways to spend money right now to have kids, but one day, I’d like to have one. Actually, I’d like to have one naturally and adopt another one for a total set of two. Boys or girls doesn’t matter, I would just like two healthy kids one day. Aside from adoption being one of the greatest gifts you can give in this world, I’m also interested in adopting because I know the stress of a pregnancy will be tremendous on me and my diabetes, both physically and mentally.
Women with diabetes have healthy babies all the time, but there’s a lot of work that goes into securing that outcome. I’d love to experience being pregnant once though, and with all the modern technology we have, there’s no reason I can’t safely have a healthy baby one day. In fact, one of my favorite d-bloggers and the OG of the DOC, has been chronicling her pregnancy with diabetes, and I have been amazed at how healthy and awesome it’s been for her.
But there’s one thing that makes me hesitate. Guilt. Every woman with diabetes who has kids asks herself at one time or another: Am I going to give my kid diabetes? Is it fair for me to bring a child into this world knowing they’re at a higher risk for getting this disease?
I’ve always thought the math was simple – if you have Type 1, the chance of your child/sibling/any direct relation to you is higher, right? Well, kind of. I was asked the question of “how much higher?” the other day, and I realized I didn’t know the stats. I know the risk of passing Type 1 to a child is lower than Type 2, which holds very strong genetic ties, but how much lower? Am I destined to pass this burden on to my child one day? It took some serious research to dig up the official numbers, but it was well worth it for the peace of mind that followed. Here’s how it really breaks down, according to the world-renowned Joslin Diabetes Center, with commentary from Dr. Warram, a lecturer in Epidemiology at Harvard School of Public Health.
- · If an immediate relative (parent, brother, sister, son or daughter) has type 1 diabetes, one’s risk of developing type 1 diabetes is 10 to 20 times the risk of the general population; your risk can go from 1 in 100 to roughly 1 in 10 or possibly higher, depending on which family member has the diabetes and when they developed it.
- · If one child in a family has type 1 diabetes, their siblings have about a 1 in 10 risk of developing it by age 50.
- · The risk for a child of a parent with type 1 diabetes is lower if it is the mother — rather than the father — who has diabetes. “If the father has it, the risk is about 1 in 10 (10 percent) that his child will develop type 1 diabetes — the same as the risk to a sibling of an affected child,” Dr. Warram says. On the other hand, if the mother has type 1 diabetes and is age 25 or younger when the child is born, the risk is reduced to 1 in 25 (4 percent) and if the mother is over age 25, the risk drops to 1 in 100 — virtually the same as the average American. (SWEET! – blogger’s commentary added for effect)
- · If one of the parents developed type 1 diabetes before age 11, their child’s risk of developing type 1 diabetes is somewhat higher than these figures and lower if the parent was diagnosed after their 11th birthday.(Crap. – blogger was diagnosed at age 10).
Ok – so that’s good news! Since I’m already 27 (and not planning on kids for several more years anyways), I won’t have the added risk of being under 25, but I’ll lose that advantage because I was diagnosed before what appears to be the magical cut-off age of 11.
The Joslin stats are also helping me understand why it’s not weird that no one else in my family has Type 1 diabetes – its just not that genetically linked. Lucky me – winner winner, chicken dinner, I got the auto-immune version of drawing the shortest straw. But I’m also the tallest kid – so HA!
I need a refridgerated desk drawer…
The devastating earthquakes in Haiti have made me think about my own disaster preparedness lately, and I have to admit, I’m coming up a little short. I’ve got back-up test strips and pumping supplies here at my work, but no actual back-up meter. Bad Lexie.
I’ve got an awesome dia-buddy one floor up who keeps a spare bottle of insulin in a private fridge here at the office (she has to use her boss’s fridge because our company fridges are fully cleaned out every last Friday of the month). It’s great to know that’s there as a back-up, but it wouldn’t be helpful if I became trapped at my desk for any length of time. My purse is never far away from my seat though, so I would hope that my normal stash of insulin and testing kit would be just a reach away in the event I was stuck in one spot for an extended period of time.
Is that enough though? Does anyone have suggestions for how to be truly prepared? Are there guidelines listed anywhere? How are people dealing with refrigeration issues at work or other places they keep back-ups? Do you want me to ask more questions? No? Ok.
Also, my medic alert bracelet just recently broke and I’ve got to find some time and money to get a good, sturdy bracelet that reflects my current information. I know I’m directly asking for it from good ole’ Murphy’s Law by not wearing one right now, but the strong ones are expensive! I went the cheap route with the last one, and well, it performed cheaply as well.
I’m not totally unprepared though – I recently took one awesome proactive step, and that was to get a glucagon kit to keep at my boyfriend’s house. I’m there enough that there’s no excuse to not have one available, and I feel better knowing it’s handy at his place. Lord knows that poor man has brought me enough glasses of juice and GU packs to have his own glucagon set (bless him).
Other than that though, I could be doing a better job of being prepared, even when it comes to the small things like keeping glucose tablets or GU everywhere, because lows pop up in unexpected and inconvenient places. My trouble is re-stashing once I use the current supply. I just need to add that to page 3,426 of the diabetes “remember to” list…..
Inspiration Station
Last Saturday I had the pleasure of seeing the documentary “The Science of Inspiration,” about people with diabetes training for the ultimate test of physical fitness: a full triathlon. For anyone that doesn’t know, a true triathlon is a 2.4 mile swim, followed by 112 mile bike ride, topped off with a full marathon (that would be 26.2 miles). In a row. As in swim, bike, run. For 10 hours. No, really.
The short film was created by insulindependence.org and one of their sub-projects, Triabetes, Insulindependence.org is a grassroots organization dedicated to helping people with diabetes live active and adventurous lives. They take groups of Type 1s on surf trips to Costa Rica, mountain climbing in South America, and to dozens of other amazing locations and adventures. I’ve always admired Insulindependence and their projects because of their mission: to ensure that having diabetes never holds anyone back from their dreams, which include (for reasons only known to the clinically insane) Triathlons. Triabetes is a USAT-certified triathlon training club that has a variety of training programs throughout the US for people with diabetes, and since their inception in 2007, club members have trained for and participated in hundreds of triathlons across the country.
The film was deeply inspiring, tracking the journey of 11 Type 1s who set out to train for and complete a Triathlon. For many of them, it was their first such race, but for one of them, this was old news: Bill Carlson. In 1983. Bill was the first Type 1 diabetic to complete an Ironman, a race considered to be the ultimate endurance challenge (check out that last link for some unbelievable footage of Bill’s 80s insulin pump – whoa!). Since completing the Ironman, Bill has gone on to complete over 80 marathons, dozens of triathlons, and even a few ultra-marathons – that would be a 100 mile run. You read that correctly.
In short, this man has logged more miles than AmTrack, and has managed to do it all while handling his diabetes – and don’t forget that 1983 was long before many of the convenience tools we have today, such as CGM and basal insulins.
Being in the presence of an elite athlete with diabetes is overwhelmingly awesome, because those are the kind of inspirational people you remember when you’re faced with intimidation. There’s been many times in my life when diabetes has been a challenge for me, or caused fear of the unknown in my heart. Running my first half marathon in August was a tremendous physical and mental effort, but I could remind myself that I was not the first person with diabetes to run 13.1 miles. Same goes for traveling to all corners of the earth – including places that are not so diabetes-friendly: I wasn’t the first person with diabetes to travel through Honduras in 110+ degree heat with little refrigeration for my insulin. I know I can get through these challenges because others have gone before me and made it work. Like Bill Carlson. Although I don’t know that I’ll be running an ultra-marathon anytime soon….
Can you at least meet me halfway?
Don’t do it Blood Sugar, don’t do it. Come on, let’s be rational here, you were at just 108mg/dL 30 minutes ago, trending downward. How did you get here? 178mg/dL? And rising?!? C’mon man, that ain’t right! All I had was 18 measly carbs, and now this? You were on your way to a low and I helped you out, and this is what I get in return? Trending upward? In the middle of kickboxing? Come on! I’m begging you here. Just calm down – this isn’t worth it! I’m already working out, I promise you, if you just stop there, I’ll work harder. I hit those sprints so fast you’ll have no choice but to level out. Just slow down and relax here. There’s no need to hit 200mg/dL – that’s the one that makes my CGM buzz and holler “HIGH.” It hurts when that happens. Makes me feel like a failure. Especially when you were fine just a few short minutes ago. What happened? How did you get this upset? I had to have a snack to make sure you didn’t get low, and now we’re here? I didn’t even turn my basal down! I just don’t understand what you want from me. I begging you, don’t do it. Don’t hit 200mg/dL.
Sometimes I eat this…
….and call it dinner. Total carbs: 10. Total insulin needed: 1 unit. Total satisfaction: Boo-yah.
Wired for success
I know some of the time on this blog (ok, a fair amount) is spent venting about the annoying side of diabetes. But every so often, I am blown away by the modern technology that we have available to manage this disease. I’ve had diabetes 17 years, and when I was diagnosed, there were two kinds of insulin (NPH and Regular), and glucose meters required a blood droplet the size of a puddle to get a reading. And folks who have had diabetes even longer remember the days of having to sterilize and sharpen needles before injecting sorta-clean porcine insulin. My how things have changed!
One recent experience had me positively marveling at the progress we’ve made. Unless you’ve been living under a rock for the past week, you’re well aware that Southern California was subjected to a torrential downpour last week that left several areas flooded, subject to mudslides, and even evacuated in some spots. And given that Southern Californians deal with this weather only, oh, let’s say NEVER, the freeways were an absolute mess, with accidents galore and me driving like a geriatric while swearing I would move south to Mexico to get away from this unacceptable weather. And of course, this was a week when I had to drive to Los Angeles from San Diego for work, which is about a 2 hour commute. On top of the rain, I had to leave after dark around 7pm thanks to a late presentation I had at my office, so I hit the road with low visibility and high anxiety.
I had been invited to give a presentation at a celebratory event for my company about living with diabetes. Since my presentation was to be given over dinner, the event planners graciously made sure my table ate first so that I could get some food in my stomach. With a blood sugar of 78mg/dL at dinner time, and a low-carb meal of salmon and salad being served, I didn’t bolus at all for the food right off the bat. I didn’t want to crash in the middle of my presentation, and I wouldn’t need much insulin for that meal anyways. I gave my presentation, said my thank yous and good byes, and hopped in the car, heading north to LA.
The rain was lighter than expected, but still made it difficult to see. Combined with the darkness of the night around me, it was enough to have me hunched over the wheel, focusing on the road ahead. I had all but forgotten about my blood sugar until about 30 minutes into the drive.
At that point, I realized it had been about 2 hours since dinner, and my BG could be starting to creep up as the protein and fat in the salmon began to break down. I instinctively reached for my DexCom: 168mg/dL with an angled, upward-pointing arrow indicating I was on the rise. I reached for my OmniPod and dialed in 1.5 units with a few clicks of the buttons. I had barely taken my eyes off the road, and had wirelessly managed my blood sugar in less time than it takes change a lancet.
Can you imagine what that scene would have looked like two years ago, when I was pre-pump and pre-CGM? First I would have to get the test strip out of the bottle, which requires two hands and some serious juggling of the wheel. Then there would be the task of again using both hands to get a blood sample. Never mind the next bit about getting the blood on the strip – I’d be moving my eyes off the road AND using two hands, which I am sure is never safe while driving. When the reading came back, there would be a whole new challenge of drawing up 1.5 units of insulin using a syringe marked in whole units (hard to do even when you’re not driving), and a vial – again requiring two hands. I hate to think what kind of issues could arise from a distraction like that when driving in already difficult conditions.
I love moments when technology keeps me safe and healthy, and above all, makes having diabetes a little bit easier. I know I gripe about all the devices I have to wear, but the reality is all this hardware gives me so much freedom to have an unpredictable life that includes late-night drives to LA or 5 different sports in a week. I have tools that my 10-year-old-newly-diagnosed self would never have believed existed. And short of a new pancreas, I’ll keep using these little gadgets so I can continue living life on my own terms.