My devices have started to feel like an extension of myself – they’re essentially working together (with my input of course) to be an artificial pancreas worn on the exterior of my body, and after two years on a pump and almost a full year on the Dex, these little plastic bits finally feel every bit a part of me as my pinkie or elbow.

Which makes going device free, even for just a day, a bizarre luxury. Showers where the loofah can scrub freely? No creative posturing on my beach towel so I don’t have to explain my pump? Rolling onto my side in bed without adjusting for my sensor or pod? These activities have become as foreign to me these days as outer space. With my devices on most of the time, my mind has adjusted to account for them spatially, so that my movements are now subconsciously aware of their locations, and protective. Being free from my plastic bits for a day had an unexpected aura of freedom around it, and it was hard to believe that was my norm for my first 15 years with diabetes. In fact, my biggest pump barrier before I took the plunge was the simple idea of wearing something all the time.  I was the most anti-pump chick around, until one day, I had a switch. And even after I started wearing it, it took getting used to.  I used to take many more pump breaks when I first started on the Pod, and now two years into it, I rarely take it off.

Even though it was a treat to be device free for a day, my control suffered considerably, and I was relieved to put my pump back on the next day. It was surprising to me that I had a difficult time with my control though, considering I had great control for years on MDI – some of my lowest A1c’s ever in fact. It just goes to show me that even when you’ve had diabetes for a long time, you get used to a certain routine and fall into a comfort zone of care that works with your lifestyle.

Either way, I’m so stoked we have options. Just this morning I had a conversation with a woman who was diagnosed with diabetes in 1975 before home glucose monitoring was available. She marveled at my CGM saying “if I’d had that, I never would have had so many problems.” She was the recipient of a full pancreas transplant due to complications from her diabetes, and was near death at the time of her surgery.  When you hear stories like that, you have to admit,  its a pretty good time to have diabetes

Tendon gliding exercises for wrist

Ice my knee for 15 minutes

Take ibuprofen 2x day

Check blood sugar 6x a day, calibrate DexCom each time.

5-10 hip stretches

3 -6 leg strengthening exercises for inner quads and supporting muscles

Calculate insulin levels for new, low impact exercises and decreased food intake due to lower activity

Call insurance company to  ask why the %^& they charged me for my pump supplies….again.

One yoga class or an hour of low impact exercise

Play with “putty” twice a day for 5 minutes to strengthen hand

Carb count anything and everything.

Also remember to go to work and engage in normal life…….

Riiiiiight, about that last bit. Diabetes has always been a full time job for me, so you think I’d be good at remembering all these other little bits and pieces that I now need to do for my body, but the opposite has seemed to be true. I think I’ve gotten a little “dia-spoiled,” maybe feeling like “look, I already have to take care of this stupid disease every second of every day, I can’t possibly be responsible for these other problems!” But the fact of the matter is, chronic disease or not, we can’t help that some of us will deal with other issues – many with issues much more serious than mine. So I gotta suck it up, find a few extra hours in the day and get to work on my diabetes AND my joint issues.

Have any of you readers out there had to manage diabetes AND another health issue at the same time? Did you find you paid more or less attention to your diabetes when it happened? And how did you remember to do everything you need to!?

Type 2 diabetes is STILL on the rise in California, and it’s still hitting minority populations disproportionately. With elections coming up and health care reform already in motion, diabetes is a more pertinant issue than ever. Beyone the lives at stake, diabetes is one of the most expensive issues in America these days – between lost work days and the cost of this disease, it could sink us faster than a double dib recession.

Newly diagnosed with Type 1 diabetes? Then you could be eligible to enroll in a clinical trial studying a medication that might help preserve beta cell function and halt Type 1 in it’s tracks. Click here for the details and sites where you can enroll.

In artificial pancreas news, it looks like MannKind Corporation will be providing their newly formulated, super rapid acting, oral insulin to the project. Check out their press release for details on their contributions to the project, and let’s all begin the countdown until a closed-loop system is available. I know I’m ready.

And if you’d really rather just waste some time today because you’re over it, look no further….

Friday night we made faijtas with low carb tortillas – there’s a few brands that offer tortillas with only 10 grams of carb per serving. I had two tortillas topped with seasoned chicken and veggies, sour cream and cheese (plenty to keep me full) and still only had to bolus 2.2 units for the whole meal. Unfortunately, those went down the hatch so fast that I failed to take a picture.

Saturday we left the house around 10am, but not before loading up the crock pot with seasoned turkey meat and tons of veggies. We arrived home around five that evening to the delightful aroma of turkey chili. Again, a low bolus and a very satisfying meal – boo ya.

Sunday however, was the piece de resistance – and pure heaven for anyone who knows me as the cheese hound I am: fondue. Real, creamy, hot off the stove fondue. Instead of dipping the traditional high-carb bread chunks in there, we used grilled meat and lots of fresh vegetables – some cooked for flavor and others raw for a good crunch. This meal was super low carb, but I had to account for the massive amount of cheese and the fat in  it that would break down more slowly. Instead of bolusing for this one, I raised my basals by 35% for the six hours following the meal, and saw nary a blip in the DexCom all night long. All around diabetes meal perfection and a VERY successful blood sugar weekend, even with all of our activities. I can’t ask for anything better! And that adorable fellow in the photo below certainly helps

Upper limbs first: My hand doctor was disappointed to hear that I still wasn’t at full strength in my right hand, a year plus after carpal tunnel surgery, so he immediately took some x-rays to make sure there wasn’t something weird going on. Upon finding nothing out of the ordinary, he surmised that I had probably lost quite a bit of strength even before I had surgery last year, meaning I was in the hole by the time I went under the knife. He was pleased to hear that I wasn’t struggling with anything day-to-day, like carrying groceries or driving, but more when I did high-impact stuff like push-ups and tricep dips. He prescribed some physical therapy that would focus specifically on building strength instead of mobility like we did right after surgery. And although hand PT isn’t the most exciting activity in the world, sometimes they let you dip your mitt in a hot wax bath, which I’m personally looking forward to!

Moving down this train wreck of a body I have going on here, my knee didn’t seem to concern the doctor so much. I still have a tilted right patella (full name: lateral patellar tracking issues), and the doctor expected this to bug me more when I did high-impact activities like running. The x-rays revealed nothing had changed since last year, so nothing in my regimen (read: ice packs and ibuprofen) needs to change either. That thing is gonna bug me when I run or wear heels a lot. Period, get used to it. I was ok with that, but I was rather unprepared for the reaction my doc had when he began testing my hip to isolate the pain.

I hopped up on the table and as soon as he pushed my right leg to the outside, I winced from the pain in my hip. “Not good” he said, and brow furrowing ensued. He studied the x-ray to ensure there wasn’t a bone fragment catching on the hip socket, which can easily cause that kind of pain. After reviewing the pics and finding nothing though, I fessed up about my nearly eight year martial arts hobby, and he knew immediately that we’d found the culprit. My hip problem: overuse while doing a completely unnatural motion repetitively; namely, roundhouse kicks.

Roundhouse kicks are the most common type of kick used in kickboxing, and the fact that I did competative karate for four years and have been kickboxing since 2007 means I’ve put both my hips through thousands of mega-rotations with every kick. A roundhouse kick involves taking the back leg from a boxing stance and rotating the hip joint to move the leg out to the side, raise it up to head-level, and then kick inward, with the impact being on the top of a flat foot as you strike your target. Long story short, it’s not the gentlest or most natural movement for the human leg, and I’ve been doing it hundreds of times a week for eight years. This hip is simply tired and needs a break.

Which would be no big deal if kickboxing were not my most favorite activity in the universe, but unfortunately it is. I have to take a break and let my hip heal a bit, or I could be in real trouble down the line. Taking a break from my favorite sport reaches an all-time high level of lameness, but it’s what has to happen. My doc also said I need to work on strengthening my inner quads to help protect and strengthen my legs all the way up. This means my kickboxing classes need to be traded for some good old-fashioned weight sessions, with a concentration on those muscles. In addition, I might have to resign myself to some walks/hikes instead of running, and dial back on anything else that could irritate my joints – like wearing heels for work.Finally, I’ve also been prescribed some physical therapy to learn special exercises I can do to strengthen and protect my hip and knee.

All around, I’m not stoked about what the next five weeks look like, exercise-wise. Exercise is my sanity – my time alone to blow off steam and take care of myself. Not to mention to help manage my diabetes – I’m already afraid of what this change in activity level will do to my BGs. But, at the same time, I’m thankful that it’s not more serious and that I have some options here. I don’t want to be confined to a walker by the time I turn 30, so I have preserve what I’ve got right now.  Yoga anyone?

I gulped down the GU and headed for the check out of the store, a thin line of sweat starting to bead on my lip. I  feel like crap, I thought to myself. I pulled out my DexCom and saw the arrow pointing straight down. I told myself to calm down and wait for the GU to kick in.

By the time I walked out of the store, my vision had started to blur and I felt weak in the knees. The drops of persperation on my lip had broken into a full-fledged sweat. I limped to my car and snatched my glucose tablets out of the center console. My hands shook as I twisted open the cap and began shoveling the powdery tablets into my mouth. My head spun, I felt faint, and I had to concentrate on the act of chewing the tablets. I swung my feet out of the car door, dangling them like a Muppet while I forced down the chalky sugar. I felt so shitty I wanted to cry. This was the worst low in a long time.

I moved back into the driver seat, full well knowing that I wasn’t driving anywhere for at least 15 minutes. I cranked the AC as I poured sweat, my body’s reaction to the extreme lack of glucose. Help me! my brain screamed, SUGAR. NOW. it begged. Just wait, I told myself, you’ve had 40 grams of carbohydrate at this point, it will come back up.

And it did come up of course. But not before I had lost almost 30 minutes of my day. Not before I ingested 200 extra calories after a full lunch that I didn’t want. Not before taking me to almost passing out. Not before making me feel like a failure for forgetting the insulin on board from 10am that had caused me to stack my lunch bolus. Not before sucking the life out of me for the rest of the afternoon.

Sometimes, I really hate this disease.

Hey guys! I am so excited today to have Matt Neal guest blogging for me. Matt was diagnosed with Type 1 diabetes last year at the age of 28, just as he was on his way to building a successful BMX bike riding career. But read his story below and you’ll find out that Matt doesn’t let that hold him back – in fact, he’s taken on diabetes management with the same passion he has for BMX riding – and in the process is showing everyone that he won’t let that – or anything else – hold him back! I loved reading his story to learn how someone with an unusual sport manages their diabetes, and I know you guys will enjoy it too. Take it away Matt!

My name is Matt Neal and I have been very active my entire life. I always enjoyed being outside and playing sports when I was a kid. I went to school with a few kids that raced BMX and I enjoyed riding with them after school. I kept bugging my parents to let me start racing with them. Finally, my dad took me out to the BMX track for my 10^th birthday. I was hooked! I loved racing and started taking it more seriously after a couple of years.

I was very fortunate to be able to travel around the country racing different events. I was even more fortunate to experience a great deal of success in the sport that I loved. I was top 10 nationally in my age group for several years and I even got 2^nd at the world cup when I was 18. I turned pro for a few races at the end of my career before hanging my bike up to finish my degree.

Fast-forward about eight or nine years and I got the itch to get back on my bike. I started riding again and went to a couple of national events. I was riding decently for not racing for so long but I was a little off. I didn’t feel like I had the power that I should and I started losing weight, a LOT of weight. I couldn’t gain a pound to save my life and I knew something was wrong.

I completed a health screening at work and my fasting blood glucose was 358 and my fears were confirmed, I had diabetes. I was officially diagnosed Feb. 20, 2009 with Type 1 at the age of 28. Believe it or not, I felt very fortunate to have a manageable disease. I took some time off of my bike again to get a handle on my blood glucose and I knew I wanted to race again. So that’s exactly what I did! I started racing at the beginning of this season. I’ve been doing really well so far. I have two wins in the Arizona State Series and I have won a national main event!

Diabetes adds a whole new challenge to racing BMX. I test my glucose levels a LOT on race days. National races are especially difficult because you don’t know exactly when you are going to race and the races take place all weekend long. They are also challenging because my adrenaline tends to raise my levels. My target level for race time is 150 mg/dL so I always keep my meter, insulin, and carbs close by. I recently started using the Dexcom CGM system. I have raced one national event with it and it was awesome to have the extra data. It helped me to keep my levels stable all weekend long and made it easier for me to be close to my target before all of my events.

The main thing I try to do to optimize my blood glucose at races is to make small adjustments. I try to eat small meals and snacks throughout the day to avoid having big spikes or crashes. It also helps so I don’t have a really full stomach when I need to race. I tend to have a few extra carbs at breakfast to bring my levels up. If I have a tougher race coming up and I know my adrenaline will be kicking in, I will try to get my blood glucose up to about 120 mg/dL because I know that adrenaline will take it up even higher while I’m warming up. If I know that I have a while before I race I will take a small correction to bring my levels back down to 100 mg/dL and then eat something to pick me back up when my next event gets closer.

After the race day is over, I try to have a few extra carbs at dinner to replenish/refuel and make a small correction to bring my levels back down. I make sure not to overcorrect because I tend to run lower the day after as my body is recovering and using up more glucose.

Overall, racing BMX with diabetes has been a good experience. It makes me feel even better when I beat other people who don’t have to manually control their blood glucose all day long. It makes those wins even sweeter!

As I mentioned before, that eye exam conjures so much emotion in me – it’s as if the fears of complications I keep tucked in the back of my mind are unpacked right before that appointment. And although fear can be a powerful motivator, it’s not my weapon of choice.

Kerri Sparling, my personal hero and favorite d-blogger, posted recently about a video that’s circulating “to create awareness about diabetes” for World Diabetes Day. And although I’m all for awareness, I don’t like fear tactics. Threats about losing limbs and sight have always been a reason for me to keep my diabetes in check, but the real motivation for me actually stems from the hope that I can live without any of those issues if I work hard. The difference is the fear of something going wrong versus the hope that nothing will – for me that’s a positive spin I need to put on things to stay motivated. As I’ve said before, if I let the dark rainclouds of fear come creeping in here too often, I feel like giving up. But hope, well hope keeps me happier.

But fear seems to be the weapon of choice for many providers out there. I can’t tell you how many patients I’ve talked to who have been threatened with lopped off limbs or losing their sight by their doctors. And working in the industry, I know waaaaay to many people who don’t take this disease seriously and need a healthy dose of that tough love. I also know firsthand from providers that they have patients who just won’t do what they have to do to stay healthy – fear might be the only option that gets results. But what would the right motivators look like in a perfect world? What would be the ideal way for us to have patients take care of themselves? And is fear appropriate to use when all else fails?

What motivates you guys? Do you use that fear to keep yourself in check? Or does positive thinking help keep you on track. I’d love to hear from any providers out there as well – how and when should fear be leveraged as a compliance tool?

I was carrying a branded bag on my arm containing sales materials, and a gentleman in the parking lot spied it as he and I walked in the same direction.

“How’s the drug business these days?” he asked, clearly knowing that I was a rep.

“Pretty good,” I said. “I have diabetes and I represent diabetes drugs, so it’s important to me!” I said.

“Me too,” he replied.  “How long?”

“I’ve had it since I was 10 years old, so 17 years” I told him.

“Oh so you have the genetic kind. Mine is supposedly related to lifestyle.”

I looked over at him – he was maybe approaching 60 years old, a small belly above his belt and graying hair– a very normal looking baby-boomer type.

“Well I think Type 2 diabetes is more complicated than that.” I said. “I think it’s always a mixture of genes  and lifestyle, in varying degrees depending on the person” I said with a smile. It sounded like he didn’t like being in the “lifestyle induced” category.

“When the doctor told me, I didn’t come back for a year” he said.

This is the part where I got confused – did he mean that he was so pissed at the doctor for telling him he had diabetes that he didn’t come back for a year? Or was it the way the doctor framed it? Or maybe it was neither – maybe he meant he just didn’t want to deal with it and so he took off for a while? I wasn’t sure, and we didn’t really get to finish that conversation -  we had to split off to reach our respective vehicles.

Although I’m not sure what the exact issue was with, the conversation did get me thinking. If perhaps the doctor had blamed him entirely for his diabetes when he was diagnosed, I can see how that would not have left a good impression on the patient. On the other hand, maybe a year ago his health was out of control and he needed the tough love. And if it was option three, his desire to deny it that kept him out , then how could that have been prevented? Maybe an immediate appointment with a CDE? A phone call from the doc? What if he had a lost a year of time in managing his diabetes – and a year’s worth of damage had piled up.

Whatever his reasons, the sad part of this conversation was that it’s all too common. The diagnosis of diabetes often warrants an adverse reaction from patients – understandable – who on earth would want to deal with diabetes? Type 1 or Type 2- they both suck!  In an ideal world, every new patient would get a free trainer, chef, life coach, once-weekly CDE appointments and maybe a shrink to boot. But with the way our healthcare works, patients are lucky if they learn how to test their blood sugar, and healthcare providers are lucky if they even have TIME to show a patient how to do that! It made me so sad to know that this gentleman had lost a year of managing his health. And until our country and the rest of the world start to place a premium on preventative healthcare, that’s exactly how it will remain. It makes me shudder to think about the burden to the world and future generations that diabetes will create.