Category Archives: type 1 diabetes

Shots all around!

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“What can I help you with today?”

The nurse sat across from me, pulling up my medical record on her computer.
“I’m here for my second MMR vaccine, I also was hoping to get my flu shot today,” I responded.
“Great, we can take care of both of those today.” The nurse handed me the vaccine information statements as she ran through the necessary list of questions before administering the vaccine. “We’ll do one in each arm, let’s start with the MMR vaccine (measles, mumps, and rubella). This one will go into the fat on the back of your arm.” 
“Well you won’t have any trouble finding a good spot then”, I thought to myself. I guess there are some benefits to missing my upper body workouts lately. 
I sat sideways in the chair, staring at the closed door. I could feel my heart rate quicken as she cleaned off the area of skin with an alcohol swab. Her cold fingers pinched my arm as I felt the needle penetrate my skin. “Just breathe,” I thought to myself. I felt the sharp pain as she pressed down on the syringe. “It’s almost over,” I repeated to myself. She pulled out the needle and placed a band aid over the site.
One down, one to go.
“I’m going to do the flu shot now. This one goes into the muscle and your arm may become sore. Just take some ibuprofen to help with the pain.” 
I switched around in the chair, bracing myself for what was coming next. I couldn’t watch so instead I focused straight ahead. I held my breath as she pushed the needle in. “Okay, just a few more seconds,” the nurse said. She pressed down and I cringed, shutting my eyes until I was sure the needle was removed. 
“Are you okay?” the nurse asked. She looked at me concerned. “Sorry, that one can be kind of painful.” 
“Yea I’m fine,” I responded as the color returned to my face from holding my breath. 
“That’s the last shot. You won’t need any more today. Are you sure you’re okay?”
I smirked.
“Yea thanks. I actually have type 1 diabetes so you’d think I’d be used to needles by now, but I still hate them. And unfortunately that won’t be my last needle today…”
The nurse gave me a sympathetic smile. I smiled in return and thanked her as I headed out the door. 
In one year I figured out that my skin gets punctured by around 1,600 needles. Over the 13 years that I’ve lived with diabetes that’s over 20,000 needles that I’ve dealt with! You’d think that 2 shots at the doctor wouldn’t bother me at all…if only that were true.

Sleep walking has nothing on Low walking

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BEEEEEP BEEEEEEP BEEEEEEEP

That incessant beeping. Make it stop!!

I rolled over. I could see the “LOW Under 55” flashing on Gig’s screen (my CGM). As I slowly started to come out of my sleepy state, I could feel the symptoms of my low becoming increasingly stronger. I felt around on my night stand for a pack of fruit snacks, knocking my water bottle and kleenex box on the floor in the process. I ripped the packet open, pouring the contents in my mouth still half asleep. What time is it? 3:34 am, great. I laid there chewing my fruit snacks when all the sudden I got this sudden craving for something crunchy.

I don’t have a ton of these type of lows, but there are some where I just become ravenously hungry. It wouldn’t matter if I just ate an entire Thanksgiving meal, these types of lows make it feel like I haven’t eaten in days. It was exactly what I was experiencing.

i'm hungry gif

I wanted an apple. I had to have it. I rolled out of bed. Disoriented from the low and from still being half asleep, I lumbered towards the door, running into my chair and tripping over the clothes on the floor. I felt like a zombie being compelled by a carnal need. Fooooooood. Must have fooooood.

I knew this low was bad. There are very few that get me out of bed and downstairs to the kitchen in the middle of the night. Now this is where low blood sugars can be dangerous for another reason. You literally want to eat everything in sight. And no, not just sugary foods, everything.

image

I stood in front of the open fridge. Where do I start?!

This is about the time where “Rational Reva” must have woken up and decided to join in.

“Woah woah woah. Put back that tub of ice cream. You can’t eat that whole thing. Do you know how many calories are in that?! Seriously.”

Ughhh fine. I took out a container of cut up watermelon. Binge eating watermelon is fine right?! After about the 10th piece I started to look around the kitchen for something else. Jackpot. I found a small baggie of Chicago mix popcorn- cheddar and carmel flavor. Before I knew it, the bag was empty. Maybe a few wheat thins. Ooooo junior mints, there’s a box in the freezer!

Rational Reva chimed in again. “You are going to feel sick. Do you realize what you just ate?? Cheese popcorn, watermelon and chocolate. Gross. AND you totally just ate way more carbs than you needed. You really should give some more insulin for all this food.”

Yea, yea. I took out my pump and bolused some amount of insulin and headed back upstairs to sleep. My stomach started grumbling, clearly it had enjoyed my super snack session less than I had. I somehow managed to fall back to sleep.

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BUZZZZZ BUZZZZZ BUZZZZZZ

I awoke to the lovely buzzing of a high blood sugar. I picked up my CGM and saw a large spike in my blood sugar from my kitchen escapades hours earlier. So it wasn’t a dream. Well I guess that would explain the orange cheesy finger smears on my t-shirt. Maybe next time I should just stick with the apple.

Changing Life’s Lancet

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I’ve decided to start a new series of posts: Life Lessons Inspired by Diabetes (still working on a better title). I’m not entirely sure how these posts will pan out, but my plan is to take something related to my diabetes and derive a lesson that can be applied more generally. It’s more than what my diabetes has taught me, it’s the hidden lessons we can all learn from an unlikely source. So here goes the first one:

Ask most type 1 diabetics when the last time they changed their lancet was. For a lot of people, myself included, it could be over a month (possibly a few) since we last changed the needle used to prick our fingers. Why is that? That’s a good question.

I think for me, I get into a routine. Poking my finger becomes automatic, and changing the lancet becomes another step, one that I don’t typically think about. But consider this: the more you use a needle, the duller it becomes. And when it comes to needles, dull needles are actually more painful than sharp ones. So really it is in our best interest to switch things up, to replace an old dull needle with a new, sharp one. Yes it takes a little more effort and conscious thought, but in the end, it’s to your benefit.

Get rid of the dull.

Everyone has their routines. Routines can be comforting. They let you know what to expect so that you aren’t caught off guard or in an uncomfortable situation. They bring familiarity, safety, and peace of mind. But routines can get old. They can become boring. You can become stuck in your patterns and rituals and forget to step outside of the safe and familiar to try something new and different.

Leaving your comfort zone takes effort and thought. It’s not always easy to do. But like switching to a sharp needle, taking risks can introduce unforeseen benefits to your life. It opens you up to new possibilities and experiences. It teaches you new things. It enriches your life in ways that you can’t imagine, and it helps you grow as a person.

I’m not saying that all routines are bad, but take a moment to think about the areas in your life where the needle is starting to become dull. Maybe it’s time to change life’s lancet. I think you’ll be glad you did.

Strip Safely & Diabetes Art Day: Strip Tease

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Diabetes Art Day has collaborated with the Strip Safely initiative to raise awareness about the issue of test strip accuracy. As stated on the website, “The goal is to collect a body of images that capture the emotional experience of relying on inaccurate test strips to make decisions about food, activity and medication that affect our immediate and long term health outcomes.”While the campaign urges people to send letters and use social media to get the message out, Lee Ann, the person behind Diabetes Art Day, recognizes that printed letters just does not capture and convey the emotion the way visual art can.
Inaccurate test strips is a huge problem, putting diabetic’s health and wellbeing at risk. We need more stringent accuracy requirements and the proper process to remove those that don’t meet this standard. It’s an issue that people need to know about. This edition of Diabetes Art Day is working to do just that, to bring awareness to this important issue so that action may be taken to ensure test strips and meters meet regulatory requirements.
My artwork for this Diabetes Art Day plays off the words, “Strip Tease”. While there is some humor involved, it points to the important issue of using test strips that are safe and accurate rather than those that may be deceiving and therefore harmful.

You can check out the gallery of images for this special Strip Safely Diabetes Art Day here.

Runner’s High, Blood Sugar’s Low

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I’m not a runner.
I mean I can run, but it is just not my preferred form of exercise. I much rather do circuits, play tennis, go for a bike ride, use the elliptical or even just go for a walk. But I’ve secretly always envied runners, how easy and effortless they make it look and the sense of freedom that comes along with running. I’ve always wanted that “runner’s high”, that feeling of euphoria but also tranquility that one gets from running.
Running for me has always been a challenge. My face turns beet red, my shins start to hurt, and even though I know I’m in pretty good shape from the other exercise I do, I still look like I’m struggling with every step. It’s not a pretty sight.
This past weekend though, I decided that I wanted, well maybe needed, to go for a run. It was a beautiful evening, absolutely perfect weather. I just couldn’t stand the idea of working out inside when it was so beautiful outside. Besides that, I had a lot on my mind and just wanted to do something that would either help me clear it or help me work through it. Running laps around a nearby park seemed like the perfect activity. 
I loaded up my car and headed to the recreational park. There were plenty of people there: families at the playground, people playing tennis, and other walkers and runners. I started to get nervous. I don’t like to run in public, usually I just run on the treadmill in my basement. 
I had checked my blood sugar before I started. It was 89, knowing this was too low to start exercising, I had eaten a pack of fruit snacks. I pulled out everything that I would need to have with me on my run: 2 packets of fruit snacks in case I dropped low, my CGM, my car keys, and my phone. My pants (like the majority of women’s athletic apparel) did not have pockets. Anticipating this, I brought a runner’s pack, essentially a fanny pack, that clipped around my waist. I stuffed everything inside and clipped it around me. Again I started to feel slightly self-conscious, I wished that I didn’t need to carry all of those supplies with me. 
I started toward the path, turning up my music. I began walking and gradually picked up the pace to a steady jog. However, the runners pack wouldn’t rest on my hips and instead kept bouncing up, becoming more distracting and uncomfortable. I alternated between trying to reposition it so it would stay and trying to keep my ear buds from falling out of my ears. I could feel my face turning red already. I jogged passed a group of older men sitting on lawn chairs, facing the path. They’re probably thinking how ridiculous I look right now. I kept my head down and jogged past without looking at their faces. I hope they aren’t watching me. Pretty soon I approached a woman walking. She must have heard me coming because she moved over to let me by. At the pace that I was jogging, it took some time for me to actually pass her. She must think I’m so slow. I eventually passed her, still fussing with the pack around my waist. 
I was finishing my first lap. My shins hurt, I was starting to get a cramp, and I was still feeling out of sorts. My running app alerted me that I had completed my first mile. I knew I couldn’t stop. I hadn’t come this far to quit now. 

I passed those same men, and the walker again. Then I saw an older gentleman approaching from the opposite direction. He was walking, his arms swinging rapidly. He looked determined. We exchanged smiles. But in that moment, I realized it wasn’t just smiles that we exchanged. It was a recognition that we were both out on this beautiful summer evening, exercising to the very best of our abilities. For him it meant walking, for me, jogging at the steady pace I was going. We didn’t need to be marathon runners to enjoy the benefits of the exercise we were doing. All that mattered is that we were outside, doing the best that we could and enjoying our time. I realized that’s what everyone was doing at the park that evening. The men sitting together in their folding chairs were enjoying each other’s company, the families at the playground were enjoying quality time with their children, and the other walkers were enjoying their evening strolls. They weren’t paying attention to me, no more than I was paying attention to them. It didn’t matter to them that I was wearing a runners pack, or that I may not have had perfect running form. And even if they did notice, who cares?! The realization freed me from my own insecurities and I instead focused on putting one foot in front of the other and finishing what I came there to do. 
Lap 3 and lap 4 were much more enjoyable and after 30 minutes, I slowed to a walk to finish up my workout. Though my shins were aching, I was proud of myself for pushing through, physically and mentally. Next time I’ll go a little longer and further, but for that night, I was happy with my progress. I got back into my car, checking my CGM. 80, not too bad. As I pulled into my driveway, I started to feel the symptoms of a low. Sure enough, I tested my finger and saw the 52 flash on the screen. 
Well,  I guess the runner’s high came with a subsequent low. But I know that even a low won’t stop me the next time I decide to go for a run.

Medical Alert

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“Is that a medical alert on your wrist?”

The question caught me off guard. I was at the counter at the bank and reached to grab my receipt. The teller was looking at my wrist.

You’d think this would be a common question. I’ve been wearing a medical alert for years now, but this was first time in quite some time that someone had noticed and asked about it.

“Oh, yea it is. It’s a piece of metal that you can fold around any watch band.”

“That’s so cool! Where’d you get it?”


I told her that I got it awhile ago online, and thanked her. I left wondering if perhaps she was diabetic too.

These days I wear my medical alert every day. Despite having a pump, which to me would be a sure sign that I’m diabetic, I know that it’s still important to wear an alert in case of an emergency situation. But while it’s important to alert an EMT, I don’t always want to alert every single person I come in contact with. A medical alert bracelet is an identifier. It says something about you: you  have a serious medical condition. While my alert does say diabetic, you may not see that at first glance. Instead, a person who sees it just knows that I have some kind of medical condition serious enough to need to wear an alert. There’s nothing wrong with wearing some kind of identifier. I do it all the time. Sometimes I wear a Jewish star, other times I wear a Michigan sweatshirt, or a Detroit Tigers t-shirt. These all tell you something about me: my religion, where I went to school, where I’m from. But those are identifiers that I choose to wear, that I want to show others. I don’t necessarily view my medical alert bracelet the same way, to me wearing it isn’t a choice, it’s a necessity.

I’ve gone through a few different medical alerts over the years, and went a few years without one. It’s been kind of like Goldilocks, trying different styles and options until one was just right.

I was allergic to my first medical alert bracelet. Ironic, right? My parents got it for me after I was diagnosed. My mom picked out a delicate sterling silver bracelet with the medical alert plate that was engraved with type 1 diabetes on one side and my name on the other. But after starting to wear it,  I began to develop a rash on my wrist where it was. Whether the bracelet actually gave me a rash or I just started scratching where it was, creating the rash, I’m not sure. But from that point on, I refused to wear it. After that one, I switched to a blue neoprene bracelet and wore that one until it started to fray. There were a few different bracelets after that, but those didn’t last too long either. And there was a brief time when I didn’t want to wear one at all.

I finally found one that worked for me, one that attached to my watch that I already wear every day, instead of being an added accessory. If you aren’t looking, you don’t see it, but it’s there in case of an emergency. While the red may have faded, it still reads “Diabetic Insulin Pump.”

That piece of metal has been on a few different watches over the years, but it’s always on me.  I forget that it’s even there. But while I might forget that I’m wearing a medical alert, it’s pretty hard to forget that I have diabetes.

Here’s the website where I got mine, they are called The MediBand and have a few different options you can choose from. It comes with a silver and gold band.
http://www.id-technology.com/

Potluck Problems and Personal Responsibility

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This past week, my work had a potluck. I love potlucks, but I always struggle with what to bring. I attended another potluck the week before, this time with friends. For that potluck, I decided to bring red quinoa with roasted beets, raspberries, and pistachios. While I thought it was delicious, I still ended up going home with a ton of leftovers. So for the second potluck, I wanted to make something that I knew would be a hit. I decided to make Oreo mini cheesecakes. Basically you put a full Oreo in the bottom of a cupcake holder and pour the cheesecake mixture on top, bake it, then let it sit overnight in the refrigerator.

When I brought my dessert to the potluck, everyone was really excited and the cheesecakes were going quickly. As we sat around the table, a coworker, about to take her first bite, turned to me and jokingly said, “So Reva, are you increasing our risk for diabetes with these?”

All eyes turned to me, “Um well, indirectly, yes,” I stammered out. There may have been some chuckles as everyone went back to eating the dessert, but I haven’t been able to stop thinking about this comment since. Not because I was offended at all, but because it really made me stop and think. I’ll start with the way the question itself was phrased. 

My coworker is incredibly smart, she also has her MPH, she knows about diabetes and she knows that I do too. Had she said to me, “Reva, are these going to give us diabetes?” or “Reva, are we going to have diabetes when we all finish these?” I would have easily said, No. That’s because although my dessert is well, a dessert and not healthy, eating it does not cause diabetes, definitely not type 1, but not type 2 either. But my coworker didn’t phrase it like that, she said, “is this going to increase our risk for diabetes?” For that answer, it depends on how you look at things and how much responsibility you as an individual want to take for the health of others.

Eating too many unhealthy desserts like my Oreo cheesecake can cause a person to gain weight. On the American Diabetes Association’s website, obesity and being overweight is listed as a risk factor and does increase your chances of developing type 2 diabetes. So with that in mind, you could argue that a person eating my dessert is indirectly increasing their risk of type 2 diabetes. But that’s putting a lot of responsibility on me and not taking into account the decision and free will of the other person. Yes, I am increasing access to an unhealthy food option, but I am not forcing you to eat. It is still your choice if you are going to eat 1, 3, half of one, or none at all. More than that, I have no control over what you do when you get home. Maybe you went to the gym and burned off that cheesecake, maybe you stopped at McDonalds on the way home. So am I really increasing your risk after all?

I found myself contemplating my sense of responsibility when it comes to the health of others. I know I do feel a greater sense of personal responsibility just because of the fact that I am in the field of public health. Perhaps I should have brought a fruit salad like I was first considering to the potluck instead of a dessert. Or if I made the dessert, perhaps I should have used low fat and fat free ingredients or sugar substitutes. But on the other hand, I also want to be able to bring whatever I feel like to a potluck without feeling guilty even if I personally don’t always enjoy the fruit (or cheesecakes) of my labor.

What is our responsibility when it comes to the health of those around us, whether as diabetics, health care professionals, or just as a fellow human beings? It’s a good question, and one that I think everyone needs to figure out for themselves.

Oh and here’s the recipe because they really were delicious! 😉
 Martha Stewart Oreo Cheesecake Cupcakes
What You Need:
 21 cream-filled sandwich cookies, such as Oreos, 15 left whole, and 6 coarsely chopped
1 pound (16 ounces) cream cheese, room temperature
1/2 cup sugar
1/2 tsp vanilla extract
2 large eggs, room temperature, lightly beaten
1/2 cup sour cream
Small pinch of salt
What You Need to Do:
1. Preheat oven to 275 degrees F. Line standard muffin tins with paper liners. Place 1 whole cookie in the bottom of each lined cup.
2. With an electric mixer on medium high speed, beat cream cheese until smooth, scraping down sides of bowl as needed. Gradually add sugar, and beat until combined. Beat in vanilla.
3. Drizzle in eggs, a bit at a time, beating to combine and scraping down the sides of the bowl as needed. Beat in sour cream and salt. Stir in chopped cookies by hand.
4. Divide batter evenly among cookie-lined cups, filling each almost to the top. Bake, rotating pan halfway through, until filling is set, about 22 minutes. Transfer to wire racks to cool completely. Refrigerate at least 4 hours (or up to overnight). Remove from tins just before serving.
5. Enjoy!

Frustrations

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I haven’t been able to formulate much of a blog post lately, my apologies. So instead, I decided to take the diabetes related happenings in my life during the past week and summarize them into two lists: the Diabetes Frustrations and the Diabetes Triumphs:

Diabetes Frustrations

  • For the past week or two, I’ve noticed that my blood sugar has been sky rocketing after I eat even though I haven’t changed my carb counting or insulin dosing. Basically I’m not doing anything different from what I have been doing, but my bg numbers are going crazy! Pretty much every time I pick up my CGM, my reaction is WTF! I just don’t understand it. On top of that, I keep waking up in the middle of the night in the 300’s and feeling sick. I’ve been going to sleep at a perfectly fine number and still wake up high in the middle of the night. Not sure what’s going on, but it’s becoming incredibly frustrating.
Grumpy Cat seemed fitting
  •  On a related note, why is it that I never fail to hear my CGM go off in the middle of the night when my alarm is set at 180 and I’m at 186, but when I’ve been over 300 for hours….silence?! 
  • A couple of days ago, I had exactly enough time to workout, shower, change, and then leave so that I wouldn’t be late for a dinner party. But of course I had to have a low (35) after my workout that threw everything off. My lows have the best timing! With no time to spare and now running behind, I ended up taking my gatorade in the shower to make sure that my bg would start going back up. Seemed like a good idea at the time…
  • At said dinner party, someone made this lovely comment in reference to the desserts, “I’m going to have diabetes when I finish this all.” ARGH! I kept my mouth shut, I just didn’t feel like getting into it. My friend standing next to me looked right at me when he said it. She knows and understands how much I hate that statement. Glad someone does!
  • While playing with my dog on my bed, I scooted backwards on my stomach and an infusion set that had been in for less than 24 hours fell completely off. Love when that happens. 
  • I got a letter from my endo’s office saying that my appointment date and time had changed as well as my doctor. Confused, I called to see why I had a different doctor listed. Turns out that the endo I’ve been seeing for the past few years decided to stop seeing patients! Grrrrrrr, thanks for the heads up! Of course this has to come right after the best A1c I’ve had in years. Unfortunately with all the extended highs I’ve had lately, I know my A1c is going to jump way back up. I’m pissed that my first appointment with a new doctor that I now have to find has to be an appointment where my A1c is going to be much higher than I want and not reflective of the hard work I had been doing.
  • I decided to sleep in on my day off after staying up late the night before. However, I was woken up by my mom who was concerned that something was wrong. She thought that I may have passed out, because I wasn’t awake before 10. No Mom, I’m not unconscious, I’m just sleeping. But, I do appreciate the concern, and thanks for checking.
  • CGM, stop with the “???”! It’s not helpful and I don’t know why you are confused!! 
  • And to top it all off, last night my CGM sensor, which had been in for only 1 day, came off in my sleep. It was in a new place and I guess all the tossing and turning knocked it off. Lovely.
Diabetes Triumphs

  • Finally remembered to change my lancet.
Ugh, it’s just been one of those weeks…
Thanks for letting me vent. But since it’s Wisdom Wednesday

Wisdom Wednesday: Blessings and Lessons

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When people come in and out of your life, it’s often useful to think that there is a purpose for why you met them. I love the musical Wicked, and there’s a part in one of the songs, For Good, that has always struck me:
I’ve heard it said
That people come into our lives for a reason
Bringing something we must learn
And we are led
To those who help us most to grow
If we let them
And we help them in return
Well, I don’t know if I believe that’s true
But I know I’m who I am today
Because I knew you

To me, finding the DOC has been a blessing, whether I ever actually meet the people I read about and talk to in person or not. 


So here’s the quote for today:

I call myself a T1D. Do you call yourself a doctor?

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The past week has been filled with some awful doctor’s appointments, and for once, it has had nothing to do with my diabetes. It’s just been a combination of poor, careless, rude, and inept care as well as well feeling like I’ve been mislead and deceived. All of this has resulted in unnecessary pain, both physical and emotional and let’s just say I’ve about had it.

But while the doctor’s appointments were not directly about my diabetes, inevitably, it always comes up. Today’s encounter with the doctor was made even worse by the following conversation.

Doc: Do you take any medications?

Me: Yes I use humalog insulin, I have type 1 diabetes.

Doc: Do you have any complications with your kidneys, eyes, ulcers, nerve damage, etc?

Me: No I don’t.

Doc: About how much insulin do you use a day?

Me: Well, I have a pump, but somewhere between 40-50 units a day.

Doc: And you called yourself a type 1 diabetic?

Um seriously?! I’m sorry, I don’t know if you meant to frame the question like that, but I don’t “call myself” a type 1 diabetic as if I have a choice or am choosing that label, that was the diagnosis that I was given 13 years ago. That is the disease that I live with and manage every day. I was not given a choice of what I “call myself” as if I could choose something else. I don’t call myself a type 1 diabetic, I am a type 1 diabetic.

Me: Yes, I have type 1 diabetes.

He went on to ask a series of other questions related to the purpose of my visit, moving away from the topic of my diabetes. Then out of the blue, he asks, “and you don’t have any damage to your kidneys?”

Excuse me sir!!! You already asked me about complications and I already gave you an answer!! Were you not listening to me? Do you not believe that someone with diabetes can not have kidney damage, is that why you are asking me twice? Maybe that’s what you learned way back when you were in medical school (yes, I’m calling you old), but it is possible to be without complications.

I couldn’t believe this doctor. I could quite possibly be overacting. But seriously, how hard is it to take 3 seconds and think about how the questions you ask and the way you phrase it can affect a person?! The appointment went on to really become the visit from hell for a plethora of other reasons. Blood was lost, tears were shed, and curse words were muttered silently.

Today is wisdom wednesday, and so I feel that I should end this post with a quote that will help me put this stressful and upsetting day behind me and to start fresh again tomorrow. Here’s hoping tomorrow will be better than today.