6 months ago almost to the day, you started this blog. You had just gone to the endo that day and she told you your A1c was 8.0%. You and your doctor had been trying for awhile to get it under 7.0. You were angry. You were tired of it being too high. You were scared what this trend would mean for your future. You decided to make a change. You started this blog. You made a commitment to yourself to do better, to try harder.

3 months went by. You counted, you bolused, you corrected, you treated. You broke bad habits and tried to replace them with good ones. You became well acquainted with your CGM, Gigi. You set goals. You got frustrated, but you kept at it. You went to the endo, nervous to see the results of your hard work, nervous that it wasn’t enough. But it was. Your A1c was 7.2!  You dropped .8 in 3 months! It was the lowest in a long time. You were so happy! You felt accomplished. You did that. You reached your goal and set a new one. Next time, you wanted to be below 7.0.

Another 3 months. You kept up the work you had been doing. Some days and weeks were better than others. Your next appointment approached, May 28th. You were nervous that there wouldn’t be an improvement. Mostly because you had been having what seemed like a lot of highs lately. You prepared yourself for news of a higher A1c.

But you were wrong. You know what it was? 6.7%!! You finally made it into the 6’s!! You couldn’t believe it. “Wait, seriously?!” you said to your doctor. She smiled and congratulated you. You couldn’t even remember the last time it was in the 6’s. This was what you had been working towards for so long. You were beyond excited. A giant smile filled your face. You tweeted the DOC the great news from the exam room, and your excitement and happiness was returned with congratulations. You called your Mom to tell her the news, she was so happy she was practically screaming into the phone. You smiled the whole drive back.

You did that. You had a goal and you accomplished it. It took years and it was hard, but you kept at it. You didn’t give up.

I don’t know when you are reading this. It may be 3 months from now, 9 months later, 2 years in the future. Your A1c may be higher than it was on May 29, 2013. Life happens. Maybe you got burnt out, maybe you got lazy. It’s okay. It happens to everyone. But do you remember how it felt that day you heard your A1c was 6.7? How great and accomplished you felt? You can have that again. You can get back there, I know you can. Stop feeling disappointed in yourself that your A1c went back up. Stop feeling discouraged. Stop saying you are a “bad diabetic” because you are not. And stop rolling your eyes as you read this. We all have set backs, it does not mean that you failed. You did it once and you CAN do it again. I believe in you.

But for right now, remember that great day. Remember what it felt like to accomplish a goal that you work on every single day and have been for over 10 years. Remember the joy you felt as you walked out of the doctor’s office with the knowledge that your hard work paid off. Remember that even when you struggle in the future, and you will struggle, that you can get back to this point.

You did it. You can do it. And you will do it again.

I know you will. Congratulations! I am so proud of you!

Love,
Me

Next goal? 6.5%

The few days before a dentist appointment, you’d think I have perfect dental hygiene. I’m not a regular flosser, but those days leading up to my dentist appointment, I floss twice a day and brush super well. For some reason, I convince myself that these few days of flossing will make up for all the days that I wasn’t as good over the past few months. I know that I won’t be able to get rid of the build up of plaque, but it makes me feel better knowing that at least I was good for the week before my appointment, whether it actually made a difference or not.

I have this same attitude when it comes to my quarterly endocrinology appointment. Even though my endo will be staring at my A1c number, a three month summary of my blood glucose numbers, I convince myself that if I’m really “good” for the week before the appointment, it won’t be as bad if my A1c is higher than I want.

“Yes, well 7.8 isn’t what I was going for, but look at how good my numbers have been the past week!”

So the 7-10 days before my appointment, I am extra vigilant. I test my bg more often. I stop swag (scientific wild ass guess) bolusing and am more accurate in my calculations. I try super hard to remember to pre bolus. And usually my blood sugars a week before my appointment are pretty good. Still not perfect, but typically better than other weeks. Since my doctor usually brings a printout of the past 2 weeks of my blood sugars, I feel better having at least one week of pretty good numbers even though that 1 week really won’t make much of a difference for my A1c. My doctor still sees the trends and helps me to adjust ratios and rates, and I feel like I have something positive to contribute to the conversations.

So the question then becomes, why don’t I pretend every week is the week before an endo appointment? Well I’m trying. It’s hard to maintain that constant level of vigilance. But yes, ideally that is the goal. It’s like the Tim McGraw song, “Live Like You Were Dying” except it should really be “Live Like Tomorrow is Your Endo Appointment.”

So tomorrow I have an appointment with my endo. If you recall, my last appointment was great. A .8 drop in my A1c to the low 7s, the lowest in years. Tomorrow’s appointment? I’m not hopeful. I can tell that it’s going to be higher this time, I’m just hoping it’s not too much higher. And I’ve been on vacation the past 4 days. That week of good blood sugars? Yeah not so good. Lots of spikes and dips and highs that take hours to come down.

So pretty much I’m not looking forward to tomorrow’s appointment at all. I’m nervous, anxious, disappointed, and slightly defeated. But probably most important, I’m still determined.

“Peanut butter?”

“Huh?”

“PB. On on your finger.”

“Ohhh. No, it stands for pre bolus.”

Yes. That’s right. It says PB on my finger, in black permanent marker.

One of my biggest challenges when it comes to my self-management is remembering to bolus before my meals. I either remember halfway through my meal, when I finish, or in a few instances, a half an hour after I’m done. I’ve talked about this in an older post and how pre bolusing feels like I am giving up some of my control. However, I know that if I can remember to give my insulin before I eat, I can drastically cut down on my post meal bg spikes. Sometimes it takes hours for these spikes to return to a normal level. I know that all of this will ultimately help to lower my A1c and hopefully finally get me from being in the 7’s to the 6’s. I know what I have to do, now it’s just remembering to do it.

Clearly that’s easier said than done.

This habit of bolusing midway or after eating is so ingrained that I am truly struggling to remember to pre bolus. I’ve tried to think of a few ways to help remind myself. I don’t really eat at the same time everyday so setting an alarm on my phone wouldn’t really work. Plus, I don’t always have my phone visible while at work. Ultimately I decided to try something different. I would give myself a “cue to action.” A visible reminder of a behavior that I want to change.  I figured if I wrote PB on my finger, I would be sure to see it. After all, I use my hands to eat, how can I miss black bold letters written on my hand?

Well, apparently I can. I’ve had mixed results with this pseudo experiment. I do see the PB written on my hand, unfortunately it’s not at times when I’m about to eat. It’s when I’m sitting at my desk working on my computer. When I’m stuck in traffic driving to and home from work. Or when I’m using my phone. Of the few days that I have written PB, I have remembered to pre bolus for only a few of those meals. A few times I remembered, but wasn’t able to because my bg was low. But there were a couple meals that I still completely forgot. I got so caught up in my conversations and food that the thought completely escaped me.

My conclusion? There is potential. Even though I didn’t remember for all my meals, I still remembered for a few. There was some improvement. Maybe writing on my finger is just not the right cue to action. Maybe I need yellow sticky notes physically put on or around my food. A sticky note on my packet of oatmeal. One on my tupperware container. On my dinner plate. Places where I literally can’t miss them. Kind of like the notes my mom used to write for my lunches in elementary school, only way less exciting:

“Hey Reva, PB! Love, Me”

It’s more work, but in this case, the benefit is definitely worth the extra effort.

This past weekend I had the pleasure of attending the Metro Detroit/Southeast Michigan Chapter JDRF Diabetes Today and Tomorrow Conference. This was significant for a few different reasons:

1. It’s my first JDRF event in…well, years. I’m not sure exactly why this is, but I guess I haven’t really felt the need or desire to go to any events until recently. I donate every year to the JDRF, but it had been a long while since I was at a JDRF sponsored event. Now that I have a little more free time, I wanted to become more involved. And that’s exactly what I plan to do. After meeting people at the conference, I’m looking forward to becoming involved in the local YLC (young leadership committee) of JDRF.

2. Not only was I attending the conference, I was on a panel at it! I was assigned to speak on a panel at the Teen Central, talking about my personal experiences with diabetes to a room full of teenagers. I have to admit, this session was completely eye opening. I was on a panel with 3 other inspiring type 1 diabetics who each had interesting and amazing stories to share. When we started engaging the teenagers, I was shocked at the stories that most of these teens had when it came to the treatment by teachers, substitutes, principles, students, and the like. Substitutes not letting them treat a low or leave to check their blood sugar. Teachers not understanding the urgency of a situation. Principles telling a student to put her pump in her locker even after explaining what it is. Gym teachers making a student keep running even when she said she felt low (testing in the 20s). A coach informing a teen that they could try out for the team but wouldn’t be able to play on it. And the stories went on. They all went on to say how they told their parents, who then called the school and dealt with the situation, but I was so surprised that these instances even happened in the first place. 

Hearing the teen’s stories made me so appreciative for the supportive and understanding environment that I had while I was in school. Maybe I lived in a naive or sheltered diabetes bubble, but I never had situations like the ones being described by the teens at the conference. If I didn’t treat a low in class, it was because I didn’t want to draw attention to myself, not because someone told me I couldn’t. All my restrictions were self-imposed. It truly made me realize how important it is to educate both students and faculty about type 1 diabetes. Even with 504 plans, there still seemed to be some misunderstanding when it came to the needs of the diabetic students.