Friday, November 27, 2009

New Set Nervousness

The time recently came to order new pump supplies. It turns out this was actually my first time re-ordering Minimed supplies, since switching back to the company on the hinges of Cozmo's discontinuation earlier this year. I returned to my initial pump company, which I never had an issue with and regretted leaving for Deltec every single day until the time came to happily go back. My mom, who I inspired to start pump therapy after I'd started in mid-2001, always said I was a poster boy for Minimed. Anyhow, after being on Cozmo for about two years, I once again found myself getting used to the Paradigm supplies and online store options. My initial switch back brought an initial round of new sites and reserviors, and that's what I'd been on for a few months - in addition to some older "expired" sets that I'd still had leftover from 2007. I used those to hold off on getting new supplies, but finally decided to make the plunge.

So, I went online and made the order.

About a week later, the box of new supplies arrived. I found the UPS brown box on my porchstep when returning home from work one day. Taking it inside, I excitedly pried it open and first found my new reservoirs - the larger 3.0s, rather than the shorter 1.8 ones that meant about three more days of insulin inside. That was a happy bonus.

However, I soon discovered that instead of ordering the Silouettes that I'd been using recently and had used my entire previous run on Minimed, I had placed an order for the 90-degree Quick-Sets. I was confused, and somewhat baffled by my mistake. I confirmed it online, and realized that I had a box. But because they were on "short supply" Minimed had only sent a single box rather than the 3 placed. That might actually work in my favor, as I can call and explain my mistake and request the other two boxes be the more-familiar sets I really wanted.

Anyhow, I am testing this newer Quick Set option. I'm not that thrilled about it. I've read posts and message boards about kinking canulas, about that pending fear of the straight-in clicking. I have put it in, and am nervous but hopeful. I can't view the cannula as with other sets. We'll see how it goes.

My huge Thanksgiving meal finally caught up with my this evening, bumping me up to about 205 after a great dinner-time test. I've corrected, and since I've got three more days off before heading back to work, I will likely stay up for a couple more hours to test at 3 a.m. Hope it does the job, at least until my Silouettes get back my way.

Tuesday, November 24, 2009

Adjusting to a Diabetic Life

I'm steaming mad after reading a story in the Philadelphia Inquirer.. Here it is.

Basically, this 15-year-old kid is trying to take care of his diabetes and have the best results possible. Great. Good for him. Apparently, he has some issue with higher morning spikes in the morning post-breakfast and uses his gym class days (which fall on 2 of the 6 school days) to help keep them down. Great. Good job on that. However, on those NON-gym days, rather than ADJUSTING his own routine or schedules to accomodate reading class, he would rather skip those basic skills' courses and have his own gym class, since he's diabetic.

His parents are battling the school district, which has bent over backwards to accomodate this kid but doesn't see the merit in singling him out and offering him his own gym class, while everyone else is in reading class.

UPDATE FROM NOVEMBER 2009: School district caves and allows this nonsense.
These whiners need to be schooled. It's called adjusting the kid's breakfast intake, or even his basal or bolus rate based on the life routine. How in the hell is this kid ever going to go on to a real life - college, real job, etc. - when he can't adjust to this simple little thing??

When I was diagnosed at age 5, my mom fought the world to make sure I was adequately cared for. This was back in the mid-80s, when diabetes care wasn't what it is today. She fought to make sure I was cared for, but also that I wasn't unnecessarily singled out from the other kids - even though there was an obvious difference like a huge elephant in the room. But I could eat some crackers or do what was needed to adjust, ACCORDING TO THE SCHOOL ROUTINE I HAD. Not once did she make the school change its routine to accomodate me, if there was another way to do it.

Just what we need this family to do: single out diabetics who need even more special treatment than we already have. Kids who already feel different and outcast don't need another reason to feel different, and this family is too damn stupid and caught with their heads up their own behinds to realize the significance of their arrogance.

I'm hoping that this blog ranting will calm me down to the point where I'm not itching to find their address and telephone number and scream at them, by voice or in writing. These people are morons, and I hope other diabetic kids and families don't take their ass-backwards lead.

Monday, November 23, 2009

Progress: A Diabetic's Distinctive Mark Alone...

There's a great quote from Elizabeth Barrett Browning, who wrote: "Progress, Man's distinctive mark alone. Not God's, Not the Beast's. God is, They are. Man partly is, and wholly hopes to be."

In my continued push for better diabetic control, I take that quote and adapt it for the progressive any diabetic always seeks in their own care. A week ago, I visited my endo and she wasn't happy with my lack of testing and care. My A1C was higher than it should be, and we vowed to work together and get it under control.

Today my first week's progress, and here's my progress report.

During the past seven days, I've made a consistent effort to do my best in monitoring and controlling my diabetes, and I have a pump history and full handwritten sheet of test results to prove it - at least six a day (depending on work day or weekend, when morning wake times vary). While I've had a few tests higher than 250, the majority have been in normal range and there's only been a handful to fall in the lower-than-wanted range. All but one or two of those higher ones can be attributed to inaccurate bolus dosing or a pump snafu, while the lowers appear to be basal rates that are slightly off. We learn, and tweak, and move on toward that progress.

It seems that the best motivation I have to keep up testing and monitoring is writing every result down on a sheet, so that I can see it and challenge myself to keep the tests lower. Without this step, I lose interest. It falls to the back of my mind. So, this is key. Not the technological advances or computer software with charts and graphs, but a pencil and paper. Old school basics of logging. It works for me.

We will never have the control of a Person W/O Diabetes, but we will also never be without the proper tools to manage this disease. For that, I am a Type 1 living in the 21st Century and I'm thankful for the progress I can make with the tools I've got at my disposal.

Hopefully, this continued effort will lead to lower averages and a drop in my next A1C, expected in mid-December. Here's to keeping it up through this entire week, which is shorter thanks to the holiday and likely to result in more out-of-the-ordinary food eating that will require extra care. I am confident it can happen, as we only have that progress to measure our ultimate success in getting through this never-ending D-Life.

Monday, November 16, 2009

Unhappy Endo

The inevitable happened today, and now I'm on the road to starting anew what should have been happening all along.

With a morning visit to my trusted endo Dr. P, I went from being a 30-year-old in control to what felt like a 5-year old being punished and having to sit in a corner and take his medicine (no pun intended). My semi-regular visit to her office wasn't a pleasure for either of us, as the expected unhappiness about my diabetes care boiled to the surface. I knew it was coming, but even as the past week went by, it was as if I was stuck in an orbit and being sucked toward the inevitable.

It began with the nurse-assistant lady, who did the basics such as measuring, weighing, blood pressure and initial blood testing. She observed that I'd lost a few pounds, likely a combined result of eating less in recent months but also lack of adequate D-care. No, this wasn't a goal of mine. She pricked my finger, and took a reading of 270 mh/dL - this was fasting, she asked in wonder??? I replied it was, not elaborating and already lowering my head in shame.

She left, and within a few minutes Dr. P appeared. She shut the door. I got a look - one of those expected looks, which can only mean a lecture is on the way. As she spoke, I sat speechless with my head hung low, trying to avoid eye contact, nodding compliantly as she scolded me for not taking better care of myself. Despite my A1C dropping slight, she correctly pointed out that it's still WAY TOO HIGH at 8.8. She let me know her frustration about not only that number, but also my lack of faxing her weekly results and the lack of overall care in the past months.

For reference, my quarter century of diabetes has had A1C tests ranging from the high teens (in my teen years) to a wonderful 6.7 in the initial months of pump therapy at the end of college. But the past years have ranged between 8-10 and it's been a work in progress trying to lower them. Dr. P has tried her best, but I do make things difficult.

My last visit was in August, about the time of a costly trip to the local hospital ER that came after a low-while-driving afternoon incident. Luckily, no one was injured as my blood sugar dropped behind the wheel and I ended up parked in a roadside ditch in front of my subdivision, as the paramedics arrived and strapped me down and carted me away. At that point Dr. P and I established better control was needed, and that it would happen once my new insurance kicked in Sept. 1.

That was then. Now, it's mid-November and we are where we are - that progress hasn't materialized.

Why, Dr. P demanded to know.

I didn't have any answer, but knew it's largely laziness on my part. More significantly, though, It's a result of the overwhelming sense of frustration and fear that's been a common companion in my 25 years of D-Life. That fear of running low, not being in control and possibly hurting myself, those I love, or just those who happen to cross my path. It's a fear that many of us insulin-dependent D-Lifers know well, and it can be crippling.

That universal question came back to haunt me again, bringing me to ponder what's better: Immediate Impact of Safe Sleeping and Living v. Unseen Future Possibility of Complications? Despite all the efforts to be in control and have good blood sugar levels, do we risk losing control and possibly cause something bad to happen now, or do we sidestep that for the safety and risk a future POSSIBILITY of complications? Nothing is certain, except maybe that more-immediate safety.

It's obvious now that the latter became my choice, following the August driving incident and subsequent ER visit that threw my game off. Everytime I see the high hospital bill or think about driving it comes back. I don't feel in control, and that scares the hell out of me. We can turn to humor and laugh or tell creative stories about these situations, which can seem insane and crazy to those not living in this D-World, but these moments mark us and sometimes can scar us... It's a constant battle, one that I try to mask and avoid if only not to bring people down.

But with the help of my supportive and loving wife (who isn't an alien) and the care of Dr. P, I can conquer this fear. It's necessary to get things back under control. It means: More testing. Writing the results down so that I can see them. Faxing those results. Basal testing. Carb counting and bolus dosages. The whole banana and peel.

If not, Dr. P. warns me the dangers of future complications will likely become a reality - they already are. Beginning signs are already present: protein in the urine, a little neurapathy that's more a nuisance than anything, some retinopathy found by the eye doc, and even a little heart concern more recently. None of this is good, and it must serve as motivation for better control.

I agree, as I have before, but this time I'm paying more attention to Dr. P's words and hope that my wife and thoughts of a future family can conquer that overwhelming fear. I've triumphed before, and I can do it again. That hope outweighs it all, even the fear about what can happen when sugars drop too low as I push for tight control. At least I have the tools in my arsenel to manage and keep them in range.

After the 8:30 a.m. endo visit, I've already started. The higher morning sugar of 270 mh/DL at her office had dropped within a couple hours to 45, throwing off my morning work schedule. I corrected it within a half hour to get to 120, and a couple regular Old Fashioned Dunkin Donuts with my morning coffee and correct carb counting kept me on target for a 1 p.m. lunchtime reading of 176 mg/dL - I'll take it. Free lunch followed, as a lunchtime meeting produced lunch meat and salad combos in the breakroom (without bread, but it was still something for the stomach).

Now, I look ahead: Results due by fax to Dr. P. on Thursday. Then, the weekend. Writing all results down, and faxing again each week. Our next visit is set for mid-December, just before Christmas, and another is set for early March. The goal: get the A1c level down, hopefully to at least 7.8 by that first visit of 2010.

Saturday, November 14, 2009

Worth the cost

Sometimes, you just need to say to heck with it.....

And disregard teh better judgement of your quarter-century of diabetes management and meal planning.

Instead, you turn to the Almighty O-R-E-O...

In the absence of a good relaxing red wine in the house, I opted for some heavenly Cookies & Milk to feed the fix after a long day and week. A day that brought in hefty paychecks but saw most of them doled out in a single day to pay off bills, buy groceries, and put toward expenses.

So, I caved at the midnight hour of Nov. 14 -a day in which we welcomed World Diabetes Day 2009. I then proceeded to stay up and watch the three-hours of DVR-ed Friday night shows - Smallvile, Stargate Universe, and Law & Order.

The cost: 5.5 carbs (4 cookies, cup of milk), 5.5 units. And a little more needed sleep on a sunny Saturday.

Well worth it.

Thursday, November 12, 2009

Pets & Diabetic Owners (A borrowed topic)

Here's a great topic borrowed from Scott Strumello's blog. Worth a personalized version on my virtual Corner Booth, I think.

Please let me introduce, Riley and Shadow. The pets who live in the Hoskins Household and, aside from their playful pet demeanors, are also keenly aware that part of their duties include being alert to diabetic issues.

On his blog today, a repost from one a couple years ago, Scott writes about how dogs can be trained to detect low blood sugars and diabetic disasters, and while cats aren't always trained as much or the same way, some (such as Kerri's cats and Phyllis) do have that diabetic-sense about them. Sadly, Shadow doesn't appear to have that sense and doesn't care too much about anything diabetes-related. Though she sometimes does like to play with pump tubing, if dangled in front of her.

Riley's a different story, though. She certaintly doesn't like the smell of insulin, as she's gotten a nose-full during a recent pump refill, and there's little liklihood that she understands the problems associated with jumping and pawing at pump sites.

Still, this black lab does seem to be able to sense when something's wrong. Typically, she wants to jump up on the bed with me and play, in order to make everything better. My crazy, delusional hypoglycemia-induced rants and arm flailings don't seem to calm her down, they just provide more ammunition for her wanting to be a part of the action. It seems whenever my blood sugar is low, there Riley is - wanting to help. Will I ever rely on her to call 911? Probably not. But she is a staple for moral support, if anything.

As Scott's blog mentions, there are specific groups - Heaven Scent Paws and Dogs for Diabetics that specifically address this topic and provide dogs and/or training for them on the D-recognition front. Good stuff, and worthwhile organizations to have. Our pets are lovable and can also serve as natural low-sugar detectors when we're asleep, if we don't have a CGM and don't happen to wake up by the time a reaction sneaks up on us.

Tuesday, November 10, 2009

It could happen to you...

Our eyes met in an instant, and a disasterous cycle of events was set into motion.

The dog leaped from her spot on the green lounge chair where she'd be sitting. I'd just arrived home from work and was ready to go change into more comfortable non-work clothes. She was in pounce mode, her backend sticking up and her eyes fixed on me standing at the top of the stairs.

"Riley!" I said happily, greeting my 4-year-old black lab.

She responded by sprinting toward me, eager to offer a similiar welcome-home greeting.

As she rounded the couch that stood in between us, it was already obvious her front paws were leaving the carpeted floor and she was leaping toward me. I braced myself, non-chalantly gearing up to catch her as she jumped up to say hello.

Her front paws hit just above the right-side of my waistline, just at the spot where my pump was currently connected to my body. Her paws hit the very site, and as gravity pulled her back down, I could feel the infusion site ripping out of and away from my stomach. The moment moved in slow motion, and it felt as if I'd been shot. I grimaced and could hear the slow-motion grunt come from my mouth. There was no doubt the pump site was now disconnected.

I looked down. My white work shirt and silver tie were turning bright red. Pulling up my shirt, blood sprayed everywhere. It coated the non-painted walls of my gameroom, spraying like a paint-gun coating the walls with color. Non-stop. The dog, tasting blood splattered on her nose, growled and wanted more. I felt weak, my legs buckling, and I fell backwards and down the carpeted staircase to the bottom floor. The growling dog that had been so happy moments ago, leaped toward me and her blood-covered teeth inched towards my neckline as I lay at the bottom of the stairs, unable to move because of now-broken legs....

Twitching, I lurched and awoke in the comfy green chair upstairs - where I'd apparently fallen asleep. A computer sat on my lap, and an expired video of the previous weekend's SNL showed on the screen. It had all been a nightmare, I realized. But it felt so real. I could almost still feel where my pump had been ripped out, and in rubbing a finger over the spot, I realized it was still connected - though a little loose, as it was approaching the next day when I'd need to change sites. Looking around, the dog was curled up in a ball on the nearby couch, though watching me with curious eyes as to what I was moving around for when I could be sleeping.

It was late, long past bed-time. I closed the computer and moved toward the bedroom, the dog now up herself and wondering where we were journeying off to. She grabbed a toy and went into pounce-mode, eager to play now that Daddy was awake.

Our eyes connected. My hand instinctly moved to cover my infusion site, and I shook my head and turned to go to bed, glancing at the unpainted walls and not wanting to interfere with that.

"Good night, Riley."

She wagged her tail, following me into the bedroom and laying down on her cloud blanket near the boxes of pump supplies in the corner - two important parts of my life, so close together, but necessary to stay apart. If not, disaster can strike when the dog and diabetes intertwine. It can happen to anyone. Could happen to me.... Or you.

Monday, November 9, 2009

I want: A Happy D-Blog Day 2009

Today is apparently a diabetes holiday, of sorts. It's been dubbed D-Blog Day, a time when we're supposed to blog about our own stories, awareness, support, and diabetes in general. For those os us who regularly write these blogs, the day almost seems moot - we probably would have done this regardless. But, in leading up to World Diabetes Day on Nov. 14 and attempting to comply for the sake of artificial days on our calendars, here's that blog.

My wife made the observation over the weekend about my diabetes. She noted that I haven't been taking care of myself as well as possible. That's true, I haven't. She inquired about how many blood tests I'd done during the past two days... As it turns out, not many. For someone who never gets a break from this, the weekend was actually a pseudo-break from thinking about it 24/7. I am 30 years old, and in my 25 years of being a Type 1, I've had my share of those "lazy" times, against the better judgement of myself, my endo, and everyone else. Thankfully, I haven't suffered severe complications to date, only some more minor ones that have done enough to motivate me temporarily. I hope to continue that non-complication trend as long as possible, so here's a blog dedicated to my desire and committment this week to testing, carb counting, bolus dosing, site changing, and everything else that may be necessary. Additionally, I offer a D-List of Wants that come to mind, randomly and in no particular order:

I want Ninja-control.

I want more body space to connect my infusion sites, without having to skip spots that bear the battle scars of past connections that have stayed in place for too long.

I want a day where my management actually leads to a consistent stream of test results, without mysterious spikes or drops that seem to have no apparent cause.

I want to sleep through the night peacefully and wake up, without falling into an abysee of low blood sugar reactions.

I want a new pump that doesn't have a scratched screen.

I want to write Minimed a letter about the non-sticky infusion sets I seem to have received after switching back from the discontinued Cozmo, sets that I went through way too quickly because of that very non-stickiness.

I want to make my endo happy.

Multi-faceted point: I want the neuropathy and retinopathy and nephropathy to stay away from me. I want my heart to keep on tickin like a Timex as long as possible. I want my nerves and roots to stop causing dental problems.

I want to make my wife happy, and be able to give her everything she wants out of life.

I want more optimism, and less pessimistic realism.

I want to leave work and see my wife, my puppy, and kitten - my motivators to taking better care of my diabetes.

I want a Diet Coke right now, but I suppose I'll settle for icewater.

I am hungry, so I want to stop eyeing those yummy Watermelon glucose tabs hiding in my topc desk drawer and instead go out in search of a real lunch, (Maybe a King David Dog State Fair Dog with tots.. Mmmm).

As I've decided the above-want is a priority now, here's the end:

Ultimately, I want a cure so that no other little kids have to live through this and grow up living with it, and get older fearing for all those who might have to live with the D in the future. I want the hope to become a reality, as soon as possible.

Sunday, November 8, 2009

Praying for a Cure - and jailed for it

We often hear from people in the D-community about praying for a cure. We have hope that someday, God will provide men with the science and resources they need to discover a cure.

But here's a story out of Wisconsin that takes that prayer to a different level. Parents who basically refused to take take their 11-year-old daughter in for diabetes care, and instead prayed that she would be healed without any medical help. Last month, they received six months in jail for letting her die and not seeking medical care. As it turns out, a story about his case aired on the D-Life show a few hours after I'd written this blog. Here's the video page, which also mentions another case about a California teenager who died from undiagnosed diabetes after his father and family declined to get medical care because of their faith.

This reminds me of the Schmidt case out of Franklin, Ind. that I covered a few years ago, when reporting for a daily county newspaper there. Here's one story and a subsequent jury verdict story I wrote on that case back in 2005. These parents' religious beliefs prohibited them from seeking medical care for their daughter, Rhianna Rose, who died of a blood infection typically treatable with antibiotics. In that case, the judge suspended most of their sentence and gave them each about a year total at a work release center, scattering the sentence for each so that one could be out to take care of their other child.

These are tough issues, particularly as they deal with people's religous beliefs. It was difficult writing about the Franklin case as a reporter, being objectionable and trying to understand both sides. Many outside that particular religous community wanted to crucify them and called them bad parents, even though that wasn't the case. They didn't see anything wrong with what they did or didn't do, and both said during their trial that they'd again choose prayer rather than medical care if the same situation ever happened again. In the end, the judge ruled that their daughter would be alive if not for her parents' inaction - and that was enough by society's standards.

But in these instances, our system is basically telling parents that they must get medical care - even if they don't believe in it and it goes against their beliefs. That's a blurry and complicated line, but in my eyes, I suppose it comes down to looking not at the parents but the children involved. Those kids may not have the voices to protect themselves or decide what's right for their own lives, and in that sense it why we have a government and legal system - to protect the most helpless who need it. I may not want to impose on parental rights or intrude into someone's medical and religous beliefs, but we're talking about something more - a child who can receive medical care to at least reach the age when they can then deny it for themselves. But, they deserve to be allowed to make that choice and put their faith in action on their own.

Personally, I believe in God and believe that he guides what happens in our life. But most importantly, as most Methodists and Protestant-related denominations do, it's important to realize that God gives us the tools to care for ourselves and survive. We have free will and critical thinking, and he gave us those characteristics in order to think for ourselves and help ourselves in order to best prepare ourselves for His Will and everything that comes after this short life on Earth. We have doctors and hospitals to help us do that, and we should use what he's provided us with.

So, while I pray for a cure and in doing so entrust our medical experts to use what's given to them in finding one someday, I also use the tools that God allows me to have - blood testing, health care, free will to manage my care - in taking care of my diabetes.

Friday, November 6, 2009

Open Letter to Pancreas

As it's been a tough deadline week with little time to post, I've decided to use this great post from the archives of Six Until Me, entitled An Open Letter to My Pancreas.

I echo these thoughts to my non-working insulin organ. Enjoy.

Monday, November 2, 2009

Be Aware...

... That November is National Diabetes Awareness Month.

Here's some words from the ADA about it, particularly a push for people to join the national movement to Stop Diabetes (I realize great movement names are somewhat limited, but it's as if there wasn't already a push for that???)

Anyhow, this month is apparently a time to "shine a spotlight on a serious disease that leads to potentially life-threatening complications such as..."

You know, just once - I'd like to read something that says diabetes is a disease that "can be managed correctly and lead to healthy-productive lives even though there will always be a possibility for complications." You know, the optimism that really goes hand-in-hand with efforts to "Stop Diabetes" or "Find a Cure." But, of course, optimism then wouldn't solidify the need as to "why" we need to find a cure or stop diabetes for those of us not living with it.

Oh well. We can hope.

Ways to take advantage of November, according to the ADA:

1. Share. Inspire others by sharing your own personal story, and invite others to do the same.
2. Act. Do something, whether it's walking, biking, or spreading the word, about diabetes and the many activities out there.
3. Learn. About Diabetes.
4. Give. Locally, state, or nationally. Personally, I prefer the JDRF. Not that the ADA doesn't do good things, just a personal preference of mine. Cuz I don't care as much about Type 2, as I do about all the kids who have or will someday have to live with diabetes without a cure.

So, hey. It's November. Now you know to join the cause. If you didn't already...