Wednesday, December 30, 2009

Emotions of Diabetes (Even For MANLY MEN)

You may have noticed a lack of posts in the past week, with Christmas here and all. Things have been crazy busy, and the holiday brings more to do at work in less time on deadline, so that's been somewhat consuming this week.

I was pondering a post about my online absence recently, as our own NinjaBetic G has done. I still might in the coming days. (so stay tuned!) I've also written some other, non-timely blog posts for the future, with little revision needed. But it's not the time for any of that.

Today, I was inspired by Crystal (CALpumper) at Randomly Capitalized, who wrote a blog appropriately called Targets. That inspired me to nod my head in agreement, and follow suit with my own along the same lines.

See, what we and many other Diabetic Pumpers share, is a common Lack of Real Estate . We're frequently forced to scour the land for more sites. We scar easily, particularly at times when we simply don't want to change a site within 2-3 days because it's working so well or simply because we don't have many other sites to choose from, and we want to maximize the limited space we have. Sometimes, our infusion sets don't work well and we're forced to abandom them all too quickly. Blood can spurt. It's frustrating. Depressing. Infuriating. Maddening. Overwhelming. WTF-ish?!?!?!

Recently, the boiling emotions of all this craziness bubbled over the top of the pot and spilled everywhere. I broke down completely - the first in a while (ya know, since I'm a MAN...). Sitting at the kitchen table, I found myself searching too long for an adequate site. See, I am a thinner body type and just don't have the excess "pinch an inch" needed for this type of D-Living with a Pump. Some might think that's good, but it can be very annoying in times like this when I simply need more bodyfat to use for a pump site. Legs haven't worked well lately, and I just don't have the body to explore elsewhere. Abdomen works best, but it's becoming more scarred and there's tissue under my skin I can feel preventing some sites and cannulas from getting in properly. At the table, I stabbed myself a couple times before realizing it just wasn't going to work on that side.

I slammed the Silouette onto the table, followed by a fist slam. Suzi was in the kitchen. She looked at me, reassuringly and offered her usual love and support. It wasn't enough this time. Bottom lip started trembling. Tears welled up. Fist clenched, even more. She came over and kneeled down and hugged me. Embraced her, and cried. One of those embarassingly refreshing and needed cries - the kind that men just don't openly admit to, particularly in blogs for the world to see. I could care less, now at least a week or so past that night-time moment in the kitchen. I recall the phrases "Want to be normal" and "not fair" escaping my lips. Hell, even now sitting at work on deadline, I can feel that frustration returning and the tears want to roll. But, it's a time to be strong. I'm by no means what you'd consider a "Manly Man," but hey even for me too much crying isn't called for. You have to approach life sometimes without emotion, with a clear head and your wits about you. It helps having a Loving Supporting Spouse, too!

It's with that clear head and loving support that I approach the question that's been scratching at the door for some time: whether it might be time for a break from pumping. The Paradigm and I have been together (despite a 2-year hiatus when I betrayed Minimed and went briefly to the now-defunct Deltec Cozmo) for almost a decade. It was June 2001, my final year of college, when I switched from injections to pumping. My A1C lowered incredibly, hitting my all time low of 6.1. It's been pretty constant ever since. I have gone occassionally without the pump, maybe for a few hours or even a day while compensating with injections. But never longer, in order to give my body a healing rest. I wonder if any long-time pumpers have done this, and whether it helps?

As I contemplate the purchase of a CGM that would require even more real estate, this may be the time to heal up a bit. Maybe. It could offer a chance to escape the ever-growing feeling of frustration when there isn't an adequate site. No one deserves to live with this chronic disease (yes, JDRF and ADA, I said "disease," and not that watered down "disorder" crap you like to use). But those of us who do live with it, WE deserve to have at least some ability to not fight off obstacles like Toxic Site Scarring Syndrome make it even more difficult. We deserve that, just as much as we deserve a cure.

Friday, December 25, 2009

Christmas Cookies - for Santa or Late-night Low?

In honor of the current test-run of the Navigator CGMs for a few days (courtesy of Mom Hoskins who's in town visiting and parted with her monitor briefly, we pay tribute to those Christmas Carbs on hand to combat any late night nosedives. My first day of using this device has been interesting, revealing, frustrating, and frantic all at the same time. A couple crashes were diverted, and I was able to witness the post-overbolusing rising blood sugars after inhaling apple juice, glucose tabs, cheezy dogs, and a fruit cup.

As Christmas Eve comes to a close and paves the way for Christmas Day, I thought it would be appropriate to set out some Christmas Cookies. You know, in case a Big Jolly Fat Man in a White Beard and Red Attire shows up for a visit. Or, more to the point: In case that CGM decides to start beeping loudly on that bedstand near my head to warn of a plummetting blood sugar. So, we have some cookies, gingersnaps (for GingerNinjas????), a glass of white milk, and of course a handy apple juice just in case we need a boost... Maybe I can even meet Santa up for a snack, and find out if he has any free CGM sensors or pump supplies in that magic Christmas Bag of his.

With that, I say goodnight with a poem:

Twas late in the night before Christmas, and all through the house
Not a Puppy or Kitty is stirring, nor is my spouse.
My blood sugar's steady at one-hundred-and-three
And there won't be a need to wake up about 3.
The wife is all nestled snug in our bed,
With visions of No Paramedics or Reactions dancing hopefully in her head.
We'll sleep well in knowing that Low Sugars won't be,
And the CGM works on through the night, protecting her and me.
Then Christmas will come and the fun will begin,
Before the day's worth of D-care starts over again.

"Happy Christmas to all, and to all a good-night...."

Monday, December 21, 2009

A Diabetic's Obituary (UPDATED)


News of Brittany Murphy's death lit up the blogosphere and online community (in December), especially with reports in the first day that diabetes may have played a part in some capacity. The ever-so-wonderful tabloid reporting of TMZ has told us that Brittany's mother told paramedics her daughter suffered from Type 2, but the coronor in LA says this isn't believed to be a factor in her death. Instead, it's more "natural" and likely related to flu-like symptoms she appears to have had in the last days of her life; a final cause could take weeks or more to pinpoint.

UPDATED: Cardiac arrest apparently was the immediate cause. We can only assume diabetes played a part in this, in some degree. Adding to this was the news Jan. 4 that the 30-year-old Casey Johnson, a great-great-granddaughter of the Johnson & Johnson co-founder, was found dead. Apparently, also related to her Type 1 somehow - she was apparently out of control in managing it and had issues with both drugs and alcohol.

Regardless of the deaths, news of Brittany Murphy's Celebrity Life with the D wasn't well known outside her family, and it obviously raised some eyebrows and stirred the rumormill in those initial post-death hours. Casey Johnson, on the other hand, was a well-known Type 1 who had in fact written a D-related book back in 94. Her D-presence is more familiar to us. But both beg the question: how big a part should diabetes play in one's obituary, whether it caused their death specifically or not?

As a newspaper man, I know firsthand there's a motto in the obituary writing business: any obituary story is a tribute to that person's life, and you're supposed to write about how that person lived, not how they died.

Sometimes, the circumstances of a death are hard to sidestep: car crashes, tragic accidents, murders, longtime sicknesses, etc. But some get written focused on how a person died, and tell little about how that person lived. In writing obit stories, I've seen my share of submitted obituaries where individuals don't want any mention of how they died. Family just submits a laundry list of accomplishments or affiliations without any mention to the cause of death. Never much cared for this, particularly in younger deaths where there is obviously something uncommon happening. Sometimes, you can guage what happened - like a longtime sickness or chronic disease - by observing any charities or organizations or alma mater groups they ask contributions be sent to.

But it raises the question: how much should be focused on the end, the manner of death? For those of us in the diabetic community, what do we think about this? As diabetics, how much do we want that to play a part in our obituary? This is such an influential part of our daily life, is it worth more than a mention? How much so? We say that diabetes doesn't define us, but that it can in many ways put our lives into context.... Is that worth shaping the story that's written about us once we leave this Earth?

I've thought about my ultimate death from time to time. Suzi calls it morbid. I like to think of it as being somewhat prepared or realistic, mindful that we all must go at some point and we might as well think about it and be ready in some capacity once we're called home. My Hoskins family motto is "Finem Respice," or "Consider the End." I've tried to do that, thinking my my life as a story that will ultimately be told in the context of history. It'll need an ending, of course, but much more important is the beginning and middle and every single detail leading up to that end.

Assuming I don't meet my end by getting run over by a drunken school bus driver, stabbed in the neck by a Christmas Elf, or walking off a cliff while skipping and singing a song, I've always pretty much guessed that Mr. Diabetes will be the one committing a Class A Felony against me, whether it be via heart attack or other "complication of." But diabetes won't define my obituary, even as it doesn't define me. It's a part of me, but not the entirety.

When I go, that's how I want my obituary to sound: Not a diabetic, but a diabetic advocate who used his life experiences to educate and impact a larger diabetic community. Not only just a writer, but a newspaper journalist who believed in telling other people's stories for the betterment of everyone. Not just a resident of a particular town, but an active participant and community leader who got involved to help contribute to something bigger than himself.

Personally, I'd like my obituary to say about my demise: "died from complications of a failed pancreas, which gave out in 1984 but didn't prevent him from living a full and rewarding life." Like the ring of that. It makes me smile, knowing that I've been able to do what I have in life so far despite this often-overwhelming chronic condition. That should be the goal of any diabetic's life, and it's worth mention in our obituary when that times comes.

Now, back on with that Productive Life of Living With Diabetes, Despite It.

Friday, December 18, 2009

Christmasy Carbs

Tis' the Season.

Not only are my newspaper sources not returning calls and being ever-so non-responsive in this week before Christmas, but yes the holiday festivities are coming in full force. All of that is a preview to the carb craziness and seasonal sugary ride that's about to engulf my Christmas week.

The past couple days have been a little off, as it seems I may be fighting off some sort of illness that's invaded my body. Nothing serious, just feel "off." And some unexplained jumps and dips in my #bgnows could be to blame, aside from the fussy leg site or whatever way the wind happens to be blowing.

That leads up to today's preview, which came with the Office Holiday Party.

For the past few years, we'd been off-site at a local restaurant in a private room with their own food and snacks. This year, we stayed in-house and gathered together for a large pitch-in festival. It began about 11:30 a.m. and lasted for a couple hours, with the desserts still lingering around afterward to find and devour as desired. This Carnival of Carb Craziness could have causd a high-blood sugar coma by itself, not to mention the calculation chaos that was inevitable. Some higlights: sliced ham or cooked turkey on a croissant, three styles of devilled eggs that included an awesome creation of DARK CHOCOLATE CHIPOLTE DEVILLED EGGS, spicy sweetened mini hot doggies, cheeseball and dip varieties, sweet fruit and veggie mixtures, brownies, cupcakes, cookies, white and dark chocolate pretzels.... And so on. Oh, man. It was insane.

I circled the tables with my mind swimming as I digested the consequences, and then went in for the kill. Carb Calculation Chaos ensued.

Only one person asked me about whether I "should be eating all that," which I didn't mind. This person wasn't asking that frustratingly-common question in the sense of "You're diabetic, so are you allowed to be eating all that?" She hears my tales of Carb Counting Madness and was asking more in that sense, as I had been talking about it. I nodded, notioned to my Paradigm and said "Probably not, but it'll have to work overtime today."

Ultimately, I believe I had somewhere around 80 carbs on my plate(s). Calculating it wasn't an exact science. But the test a few hours later hit 200, and then all was back within a few hours for dinner after that. Not too bad, I thought. This all followed my Endo appointment on Thursday, which resulted in some basal and correction rate changes that will be monitored during the next several days. All these holiday feasts throw things off, of course.

So, while it seemed OK at first, the sugary fun was still in my system. Plus, it followed me home. Left the office at the early-closing time, and came home to catch a nap to help fight off this "offness." But a gooey brownie for Suzi and huge chocolate chip cookie followed me home. While all has been mostly well tonight, that huge cookie is sitting nearby, staring at me and whispering in my ear. I resist, waiting for the time to do my evening blood test. Cookie tells me resistence is futile, but I refuse. I will prevail.

That's not the end, though. It gets tougher. As I sit here, Suzi has eaten her brownie but is over at the kitchen table preparing some holiday-gift treats: chocolate covered pretzel rods. Some for me, of course. And that cookie is somewhat persuasive... I can't stop glancing at it. May have to reach here, soon... soon... (Guestimating it's about 20grams, plus double that for two or three of those yummy pretzels... At 112mg/DL, we'll see where that dosage gets us in the next couple hours before bedtime.)

Of course, today was just a preview of what comes next week. The real-enchilada, following the chips & salsa of meal-planning (er, brain surgery) performed today. Will be great to celebrate with family and friends, and be in the seasonal spirit at its prime, but that doesn't take away the nuts-and-bolts of Living With The D At Christmas. Oh, the fun. Merry Christmas Carbs.... Tis' the Season.

Thursday, December 17, 2009

Crystal CGMS Persuasion

Anyone who loves classic rock from the Summer of 69 knows of the acoustic song Crystal Blue Persuasion by Tommy James and the Shondells, a song that inspires some great groovy relaxation. Historically, James' manager once said that the songwriter was inspired by a reading of several Bible Book passages speaking of a bright future where everyone lives in peace and harmony.

Well, in my never-ending quest for Better Diabetes Control, I've decided that's how I want to live my D-Life - peaceful, harmoneous, without complication. In striving for that balance, I am convinced that the best way to achieve that goal is by using a Continuous Blood Glucose Monitor. I have been pursuaded by recent rocky ups and downs in my diabetes care, and it's time to make the move.

We're talking Crystal CGMS Persuasion, here. Sing it. Groove with it. Be one with the melody of knowing you'll always be aware of where your blood sugar levels are at, and which way they're going. All in the name of tighter control, without the sudden and consequential night-time or any-time Lows.

Recent events in the past week have inspired this new mantra. Last night, I crashed following some night-time new site issues. Higher tests plagued my Tuesday post-dinner period, and two correction boluses over the course of seven hours suddenly smacked me about 3:30 a.m. Wednesday. I'd gone to bed at 1:30a, wanting to make sure everything was kosher like a pickle. A test of 237, down from the 300s earlier, offered some assurance it was coming down and I'd be safe enough to sleep. Well, within two hours, sugar levels plummetted and the paramedics were summoned. At one point, I tested at 20 and then within a few minutes, my reading declared. "LO." I don't recall ever having that before. An IV brought me back, and I awoke in my own bed to the sight of six paramedics standing nearby. Luckily, I wasn't out of the house or driving when these crashes came - situations that have happened in the past year of my Never Waging War Against Diabetes. Following this Low, Suzi and I stayed up once the paramedics left and all returned to normal about 4:30 a.m. I Tweeted about the experience, and started formulating a blog while keeping tabs on where my sugars hovered. They fluctuated throughout the day until I came home and just about dinnertime, we had some Diabetic Deja Vu.

I dropped suddenly again. Speech and coherentness blurred, confusing my common multi-tasking talent of Suzi conversation, carb calculation, mentally tallying a grocery list, and observing an intriguing legal issue shown on Law & Order. Suddenly, I knew little and couldn't carry on a conversation or answer a simple question. I felt my level dropping. A test revealed a 47, down from the 79 just shortly before eating my two meatloaf sandwiches. No paramedics needed this time, and I was still somewhat aware of my surroundings. Inhaled glucose tabs and an apple juice box and spoonful of honey brought me up within an hour to 138. Safety. But just to be sure, I kept the Paradigm 722 suspended for a handful of hours into the evening. That was overkill, but physologically needed as reassurance.

It's all enough to make a Diabetic not want to strive for tight control, but rather hold out for higher sugar levels and ensure immediate peace of mind. After all, we're fighting to avoid complications down the road that may happen even with our better control, so sometimes the thought of Here and Now trumps what may or may not ever come to be. You can drive yourself mad with it.But I won't let this deter me. This two-day rollercoaster ride, coupled with situations from the past where I've bottomed out, have pursuaded me to go out on the CGMS branch. Fellow D-Bloggers have shared their stories and spoken highly of it, despite the nuisance of having to find additional Diabetic Real Estate for another infusion site. I am not eager about that, but the benefits and peace of mind of more constant monitoring far outweighs that issue. I have made a decision to go ahead. Luckily, this comes just prior to my Thursday morning visit with Endo Dr. P, whose office has already voiced support in this device-obtaining process. I'd started the process in August after a Low-While-Driving Incident, but decided to hold off until a later time because of insurance changes happening at the time. But now's the time.

I'd like to start with the several-day trial. It will be the Guardian REAL-Time CGM, along with the CareLink software device and the needed sensors. I understand that my insurance company has a policy where you basically have to have tests below 50 mg/dL, a number that in my opinion is arbitrary and a "one-size-fits-all" line of thinking for something that by definition varies for each person. Still, that's the insurance industry decision-maker's call, whether I like it or not. It doesn't matter - I fit the mold, having those too-low results, and the paramedic calls and doctor's evidence to back it up.

So, this will likely happen in January, since we're a week before Christmas and also thanks to that being the time when my insurance deductible starts over. I will start on a trial, and depending on how that goes, decide whether to push ahead for a more long-term committment. The scary $350 pricetag for a 10-pack of CGMS sensors is a daunting part of that equation, unfortunately, and it will all factor into a final decision once that times comes.

We'll see whether that groovy, Summer of 69 tune and philosophy can carry over to 2009 and beyond, allowing that Crystal CGMS Persuasion to win out in hopes of a Diabetic Eutopia of Even Greater Control.

Wednesday, December 16, 2009

Tiger, Tom Petty, & Diabetic Anticipation

I have a date on Thursday. (Sshhh... Don't tell my wife.)

Don't worry, I'm not pulling a Tiger Woods. Actually, my wife knows about my date and is anticipating it, much as I am. She isn't sporting any golf clubs and I don't plan to have a low while driving down my driveway, leading me to crash into a tree.

No, there's none of that. This isn't the PGA. It's Diabetes Land - Hoskins style.

This encounter is with Dr. P, my trusted endo who's the crucial third leg of my three-legged diabetes care team stool. My wife and I stand sturdy, but we always welcome her support and feedback so the stool doesn't tip in any direction once the huge rear-end of Mr. Diabetes comes crashing down to sit on our life. She's like milk, making us stronger so that we can be better stool legs (stooleys???) and keep this stool standing.

The past month has been a time of greater diabetes control in my life, where I've had many fewer examples of high sugars (I write as my newly-inserted leg site may be showing some fuss...) The ups and downs happen from time to time, but I can quickly get it under control and there's more satisfaction in knowing I've triumphed, at least a battle in the Never-Ending War Against Diabetes-raq. Despite the hilly deserts and mountainous terrain filled with terrorist threats and landmines, I feel as though I'm the General In Control. There's no ground-support and wave of reinforcements; just me, the master General, waving a nuke like a madman in the face of diabetes.

At age 30, I finally figure it's time to become this General more often, make this a constant routine. While there have been some lows and some periodic spikes in sugars lately, I typically know the reason why and can account for both extremes with some extra insulin or food. Pump and infusion set woes always can complicate that care, and create an unwanted rollercoaster ride of blood sugar variance, but that hasn't happened much. Thankfully.
So, with all this, I am eager to hear Dr. P's diagnosis of my past month's test results. Faxing weekly gives her a rundown of how they are, but I look forward to the face-to-face conversation and feedback. Also, I do want to get an idea of what my A1C might be hovering at. The last was at 8.8, so the hope is this has come down. She does an inter-office "unofficial" A1C test while I'm there, but it's not the real version that apparently does a better job forecasting where my three-month level is at.

Sadly, I'm not going all out on labwork this round, even though Dr. P wants it done prior to this coming visit. That'll have to wait. Reason? Insurance. That pesky $1,000 deductible starts over in January, so it would basically be like wasting the amount needed for these tests (roughly $300-400) only to have it count for my deductible for a couple weeks. Coupled with that, our Flex Account period runs through May, so it seems a waste to get the tests now. I'll wait until before my next visit in early March, meaning I can then use my flex for the labwork amount that will then also go toward a deductible lasting through the rest of 2010. Seems more practical, but sadly means I must wait on knowing that "official" A1C.

Anyhow, there's always the peace of mind in continuing the tight control for the next months so that result will likely go even lower, toward that ultimate goal of 6.1 that I've achieved once after initially going on the insulin pump. I'll get there, I know it. But really, I can't wait.

As rock legend Tom Petty tells us, "The Waiting is the Hardest Part..."

Indeed. The anticipation of knowing what the A1C result is can be daunting. It can feel as though you're Free Falling into an abyss of diabetic uncertainty, or that you might actually Breakdown. But, with the love and support of my American Girl, I continue Running Down A Dream that my A1C will reach that desired level. Then, I'll be able to smile in the mirror and say, "'You Got Lucky,' Hoskins." This isn't your Last Dance, but the start of something great.... even a Great Wide Open land where great diabetes care isn't a worry, but a reality.

And so, I wait for Thursday, then March. I'll toast a New Year of better D-control in the meantime, a gift that came a little early this Christmas season. Thanks, 2009. Appreciate the help.

Friday, December 11, 2009

The Marathon Mind Late At Night

It's 3 a.m., and this isn't a Matchbox 20 song. It's reality. My reality, as I sit up and watch the clock and fumble around online. Sleep beckons, tugging at my eyelids and forcing yawns every few minutes, but yet...

I cannot sleep. I won't. Instead, I wait.... And wait..... And wait some more.

For the time to do another blood test.

You see, the D-monitoring has trumped my sleepy-time tonight. That metaphoric kick in the head to get my health under control seems to have finally happened, and it's kept me awake tonight and many anight recently. It's addicting, wanting to get a that line to be as flat as possible without having the CGMS at your disposal. "Hey, if a DexCom can do it, SO CAN I."

And so, I'm a Human CGMS. Monitoring constantly to stay on key. Every half-hour seems a little much, but the couple-hour break is too long.... The compromise is every hour.

It's worth it. My readings have been outstanding. Like wicked-sweet outstanding. The kind where you could scarf down a GIANT CUPCAKE and not see your bg budge. That awesome! Sure, the occasional highs have crept in like squishy mouses slithering through a crack in the doorwall and festering the house. Mostly, I know why: inaccurate carb counting, missed or mis-cused bolus, site or pump issues... Still, they've few and far behind. My last A1C was too high, in the 8s, and it must come down. See, I'm 30. And I want to see 40. And 50, and beyond. Buzz Lightyear would want me to, so it's the plan.

A family is the reason. Life. Friends. God. Community. Being around those people and sharing in their love, and sharing that love with strangers in the world to make a difference, that's the point. My love of life is the reason. It's all too good to pass up, or leave too early if you can help it. And I can. Thanks to the modern era of D-Care we have at our poor-pricked fingertips.

The wife went to bed hours ago. It would be nice to be snuggled there next to her, under that soft warm comforter on a night dipping into the teens. But I can't. Not when the blood meter is taunting me, calling my name and challenging me to beat my score. It wants me to run around the block to drop my sugar, or raid the cupboard to raise it up, just so it can laugh at me for missing the target range. But no.... I won't be mocked. I will win, diabetes. Yes, I will.

I have an appointment with Dr. P next week, the last of the year, and I'm determined to make her happy with my progress in the past month. No longer will she be an Unhappy Endo.

Sitting here in my green chair, I anxiously await the next moment I can test. Lately, I've been hitting at least 8 a day. There's been times in the past couple weeks where I've done 12 or more. It feels good, knowing where I'm at every hour, and being in control. In a time when we have so little control over things, this is a great triumph.

The dog is dreaming, snipping and barking in her sleep. I move, she wakes up and is now staring at me. She probably wants to know what my bgnow is at, I presume... I'm sure the cat's curious, too.

You may notice that my late-night postings ramble.... Admit it. You love it. You wish it could be you. Why? Because there's motivation in these rants. An energy to get going. To re-engage myself in the JDRF Cause here in Indy. To write, newspaper stories and poetry and blogs and political essays and love poems and Christmas letters and pet biographies and diabetes outreach letters and church news releases and blood test results.... Whatever I can. Giving a late-night props to G (the wonderous NinjaBetic), I want to step away from the keyboard and write on paper with a pen. Just like I want to hold a newspaper, feel and smell it while sipping a steaming cup of coffee. Irreplaceable feelings.

Yet, even as those offline experiences are cravings at the moment, I'm in an online world and fully wrapped up in it. I've read so many blogs tonight. Written several to have on the backburner, also. Have done some legal newspaper writing, in advance of deadline. Outlined our Christmas 2009 letter that needs to get into the mail soon. Read JDRF sites, joined Juvenation.org and updated my TuDiabetes Profile. SugaBetic taught me more about the interesting Omnipod Pump and how intriguing it is.... And both she and Kerri (Six Until Me) got me thinking more about Vlogs, and whethr it's time to venture into that video world. Even found some new Twitter D-friends, and scoured the Web for Pirate-speak so I'll be prepped for the lively Tweets in honor of K2. I thought about venturing into the Left4Dead world, but opted instead for Resident Evil 4. What a time.

But now, that awaited moment has arrived. To step away from this keyboard momentarily and see what the blood meter proclaims this time around.

The result: 108. An hour ago, it was 120. Two before that, it was 119. Food came into this equation, too. I'm that good. I'm in the Zone. Like ESPN. Or EA Sports - it's in the game. But now, it must be done. Time for sleep. My fingers need a rest, and my eyes could use some catchup before the adventure begins again.

Wednesday, December 9, 2009

Your Input Needed: Lows

We all have those Diabetic Horror Stories, tales of what happens when our blood sugars fall so incredibly low that we cease to recognize reality and enter a diabetes-induced drunk-like state. They aren't a common occurrence, but they do happen as we venture on this D-ride together. I've had my share through the 25 years of living with the D, and I've tried to share some of those more recent stories here at The Corner Booth, in an effort to not only share my experiences but also help educate others with a touch of humor.

In elementary I recall screaming in class and trying to punch the teacher or fellow students. Luckily in those days, I was smaller and could be held down and force-fed juice or candy. In high school, I recall passing out in the pool during practice and having a teammate come to the rescue. On the job, I once passed out in a newsroom while sitting in front of a computer - awaking, I was sprawled out on the floor with my boss and paramedics hovering above. The paramedics have also been to my home a handful of times in the past years, and I've come out of those reaction-states seeing my bedroom ceiling, an IV in my arm, and those Greenwood Fire Department faces above me. (It's a good thing I don't sleep naked...). The "Are you Kidding?" and "Oh Sh-t!" moments quickly follow the realization. Some of these stories I've shared more recently here at The Corner Booth: The Dog's Trying to Eat My Head. My Alien Wife Trying to Force Alien Poisions of Apple Cider & Honey Down My Throat, and so on... Twice in my quarter-century of diabetes life the situation has gotten dangerous enough where I've found myself behind the driver's wheel in this condition. (This comes amid a new study showing Tightly-Controlled Diabetics Present Greater Car Crash Risk.) On occasion, I have also managed to meander from my office outside, stumbling around as I'd tried to find my way to the parking garage. Riding up and down in the garage elevator in a haze, at times phoning my wife just enough to put her in a panic. Fortunately, I was blessed to not harm myself or anyone else.

Paramedics have been summoned to fill me up with IV-delivered sugar. My wonderful wife has had to force-feed me juice, icing, cider, glucagon. Earlier in life, my parents were the ones. Only once, I've been tucked away in an ambulance and carted off to a hospital - (I would've objected had I been in a more coherent state, and I paid the cost - literally - when the way too costly hospital bills started arriving...)

It's enough to drive a person crazy with worry, not wanting to drop into this state and put yourself or others in danger. I've stopped managing my diabetes and intentionally kept my sugars higher, just to avoid this. It's a psychological nightmare - do I stay higher and out-of-control in order to avoid this overwhelming loss of immediate control that could lead to danger, or do I push for Ninja Control to ward off the possible, uncertain complications that may or may not arise and may even come with the best control? Hmm...

In reflecting on all this, I've realized that there are few stories out there in the DOC blogosphere about others' reactions. Fellow D-bloggers have shared the low-sugar symptoms and what they've done to ward them off, but not specifically the reaction horror stories.

So that's what I want to hear now. From you. Those who've lived it, both diabetics and non-diabetics. The ones who've experienced reactions. Spouses enduring and treating them. Family members and friends who've watched and worried. Co-workers who've heard about, but maybe never experienced it. Input from all makes the most complete picture.

Please, take some time to share:
- How often you do/have had these happen?
- Stories that stand out, for better or worse?
- Worst (most dangerous) examples?
- What brought you out of that reaction?
- Scariest part of all this?
- Lessons learned?
- Whatever else might be pertinent, relevant, or randomly of interest?

This is my effort to create a more interactive blog post, where commentors can share revelations through the comment section. Thank you in advance for your willingness to participate and share these very personal issues. Now, let's get back to those Head-Eating Dogs & Alien Spouses who follow us on this never-ending D-roller coaster ride...

Monday, December 7, 2009

My Endo: A Control Freak?

Those who read The Corner Booth regularly know that I've been on a tight control kick recently. It's not that I've necessarily been in "poor" control, just that I haven't monitored my sugars as closely as is needed and that carb-counting and bolusing has sometimes fallen to the backburner. My last A1C was 8.8, which is too high but not nearly into the higher double digits I've seen throughout my 25 years of living with the D. Anyhow, being 30 years old now and wanting overall better control for a variety of reasons, I have begun closely monitoring my blood sugars once again and getting to where I need to be. The goal: 8 by my mid-December appointment when I get more bloodwork done; by the next visit in early March, I hope to have that down as low as possible.

With this tight-control comes more communication and work with my all-knowing Endo. Through the years, I've had three endos - in addition to my two pediatric-focused ones who were part of the package until age 18, and the primary care physician who during my early 20s basically handled all my Rx needs and allowed me to handle my own diabetic needs. I've been with my current endo for about three years, and she's highly-praised and sought after in this area of Indianapolis - evidenced not only by recommendations from other docs but also her schedule that is always booked full at least three months out. So, if you cancel an appt, be ready for a wait. She also has this fix on having you fax results each week to her for review, on a specific form. I oblige.

In getting back on track, I have decided to tweak some basal rates a few times in a few places. Again, I've just been getting back into the routine of regular carb-counting and testing and realizing where a couple points were off . My experience tells me what's wrong, and what the consequences would be in making those adjustments - so I determined what they were, let her know what was going on, and the reasons for why the changes are needed.

This morning, I get a voicemail from assistant at my endo's office: "She wanted me to tell you that she can't help you if you insist on changing basal rates yourself. That's her job." I chuckled, then heard the rest: Don't change anything. Leave it as is for a week, then fax the results again, and she'll determine what's needed.

I differed, knowing exactly what I've seen and experienced in recent days and that changes were needed. Bedtime lows, resulting in a lack of sleep in order to stay up and monitor my low sugars and eat accordingly, weren't what I wanted to live with for another week. The higher results in mid-morning wasn't a result of carbs, as I'd skipped breakfast and still observed higher results.

My thought: "No, the changes are needed and I'm going to make them regardless of what you say. Then, I'll do my best to work with you in making sure everything is kosher from your perspective and that we're on the same page."

I realize the importance of having an endo as part of your diabetes care team, and realize that many of that endo's functions are irreplaceable. However, after 25 years of managing this myself, I am well-equipped to recognize what needs to be done and make those SMALL adjustments myself. This by no means translates to me wanting to do it all myself and keeping her in the dark, or not listening to what she says. Not at all. We have to work together, as I've done in the past with other endos. The last one I had in Michigan (before moving) encouraged my taking control of my diabetes and recognizing these, as long as I let him know about it up front.

But it's not like I've just fallen onto the Diabetic Bandwagon, or even that I'm a Type 2 who's recently been diagnosed after living without the D for an entire lifetime. This is a way of life, and I know what I'm doing here. That lifetime experience means something in my opinion, and it's just as important as the expertise of a non-diabetic who's gone to medical and endo school and studied this for the same amount of years I've been living with it.

It's a partnership, a two-way road. But the bottom line: I'm the one driving the car, and will ultimately crash or burn based on what's decided or not decided.

Saturday, December 5, 2009

Wife of a Diabetic

Long before we committed to being lifelong partners in marriage, I had already committed to a different lifelong partner. Not by choice, but by necessity.

Diabetes and I had been together since my 5th year, and we'd been through a lot together. Schools. Camp. Daily injenctions, when there were 2 and times when there were 4. T-ball, baseball, high school swimming. College. Fraternity life. Newspapering. A1C results that hovered around 13 and went into the high teens at times during those "rebellion" years before falling closer to where they should be in the non-double digits. We'd been through a rollercoaster ride, and I was only in my early 20s then.

Then, came Suzi.

Despite my D-partner who often interrupted our time and was always there in the background, hovering on dates and anywhere we went, this woman fell in love and decided to spend her life with us despite all the quirks, flaws, and frustrations.

Now, we've been through much in almost a decade: college graduation, job changes, move from Michigan to Indiana, apartments and new house, career finding, and life building. Not to mention the carb counting, night-time lows, complication talk, endo switches, the Minimed-to-Deltec move and Minimed-return, and countless other diabetes-related moments. There's too many to list, but you all know what they are from experience.

Aside from everything else in her life and helping do tasks such as cleaning, cooking, laundry, and all the regular-life items, she does various things on D-front: She counts carbs. Reviews my daily and weekly test logs. Reminds me of testing and meds. Helps insert sites and tape tubing. Retrieves glucose tabs, glucagon, juiceboxes, and candy for lows. Calls 911 when the time is needed. Endures the worry when I call in a low-sugar state. Manages through the higher sugars. Hangs tough when the frustrations mount. You name it. She does it.

Sometimes I unknowingly take out my D-frustrations on her, and I apologize for that. She doesn't get enough credit. But she should. As should all spouses and people who put up with us PWD. Even the pets of PWD.

In this Hoosier Hoskins Household, it's just the 3 of us. Plus the Riley Dog and Shadow Cat.

This post is honor of my wife, who has recently been preparing some advanced dinners of meatloafs and meatballs for the week and cutting up some carb-free carrots to snack on. Then there's the dishes and laundry and all else. She asked for a blog about her, so here it is.

Quite simply, the point of this blog is to say: Thank you. To Suzi. To all the diabetic spouses out there who stay with us, through thick and thin and the "highs & lows."

We couldn't and can't do it without you.

Wednesday, December 2, 2009

Tapping New Diabetes Real Estate

I've finally done it.

After eight years of pumping, I have finally tapped some new, unused diabetes real estate. This has meant moving away from the traditional tummy, abdomen, thigh and leg sites for infusion sets that I've mostly relied on during my pumping years. Now, my right arm is proud to be the new four-day home of an infusion site.

Earlier in the day, a surprising out-of-the-blue 536 blood sugar nearly floored me. It came about three hours after lunch, which I had dosed for accurately, so I assumed it could be a site issue. Took a bolus to correct, waited an hour, and did another: It ballooned up another 30 points, to 580 mg/dL. I was evil-clown-afraid when seeing these results, and set out to bring them down. I yanked the abdomen site and readied myself for a new one, but finding the spot would take me to new places. Investigating options, I turned to the online diabetes community and bloggers who've tackled this topic, such as Six Until Me - which helped greatly in not only the logistics but also imagining it. (Thanks, Kerri!) Ultimately, I opted against the legs (which I've used) and untapped lower back area this time, instead choosing the arm. Since I'm left-handed, I voted to use that hand to insert on the right arm.

It didn't come without worry and hesitation. Not to mention the nervousness that came with transitioning to new 90-degree Minimed Quick-Sets and a debut appearance by my Quick-Soft-Serter device. I was a little freaked out, fearing the worst: that I'd hit a nerve, and overwhelming pain would seep through my arm and body before streams of gushing ketcup claimed freedom. None of that happened, though. I pinched the site, and my wife actually pushed the buttons to initiate the plunge. There was hardly a prick and I felt little as the site went into the right side section of my upper arm. We withdrew the device, and all was well. We secured a small loop of tubing with tape, and all seemed OK. We proceeded to check it out in the mirror, and also disconnect and reconnect it a few times just to make sure all was indeed kosher like a pickle. It was.

After that, I garnered some additional paranoia when pondering the task of putting on a shirt. Discussing the procedure with my wife, closing my eyes to imagine it, and then carefully applying the shirt to these pre-imagined moments all took longer than it probably should have. As did the same process of figuring out how I'd need to put on a workshirt. Suzi laughed at me. The dog watched from the other side of the room, wondering what the commotion was about and why it wasn't focused on her. The cat couldn't have cared less. I was the most proud, beaming like a man in a new suit who just got a new job. Within moments, I tested again, and in seeing yet a third very too high test, immediately shot up with more correction bolus. No new site tingling or anything. All is good, and hopefully soon my fruity sweater-mouth will be wiped out by the new surge of insulin to the arm. (It's slowly inching downward, but not nearly as fast as I'd hoped and we have ways to go...)

Digressing, with a poem: (Armed & Dangerous to High Blood Sugars, I am I am. First they'll be there, then they'll get a WAM, and they'll go down the drain like yucky Green Eggs & Ham. Then soon I'll be low, thanks to my new arm site in tow, and death is all those bad ketones will know!)

Anyhow, that's that. Proudly, I have tapped prime new real estate, a spot that I used regularly during my many years of insulin needle injections but one I'd never ventured to with a pump. That has now changed. I have mastered this body land, and claimed it for my diabetes like a colonial settler claiming new frontier land for his home. Luckily, I didn't strike oil and get a surge of anything rushing out, but I do feel richer in tapping this new space for site use.

Next, we'll cruise over to the left arm and then explore the lower back for possible claims on new real estate. Hopefully, that will give the current and past site market a chance to rebound and better serve the infusion site housing market.

The Eyes Have It (Part I)

Beware: This is a longer blog post inspired by recent events, and it delves into a few happenings during the past couple years. In the end, it all comes together. So please: Bear with me...

It was with great shock and sadness I recently read a blog from a fellow D-Blogger Kelly, about her recent eye issue. That post can be read here. We all have wished her well and she's doing great, despite losing vision in her right eye, and it's down-right inspirational to see the kind of fiber she continues on with. Her attitude is quite simply, outstanding and something we should all look up to.

Though her eye issue had nothing to do with diabetes and was a "one in a million" scenario, her ordeal and a combination of other events prompted me to reflect on my own diabetic, eye, and overall health.... And it brought up some thoughts ranging from a recent D-focused nightmare, eye scares both my parents have endured, the overall state of diabetes and retinopathy standard of care, and of course my own eye issues that have become more prevalent in past years. Those include the regular and diabetes-related, including a rare condition that only a small percentage of diabetics ever experience.

As far as my diabetic concerns lately, it's appropriate to say "The Eyes Have It."

The title actually fits in perfectly with the next point on topic. My wife and I are fans of the show Criminal Minds. We love it, despite being a little concerned that there are actualy people as demented as this in the world and there's a TV show based off of these sick crimes. Anyhow, there was a recent episode (or a rerun) called The Eyes Have It - basically, a crazy hunter guy snapped after his dad died and decided to start cutting out people's eyes and putting them into the hunted animals' empty sockets. Despite the crazy sickness of this, I thought it was a good episode.

This, of course, sparked a dream-nightmare soon after, one that basically involved a giant Diabetes Monstor stalking me and trying to cut out my eyes. He wore an eye patch and carried a syringe, but my dream haziness couldn't muster up any more of an actual description. Just believe this wasn't a Mike Wazowski; it was dauting demon and it seemed as though I couldn't escape it... (Dream anaylsis, anyone?) I woke up and there was no Diabetes Monster, though the thought remained for several days and still does.

This all also made me start reflecting on recent happenings in my life that all revolved around the eyes. Since I've been living with the D now for 25 years since age 5, my eye doctor has told me that I've shown the early, most minimal signs of diabetic retinopathy. The first mention of this was a couple years ago, and he said there was really nothing to do that point other than keep blood sugars under control. Nothing else required or necessary. I complied, at least for a while before falling back into my lax routine. A later visit found it had basically reversed itself, and all appeared good in the eye world once again.

It was at the initial visit that I also learned about a new eye-diagnosis I'd never heard of nor been told about before: (superior segmental) optic nerve hypoplasia. Apparently, while it's rare and can happen in non-diabetics it mostly occurs in a small percentage of the children of juvenile diabetic mothers, especially those pre-mature babies. That's me - I was a month premature and my mom's been a Type1 since age 5. It's only in my right eye, and basically my optic nerve didn't form all the way and only goes through half the eye. This means that if I'm looking straight ahead and cover up my left eye, out of my rightI can only see the upper half of my vision field. Waving my hand below that line isn't seen, until I move it up closer to the half-way point. It doesn't get better or worse, and it really doesn't affect anything since I can see the full picture from my other eye and obviously moving the trouble eye up and down allows me to see everything. Just an interesting tidbit to learn about, almost at age 30.

"Interesting and rare..." That's always something to gulp about when those words come from any doc's mouth.

Well, it happened earlier this year again when he told me that retinopathy was showing itself again. Again, nothing to do except keep in control. He moved on and also informed me that I had protein buildup in my left eye, a more common issue that wasn't diabetes-related and basically could have resulted from wearing my contacts too much. I should stop wearing them for a while, he suggested. I listened, but as a result soon found myself in a new frustrating situation that sparked even more headaches even as other eye woes came to light.

This story will continue with tales of more Big Eye Monsters, Pirates, Lasers, yelling-matches with the eye clinic people, and what it all means for the diabetes world. In the meantime, I'm thankful to be able to see, that we live in a world with the tools to manage both diabetes and eye care, and most of all I'm thankful for the love and support of family. Not to mention, the great DOC who offers continued support and opens my eyes each and every day.

Tuesday, December 1, 2009

A Diabetic's Christmas Tree

Well, this year marked a change in the Hoskins Household. Rather than following my motto that we must wait until December to put any Christmas decorations up, we opted to put up the tree and everything on Thanksgiving night. By the end of the weekend, everything was up. We even moved it around and opted to place things in different places this year. And we even painted the kitchen. All around productive four-day weekend.

Of course, in the true diabetic spirit, our tree also sports everything a great diabetic tree should:

A sugar-free chocoloate M&M, next to a sugar-free candy cane (Suzi may argue that this is a good ole-fashioned sugar-saturated candy delight and she may win that one, as there are two other M&Ms that can rightfully be claimed as no-sugars.)

Pump tubing tinsel, hanging without worry of being yanked loose by a jumping dog or sneaky doorknob.

A Mug O' Beer, in honor of my Oaken Barrel mug. A light beer, which has fewer carbs to count.

A Green Pickle, a tribute to the real Green Pickle pantoon boat. And it isn't sweetened, so it costs less in carb-counting!

Nearby, the Christmas Kitten (Shadow) guards in a purring slumber all the tree goodies against those mouse-like intruders. The Santa Dog (Riley) watches the action from beside the tree, as well.

In my comfy chair next to the tree, Riley and I doze off dreaming about the sugar-like riches the holidays hold: the now-passed Thanksgiving feast complete with deviled eggs, the soon-approaching Christmas, and all the wonders of family and friends who will come to see our tree during this Christmas "let's call it what it is, not just another holiday" season.

Now, it may not be a Little Charlie Brown Christmas Tree. And our pets may not be the real Garfield or Odie But hey, it's the Hoskins Family Tree, with all the trimmings to compliment our lives and Hoosier Household. It's time to mark the season in our own ways, and we love it.

Here's to December, and the start of Christmas Season 2009!