Tuesday, March 5, 2013

Diabetes Through the Years





First off let me say thanks for taking your time to read this piece.  It took me quite some time to put everything into words.  What I am trying to convey in this piece is how diabetes, while part of my life, has meant something different to me at each stage of my life.  Sometimes it consumed every aspect of my life while other times it was behind the scenes as an afterthought. Regardless of how front and center or back behind me it was or is diabetes has changed who I am and has changed my life forever.  


D-Day

October 1995, I was 8 years old and in 3rd grade.  I was looking forward to Halloween, dressing up and eating candy until my stomach hurt, or until my mom took it away from me, whichever came first.  Instead the 2 weeks leading up to Halloween went like this…

Jumping off the school bus with my little brother, we raced inside.  It was a Friday afternoon and what kid wasn’t excited about 2 days of freedom?  We had our normal afternoon snack, my mom said there was something different going on, but I didn’t notice.  All I wanted was something to drink, and not just a glass of juice or tea or water, but more like a pitcher of anything.  I was thirsty, like if I didn’t have something to drink my tongue might just fall out of my mouth and dry up right in front of me.  I continued to play with my siblings but besides wanted to drink everything I could get; my play time kept getting interrupted because I couldn’t stop having the urge to go to the bathroom. 

Well, all of you familiar with diabetes know, these are the key symptoms.  My mom kept an eye on me all weekend and told me Sunday night at dinner that I was not to have a snack before bed or to eat breakfast that we would be going right to the doctor’s office on Monday morning.  Monday morning came and off we went, where my mother explained to our GP what was going on, they did a finger stick and came back to the room and blurted out, “Your daughter has diabetes.”  Mom burst into tears, I was confused, but since mom was sobbing, I thought, “I’m dying, I’m going to die!  This is really bad if mom is crying like that.”  The doctor and nurse tried to console both of us and explain to me what was wrong.  From there they sent me to a pediatrician and then onto the pediatric unit of our local hospital where I spent 1 week learning about diabetes and being poked and prodded like cattle.  When I finally came home, my mom and dad kept me out of school for another week to help me adjust to my new life, needles, needles and more needles followed by insulin vials, glucometer strips and glucose tabs.  I remember each time the phone rang, I secretly prayed it was the doctor’s office saying they had made a mistake.  Too bad that phone call never came.

This was my new life.  October of 1995 this was when I went from a child to an adult.   The old me was gone and the new me, the diabetic me, was here taking on the burden of a disease, becoming responsible and having fear and worry become part of my every day. 
8 year old me after diagnosis with my hideous medicalert necklace


Elementary School and Middle School

Being the only kid with diabetes sometimes had its perks.  Not that I took advantage, but if I was hungry I ate in class, if I had to go to the bathroom I went and if I didn’t feel good I left class.  No one questioned the only diabetic kid in town because no one really understood diabetes. 

Elementary school and diabetes to me meant being a little different, but most of my friends liked being able to get out of class with me to walk to the nurses office, so no biggie there.  Moving on to middle school though, diabetes took on a whole different meaning.

Pre-teen and beginning teen years with diabetes were tough, especially as a girl.  Having diabetes meant I wasn’t like my friends.  I had more trips to the nurse’s office, I had to take more insulin usually in the middle of the day which meant more shots, and there were more low blood sugars more frequently in class.  I went on my insulin pump during middle school, which was cool for a little bit but eventually only added to my non-normalcy.  Teachers would stop and tell me pagers weren’t allowed in school, and kids would ask a gazillion questions about it.  I started referring to it as my “idiot detector,” because only idiots would repeatedly ask me to take off my “pager” even after I had already told them it’s an insulin pump.   A slippery slope started during these years as well.  My doctor’s had foolishly told me having an insulin pump meant that I could eat whatever I wanted.  Who does that?  Beyond dumb!  So there began my battle with body image, eating issues and exercise. . .

I wanted to be like everyone else, especially the more popular girls eating junk food and staying skinny.  These were the days when schools were first having Little Debbie cakes in the lunch rooms as well as vending machines for fruit punch.  Wanting to fit in, I did more damage than good to my body.  I ate that crappy food, knowing the consequences but risked it because I wanted to be normal.  Fudge rounds and a canned fruit punch would be my lunch, not every day but frequent enough that I recall wanting to fall into a deep sleep within 20-30 minutes after lunch (gee I wonder why? I’m sure my sugar was sky high).  I think back to how stupid I was, eating practically 100grams of junky carbs for lunch.  The outcome, a bigger jean size, higher A1c and more insulin-not so great!  My solution was far from intelligent, bouts of starvation diets where my thinking was, “well if I don’t eat my blood sugar will be lower (helping to lower my A1c) and I’ll lose weight and be like the popular girls.”  My poor mother never knew the crazy things I did until recently, and one of these crazy stints actually caused severe hypoglycemia with a reading in the mid 20’s, numb arms and complete confusion and the inability to feed myself.  Luckily I never lost consciousness and I was with my mother when it happened.    Moving onto high school and dating with diabetes. . .




The Teen Years in Full Effect aka High School

Oh high school, such a mixed bag, boys and dating, soccer and friends and my sidekick diabetes.  Let’s start with dating. 

Kicker for the varsity team
I was always an open book with my diabetes, I never hid it but high school opened a new can of beans, especially with the boys.  Yet again, dating and diabetes to me meant I was not like all the other girls.  I was embarrassed, was afraid of being judged, I was afraid of being different.  What if my finger pricking freaked out my date?  What if I passed out on my date? What if, what if, what if?  My first date I remember planning what diabetic essentials I absolutely had to take to be safe and thinking how I could discreetly hide my glucagon.  Instead of enjoying my date I spent my time terrified of a low or high blood sugar, pump malfunction, what if he wants to eat food I can’t, etc., not exactly what a teen girl wants her first date to be.  (Luckily, when I met my husband at age 17, I had gotten over feeling awkward with diabetes and dating.)

Where I did find my stride and I wasn’t different was the soccer field.  I had diabetes but despite it I was strong, I was determined and I was able.  Granted I did some stupid things like not waiting to be fully recovered from lows before I took the field because I became OBSESSED with the game. During the high school years I learned of the dreaded high blood sugars from intense exercise and trying to combat those after a handful of 90 minute, stressful games (which all of I had to disconnect my pump).  Half time team huddles for me consisted of blood sugar checks and correcting highs with my insulin pump or lows with the nearest juice box or whoever had Gatorade would share.  I had a great group of girls and a great coach that looked out for me and I could forget about my diabetes for a slice of time mid-game and just be Dorothy.  


Goodbye Home, Hello College & A Serious Relationship


What a jump from my tiny, fishbowl town, to a school that had more students than my town’s population.  Having diabetes in college meant so many things; I was really on my own with this disease!  No one knew me here except for my roommate, there was no one else to look after me or help me out.  It meant being the college kid at the party with the water bottle while everyone else was drinking.  It meant when I did drink I was usually scared beyond belief that my blood sugar would whack out so badly who knows what would happen, but peer pressure is a tough thing sometimes.  It meant that I addressed every professor on the first day of class and filled them in on my diabetes and I usually sat very close to the front row. Diabetes in college meant (at least for me) that I was more responsible.

An awesome thing that happened during this time period was the fact that I allowed someone else in to my diabetes realm to help me other than family.  My now husband was the first guy that I shared everything about my disease with and let him help me with everything, finger sticks, changing my insulin in my pump, treating my lows, my anger at my highs.   
This is when I learned that having diabetes and a relationship meant NOTHING!  Having diabetes didn’t cause judgment, embarrassment or for him to look at me differently.  I was just a girl and he was just a boy and my diabetes didn’t matter when it came to love.

I graduated Cum Laude with a business degree in 2009, with a diamond ring on my left hand and a wedding planned for June.  What would diabetes and newlywed life, working full time and being a real adult mean?


Welcome to the Real (business) World

I want to warn everyone reading this that not every diabetic has the same experience that I did in the workplace.  However, having diabetes and working meant that I needed an understanding employer that accommodated me needing breaks for the bathroom, blood sugar checks, dealing with lows or highs, lunch and my endocrinologist appointments every 3-4 months.  My position started out with management that understood all of this but quickly changed once I went from part time to full time. 

What T1D and working turned into was misery.  I almost never had a set lunch time, many days without lunch breaks or breaks at all or I would be called off of my break, trying to control my blood sugar under the amount of stress I had was ridiculous, having many people understand that when my sugar was low I needed to address it right then, not in 10, 15 or 20 minutes.  I had a schedule, but frequently would be packing up for the night and would be told I had to stay meanwhile I was unprepared and would have no dinner and my days would stretch from an expected 8 hours to 10-12.  Overall, it was a bad experience; my A1C began to climb from the long days which exhausted me and I quit exercising, crazy eating schedule, stress, etc. Everyone with diabetes also knows that ensuring our feet are in comfortable, good, supportive shoes is a necessity.  I was regularly harassed by my superior about my shoe choice to the point of tears and she finally relented after saying, “We’re not having this conversation again about your shoe choice.”  Tears filled my eyes, “ugh, if this is because of your diabetes then I guess we just won’t talk about it anymore but you could probably find better looking shoes.”  They were brown clogs and I stood on my feet practically all day behind a counter at a bank, no one cared what my shoes looked like as long as I could deposit their money.  To make a long story short, after 4.5 years of banking, depression and the highest A1C I’ve ever had (7.3%), my husband landed an awesome job and I was able to put this in my past and put myself first.


Taking My Health on as My Full Time Job


There I was at 24, coming out of depression, leaving a miserable job and putting myself first again.  I wanted to take a break from my insulin pump and found many people supporting the theory that I had come to on my own; my tissue was no longer absorbing my insulin correctly due to scar tissue therefore my blood sugars were inconsistent and my A1C was up.   My endocrinologist shrugged at this and became less and less help in the months that passed.  I knew that I had to do something and I became consumed with research and educating myself on nutrition, diabetes, alternative medicine and fitness.  At this point in my life, having diabetes meant that I had to be my own advocate, my own experiment and take control of my health 100%. 

Finishing a 5k in 2012
I slowly began cutting dairy out of my diet, then grains and sources of sugar and was finally 100% paleo.  I saw a drastic turn around in my blood sugars within a week.  I picked up kettlebell exercises twice a week, jogging 2 to 3 times a week and dropped 8 pounds in 2 months.  Everything seemed to be going well and I finally felt that I had found the solution to diabetes management.

This past fall I found Dr. Richard K. Bernstein, a T1D himself and began following his plan.  I approached my new endocrinologist with a well put together treatment plan which included disconnecting from my insulin pump and going back to MDI’s.  My plan also included a ketogenic diet of 30-45 carbs per day from non-starchy veggies, moderate protein intake and a higher fat intake.  I was very surprised when my new doctor got on board and on January 3rd of this year, for the first time in 12 years, I put my insulin pump in a bathroom drawer and picked up an insulin syringe.  Granted, there are ongoing adjustments when switching from one regimen to another, I am taking at least 6 shots a day and testing my sugar 8 times a day, but I feel great.  I’ve had to experiment with dosages, figure out a different strategy to combat the dawn phenomenon and become my own guinea pig however I feel that it has been 110% worth the extra effort.   My A1C is finally in the 6’s after years of struggling to get it back down, I’ve lost a little weight and I have nowhere near the number of extreme highs or lows that I previously experienced on my insulin pump.


The Here and Now-What Does Having T1D Mean to Me

After years of merely existing with this disease and letting it run its course however it pleased, I finally feel that I’ve gained back control. Having diabetes means to me today that I am blessed.  Yes, blessed.  Why you ask?  Because I don’t know who or how I’d be without it, so while some may consider it a curse, it is my blessing.  Having this disease has opened my eyes to realize the beauty of life, to see how precious life is, how intricate and wonderfully made we are, how complex our bodies are.  It has given me a great passion for education, alternative medicine and holistic nutrition.  This disease has given me a life that at times may be challenging, but it has enabled me to inspire and help others navigate the ins and outs of diabetes and for that I am grateful.  


~D

Sunday, February 24, 2013

Recap



My endocrinologist appointment went very well last week.  I went armed with information for her to delve into and documentation of all my latest experiments for her to dissect.  My doctor was very happy with my lab work, my weight loss and the hard work that I’ve been putting into managing my diabetes.  In fact she was quite impressed with all of the extra leg work I’ve been doing with crunching the number and self-experiments I’ve been putting myself through.  She loved the ways that I’ve been trying to combat my dawn phenomenon and commended me on figuring out such a good system.  It feels good for the hard work to finally be paying off.  I’ll be heading back to see her in 3 months and it is my goal between now and then to reduce my A1c further, 6.7% down to 6.4%.  

I took advantage of the time I had with my endo and picked her brain about potential career paths.  For those of you that don’t know, I originally started college as a health science major with the intention of becoming a CDE (certified diabetes educator).  In case it isn’t blatantly obvious, I have a strong passion for diabetes education, nutrition and overall health and wellbeing.  Talking to her has led me to look into a few career paths that I had briefly thought about but never truly considered as options.  Needless to say, I have some decisions to make and am hoping that sometime soon I’ll be able to reveal a new plan about my career future to my friends and family.  I have always felt that this disease was part of my life for a reason and if I can help others through what I’ve learned, that’s what I’ll do.    

My blood sugars have been getting better over the past 2 weeks.  I was able to cut down my long acting insulin by 1.5 units this week, which is great!  Any reduction, no matter how small is a step in the right direction.  However, I have felt like I’ve been hitting more veins lately and my bruises are slowly taking over my injection areas.  Yesterday I invested in Arnica gel, which is supposed to help heal bruises faster.  Other than the decrease in insulin, I’ve made no real changes.  I am happy to report that I have been off my insulin pump for over a month and a half and cannot see going back to it in the near future.  I’m still enjoying my pump vacation and am looking forward to the summer months where I’ll finally be able to fully enjoy floats on the river, bathing suits and dresses without worrying about my pump!  Bring on the warm weather!

Besides my great appointment, I’ve been working on a guest blog post for a fellow blogger who also has T1D.  Look for that soon!  It will be about what diabetes has meant to me at different points throughout my life.  It is funny how having diabetes meant something different to me in grade school, to college, to married and working life.  I won’t go into too much detail, that way I won’t ruin the coming post for you guys.
As always, thanks for reading!
~D

Tuesday, February 12, 2013

The Mad Scientist - Being My Own Experiment

I intended on getting a post up a few days ago, but sometimes life gets in the way!  Better late than never!


Knowledge is the key to everything.  Obtaining knowledge comes at a price sometimes, for me the price was no sleep and no food.  I spent about 20 hours fasting in order to understand how and when my body was releasing glycogen from my liver and muscles and if my basal insulin dosages were correct. 
Here are my fasting basal testing blood sugar results showing the dawn phenomenon (which I will abbreviate as DP):

7am-117mg/dl accompanied by my basal dosage of 8units Levemir
8am-145mg/dl
9am-188mg/dl
10am-198mg/dl
11am-179mg/dl
12pm-174mg/dl
1pm-141mg/dl
3pm-138mg/dl accompanied by basal dosage of 8units Levemir
4pm-126mg/dl

Just to remind you these numbers are showing an upward trend WITHOUT me consuming anything besides water.  For anyone who is unfamiliar with diabetes, this is the DP and let’s be honest, to most diabetics it is a HUGE pain in the butt.  It is unpredictable, frustrating and at times it feels that it is uncontrollable. 

Each person, diabetic or not experiences the DP.  In the morning, anywhere between 3am and 8am our bodies are preparing for our day, releasing a plethora of hormones such as cortisol, glucagon and epinephrine which causes our liver to release the culprit…GLUCOSE!  What is so interesting about this is that these circulating hormones actually cause less sensitivity to insulin.  Therefore those of us injecting or pumping insulin have to increase our dosages anywhere from 20%-50% to fight against this surge!  Non-diabetics are able to combat this since their system of “checks and balances” is still in place, meaning their body recognizes any slight rise and secretes insulin while those of us with diabetes have to pinpoint the time that our body typically “dumps” this glucose and try to have the upper hand via low carb breakfasts, more insulin or adding Symlin (injection) which is to replace the hormone Amylin that T1D’s also do not produce.

After doing my basal testing and reviewing my previous glucose logs, it was evident that each day my blood sugar was climbing anywhere from 60 to 85 points each morning even with a NO carb breakfast, peaking between 10am and 11am. 

My first experiment with this new information went a little like this (and for those diabetics reading this, you may think I’m nuts):
1) Take morning blood sugar reading and add 75 points, which was a typical point increase I was experiencing.  Gives me a new number to bolus to.
2) Subtract 120 (target blood sugar) from new number.
3) Divide by 45 (this is my correction factor)
4) Add X units to morning bolus.
EX:  1) morning reading 100 + 75 = 175
       2)  175-120=55
       3)  55/45=1.22
       4)   1.22=number of units to add to morning bolus (in hopes of combating DP)

I tried experiment 1 for a few days and found for me that it only worked well IF I was combining both rapid acting insulin and Regular insulin that has a slower peak. 
Time for experiment number 2:  Reintroduction of Symlin aka make me wanna puke medicine
I have to give credit to a fellow T1D, Jason, who had written a whole post called, A Practical Symlin Guide for Type 1 Diabetics - Part 3: Advanced Techniques, Train Wrecks & Disasters, and High Protein/Lo-Carb Diets.  He suggested combating the DP by injecting Symlin early in the morning to keep the dump of glucose from the liver.  

Fast forward to this morning, blood sugar of 114, I injected the Symlin first thing when I woke up, 30 minutes later I took my insulin, but decreased it by about 2 units, ate my no carb breakfast about 15 minutes after that and drum roll please, post breakfast blood sugar was 144.  An increase of 30mg/dl (I’m aiming for no more than 20mg/dl increase or decrease), that sure beats an increase of 75 or 80mg/dl increase I was having!
I plan on furthering this experiment, especially considering that I only took 15mcg of Symlin which is the bare minimum and you must build up your dosage on this medication.  

Moving on from my experiments, I’m excited to announce that after months of hard work my A1c is finally below 7%.  For years now I’ve been bouncing between 7%-7.3%.  My triglycerides have lowered significantly and my good cholesterol is way above the target at 74.  Low-carb, higher fat, no sugar, more exercise has helped me to accomplish this.  I gave up fruit January 1st, I had already given up all grains 90% of the time, but went all in also on January 1st.  My meals consist of fat, protein, veggies and some people would be scared to learn that my daily intake of fat is about 50% of my daily calories!  Your body needs fat people, what it doesn’t need is a ton of glucose which comes from fruit and grains!  

Do you think that what I’m doing is following the traditional path of diabetes care?  No, it’s not.  I previously had two doctors and three nutritionists who shut me down every time I brought up doing anything low-carb or disconnecting from my insulin pump and “back tracking” as they said to injections.  They insisted I could eat a diet that consisted of 60% carbohydrates and just as a refresher, carbs turn to glucose, which I cannot metabolize correctly.  Does that sound like a good treatment plan for someone with diabetes? 
What I hope that people can take away from this post is that YOU are your best health advocate.  Realize that you are in control of your health!  Don’t be afraid to change doctors until you find the best fit for YOU!  Do your own research; seek second, third and fourth opinions when it comes to your health.  Be in control. Read, read and read some more, take notes, talk to others with your condition because they may have stumbled across something you’ve never heard of!  Keep the lines of communication open with your physician, because you may teach them something and they may get on board with your plan, like my MD is now.  

Well guys, thanks for reading this week!  Hopefully I’ll be posting more positive results as time progresses.
God Bless,
~D





Sunday, February 3, 2013

A Month Already?

4 weeks without my insulin pump!  I can hardly believe it!  While I am still thrilled to not be attached to anything, I am still frustrated that I am working out the kinks of MDI's.  I have not found anything to work 100%, and as I've realized over the past 17 years, nothing ever is 100% a solution for this disease.  
This coming week will most likely be the most challenging, starting tonight actually.  I will be doing a basal test.  Basal insulin is my long acting insulin that I have been taking twice a day, to keep my sugar at an even keel.  A basal test requires fasting and last time I checked no person likes fasting.  Dinner tonight will be my last meal until tomorrow night.  I will continue to take my long acting insulin and will have to check my blood sugar every 2 hours to try to determine any type of pattern that is occurring. 
The biggest thing I am hoping to accomplish from this is to determine when my "dawn phenomenon" is starting to occur and that lovely hormone, cortisol, is destroying my blood sugar. This test will also help me determine if my basal insulin dosages are even close to correct.  However, if my blood sugar drops during this time period, it's abort mission and I will have to start all over another day (yuck).
This week I will unfortunately be eliminating my delicious Starbucks coffee, which I indulge in each morning straight from our Keurig brewer.  Caffeine is another substance that changes blood sugar, so I am doing my best to eliminate any possible offenders.
Besides my basal testing, I am considering a few other guinea pig experiments on myself.  One of which will include Symlin, a medication to help with my stomach emptying, satiety and post meal blood glucose spikes, because on top of not producing insulin, I also lack the ability to produce amlyin.  When your body destroys the beta cells in your pancreas all kinds of fun things happen!! NOT!  I have tried Symlin before, when I was on the insulin pump and I never really stuck with it.  Partially due to the fact that for the first month, you practically want to throw up for 6 hours out of the day and it takes all my energy to move from the couch.  Joy!  It seems if I can get over that, one day pregnancy morning sickness shouldn't phase me right?!?!  However, if I can get past the weeks of adjustment and past the puke phase, this stuff might just work.  
For those of you out there keeping track this will increase my daily number of injections...what's another 3 needle jabs when you're already doing 6-9?  Yes, this year for Halloween I will appropriately dress up as a pincushion! 
Well, thanks for dropping by and keeping up with my crazy rollercoaster! 
Update soon,
D