Battle of the Buldge

As I was dressing this morning and stepped onto the scale (a near daily habit) I smiled as I saw the number appearing there. It reminded me of the years past when the number wasn't so low -- I thought I'd take a moment to share my journey.

I want to start by admitting that I've never been a very large person. I know I've been blessed with a good metabolism and parents who taught me good habits for weight management. I'm posting this on my Diabetes Blog because I believe my weight gains/loss are often tied with my diabetes.

All through high school, my weight stayed in right about the same place. I went through periods of diet or exercise (never combined, but I'll explain why) with little fluctuation. I determined that it was just the weight my body liked to be at. It was bigger than I wanted to be, but I saw little I could do about.

Now as for the why just diet or just exercise. At this point in my life, I was using insulin from a syringe to manage my diabetes. I was on a combo of NPH (long acting insulin that peaks after a certain number of hours) and Humalog (a fast acting insulin that works quickly and doesn't peak too bad). NPH was taken in the morning and evenings.

Exercise is critical for diabetics, just as it is for anyone who wants to remain healthy. Exercise can lower blood sugar levels -- sometimes dramatically. The problem I kept running into was that when I exercised, I'd drop low. This would create a need to drink juice or eat some sugary item which, of course, also contained calories. The good I did in exercising was undone in the calories that I'd have to eat later. The NPH insulin, once in, can't be withdrawn -- so while I could be active, I'd have to compensate for it later with food.

Anyway, fast forward several years. I still maintained the same weight. I'm happy to say I didn't gain weight after high school. There was no freshman 15 (I was very afraid of that -- I felt if I put on the 15 pounds often associated with college then I would have to consider myself not just a bit bigger than average, but overweight. The fear of gaining probably kept me more cautious, thus I was okay) added to my belt. I still wasn't able to lose weight and had just about given up on trying.

Finally, I graduated from college. I got a job with much more respectable insurance than my current state plan. The new insurance policy would cover 80% of an insulin pump and the insulin pump supplies. My old policy required me to be in renal failure before they'd consider covering it. I had a doctor that didn't want me to spend 7 days in the hospital in order to train on the pump. The stars aligned, and I got my pump.

Now I had the power to exercise, drop the amount of insulin I was receiving and thus diet at the same time. Since getting on the insulin pump (thats when I thinking the pounds started coming off) I have dropped 13 pounds from those high school/college days. Not only can I diet and exercise (when I'm being good -- right now I'm a slacker), but I can choose how much to eat more freely than before. If I am not hungry, I'm not required to eat anyway. I feel better about the way I look, and more confident in my bodies chosen weight.

Now, I probably can't attribute everything to the insulin pump. Prior to the pump I started making some difficult but beneficial choices about what I ate. I stopped eating out at fast food restaurants (completey for a time and now if I need to get something in a hurry, I choose wisely -- Subway type places, or if a more fatty chain, I make sure to pick items on the menu that I know the fat content already). I avoid fried foods (with the exception of some pastries -- can't go completely cold turkey... maybe some day) in general. I've found restaurants will allow me to substitute the fries that come with their sandwiches with fresh veggies. It isn't that I never indulge -- its that I indulge less in those things which don't satisfy.

Through this process I learned that my body is pretty smart. If I follow it, I'm usually happier. I was once told that food was going to waste whether you ate it or not -- meaning, you don't have to finish something just because its in front of you. By following my bodies ques, I feel healthier and stronger. I try to pay attention to the signals it sends me. Stop eating once you are no longer hungry -- not when you are necessarily "full." That sort of thing. Its proven effective. I've also learned to distinguish better between appetite and hunger. Cravings can be ignored -- hunger shouldn't be.

Anyway, after getting married I put back on about 2-3 pounds. I've since gotten back on track and back down to my "wedding weight." I wouldn't mind losing a few more, but I feel pretty good about whats happened. I laughed at myself a bit when I found myself worried about the slighter higher number on the scale, realizing it was still 10 pounds below my old weight.

As a final P.S. -- my last A1C was a 7.1. Its still not perfect, but its the best I've ever had in my diabetic life. I'm really pleased with the progress. A little more tightening up of the control and I'll be in the approved range for "good" control. (Between 7-8 is not called uncontrolled or controlled... about 8 is uncontrolled, below 7 is controlled -- at least, thats how I've always understood it)

Just thought I'd share! Hope all is well! I'm out of here.

Argh, argh, argh!

Sometimes I really hate this disease.

Okay, its not as bad as all that. My numbers have been.. okay today... I'm just tired of seeing my blood sugars run whichever direction they want. I've been trying to be a lot more careful when I can about my carb counting. If I'm home or even going to someones house, I try to bring my scale out and weigh the food and look it up in my book. Despite this, I still have moments of blood sugar crazies. Take a few days ago...

I was home alone while my hubby was at work at two different times that day. I was napping in the early afternoon. I had carefully figured my carbs for lunch. It was a meal I'd have before, so it wasn't difficult. I kept hitting my snooze button, even though I could feel my blood sugar might be a little shaky. It should have clicked that I needed to do something, but it didn't. Sometimes thats how these blood sugars go, right? Well, I finally rose from my nap and found my blood sugar had dropped to 37! Whoops! I quickly overreacted and drank more juice and ate more food than I should have. (When I get that low I feel like I'm starving so I tend to overeat).

This of course, led to dramatic high. I took care of that as best I could... using the same sliding scale that I always use with high blood sugars. It usually works fine. My husband had come home in between, but he then had to go back to work. So once again I was alone when I caught my blood sugar at 64. I was trying to be better about following my "low sugar" plan so I drank a small glass of orange juice and waited. As I was waiting, I started to feel worse. After about 15 minutes, I tested my blood sugar again.

It was 40.

Now, I don't usually have my sugars drop that much after the initial test. As long as I drank the juice, if its on its way down further still, it at least stabilizes and will be a similar number to the first test. Seeing the 40... well, I panicked. I don't have any other way of putting it. Perhaps it was the book I'd been reading, but somehow the thought popped into my head that my body was trying to kill me -- literally. I was sure that nothing I would do would bring it up. I drank some milk and some juice and then sat on the couch and cried as I tried to call my hubby (whose phone was dead). It was 11 o'clock at night so I didn't want to trouble anyone that might be asleep, so I sat trying to test and see what was going on. It reached 42, then 56 and finally 100.

I tried to stay up for another hour once my husband got home to see how much my panic would cost me. An hour later it was only up to 126, so I went to bed feeling pretty certain I'd be okay... and then I woke up high. Fortunately, at that point I was able to stop the roller coaster that I was on and level things off for the new day.

The most frustrating aspect of this disease is the constant fluctuations. Something that is working can suddenly dramatically change. I can have a couple of really good days and suddenly be spiking left and right. I just keep adjusting, keep calculating, and keep trying... Its all I can do. All I can hope is that the fact that I try will count for something.

On a side note, to try and help myself monitor things more closely I called my doctor and requested that he increase my test strip prescription so I can test even more times a day. This last month I've been testing more than I have test strips to cover. I'm going to run out early and that means buying them at cost -- not cheap. Hopefully he'll get that called in soon so I can avoid that. At least I'll have it worked out for future months.

Thanks for reading!

We're walking!

Billy and I have decided to join the walk for diabetes on September 27th. If you want to join our team or contribute, go ahead and visit this site! :)

http://main.diabetes.org/site/TR?pg=personal&fr_id=5290&px=4298176

Insurance: Grr.

I test my blood sugar a lot. I average 6 tests a day. My prescription is written to cover this type of testing, so each month I get 200 test strips to work with. Some months I still have a good 25 test strips still available to me when its time to refill, but more and more lately I'm coming close to maxing out when those 30 days are up.

I filled my last prescription on June 29th. That means my 30 days is up on July 30th. It used to be that I could fill my prescription a day or two early. Makes sense, right? I mean, if it runs out 30 days after its filled, you may want to give people a few days to get things in order. Well, for whatever reason, this time they won't fill it even one day early. So I'm not allowed to fill it till tomorrow. I have 8 tests left -- so normally I'd pick it up first thing in the morning... unfortunately, (or fortunately?) I have things going on tomorrow morning. I can only hope that I'm home early enough to fill it and that I don't have a need to test too many times. GRRR!

I'm calling my insurance company tomorrow to let them know that that's not going to fly and that if they won't let me fill earlier I'll get my prescription increased so they can pay for more to ensure that I have enough to get me a few days past 30 days. At a dollar a test, maybe that will get their attention?

While I'm talking about my insurance -- they directed me to a certain company to work with when I got my pump. They wouldn't tell me what to do, they just said "Use this company, they know our procedures." As it turns out, that company was charging me an extra 70 per box of pump infusion sets! I go through more than a box a month, so that means my insurance was paying more simply because they were too lazy to tell me their own policies. I finally discovered it and have found a new supplier. Hopefully it all goes through without a hitch.

Oh How I'd Love a CGMS

A CGMS - Continuous Glucose Monitoring System is the latest wave of diabetic technologies that's making its headlines in the news. There are now 3 different companies sampling their CGMS's on the market. One of these is Medtronic, which is the same company that produces my insulin pump.

When I bought my pump, I chose the one I did for two reasons. First, it was the only one that held enough insulin for my 3 day supply (according to the trainers). This turned out to be wrong (I use less insulin with the pump than they predicted), but that was their initial thinking. The other reason was that it was already equipped with the technology to communicate directly with a CGMS.

What a CGMS does (as the name implies) is continuously checks your blood sugars. All day long, 24 hour hours a day, 7 days a week, it senses your current blood sugars, logs them, charts them, and even (this is the part that really excites me) can be programmed to alarm if your blood sugars fall out of the desired range. Imagine the potential? In theory, I could set up a CGMS to alarm me when my blood sugars reached about 120 or below 80 (these are the blood sugars a nondiabetic expects to see). No drastic lows in the 30s that I can barely think straight enough to take care of... no unexpected highs of upwards and over 300 because my pump tubing got tangled up in a knot. Near perfect control.

So why haven't I gotten one yet? They are insanely expensive. When I got my pumps, my very kind and loving parents offered to pay for the CGMS receiver, which would have cost an additional $1000. I was thrilled (I think I even cried) because I so desperately wanted one. Well, I called to look into it and found that the initial $1000 was just a start. A months worth of supplies to keep the thing going cost $350. $350 a month? Who has that kind of money lying around? That was beyond my parents reach and mine (See, school teachers just don't make that much money). The extra cost of the pump supplies was already a bit of a worry... that just wasn't going to happen.

Well, an ariticle I read today said that some of the biggest national insurance companies are starting to pay part on CGMS systems. Its only a matter of time till more jump on board to stay competitive. I can't imagine that mine will be amongst the first to take them on, and even if they do... my 20% of that each month would mean an extra $70.00 a month (assuming these sensors don't go bad on me early like my pump sites do). So its probably a ways off... but I can dream.

Someday I'll get a CGMS. Eventually those prices will come down as the technology becomes more mainstream. Eventually my insurance will cover part of it. Eventually, I'll have the chance to manage my diabetes in a way that was beyond anyones wildest dreams just years ago.

Here's hoping!

Recording Those Numbers

Well, I'm trying to get back on track. Between the wedding, the honeymoon and trying to find a sort of rhythm to my new life as a wife, I haven't been very good about recording my glucose numbers. A few months before school let out I had finally (after how many years?) found a system I was happy with. I record my blood glucose numbers on google docs. I also use the same program to record what I eat, the insulin I took for it, etc. It was working pretty well for me. It was helpful to be able to look back and see what areas were out of my target range on a regular basis and things like that.

After the wedding, after the honeymoon, I kept putting off getting back to recording. I didn't want to try and catch up my record for several weeks. It can be tedious and the only way I stay motivated is if I do it on a regular basis. So this morning I finally decided to just start fresh, rather than putting it off even longer.

The reason I've liked using google docs so much is its on the computer. I do a lot better if I can type things into charts and such, rather than having to fill things out by hand. I set my web browsers so that google docs is my homepage. This reminds me to fill them in each time I log on. Its been a pretty good system and now that I'm starting up again, I'm sure I'll find lots of areas that I can improve. One of the hardest thing about life with diabetes is how often and quickly everything can change. You need to constantly be aware of what is going on because things that were working before stop working and you have to do something new. What a joy huh?

Anyway, so that's the message of the day. I'm back on track with recording the numbers and the daily food. (P.S. Keeping a food diary also makes you less prone to snack or eat badly... because when you know you'll have to write it down, you think 'Na, I don't really need that.')

Pumping It: How Its Changed My Diabetes

A year ago February, I finally had an insurance plan that would allow me to purchase an insulin pump. It was an expensive en devour, but one I'd spent a lot of time planning for.

Prior to having an insulin pump, I used two types of insulin. One was called "Lantus" and the other is called "Humalog." When introduced to Lantus insulin, I was thrilled at the concept. Lantus insulin is claimed to be a 24 hour acting insulin that has no peaks. That's a big step in the right direction, since prior to the Lantus I used "N" insulin which lasted about 8 hours (if I remember correctly) and peaked about halfway through the cycle. Lantus allowed for some major improvements in my management. The problem was that my Lantus would run out early -- after about 22 hours.

Splitting that dose up into two shots helped over the gaps that it left, but I was up to five shots a day minimum. Also, despite filling in the gaps with two shots, my body didn't need the consistent basal that the Lantus gave. Some hours of the day, I needed more. Others, less. Night time lows were a cruel and frequent visitor, disrupting sleep. So while it was a better system, it wasn't a perfect system.

Well, finally I got the pump. I have about 5 or 6 different basal rates depending on the day. The insulin pump works by continuously delivering tiny doses of insulin throughout the day, and allowing for bolus doses when I eat or experience high blood sugars. I can alter my basal rate temporarily if I do something that might cause me to need more or less insulin.

All in all, I'm very happy with it -- but it is a constant learning process. When Billy and I were in San Diego, my blood sugar was running consistently higher than usual. It was frustrating and I wasn't sure what was going on. While we were sitting at the airport waiting to leave, I overheard a group of people talking about how the difference in our air pressure makes your exercise more effective in Salt Lake. Well, within an hour of being home, my blood sugar dropped too low. I had to bring it up with extra sugar. A few hours after that, it dropped again. As it turns out, my body seems to have to work harder here in Utah than it did in California...

I'm constantly changing my basal rates as the events of life cause more stress or leave me less stressed. The nice thing is that I CAN make those changes now. So for that, I'm grateful for the pump. I have options -- I can skip meals, I can eat at different hours of the day, and next time I go to California, I can adjust my dosing to compensate for the easier to breathe air.

My Introductions

Well, where to begin? Hello! My name is Melissa. I'm a high school math teacher. I enjoy singing, dancing, reading, and spending time with my wonderful fiancee. I graduated from the University of Utah with a degree in Mathematics Education. I enjoy my job, though it definately has its pitfalls and distressing moments. I'm a member of the Church of Jesus Christ of Latter Day Saints, and love all that goes with that gospel. I enjoy spending time out of doors during the spring, indoors during the summer. I enjoy playing golf, watching college football, and remaining active. Oh yeah... I'm also a diabetic.

I was diagnosed with Type 1 Diabetes when I was 11 years old. Now, 14 years later, I'm still realizing that I don't know nearly enough about a disease that influences so many of my decisions. While I haven't often been considered "out of control" I don't believe I've been considered "in control" either. As a person who likes to believe she can control anything, this is something I'd like to change.

So here begins my journey. As I step out of my comfort zone, talking with more and more people about a disease I should be more familiar with, I'll share my story with you. As I strive to better understand how to manage the various challenges that come with diabetes, I'll share what I learn. Welcome.