#dblogweek ; The crazy stories (wild-card)

So I knew I was going to write this post waaay before it was selected as a Dblogweek topic (Thanks to Karen being awesome).

I need to preface this by saying that these crazy experiences all occurred at the start (first couple of years) into my adventures with type 1 diabetes. Back then - I just didn't know any better - today I do! All in all, they are all a result of lack of education (surprisingly in three days at the hospital noone told me about diabetes + alcohol and diabetes + exercise, nor did they tell me lows could be as serious as I now realize they can be..) Of course, it's probably my fault for not researching a ton into my new diagnosis, but let these be a reminder to health care professionals not to assume they newly-diagnosed (especially teenage and young adult) patients are know-it-alls.

3) I am in the country on the outskirts of Amsterdam.

Things are great. Except for the part where I am walking 10-15 km per day (that's right!) to go from either our countryside hotel to the bus stop of from there to Edam (where the good cheese is). It is literally the middle of nowhere (beautiful) and I am doing all this exercising, bolusing Humulin R and still on NPH back then with nothing to account for the increased exercise sugar-wise (meaning I did not carry any kind of fast-acting sugar or any food period! on these excursions). In the middle of nowhere. With Diabetes. Not realizing how awful things could've turned out. Gladly, I was rescued by the loaf of freshly-baked white bread we bought in Edam (with Salami and wine to complement all the pot, of course). I must have consumed half a loaf on one of those 7-km walks back from Edam to the hotel that one day. I never tested (because I severely lacked in test strips when I lived in Europe and also because I just trusted myself back then to do what needed to be done without checking often). I just knew that I had to eat! So I did. And I survived. Cause, really - it would've sucked to have just passed out there. In the middle of nowhere. Even the thought that that could have happened and the distress that would've caused to my poor husband still scares me.

2) This one is crazier, perhaps. I am in Costa Rica for a week. I *think I have enough test strips. But, alas, I don't (after an all-time low of 37 mg/dl I have used up a lot more than intended - again extra exercise was unaccounted for). With three or four days left in the trip, I am 100% out of test strips. I try to get some for my meter at the pharmacy, but they don't have that brand - they will "order it" for "later in the week". Won't work. They offer a whole new system that is ridiculously over-priced (like I can't afford it). So what does this girl do you ask? Well - this girl - forgoes testing for four days, continuing to enjoy her vacation, whilst swag-bolusing away. Unimaginable to me today. But I came home with a BG of 176 and no emergencies. Boo yah. (I don't recommend doing such things :)
Here's a pic of Costa:


1) This one takes the cake and it involves first heavy alcohol use since diagnosis. It was in fact my mother's wedding (I couldn't be happier because my parents' divorce was overdue and I was thrilled she found someone she was happy with again). But. It was a Russian wedding, which pretty much always means lots of Vodka. I remind you that I at that time was not aware of the BG-lowering effects of alcohol and the sky-rocketing of insulin sensitivity that occurs. So, after consuming what was probably some stupidamount of very expensive Vodka, I went to check my BG and was in the 200s. I promptly bolused Humulin R to cover it, not accounting for the drinking. And then the shit hit the fan. Within an hour or two I remember crying and that I had real trouble walking (like I would stand up and my legs would just not really hold me up at all). Here's the kicker: Everyone (myself included) thought I just got ridiculously drunk (which I'm sure was true). But we all know that wasn't the whole story. My boyfriend (husband today) and his cousin (we all lived together back then) took me home to "sleep it off". I remember getting into the vehicle. The next thing I remember is sitting up in my bed, leaning over into the provided bucket, and (well you get the point). And then I received a recollection of the events. Apparently, when I got home, I became incredibly belligerent with my boy and his cousin in law. I was told that I was hitting them! And screaming about how I hated them and to leave me alone. And then I was passed out (but breathing) on the bed for "some time". I came to and my boyfriend was so upset - he thought I meant all the nasty things I said to him about how "I didn't love him anymore" which again, I don't remember any of. When I woke up and threw up, I felt shitty and low, and I remember that I walked to the kitchen fridge and chugged some juice and went back to sleep pretty soon after that. As B helped me take off my clothes and put me to bed, he made eye contact with me and said "So - you still love me?" "Of course I do!" I said feeling guilty for getting so shitfaced and stupid, especially on this day. "Good, I'm glad you're feeling better. Man you should've seen yourself - the spitting image of Courtney Lovefor a bit there" he laughed. For some reason I remember that remark vividly. He was right. Looking in the mirror with my hair messed up and makeup smeared with puffy eyes and white button-down shirt wrinkled - I kind of did look like her. The thing is it took me several years to realize that all this craziness was probably a result of very severe low blood sugar, induced by over-doing it on the Vodka, and not "just being too drunk". Scary shit kind of. I talked to B about it too, after I figured it out. Definitely the craziest and scariest diabetes moment ever. I hope health care professionals and D-parents will take time to talk to their kids about alcohol use and Diabetes. I definitely learned the hard way...

Today, I know a lot more and make more responsible decisions. I know that people around me know I have diabetes, and they know what a low blood sugar can look like. I carry Glucagon, and snacks everywhere with me. I am careful about drinking. I know Glucagon won't work if drunk. I am so much more careful. I haven't lost little rebel - she will always be there - but I gained so much wisdom it would be stupid not to use it <3

How about you?!

#dblogweek : keeping it to myself

With the exception of this blog and my husband, my diabetes is almost imperceptible to anyone around me. I don't talk about it a lot, I don't test or inject "in public". When I go into a lab meeting or presentation with a bg of 300-something, my boss doesn't know about it. When I am low low low and my hands start to shake I quietly go to my office and stuff my face with candy or juice. I sit there quietly, as patient as one can be, using all of my willpower not to scream "help - I feel like I'm dying" to a coworker. All in the name of keeping D generally well-hidden.

It isn't shame. Nor is it a lack of a desire to educate. It is simple: I just want people to see ME first.

More recently, I shared my (postsecret) fears of complications and feara of pregnancy with diabetes with my husband. I feel better that I did. But I also feel like I lost a part of the happy-go-lucky demeanor I tend to project as a result. So while sharing is healthy, for me, keeping things hidden also works jn my favor by not allowing me to prioritize diabetes (management, fears, etc) over living my life.

#dblogweek : I can, we can

In some ways I think diabetes  kind of lit a fire under my ass. It has made me face my mortality far younger than most probably think about things like death or old age, but its not necessarily a bad thing because now I know that:

The time is now. Time to travel the world (no matter how poor), time to grow the cutest furrriest family, time to pursue my relationships as well as my career with all the passion I have to give every day. Time to make time for what's really important. Now.

No time for: negativity, laziness, sulking, or questioning.

I can because I have since my diagnosis - gotten married, lived in Europe and traveled to Central American numerous times, adopted three dogs we probably cant afford but love to death, gotten into grad school and got a Ph.D., became an auntie, amateur gardener, avid hiker, and a docophile (am I the first ever to use this word? ;) And I am super excited about what's next! Without diabetes it feels like it wouldn't be the full me anymore - its been about 7-8 years with D but there is no denying it's a huge part of who I am - and I can all the things with it as part of me...

I can, we can - thank you doc for all your support, for reading, for putting yourselves out there. We all have an important story to tell <3

Update!

Here's the update on the lower carb higher fat diet:

I feel good, my 7-day bg average dropped by 60 (mg/dL) points, I have had no lows, and my highest pp bg was 240 (this exact # made an appearance exactly 3 times this week, 1.5 hours after a meal, each time the meal was more than 35g of carbs.) I aimed for steady mid-100s for now and I would say that I did pretty well! I am terrible! at pre-bolusing (probably because I often don't need to, especially after exercise), but I definitely need to in the morning and at lunchtime at work when I'm just sitting at my desk.) Another important lesson I learned this week is that veggies aren't "free foods" (although it may seem that way when they make up a tiny amount of daily carb intake). But now I know that when I have a cup of veggies, I better take a half a unit of insulin and that will be perfect and will make all the difference between 180 and 120. This week, my goal is to continue with this eating plan and do my best to range between 100-160 (160 for pp values and 100 for fasting).

The best part isn't better control - the best part is the lack of anxiety about when did I bolus and am I high, and what am I doing, and how much insulin on board, and do I need to eat again, etc. Things are much more predictable, much more stable, and much more close to "normalcy". I realize very clearly now how horrible the feeling is when you have a ton of insulin on board and all you can do is worry (I'm prone to worry sometimes often?) and the roller coasters that can arise as a result that make you feel shitty and depressed really suck even more.

My Humalog use has been between 5-10 U daily, so basically I cut my carbs and my fast-acting insulin dose in half. My weight was recorded incorrectly last week. I actually started at 119ish and am now between 117-118. Alcohol intake was zero this week so that helped with stability of bg very well, especially with overnight control. (My Levemir dose is still set at 6 U twice a day and seems to be working pretty well.)

I don't feel deprived; probably because I ate well-balanced and also I wasn't so anally strict with myself that I didn't incorporate some foods that probably aren't awesome for bg but tasted delicious (like egg-rolls, freshly-fried morel mushrooms that we picked, and some bread as well). I ate out once this week and I got a large Greek salad with a small side of cole-slaw and also some cilantro tuna salad on top - it was delicious!

 I also tried a lot of new stuff like making oopsie bread, and having my first ever burger on lettuce instead of bread! I also enjoyed dark chocolate, full-fat (indulgent) chobani yogurt, nuts&spices kind+ bars (yum!) Here are some pictures of the kinds of foods I ate this week:

Making some changes...

So instead of whining (see last post ;) I have decided to implement some actual changes to my lifestyle that I hope will make a prompt difference in my D management as well as my state of mind. Basically, I am going to alter my diet in a consistent way, while shifting toward lower carb - higher fat eating (although not to an extreme). I have used low-carb meal planning before and found it to aid greatly in weight loss as well as making my bg more predictable (easier to dose for smaller amount of carbs, etc.) Basically, I am planning an adjusted  Bernstein/ Paleo - type diet (look up Bernstein if not familiar - I think he's got a really cool story). And I say "adjusted" because I very-well known that I will NOT be 100% cutting out ALL pastas, pizzas, breads, rices, etc. And I will not be eating as little as 30 carbs/day (probably more like 50-80 I'm thinking). I instead will change the proportions of these foods I eat relative to other things, incorporating greater amounts of veggies and also some fruit (funny thing with fruit - I can never bolus properly for a banana but I can have a berry/milk smoothie like a champ! damn bananas..) I will also not restrict protein/fat intake of any kind - I don't anyway (although I will not go over-board by eating salami sticks and cheese all day long either :) YDMV as they say, as do our dietary needs. But after much research recently (reading science articles, but also hearing about LCHF advantages from PWDs of many walks of life by word of mouth), I have decided that I would like to try to make these changes and see how it goes. And since I'm trying to drop a few pounds/tone up for our upcoming trip to Europe at the end of June, I think it will be good for that anyway, even if I decide that it might not be right for me in the end... You live you learn, as they say.

So - now I start. And I will need to have some accountability. That is not to say that I have to be "perfect" but I hope I   will find as much time as possible to blog here about my adventures trying new things with my diet - so hopefully lots of food pic and recipes, carb counting, insulin dosing, exercise adjustments, and a general run-down of what's working/not working/ how I feel, etc. (none of it medical advice, of course).

I plan to continue to exercise as I have been (1-2 hours of hiking hills with dogs at least 4 times a week :) And (at least until I figure out how the diet changes are affecting my BGs along with continuing exercise, and readjust my basal doses and I:Cs if needed), I am probably not going to be drinking any alcohol at all. I plan to experiment with wine/possibly beer in the future and see how this might incorporate into a life with (hopefully) better bg control, but first things first...

I have to admit I'm a little nervous posting this, because I'm not sure if I will be able to do it and I am really scared that I will feel defeated if I don't see a sudden improvement in my D control or that I just won't be able to stay consistent. But I have to! I feel like this is great preparation for a potential pregnancy, because I'm trying to be healthier in my diet/habits/  bg control in a more concerete long-term way, and having a solid plan of things that I will be doing/ not doing not just in my head but out here now! And I'm glad I have this blog to kind of make me more accountable. I'm excited to share how it's going - let's try every Friday (?) maybe...

So here is "baseline":

weight: 121-122 ish (I'm a shorty!)
7-day BG ave: 228 (cringe!)
estimated insulin usage/ day: 12 U Levemir (spolit to 2 6-U doses; + between 10-20 U Humalog - this varies greatly)
general state of mind: tired but cautiously optimistic

after treatment.... a look back (aka the power of insulin)

Every April it's my birthday, and also every April I get nostalgic/nauseated thinking about when I checked myself into MGH back in 2008, two days after my 20th birthday, to start treating (once and for all) my type I diabetes.

As I mentioned in my last post, my A1C was "over 18" at that time. I had spent over a year walking (zombying) around Boston, putting on the regular face of a very skinny undergrad who happened to have to pee 2-5 times an hour. I remember when the depression set in (can you blame me?) and I remember the severity of the denial - the food binges at Whole Foods, the endless bottles of gatorade/powerade/younameit as I stood behind the CVS Rx counter pretending to be a friendly and efficient pharmacy tech. {In case you aren't familiar with this blog, stop feeling sorry for me now! Today, I am more than OK!} Nevertheless, every April I can't help but look back to some degree. For some reason, it's hitting me harder this year, 7 years after the fact (7-yr itch I guess).

I think the reason I was able to hold on for that long was the slow progression. One of the main reasons I didn't treat right away was that  oftentimes I would check my BG and it would be in the 90s (without any insulin whatsoever), although it would often be 300+ after meals) So - it was caught early and progressed slowly (did I mention that I really didn't like needles back then - of course, I am now apathetic to them).

That day. I went to lab. I peed. I was trying to do lab work. I peed. I had the most awful disgusting deep cough you could imagine that wasn't going away. And a headache. My adviser suggested I go to health services. I obliged. My bg was "high", my ketones were "through the roof", (should I even talk about my cholesterol, triglycerides, etc. & oh! and my weight of 90-something pounds!) my pcp pleaded with me on the phone to go to the hospital. I obliged.

Standing outside (in the rain) waiting for the taxi (I told HS btw that I was going to "walk there" and they were like "No, We are calling you a taxi!") to go the the ER. Making the phone calls to my mom and boyfriend seemed surreal. "I'm going to the hospital and getting insulin because I'm really sick and I'm done fucking around." I said. Or something to that effect. I pretty sure I described most of the hospital experiences themselves (all two fucking days of them) in my older posts back in 2012.

There was paperwork. There were nurses and doctors. There was a silly student who said - "oh, birth control and diabetes - you must have blood clots and that's why your legs feel crampy! " There was an attending who promptly corrected him (as in "she's in dka so the leg cramping is likely from that, not the birth control [ps. thank god I was on birth control back then"]) In the end, the defining moments were: 1. receiving insulin; 2. administering my own insulin; 3. getting out.

Here's on the getting out part;
The trees were clearer, the sun was brighter, the depression was nonexistent. Non-existent. I was alive again. I walked to CVS to fill my scripts. It was a little strange because I had just transitioned from working as a pharm tech at that one to going to a private Rx to tech, so I knew those who filled my scripts (in fact, the days I was hospitalized were supposed to be my last two days of work there and wow! what a way to exit and then come to fill a bunch on insulin scripts to prove I wasn't just calling out sick).

Looking back, I obviously wish I treated sooner. A lot sooner. But I can't blame myself forever. All I can do is try to give back by raising awareness, making connections, doing the best I can today, and slowly building my career so I can have a lab of my own (which I will undoubtedly end up using for Diabetes research to an extent, regardless of what the grant money's for ;)

On that note - don't worry if I'm out for a while (grants don't write themselves you know  <3

The person, the numbers

Hey there -just a random story today -

Back when I was first diagnosed and struggling to accept the fact, a pharmacist I worked with said to me:

"You? Type 1 Diabetes? Cake! You can do it. If anyone can do it it's you because you're so smart! Seriously - you're lucky; you can do this."

I have to admit I had no idea what he was talking about back then. At the time I was in denial and refusing to treat, even refusing to learn about treatment - and here he was - assuming that because I was a biochemistry student I should be "all over it" (in more ways than one). That's the thing about the emotional impact of a chronic disease diagnosis - it doesn't matter if you're educated, it matters whether or not you're willing to accept it and deal with it. I know there are plenty of people who don't study biology and were more than willing to accept (even be relieved at) a diagnosis and motivated to learn how to best treat. But not me. I spent a year and a half stuck in the mentality that there was no fucking way I was diabetic, walking around with n A1C of "over 18" and lying to myself. No, dear pharmacist, it didn't matter then how "smart" I was (according to you anyway).

I don't know why I am so bitter about that memory. Probably because once in a great while I can't help but think of how pathetic I felt that whole year+ and how I may live to see the consequences. I hope if anyone out there knows someone or is that someone who was in my situation, they will seek treatment sooner.

Because it's not so bad. And he was right - I can do it. I can count carbs in my head (cake), I can keep numerous variables in my head, I can adjust rapidly, and when I/m really diligent and everything comes together, I am in fact full capable of reigning diabetes into staying in the low to mid 100s with no lows (almost) indefinitely. Although, I am human still - and there is the emotional element. No matter ho much of  a diabetes beast I can be, I can be in a rut all the same. Still the same person - whether the A1C is 6.2, 8.6, or "over 18".