Catching Up

It's been a long time and I'm happy to report that I have not fallen off the face of the Earth (literally, yet)... Here is a bit of everything (diabetes and non):

1) Last week I was in Boston, MA for a family wedding and had the opportunity to meet two IRL type 1s (my 4th and 5th total T1Ds IRL). One of the two was Dr. Shara of http://diabeticdoc.blogspot.com/ who is as lovely in person as her writings convey. This was no coincident and was planned well in advance and I am really glad to have been able to go. There is something about seeing/hearing for yourself (outside of formal support groups or doctor's offices/hospitals or internet pages) the real people who live with such a unique and giant aspect of what you have to live with - type 1 diabetes. And that they are successful and funny and happy and not phased by it at all. Because this disease is difficult and it's easy to let it completely drown you, but knowing that meeting others who have been doing it for decades and are well-spirited, ambitious, and continue to work at it everyday after a long time is really inspiring.

2) My husband and I drove for 15 hours in 1 day (twice last week, with stops) with 3 dogs in the back of my hatchback. That was crazy but we made it. Blood sugar cooperated better than last year's trip. It wasn't even close to what I wanted and the trip made my BG average shoot way above what it has been the last few months, but I still had a great trip. It is a lot easier to use Novolog to correct quickly and effectively than Humulin R, I have to say that...

3) FAT! Can we talk about fat? Seriously. I knew that eating hi-fat meals would raise BG hours later due to gluconeogenesis by liver but I never realized how bad it could be. Something about the travel and family-time foods, followed by the cold front coming in after getting back to Ohio has prompted me to eat large like enormous amounts of cheese, hungarian salamis, and what I can only describe as Russian-style cured lard (with bread), caviar, and pretty much any other 80%+ fatty delicious things that go hand in hand with cold weather and red wine... (At one point I hit 429, slept through a lot of it, woke up still in the 300s after like enormous amounts of insulin... It was BAD. and silly. and unavoidable somehow.) PS. I'm totally OK though :)

4) On the work/school front - I submitted a breast cancer postdoc grant to the ACS last week and the next deadline is for an NIH grant on Dec. 8th. I should also start writing my dissertation (any time would be good). I'm trying desperately to get a semester off from teaching freshman bio labs in the spring so I can actually work - they like to keep us grad students busy... Finally, this upcoming Saturday, I will MC a student-run cell biology conference in West Virginia and I am super nervous but excited for all the planning to end... Event planning is stressful and I'm never doing it again! I think I may break out that last expired Dexcom sensor later today or tomorrow and hope it serves me well through the stresses...

On that note, I really hope that my next entry isn't a month and a half away... I miss this place <3

Synopsis

The week that school starts up again (for me this means ~20 teaching hours on top of research and seminars in my graduate program) calls for a big and tough adjustment, diabetes-wise and otherwise. It has been especially challenging considering that I crashed my car on Monday morning (the day I was supposed to start teaching). In fact, I may have saved a curious and playful (with cars unfortunately) Border Collie's life by the accelerating and swerving around a dirt-road curve on my way to work, causing me to spin out and crash into a barbed wire fence and wooden posts... Yup. Thankfully both I and the dog are OK but the same could not be said about my car. Thanks to support from friends and my mom's kind comments about good karma for possibly saving a dog's life I'm pretty over it and can't wait to get back into the car that's being repaired. In the end, it was only a busted radiator, but having the cheapest (liability only) insurance left us to fund that replacement, causing more financial stress on top on carpooling stress on top of start-of-school stress... Whew.

Diabetes-wise, the increased cortisol levels and sedentary condition are causing major insulin resistance that are causing me to rethink my basals. Additionally, I don't drink on weekdays and most weekends during the school year, whereas summertime in grad school pretty much means beer and BBQs on a semi-regular basis, which obviously lower BGs on its own, although I don't think that has that much to do with it.. On the bright side, Integrated Diabetes (@Integ_Diabetes) sent me 4 free Dexcom 7+ sensors, as they received a donation. Although they all expire within a week, I think it'll be just fine, this sensor I installed has been very very accurate, and I plan to set a high alarm of either 180 or 200 as soon as I get this shit straightened out:

Honestly having Dexcom back for a little bit right now has made my week (well that and not killing a dog with my car).. I'm pretty annoyed with the high pattern, and have increased my Levemir from 10 to 12 total Units (split) in the last 16 hours. Not too concerned about it, unless one of my insulins went bad, given the recent heat-wave. I've been holding off switching out the Novolog, but I think I may have to, as I've corrected a few times this morning, and it just doesn't seem to be working well. But I seem to also be going up between meals, and that caused me to change my basals first... I've almost always had a consistent I:C if I stay at the same weight (which I have been!), although I recently figured out that in the mornings with coffee, I'm more 1:10 or 1:12 than the usual 1:15... I'm trying to be patient here and not change too many variables, but I'm seriously starting to suspect my Novolog... But I will get it figured out. Today. Maybe tomorrow.

This week in diabetes and graduate school:

1. Stubbornly High BGs this week due to 1. stress; 2. high progesterone. By stubbornly high, I mean consistent! 200s while taking unit after unit (every hour) of Novolog.

2. To elaborate on the stress part, I have post-doctoral grants to apply for. They are due this Fall and will pretty much may largely determine whether I continue as a graduate student making a measly 22K per year for 1 final year OR if I can actually get that (oh-so-elusive) Ph.D. and make 50K + (ish?) next year - I'll take whatever I can get though, regardless... Stress, emotions, me being me, lead to high BGs.

2. (A) On top of that I had to take a pregnancy test last week. (It was negative). But I was stressed for a bit there on top of all the grants. [because I am not ready for a child at this moment]. All's well that ends well and I am waiting for insulin resistance to pass and feel better about BGs at least for the next couple of weeks. Next month, I think I will try to change basal rates - I don't pump, so I guess that would be basal doses - during different weeks of the month. Got to love being a woman. Well, I do, but Diabetes doesn't always hardly ever play nice with hormones (in general, like seriously).

2. (B) School starts again soon (like I don't want to think about how soon). Although I don't have to take classes, I do have to teach, on top of doing my research and aforementioned grants... Stress aside, need to incorporate exercise and relaxation, Diabetes, I am coming for you! I'll do the best I can with what I've got.

* On a very bright note, I will be joining the TuDiabetes community soon! I can't even tell you how often I am on those forums, reading it up! Also, I am excited for the emotional support I always gain what I  meet others living with T1D (online or IRL). I hope to drop by DSMA tonight.

With Love, MM

Diabetes vs. Car Crashes (aka Once Upon a Time)

Once upon a time (in the Fall of 2008), a young (20-yr. old) woman (OK, Me) who was treating her T1D diligently (although with minimal testing, aka a little nonchalantly)  was moving with her boyfriend in the Boston area. On the third or fourth trip, going back for more furniture, the couple got a little lost in the new neighborhood, and while looking for the right turn, in combination with awkward ramps and blinding sunlight (not to mention the hunger), hit a metal ramp head on in their little Honda going no more than 35 MPH...

The Driver's (male) airbag goes off, the passenger (ME, MM!) is left stunned. The hood of the car is smoking and leaking fluids, what's worse it the Driver's head, which is leaking blood. The passenger calls 911.

What may be more distressing than a (Thank God, [seriously]) more superficial than at first thought wound to the Driver's head was the fact that I (the Passenger) pre-dosed (oh-so-diligently) 2U of Humulin R in anticipation of a some sort of fast-food cheeseburger on the way to pick up the furniture...

I remember pleading (in shock) with the Ambulance guy to "give me glucose tablets" (they only had gel, which was super-gross). They lead me (calmly) onto the back of the ambulance to test my BG. Once he got out the thing (meter), he was like " I'm not sure how to use it [what??!!] ". At that point, I snapped out of my shocked state and remembered that I (in fact) had a BG meter in my bag. My blood glucose level was 110. (Insert shock and feeling like the Ambulance guy thinks you were kidding about the Diabetes) LOL.

Fast forward 1 hr. and I'm having Coke (non-diet, unknown amount) in the ER because I "feel like it". I alternate between bitching about Diabetes (aka confessing my Dx) to my [back-then future] mother-in-law (whom I called on the ambulance ride to MGH)... and also this is my first time BITCHING about DIABETES to anyone ever... Fast forward 4 hours, as we're finishing moving (while my then-boyfriend, now husband, is still at MGH). I'm exhasuted as I sneak out for a cig [Parliament] , and I feel shaky (still haven't had dinner). I go upstairs and (discreetly) test my BG (it's 40-something). I drink some juice and throw away the rest, I help clean up, move furniture into car, deliver it to E. Boston, pick up boyfriend from hospital, thank God I'm still alive.

Such as life, funny to have remembered this so vividly almost 5 years after...

Accountability in T1D Management

Honestly, when I write down what I eat and how much insulin I take and when, and what my blood glucose is at all times, it's a lot easier to be happy with myself regardless of the actual numbers (I think they call that logging, but I like to call it being accountable). If I'm having highs, I correct, make note of it, and also list some possible explanations. I feel more confident making small changes to my treatment plan when I see all the data in front of me on paper, in fact I become more comfortable with a lower BG range. I am my own little science experiment. When I'm having a bad time, careful logging tends to bring me out of it, as I tend to be extremely more honest with myself on paper about the carbs I eat (as opposed to handfuls of blueberries unaccounted for, guilty ;). I hate being high, I am sick of it. Not that I'm always high. But a lot of the time I'm higher than I should be. And while I can avoid looking at my meter averages or tell myself that I don't have to correct the 180 because I "might" exercise later, it all becomes so much more difficult to ignore when you have all these numbers in front of you six or seven times a day... Accountability... Furthermore, the logs provide invaluable information over the course of long-term events, like finding out I ALWAYS seem to need extra insulin on Monday mornings, that Tuesday and Sunday mornings are the most carb-friendly, that my insulin resistance increases after ovulation (due to progesterone increase I think)... It's time to break out the log again I think.

In Progress...

Today is my 4-year wedding anniversary. I was 21 when I got married, following a 3-week engagement, and preceding a 10-month stay in Madrid, Spain. While I must say that at the time of our big announcement, a shock and awe reaction arose (amid perhaps some doubt about our young age and long-term intentions), to us it was more like "well, it's going to happen anyway, and what a way to honeymoon for almost a year" :) I'm happy to say that looking back, I would not change a thing <3

The picture below depicts us just after saying "I do", walking away to "All You Need is Love" (by The Beatles).

The title of this post,"In Progress" is because that is just the way things are - all of our lives in many if not every way. As I think about how my husband and I grow together, I can't help but also think about my Diabetes, and how we grow together as well. It's not always unicorns and rainbows, but in the end, a combination of compassion, dedication, and hard work, and most importantly, LOVE will get you where you need to be (meaning you're kind of there already) - that is while ever-changing, and always being "In Progress". 

P.S. I Love You

-MM

This Morning's Blood Glucose BullSh*t

When I woke up at 3 am and tested my BG, my meter said "176". I took 1/2 U of Novolog and went back to bed. Given that 1/2 U "should" lower me by 50 points (although it varies a bit depending on time of day, not even considering activity levels), I was not surprised to see the "131" at 6:30 am, in fact I was rather pleased. I dosed 4 U of Levemir and went on to take a shower, feed and take out the dogs, prepare lunches, etc...

Upon opening the refrigerator, I felt a strange chill. Not surprising - the fridge is a cold place. OK. I feel strange. Am I anxious? I can't be low, I just tested 30 mins ago and I was 130, I thought looking at the clock. There is NO WAY I'm low. Why do I feel like I'm having heart palpitations. And why am I sweating, I so much?? (A second ago I felt cold). Another minute and two fingers on my (carotid? :x) artery, and I was like - OK clearly your body is trying to tell you something. I tested and the "60" came back, glaring.

What came next was quite surprising (to me). I measured out the appropriate amount of juice, treated. 5 minutes passed and I was "64" (I DID NOT DRINK ANY MORE JUICE!), waited 10 mins and I was "92". OK. 30 minutes later I was about "140". I'm proud of myself for remaining calm and not ridiculously over-treating. It gives me confidence and hope that I can do that in the future more consistently.

Sadly, it seems that natural Glucagon reeaaally kicked in later, kind of spoiling everything, and raising me into the 200s without any food. (At least I assume that I'm in rebound mode now).

So it's been an interesting day so far. I'm really still confused about how I could've gone down 70 points in 30 minutes (from 130 to 60) without any Novolog or exercise. My best guess is that something was messed up with that first test, although I have no idea what it could've been... I'm certain nothing is wrong with the meter because the #s correlate to how I feel (although guilty of losing control solution). Also, ovulation is around here, so it could be that. I've never heard of any kind of Levemir mishaps in term of absorption - it has fatty acid chain on it, which binds to a protein called albumin, so as the albumin "falls off", it is slowly used in the bloodstream. I've heard with Lantus that you can get immediate absorption is the injection is not SC, because of the pH solubility, so with Lantus a butchered injection may cause a sudden drop but not with Levemir (please please correct me if I'm wrong)... The reason I'm even entertaining this is because I would expect such a drop if the Levemir did somehow act "all at once"...


(and yes, I'm certain I took 4 U Levemir and NOT Novolog lol)...