Friday, March 27, 2020

Coronavirus: Hey DOC - How You Doing?

Hey DOC  - 
Sorry for the radio silence on the bloggo. 
Like all of you,  I’ve had a lot on my plate and much to take in with what’s going on re: the Coronavirus pandemic. 
Prepping re: supplies - as in food and filling RXs, trying to rearrange work gigs, working from home is not business as usual because life isn't business as usual.  
Focus is hard to come by as of late - FOR EVERYONE.  
I live by myself - it's been hard dealing with what's been going on alone.  
I know I’m not the only one who is struggling with feelings of isolation and loneliness.
I’m worrying. A lot. 
I worry about me, my family, my friends who are family - including my you dearest DOC. 
Worries galore and in all dimensions: Work, income, diabetes, my country-everyone else around the globe dealing with this pandemic. 

Sleep has been crappy, lack of human interactions from less than 6 to 10 feet a part has been rough - but I’m doing it - And I’m staying home as much as I can! 

Every day the news overwhelms us all more than the previous day. 
Seriously guys, this episode of Black Mirror sucks!

And yes, I’m angry and grieving because it didn't have to get to this point.
But it did. We are here.
Not that I've stated all of the above to you  - I feel better!
THANK YOU FOR LETTING ME SHARE. 

Now we need to fight - some of us from our homes/home offices, others from the front lines. 
And every single one of us needs to vote in November - make sure you are registered and continue to triple check your status. 

And WE MUST stay connected and practice self-care. 

Our diabetes online community has always been leading the pack when it comes to connecting in the digital world! It’s almost like we invented it - we didn’t, but you know what I mean! 
Keep connecting! 

Tweet, write, Skype, Zoom, text, phone a friend and use all your digital lifelines on a daily basis. Pick up the phone when a loved one rings - you both will feel better!

Connecting allows us to… well, CONNECT. 
Sharing prevents us from holding it all inside. 
Being able to say things out loud to our selves and others lets us know we are being heard and that makes it easier to focus, feel much-needed normalcy 
I’ve started dividing tasks into increments of time (THANKS Team egg timer and iPhone timer,) and rewarding myself when tasks get moved to the “Completed,” pile.

I'm willing to hunker down for as long as possible and as long as I am able to work from home to stop the spread 

And I am so incredibly grateful to the healthcare workers, cashiers, restaurant workers providing takeout for the masses, grocery store and pharmacy workers, cashiers, postal employees, police, fire, and EMTs - every single person running towards the flames because it's their job. I pray for their safety every night. 

I pray for all of us to stay safe. 
When this all over, I'm hugging every single loved one, friend, and coworker tightly - I’m going to drag my friends out in the sun for drinks and good food. 

And I can't wait. 
Until then, stay safe, stay in touch and let’s stay connected! 
#WeAreInThisTogether
Xo, Kelly

Thursday, March 5, 2020

This Is My Brain: This Is My Brain On Diabetes - And Sometimes It's Exhausting

Diabetes is so damn different every day and at every turn - it's a goddamn crapshoot!
For example, 3 days ago I filled up a new omnipod with 150 units of insulin (180 unit is normally too much,/as in too wasteful for me,) and placed it on my side boob.

95% of the time, boob sites work really well for me. 

This boob site is working exceptionally well. 

We’re talking almost a solid flatline on my Dexcom for the past 72 hours, except for normal post-meal spikes and 3 actual low blood sugars. 

All of the above had me seriously thinking: Oh my God, did somebody kickstart my pancreas and neglect to tell me?
Anyway, pod expires in two hours, at 6:11 pm tonight. 
I currently have 36 units in my pod. Even if I keep it in for an additional 3 hours (half the 6 hour grace period after the time on your pod officially runs out,) and bolus for my dinner, I’ll still have more than 31 units left. 

Do I really want to start a new pod at almost 10 pm at night and post-meal? 

I DO NOT. 

WHY? Because then I’ll have to stay up and make sure everything is copasetic with my new site/pod. If it isn’t  - I have to start the process all over again. I have to work tomorrow - I don't want to be up super late!
Not to mention the fact that if I change out this pod late night tonight, that means in all probability, I'll have to change out the next pod late at night- unless I can sync my morning alarm with the 6 hour grace period and make sure I have enough insulin in said pod during that grace period. Or I run out of insulin before the pod times out. Or an occlusion alarm goes off. 
Or 390 other different diabetes wrenches getting thrown into the equation.
This isn't projecting, this is what is required for those of us wearing diabetes robotical parts. 
SIGH. 

If I put less insulin in my new pod, there’s a 50% chance that diabetes will switch it’s bitch-switch and I’ll go through my normal 150 units in less than 72 hours and will have to change out my site early - unless of course, that doesn’t happen. 
Again - who the hell knows what will be required from a new infusion site and no matter what brand of robot pancreas you’re using. YES, the same happens with tubed pumps.

Or like... do I put less insulin in the new pod and do correction injections from the remaining insulin in my previous pod? 
For fuck sake, insulin is the 5th most expensive insulin on the planet and I don’t want to waste it!

Yeah, this is only a small portion of the mostly necessary and seriously annoying diabetes minutia that runs through people living with diabetes minds and on a daily basis. 

This is also why when a healthcare professional asks me how much insulin I take a day I look at them with daggers in my eyes. OK, maybe not daggers - especially if they're nice. But I definitely channel my inner 13-year-old self and roll my eyes at them and I'm all like, WHATEVER.

Every day with diabetes is different - and requires a different amount of insulin - and for dozens of different reasons. And there are dozens if not hundreds, maybe thousands, (but for real it feels like MILLIONS,) of different diabetes scenarios having nothing to do with site changes or insulin or carbs.  

AND SOMETIMES IT'S GODDAMN EXHAUSTING. 

This my brain. This is my brain on diabetes.  

This spot-on cartoon was created by the amazing Haidee Merritt.
To see more of her work, laugh your butt off and maybe buy her books,  click HERE. 

Wednesday, February 12, 2020

#SpareARose 2020 & A DOC Valentine


https://lfacinternational.org/sparearose/
The following #SpareARose Valentine's Day poem was originally published here on the blog in 2013 (I've updated & republished the poem because it makes me smile,) the first year of #SpareARose
Seven years later - I'm proud that our amazing DOC continues to help spare roses and save thousands of children living with diabetes - providing them with our life-saving elixir of life, insulin. 
Insulin they wouldn't have access to otherwise. 

Follow the steps and click on the link above, and learn how for the cost of one rose this Valentine's Day, you can #SpareARose and can provide one month's worth of life-saving insulin to a child who desperately needs it!! 
######

Dear DOC - I LOVE YOU!

fyi: The cute little redhead in the pic is my niece Tess, circa the mid-1990s!


Dearest DOC- 
You make me smile, you make laugh - you understand my occasional need for time-In-Range charts and graphs. 

You tell me "I will" and "I can," whenever I have doubts - 
You answer my diabetes questions - even the ones about Brussels sprouts.

You see the best in me - even when I can't.

 You listen with understanding whenever I go off on one of my "G*ddamn Diabetes Police/diabetes and the media's stupidity, rants.

You have been there for me on my darkest of days.

You've waited patiently on the twitter with me during a high/low blood sugar haze. 

And hopefully - I've been there for you in some small way - 

Even if it's just making you smile on a particularly craptastical day. 

Together we move mountains - Alone we trudge up hills. 

Together we help others living with diabetes, both online and off...

And unfortunately, the only thing I can think of that rhymes with "off" in terms of the next line...is Hasselhoff. 
NOPE.
And now you can never, ever unsee this.  
So I'm done with prose - I've mostly run out of rhyme. 
I love you all so very much and thanks for your time. 

One last thing before I go - please darling DOC don't forget to #sparearose - As in Spare a rose, save a child living with diabetes in a faraway place, 
where insulin isn't readily available and many hearts break. 

Damn straight 5 bucks goes a hell of a long way, to save a child with diabetes this Saint Valentine's Day~ 
Xoxoxoxo k2~

Thursday, February 6, 2020

Diabetes, BG, A1C: Here's What Happened When I Focused On Time-In-Range For 99 Days



Me getting all scientifical.
Not really, it's Google Doodle's salute to Hedy Lamarr's contributions to science. 
This is what happened when I committed to focusing on TiR (Time In Range,) for 99 days,  re-embraced my inner D scientist and used my body as lab and experiment.

Diabetes Weaponry: Omnipod OG, Omnipod PDM, Dexcom G6, Glooko, G6 App, Clarity App, Apple Laptop,6+iPhone, The Diabetes Online Community. 

Longer than usual post and it's straight from the heart.  
#######
There was a time in my adult life where I kicked diabetes ass with A1c’s in the upper 6 range. Times change, life got hectic, adulting is complicated and I’ve been struggling with my A1c on and off since 2011. 

I've tried all sorts of things to get back in my diabetes comfort zone. Some things helped, some things didn’t. 

My a1c has fluctuated between 7 and 7.8 since 2011 - with the exception of one lone 6.9 in January of 2017.

7/17 - 11/17: My a1c refused to budge from 7.4. 

07/18: Officially diagnosed with Hashimoto’s. My a1c dipped slightly after the Dx to 7.3, then stubbornly increased every 3 months until 10/19. 

10/21/19 Endo Visit
A1C: 7.8. The “Rocking Dr. J” and I were incredibly frustrated in all dimensions. 
Dr. J, his right hand and my AMAZING Diabetes Care & Education Specialist Cheryl, and I had managed my diabetes together since the late ’90s and we’d achieved much.  
But we'd encounter A1c roadblocks in recent years, and 2019s continual A1C creep in the wrong direction was a collective drain on my Diabetes team.

Dr. J looked at me and asked: Kelly, do you what Time In Range is? 

Indeed I did. TiR (Time in Range,) is the amount of time you spend in your preferred blood glucose target range on a daily basis. It doesn’t mean you don’t have high blood sugars. 
Of course you do you have diabetes. But you have more time when your blood sugars are within your set target range. 
Your TiR is determined between you and your healthcare team. 
TiR was one of the big buzz words at ADA, AADE, and DTM. 

My personal time in range is set between 70 and 180 during the day, with an evening TiR between 70-170. Clearly, that wasn't happening. 

I agreed to upload my Omnipod PDM and Cgm data to Cheryl so we could make tweaks, and promised that for the next 99 days I’d focus on TiR. 

I waited until I hit the parking garage before I started to cry.
FUCK THIS. I was done. Come hell or high water I was going to share my diabetes data, focus on my TiR one day at a time, record my observations, and hopefully learn from them.

I was going to re-embrace my inner D scientist and use my body as both lab and experiment.

And So It Begins
10/22/19
I uploaded my devices to Glooko and Clarity, emailed Cheryl and sent her a share code. 

Starting TiR
Glucose numbers weren’t terrible. 
My TiR for the previous 3 months was 57%, thirteen percent lower then the 70% goal we’d set when I started CGMing in March of 2019.

Cheryl noticed that my overnight basal seemed too high and the culprit might be my constantly fiddling with my temp basals - which seemed to be “reactive re: increased glucose levels, not proactive - as in preventing them.” 
She offered several options and told me the choice was mine. 

I gave up all control and told Cheryl it was her call. 
We changed my carb ratio to 7, between 12pm to 12am and lowered my 12am basal  to 0.90 

Observations
I noticed more positive numbers immediately. 

In the beginning, I looked at my TiR, but not every day. I celebrated when my TiR increased by a percentage point. I was OK with it when it didn’t. 

As the weeks passed, I checked TiR almost daily - except when I didn’t check at all. 

Dietary Tweaks
In October of 2018, I made a goal to maintain my weight during the holidays & I did. 
I made the same goal in October of 2019.

November
I switched from half-& Half to full-fat Oatly milk in my morning coffee, in the hopes of reducing my post morning coffee bg spikes. 
Also: I needed to break my 1/2&1/2 habit - I was going through 1 quart a week! 
Oatly Full Fat milk didn’t taste disgusting in my coffee, contained more carbs and fat per 8 oz serving than half-and-half, but since I was only using 2 or 3 ounces, I bolused for the same amount of carbs. 

My post-coffee morning spike numbers time reduced by half. 

I upped my plant-based protein consumption at home to roughly 75% and stuck with “anything goes” when eating out. 
And yes, I’m still addicted to and enjoying cheese as a food group, fish, the occasional cheeseburger with the works and the likes thereof.
I'm not eating birdseed and I'm most definitely eating carbs! 

Practicing Conscious Pre-Meal Bolusing
I committed to pre-bolusing 20 minutes before every meal - and I noticed decreased numbers and shorter time re:post-meal blood sugar spikes. 

I continued with my separate morning coffee bolus (which I've been doing for a couple of years now,) followed by my breakfast meal bolus. 
Depending on my blood sugar and the dinner I was making, I began giving a blood glucose correction bolus while prepping/making my dinner, followed by a carb/bg bolus 10 minutes before the meal was ready. 

I Looked At My CGM Arrow Before Post Meal Rage Bolusing
Patience is a virtue - one I have - except when I don't. 
After I gave myself a meal or correction bolus, I did my best not to automatically rage-bolusing if my BG went passed a certain number and under a certain amount of time,
post-meal. 
If my CGM arrow was flat - I forced myself to wait. Nine times out of ten, my glucose number would start decreasing - just like it was supposed to. 

A-HA Moment
11/14/2019 
I covered (DTM) the Diabetes Technological Society’s meeting for Ascensia Diabetes Care, where I sat in on a discussion re: glycemic variability metrics,TiR & heart damage.  
It was the first time the whys behind the diabetes/heart disease connection were explained to me clearly - from the inside - in terms of the damage long term time spent outside of range does to the heart’s arteries and blood vessels. 
It was a goddamn game changer. 

I’d always assumed “diabetes and heart issues automatically went hand-in-hand,” because, since my DX as a child, that’s what I’d always been told. 

"That” and of course, genetics.  
My family genetics is interesting. 
My diabetes team knows my genetic health history because I shared it with them from the get-go - and we’ve been proactive re: my both diabetes and good heart health since the late 90s. 

With that being said: I thought about the heart/TiR connection for weeks, and every time I looked at my cgm, did a finger stick, or pre-bolused for a meal. 
It was and is an excellent motivator.
You can read about that life-changing session by clicking HERE, scroll down to Day 2:Diabetes Data From All Sides, and give a read.

Insulin Reduction 
At the beginning of December, I noticed that my 24-hr daily insulin totals were decreasing. By January my 24-hour daily insulin totals had dropped to the mid-30s and mid-40s, versus pre TiR experiment insulin totals in the mid-40s to 50s.

Exercise
Tendonitis was slowly easing up. I started walking three days a week (20-40 minutes,) in December, and up until I sprained my ankle falling down the steps (and totally sober,) the Friday before Christmas. 
The ankle is better. I need to get back on the exercise horse.

PARADOX
12/25/19 
Lots of Christmas cookies and pumpkin bread, and a freakishly good time TiR.
On the flip side and on odd rando days, the opposite occurred - and that was OK. 

Technical Difficulties 
1/03/2020 
Uploaded devices to Glooko And Clarity, and sent Cheryl a share code. 
After looking at my data, she realized I had a faulty transmitter.
HOW? While my TiR was 62%, only around 30% of my actual data had uploaded to Clarity since the transmitter’s November start date. 
Heads up: If your G6 app graph lines continually stop and start when you're less than 20 feet away, you probably have a faulty transmitter.

My Clarity data was unusable in determining the last 60+ days of my TiR. 


I. WAS. LIVID.  
I let Dexcom know it. They overnighted me a replacement transmitter, plus two replacement sensors.

I kept moving forward. 

Cheryl suggested that we stick with my current settings, told me to continue doing what I was doing and to send her my data uploads a few days before my January 30th Endo appointment. 

Days Outside of Range Didn’t Make Me Feel Like A Failure
Don’t get me wrong, it was (and is) annoying, and sometimes I’m downright pissed.  
BUT... I realized that the days my blood sugar graph was full-on wonky, were occurring less often.
Percentage-wise, my day/clusters of days spent outside of range weren’t nearly as horrible as they could have been.

1/21/2020
9 days before my Endo appointment, the first day of my period, and the first time I’d stepped on the scale since before Christmas. 
Even with bloating, I weighed 3 lbs less than my pre-Christmas/pre-period weight. Usually, I'm 3 or 4 pounds heavier than my normal weight. WEIRD. 

1/27/2020
Received email from Labcorp informing me my results were available via their portal. 
Ignored it. I know me - I’d start googling and obsessing. 
Nope, I had shit to do. I'd let Dr. J tell me.

1/28/2020
Uploaded my data to both Glooko and Clarity, sent Cheryl the Clarity share code and she promised to get back to me by my Thursday afternoon appointment.

1/29/2020
Weighed myself. 
Immediately stepped off the scale and then back on and weighed myself again. 
I’d dropped 8 pounds since Christmas. 
Did I need a new scale? 
Put on a pair of jeans that had been way too tight in July - and not in a good way. 
They fit. 

1/30/2020 - Endo Day
Checked email on my phone in the waiting room and no surprise because she always keeps her word, there was an email from Cheryl, who works from home on Thursdays.  

According to Cheryl,(who was super stoked,) my TiR for the past 99 days: 84% with 1% in the low range. 

COME AGAIN? 
Before I could process or reply, I was called back by the PA to get weighed (still 8 lbs lighter,) and blood pressure checked in one of the waiting rooms. 

I tried not to think about my labs.
30 and 60 day estimated A1C on my CGM clocked in at 6.8, but with transmitter issues, 
I wasn’t banking on anything.

10 minutes later Doctor J walks in: What’s going on Kelly? 
OK, let me rephrase: What have you been doing differently? 
And how are you feeling about the changes you made?  Your A1c is great! 

Me: What’s my A1C? 
Dr. J: You didn’t check the portal? 
Me: NOPE. 

Dr. J: Your A1C is 6.7%, down 1.1 points from last time! I’M SO HAPPY. 
I don’t know what your TiR is, because I haven’t talked with Cheryl yet and she’s not here today. I can let you know tomorrow - unless she’s already emailed you? 
The rest of your labs( which we went over,) are awesome - And you’ve dropped 8 pounds. I’m so proud of you!

Me: You’re sure my a1c is 6.7?
Dr. J: Yes.
Me; You’re positive
Dr. J: YES.

Me: Cheryl emailed 30 minutes ago. My TiR is 84% with 1% lows

Dr. J: AWESOME. We want TiR to be 70% - I am so proud of you!
What changed for you Kel?

Me: Honestly? Focusing on TiR one day at a time is a lot easier than focusing on a good A1C for three months. 
Then we had a heart-to-heart and I shared my 3-month TiR observations. 

I left feeling happy and a little weird - but in a good way.

CONCLUSION
Whatever happens between now and my next Endo appointment, I’m taking it one day, one daily TiR at a time because it’s working for me. 

People with diabetes are continually bombarded re: long term diabetes management, complications, etc. And I absolutely understand why - but sometimes the weight of all that knowledge gets incredibly heavy to carry.


For me, managing my diabetes one day at a time re: TiR is not only easier, it's also more gentle and less overwhelming for me to process emotionally, mentally, physically - both on paper and in real life.