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. 

Tuesday, December 24, 2019

Dear DOC: Love & Happy Whatever ~


"The wings", 1958 / Salvador Dali; 1904-1989- Internet
Dear DOC - 
Whatever the holiday season means to you, no matter what you celebrate and or don’t,  
I want you to know that each and every one of you means the world to me - I appreciate and I am incredibly grateful to you have in my world and on my side. 

You are my gifts - the kind that keeps on giving. 

You inspire; make me smile, teach me lessons every damn day, make me laugh from my belly, and lift me up whenever I stumble and fall. 

You make me a better person - diabetes or not.

Please remember that you count, that you make a difference  - that you have made a difference in my life - and others. 

You are more than the sum of your numbers - more than your last a1c.

You are more than you realize and you matter to many. 

Celebrate yourself and all your victories - large and small.  

Each and every one of you - across the board and no matter the diabetes type, are truly magnificent.

Simply put: YOU ROCK and rock my world in the best of ways.

Love and happy whatever, 

K2  

Wednesday, December 18, 2019

Feeling Stressed During The Holidays? You Are Not Alone!



YAAASSS
Also: Pic via the interwebz

It’s the holidays - lots of running around, trying to finish up end of year work projects (speaking of - please check out my 3 part series covering the Diabetes Tech Meetings over at Ascensia,) getting our ducks in a row for the new year, while shopping, cooking, and figuring out all the holiday logistics. 

Diabetes - factors into our end of year craziness too. 

Cramming in last-minute doctors appointments, getting our end-of-year Rx’s filled - or at least trying too - many running into roadblocks when it comes to end of year durable medical equipment Rx approval and delivery - before January 1 and a new deductible rolls around - and trying not to lose our shit in the process.

Navigating the holiday carb party extravaganza, including explaining that “yes we can eat that,” because we have done a lot of work, including all the diabetes math, in order to have those Christmas Cookies/wine/and or whatever else is on our plate. 

Not to mention dealing with blood sugars in all dimensions because there are at least 42 different factors that impact our blood sugars. 

For some, the holidays bring up family dynamics that are complicated and anything but happy. 

Many others are feeling the tremendous loss of loved ones that only the holiday season can bring. 
For some this holiday season is the toughest part in the year of firsts without the person they love. For others, the loss and sadness pops up again … and just when they thought they were OK. 

If you’re feeling stressed, overwhelmed, or sad re: all of the above and or things not mentioned above - that’s OK. 

You are allowed to. 

You are doing your best. 

You are not alone. 

You are human. 

You are magnificent. 

Monday, November 11, 2019

12 Years Blogging About Diabetes - Still Learning And Still Grateful Every Damn Day~

Diabetesaliciousness as a 12 year old magical unicorn!
Image via the interwebz~
Diabetesaliciousness turned twelve years old this past Saturday, November 9th - and  
I can’t believe it.
12 years of blogging, 1,534 posts about the good, the bad, and the diabetesaliciousness of it all.
When I started blogging in 2007 I had no idea the there was such a thing as the DOC and I had no idea what I was doing - hence the name.
When I was filling out the URL form for my blog I distinctly remember saying right before I pressed ENTER: “HEY, let me add an 'ness' to the end of diabetesalicious!” 
Silly blogger!

The only thing I knew about blogging was that Perez Hilton’s website was a blog and that creating a blog was easier than creating a website. 
IMO, blog templates were and are similar to Word templates - of course I could do that!  

I was tired of diabetes myths being perpetuated as diabetes realities (Hey Halle B and your actor’s studio interview - I’m looking at you. You are the reason I started blogging - so thanks!) and I wanted and needed a place to voice my opinions. 

The DOC was much smaller back then, consisting of a scattered and small group of ragtag people with diabetes who wanted to be heard and acknowledged - and found a space online were they could do just that.  
Back then corporations and orgs were gingerly dipping their toes into the Social Media pool. 

Because of the DOC, I found my diabetes voice and platform - and I found parts of myself I never knew existed.
Because of the DOC I have a global diabetes tribe who I love, protect/am protected by, and learn from every day. 
There have been times when the Diabetes Online Community has carried me when I struggling. And I am so incredibly thankful. 

Blogging about diabetes has taught and continues to teach me that I CAN in all dimensions. 

What started out as a hobby has blossomed into a passion and a career. 
FTR: If you were to have told me 20 years ago I’d be working in the diabetes space 
I would have said that you were freaking nuts. 
I dealt with my diabetes personally, I didn’t want any parts of it professionally.
Sometimes the thing you try the hardest to run from, is exactly what you are supposed to be doing.

12 years in and the DOC has exploded across social media platforms, people with diabetes are  using their voices to create change - and brands. 
Corps and orgs are not only listening and engaging, they are actively lurking, listening, and participating. 

Like the DOC, my blog had successes and growing pains - and next year it officially becomes a teenager! 

Blogging about my diabetes allowed my to share my diabetes stories and learn from your yours. Thank you for sharing your stories and teaching me with each and every tale.

Blogging about diabetes turned my biggest perceived weakness, my busted pancreas, into my greatest strength and biggest passion - and for that I am incredibly grateful. 
12 years in and I worry about repeating myself content wise - which means dealing and working writers block - reminding myself that not everyone reading has read all of 1,534  posts. 

12 years blogging and I am still learning new things about life and life with diabetes every damn day.

12 years blogging and no matter the type, we are in this together! 

12 years of blogging and I am so damn grateful!