The Principal's Office

Every three months I see my endocrinologist.  Usually it's just a recap of what's been going on, a review of my labs, discussion of medication needs, and quick exam (feet, glands, etc.).  Sometimes it feels more like a trip to the principal's office - I know I've done something wrong, but I don't know what the punishment will be.  

Last Tuesday I drove to my appointment with a feeling of excited anticipation.  Based on my CGMS data, I should have an A1c of ~5.8.  This is amazing to me since I've been trying to get below 6.0 for over a year (in preparation for pregnancy).  I walked into my doctor's office with an almost smug expression, waiting for him to deliver the good news.

"Well, Shannon, your A1c is quite good," Dr. S. proudly says.

"Sweet!  What is it?" 

"You're right at 6.8%."

"What the hell?"

After explaining that I was expected a much lower result, we review my CGMS data together (via Minimed's CareLink website).  He agrees that my average BG is much lower than the A1c indicates.  He then explained that he was becoming less confident in the accuracy of A1c readings.  Feeling quite a bit better, we move on to the rest of labs.

Dr. S.:  "Your cholesterol sucks."

Me:  "What is it?"

Dr. S.:  "It's 215 total, but your LDL is 140.  As a diabetic, your LDL should be under 100."

He then starts going on about statistics and how the LDL guidelines for diabetics may go even lower.  Being a diabetic is (apparently) the same as being someone who has had a heart attack. Everything must be lower than what a "normal" person has.  We discuss medications, fax off a quick Rx to my pharmacy, and talk about other things I can do to improve my overall health.

He indicates that as we get older, we have to pay more attention to these things.  He wishes me a belated happy birthday while I groan about turning 35.  He jokes that reaching that age as a doctor is a much happier experience - he's taken more seriously.  He tells me that he just turned 35 last week.  WTF? I'm older than my doctor? How did that happen?  

We move on to the rest of my labs.  Fortunately, everything else is great.  So far, I've had no complications of being a diabetic.  Hopefully, that will continue for another 10 years.

Finally, we cap off our visit with a discussion of my basal rates.  He doesn't want to change anything.  He suggests I review my patterns and makes changes myself.  For whatever reason, I'm still in the mindset of waiting for my doctor to change my basals.  Must come from having a complete control freak of an endo for my first 7 years as a diabetic.  Any unauthorized changes in basals were forbidden under penalty of prescription refill denials.  Perhaps this is why I feel like the endo = principal's office.

I left feeling like a bad pupil once more.  I really want a good report card next time.

And Your Little Fridge Too!

Back when I was working for a small IT consulting firm, I had a rather difficult relationship with the management team.  I was hired to manage a department based on my education, experience, and success.  Instead, once I was "on the job," I was expected to do everything the same way it had always been done.  Obviously, this was not a successful formula, and my ideas would have helped the company overcome some of its greatest limitations.  

I ultimately left that job for obvious reasons.  One example of the type of treatment I received was when I brought in a small fridge (brand new, super energy efficient) to hold my insulin, symlin, juice boxes, etc.  The only other fridge in the office was a community fridge in the "kitchen."  I didn't feel comfortable keeping my injectable meds in that fridge, and I was concerned that when I needed one, all of my juice boxes would be gone.  At every other job I'd had, a mini-fridge wasn't a problem.

So, after asking my boss about an expense report that still hadn't been paid (this company liked to play "funny money" with things including paychecks and 401Ks), he said, "That little fridge on your desk has to go."  Naturally, I was unhappy and asked why.  His response was that it will encourage others to have similar appliances in their offices or cubes.  I then responded that I needed a fridge because I am a diabetic with meds that must be kept cool.  He snapped, "This is the first I've heard about you being a diabetic."  I responded that I never mentioned it because it was (frankly) none of his business.  He told me to keep the meds in the community fridge.  I said I was uncomfortable doing so.  He said the fridge had to go. PERIOD.  I left his office saying nothing.  

About an hour later, I was summoned to the HR person's office (who just happened to be my boss' wife).  She said that if I needed to have a fridge at my desk (moving into the Americans with Disabilities Act), then I'd need a note from my doctor.  She used the term "make reasonable accommodations" several times.  Obviously, she told her husband that he can't just demand that I remove the fridge.  I told her that I'd have a doctor's note faxed ASAP.  

The next morning, note in hand, I marched to the copy machine.  I made one copy for HR, one for my boss, and one I stuck right on the front of the fridge.  Overkill?  Perhaps.  I didn't care.

The last thing I packed up when I finally left that job was my little fridge.  

Happy Anniversary CGMS!

*Originally posted on 3/1/09*

One year ago, after an A1c of 8.2% and a strong desire to start a family, I decided to take my doctor's advice and purchase a CGMS. Having already been a user of the Minimed Paradigm 722 insulin pump, I figured the best CGMS for me would be the Minimed Real Time system. Since insurance wouldn't cover the CGMS or any sensors, I paid the $1000 or so to get started and the $35 per sensor thereafter.

It took me almost two hours to work up the nerve to insert that first sensor. The needle was HUGE - way bigger than the infusion set needles I was used to. Surprisingly, that first sensor insertion didn't hurt at all.

Since that first sensor, I have been monitoring my BG 24x7. I haven't gone a single day without a sensor. I have had sensors on my abdomen, my arms, and my legs. I've had at least two sensors last over 21 days. The average time I get from one sensor is about 10 days. I have seen my A1c drop down to an amazing 6.0%. I have had many sleepless nights with low and high alarms. I have been saved from hypo unawareness more times than I can count. The lowest number I have seen in the past year is 41 mg/dl; the highest was 310 mg/dl. I've worked long and hard to maintain good control, but the CGMS, in conjunction with my pump, has been the greatest tool I could have asked for (other than a working pancreas).

Finally, I was notified last month that my sensors are now covered by insurance (Aetna). I think it will be a long and healthy relationship for years to come.

CGMS Denied

*Originally posted on 7/1/08*

Like so many others, I've been denied coverage for a CGMS. As a diabetic hoping to start a family very soon, I need constant monitoring of my blood sugar. I use the CGMS to treat highs before they get out of control, to stop lows before they become dangerous, and to see trends in my blood sugar.

I purchased my CGMS out-of-pocket because I felt that the information it provides is critical to managing my diabetes. To date, it has cost me $2064.00.

Shame on insurance companies for not covering this valuable and (in my opinion) life-saving device. Frankly, I'm not sure how these people sleep at night.

Why?

*Originally posted on 6/25/08*

After yesterday’s appointment with my Endo, I saw my cautious optimism become a distant memory. Despite what my meter and sensor data suggest, my A1c was a still-too-high 7.0. Not only that, I’ve gained almost 10 pounds in three months. Needless to say, I spent the first half of the appointment in tears. Why, after everything I’ve done, is my A1c still high? Why does my meter and sensor data suggest that I’m hovering right around 6? Why can’t I rely on one versus the other? And why the hell am I packing on the pounds?

Once I finally calmed down enough to actually listen to my doctor (I wasn’t in hysterics or anything, just upset), we talked about Symlin. A big part of my problem with blood sugar is that I’m a yo-yo. I’ll eat a meal, bolus accordingly, and still spike to over 300. Naturally, I correct, but then I’ll drop like a stone a few hours later. He said that Symlin should help even me out and reduce the need for correction doses hours later. Since an added bonus to Symlin is decreased appetite and weight loss, he thought I should give it a try.

As I’ve written before, I struggle with diabulimia. After I left my doctor’s office, there was a big (very big) voice inside my head that screamed “just take the stupid pump off. It’s not working anyway. Besides, you’re never going to be able to have kids, so at least you could be thin.” Why do I do this to myself? Why are we so obsessed with weight that I feel enormous pressure to lose what I’ve gained? Why does my mother think that being thin is more important than being healthy? Why, despite what my doctor has repeatedly said, does my mother think that I’m diabetic because of my weight, and that it will simply go away if I’m a size 2? And, why do I care so much what my mother thinks?

After telling this voice to shut up, I filled the Symlin script and went home. I didn’t use it last night or this morning just in case I had nausea. I’m going to start it with dinner tonight and see how it goes. Wish me luck.

Cautious Optimism

*Originally posted on 6/11/08*

I just did a massive dump of my sensor and pump data to Minimed’s CareLink website. According to the sensor data, my average BG for the past 84 days (since just after I got the CGMS) is 142. My meter says 147. Either way, this pleases me on multiple levels.

First, this shows that the sensor is pretty close to my meter. I know I’ve been pretty quiet about my experiences with the CGMS, but overall, I love it. It feels like an alarm system. Most of the time, I forget about it, but when something happens, I love having the advance knowledge. Overall, I think it was well worth the out-of-pocket cost for this handy tool.

Second, an average BG of 142 equals an A1c of 6.16. I have NEVER had an A1c this low. Moreover, I think that my OB/GYN will give me the green light to start trying for a baby. She said that I’d need an A1c below 6 to conceive, and since I’m on the right track (and I’m not likely to get pregnant tomorrow – fertility issues . . . more on that another time), she’s more apt to let me start on the fertility drugs (Clomid).

Finally, this means that all of the hard work I’ve been putting in hasn’t been for nothing. I so often feel as if I’ll never get a handle on this disease. It’s plagued me for more years than I care to remember. With this result, I think I just might be winning this battle (if not the war) after all.

How LOW Can You Go?

*Originally posted on 5/8/08*

I love my CGMS. I know I’ve said it before, but it’s now been almost two months and I can’t imagine life without it.

That said, sometimes it really makes me angry. One of the reasons I got it (and paid the $1200+ out-of-pocket for it) was to help me catch impending lows (I HATE being low). Unfortunately, this is not where the Minimed CGMS excels. When I’m in the “normal” range, the results are fairly spot-on, but it completely missed the low I had yesterday afternoon.

Usually, I’m very hypoglycemic aware; if I’m in the 70s, I feel it. Not so yesterday. I had some errands to run during lunch, and when I left my office at 11:28am, my BG was 234. According to my pump, I still had active insulin on board (I did a combo bolus with breakfast, which is the same breakfast I have nearly every day), so I didn’t bolus for this high. I ran my errands and was driving back to the office when I felt that feeling. You know the one – it’s more of warning in your head to eat something soon. Since I was only about 5 minutes from the office, I ignored it. Lunch was waiting at my desk (a nice sandwich on whole wheat bread). As time went on (it was 1:06 pm) , the warning grew louder. Finally, while stopped at a traffic light, I grabbed my new One Touch Ultra Link meter (thanks Minimed!) and, with shaking hands, tested my blood.

51 mg/dl

Panic set in. Not only was I stuck at a traffic light; the only glucose I had are the chalky tabs of which I have to chew three. As I searched for them in my purse, the light turned green. I gunned the engine hoping to make it to my office parking lot (it’s only two lights away). Unfortunately, I started to feel dizzy, and I had that "you’re-going-to-pass-out" feeling. I pulled into a random parking lot, put my car in Park, chewed the nasty glucose tabs, and waited. I was totally drenched in sweat, so I hit the A/C and did some deep breathing.

Finally, after about 15 minutes, I felt well enough to drive the one block to my office. I was still shaking, still sweating, but I didn't feel like I was going to pass out anymore. I got back to my desk, grabbed a juice box from my stash and sucked it down like there was no tomorrow.

Naturally, my BG jumped to 220, but I didn't even care. I’ll take a high over a low any day. I worked through the rest of my day in a haze. When I finally got home, I changed my clothes and crawled into bed. Sleep. Blissful sleep.

According to my CGMS, I never dropped below 80 mg/dl (which is where I had the "low alarm" set). So, I have two questions: Why did I drop almost 200 points in 1.5 hours, and WHY didn't my CGM catch it? Was this just one of those wacky diabetes moments, or was this something else? Granted, my numbers have been pretty crazy for the past two weeks (I had strep throat and a stomach bug at the same time), but this was after two days of steady readings.

I guess this just proves that we can't really rely on our CGMs to catch any highs or lows; we've still got to do it the old fashioned way. Maybe someday we'll get there . . .

Praying vs. Insulin

*Originally posted on 3/26/08*

I just read a news story that broke my heart and left me shaking my head in dismay. The headline reads:

Girl Dies After Parents Pray for Healing Instead of Seeking Medical Help.

This story (click here) describes how 11-year-old Madeline Neumann died from diabetic ketoacidosis. Authorities said that she became increasingly ill over a 30-day period, while her parents did nothing other than pray. From the story:

The girl's parents, Dale and Leilani Neumann, attributed the death to "apparently they didn't have enough faith," the police chief said. They believed the key to healing "was it was better to keep praying. Call more people to help pray," he said.

I’m not a religious person. I believe in God, just not in religion. Whether you do or don’t doesn’t really matter. How could any parent watch their child suffer in this manner and do nothing other than pray? I know how lousy I feel if my BG is even a little high for one day. I can’t image the agony of 30 days of increasing DKA symptoms. I only hope this young girl was too “out of it” to feel anything.

Shame on her parents for not seeking medical help. Even if they were unaware of her type 1 diabetes, which I suspect they were, they should have recognized that she was very sick and needed medical treatment not prayers. I can’t fathom any God that would condone that kind of willful neglect.

Riding the Low-Carb Train

*Originally Posted on 3/19/08*

Here I am on day three of low-carb eating. I must admit; it’s not as bad as I expected. There are several very good things about this diet:

My BG has been relatively steady for three days: Monday highest = 158, lowest = 91. Tuesday, highest = 150, lowest = 88. Today (so far), highest = 123, lowest = 87. I’ve had no alarms from the CGMS at night, and I haven’t felt low once. The CGMS looks like a flat line.

My energy level seems to have increased. I’m still a little tired, but that’s because I didn’t get to sleep until after 1:00am last night.

The food choices are pretty great. I went to the grocery store yesterday and picked up lots of low carb goodies. Here’s what I’ve been eating (yesterday’s menu): Breakfast – 2 eggs, 2 brown n serve sausages, and coffee with sugar free creamer. Lunch – Salad with cheese crumbles, bacon pieces (the real ones, not the icky bacon bits), hard boiled eggs, and low carb dressing. Dinner – shrimp scampi appetizer, grilled salmon with lemon butter sauce, and green beans. For snacks I’ve been having sugar free pudding, peanuts, or salami and provolone roll-ups (a slice of hard salami and a slice of provolone, roll it up and eat).

I’m not hungry. AT ALL!

As you all know, ketones are bad for a diabetic. I’m so used to being concerned when that little strip turns dark purple. Anyone who has done this diet knows that ketones (when your BG is low) are actually a good thing. They indicate that your body is burning fat for fuel. This means that you’re not storing fat. Anyway, I saw my urologist yesterday (more fallout from the car accident described in my previous blog). Because I’ve had persistent blood in my urine, he always makes me provide a sample, which they then test for everything. As he’s going over the results, he says, “You’ve got trace ketones.” He knows that I’m diabetic, so I think he expected me to be concerned. Instead, I broke out into this big grin and said “REALLY!?!” I didn’t think I would transition into ketosis so soon, but I guess I’m almost there. When I explained why I had the ketones, he said, “Well, yeah. That’ll do it.” As a side note, there was no more blood in my urine, so it looks like my poor bruised kidneys have finally healed.

All-in-all, this diet is a lot easier (and better tasting) than any diet I’ve ever done.

Gotta head home to make Steak Au Poivre for dinner tonight ;-)

Is that a Jaguar in my Back Seat

*Originally posted on 3/17/08*

In my last blog, I promised to write about the car accident I had in January, so here goes.

First, some background . . . I live about 30 miles northwest of Baltimore. Every day, I commute to my job as a technical writer for a major package delivery company (what can Brown do for you?). I usually get to work around 7:30am and leave around 3:30pm.

On January 7, 2008 I left work much later than normal. It was about 4:15 when I got into my car and began the tedious drive home. Normally, the drive home doesn’t stress me out as much as the one in the morning, but since I was already late, I was anxious to get home. When I tested my BG before I left the office, I was around 110, which is exactly where I want to be for that time of day.

The drive was surprisingly easy for a Monday afternoon, but since it had been an absolute nightmare that morning (at least three major crashes that affected my commute), I figured we (the commuters of Baltimore) deserved an easy ride home. After breezing down the beltway, and cruising for a few miles down I70W, I noticed that traffic was slowing down ahead of me. For anyone who knows the area, this is a point on I70 where traffic always gets backed up (the rt. 29 split).

I gently slowed my car, coming to a complete stop behind a truck. As I stopped, I glanced in my rearview mirror to see if there was anyone behind me (something I always do). That’s when I saw these headlights coming at me. FAST. My first thought was that whoever was driving that car (a shiny new Jaguar) would notice that traffic had stopped before she (as I later learned) even got close to me. My next thought: holy crap, she’s not stopping. She’s not even slowing down. As I was thinking this, I tried to let up on the brake, and slowly let out the clutch thinking that I might be able to get out of the way. No such luck.

BAM, CRASH, BAM (again), CRASH

As I became aware of my surroundings, I noticed that there was a lot of smoke in my car. Not only that, I could feel so much heat coming from the dashboard area. Natural conclusion: Oh my God, my car is on fire . . . must get out now . . . I tried to open my door, but it wasn't moving. I tried to get the window down, but the power windows weren’t doing anything. I reached over and tried to open the passenger door, but it was stuck too. But, good news, the passenger window had shattered, so I could crawl out (if I could just get my body to cooperate). While this all seems kind of rational now, I was not thinking rationally. I undid my seat belt, and began to crawl over the center console to the passenger seat (which was covered in glass). At that point, the air bags were deflating and the smoke in the car had lessened significantly. That’s when it hit me – the car isn’t on fire; the smoke is from the airbags (both driver and passenger bags deployed).

Just for fun, I tried to budge the passenger door open, and finally, it moved. I managed to crawl out, hitting the pavement hands first and sort of rolling out. That’s when I began to notice the pain. My legs felt like they were on fire. I was immediately helped to my feet by a very kind lady, who stopped when she saw the crash. She, unlike the rude jerks who honked and yelled at me for creating traffic, helped me to the back of her SUV. She stayed with me until the police and paramedics arrived.

From the back of her SUV, I could clearly see my car, or what was left of my car (which wasn't much). I’m not a gear head or anything, but I loved my car. She was a beautiful BMW 330xi, with all the bells and whistles. I loved the sound she made every time I started her up (vrrrroooommmm). I loved driving her – I could zip around like the aggressive driver I am without breaking a sweat. Now, she’s crumpled up like a beer can against some drunk guy’s forehead. When the car hit me from behind, the force of the impact pushed me into the truck in front.

So, I was looking at my car and crying when I realized that I have to call Brian (my husband). Except, I didn’t know where my phone was; I didn’t know where my purse was. Fortunately, the nice lady (I wish I’d gotten her name) had grabbed my bag when she helped me out of the car. I found my phone and called Brian. I probably wasn’t all that coherent, but he managed to get the gist of what happened. I noticed that he sounded kind of funny, but I was too stressed out to worry. I assured him that I wasn't dying or anything, and told him that I'd call back when I knew what hospital I was going to. That's when the paramedics finally arrived. I was immediately placed on a stretcher and loaded into the back of the ambulance.

The EMT (a really cute (young) guy named Nate) started asking me questions (while removing my shoes and socks). Rather than answer him, I was too busy kicking myself for not getting a pedicure – I just knew my feet looked like crap with the peeling polish and rough edges. I was also thinking that I was grateful that something told me to shave my legs that morning. As any girl will admit, in the winter, we’re just not as concerned with shaving. I need the extra insulation that a little extra hair can provide. My next thought: what underwear do I have on . . . ? I couldn’t help these thoughts - I’m a girly girl.

Anyway, Nate was looking me over, checking for signs of shock, internal trauma, etc. He asked me if I had any neck or back pain, which I did, so I said yes. Big mistake. The next thing I knew, I was maneuvered onto a back board, they put this foam thing around my head, and I was being strapped down. I couldn't move, and I didn’t like it. Nate continued his exam noting the various cuts on my hands and arms. At that point, I noticed that the ring I had been wearing on my right hand was broken. The ring, bought by my husband on our honeymoon in Bermuda, was missing the center stone (a pear shaped aquamarine). That's when I got pissed. Before I was only upset and feeling sorry for myself.

As luck would have it, that’s the moment when they assisted the driver of the car that hit me into the ambulance. She’d declined treatment, but described what happened. She claimed that the car to her right had been driving without headlights, so she was attempting to alert the driver. She said that she never noticed that traffic had stopped, and didn’t slow at all before hitting me. I was fuming over the whole thing, so I said “but you were going so fast!” She said that she was going the speed limit (which is 65mph). She was very apologetic and wished me good luck for a speedy recovery. It was hard to be angry with someone who was being so gracious. After signing a statement declining treatment, she was let out of the ambulance.

A state trooper came in next. I was thinking: Are they ever going to take me to the hospital, or are we just going to sit here all night? The trooper asked for my license, which thanks to the nice lady who helped me, was in my purse at my feet. She rooted through my bag (it’s times like these that I’m glad I’m not some druggie or anything), found my wallet, and took my license outside. Nate kept checking my injuries, but not before commenting on my engagement ring. I’m used to the comments because it’s a really beautiful ring (an antique, platinum, Edwardian setting with a 2.5ct Old European cut diamond – it’s been in my husband’s family for years). Nate said, “Your husband must really love you judging from that rock.” Oh crap, my husband! I asked Nate where they were taking me. He said “Howard County.” I said that I needed to call Brian to let him know, so Nate grabbed my phone, dialed Brian’s number, and put the phone on speaker. Nate’s handy with the electronics. I told Bri where I was going, and he promised to meet me there. Nate ended the call, put my phone back in my bag, and told me that we were about to head out. The state trooper came back with my license, and off we went.

When I got to the hospital, after a very nauseating ambulance ride (being strapped to a board is not fun), I was left in a hallway while everyone discussed my injuries. Since I didn’t have shoes or socks on, my feet were freezing. When Nate came by, he was holding a blanket for me, which he kindly tucked under my cold feet. If it wasn't for Bri and the (at least) 10 years separating our ages, I would totally love Nate. I asked him if he could take me off the back board because it was really starting to hurt, especially on the back of my head. It felt like someone was digging a knife in there. Nate assured me that once I was cleared by a doctor, I could get off the back board.

I waited, and waited. I was (finally) moved from the hallway to a private room (I later learned that it’s the “psych” room). Rubber walls? No. Just nothing. Just when I thought I couldn’t take it anymore, Bri walked into the room, white as a sheet with tears in his eyes. So, of course, I started crying. He grabbed my hand and murmured gentle words to me, while I just cried. After getting some composure back, I told him exactly what happened. I could tell he was getting angry because he got quiet. “How the hell could someone not notice that traffic had stopped? Even if she didn’t see at first, she should have noticed before she got too close to you and hit her brakes.” “Nope,” I assured him; “she never slowed down.”

As we were waiting, he began to pluck pieces of glass out of my hair. I then realized that the awful pain coming from the back of my head must be from a piece of glass.

We were finally graced with the doctor’s presence at that point. He did some cursory checks, determined that I didn’t have a broken next or back, and finally removed the back board and neck brace. Thank God! I checked my scalp where the pain was; no blood, but sore. I did a head shake and a few more pieces of glass came flying out. Fabulous. But, the good news was that I could actually breathe again. I told the doctor that the worst pain I had was in my upper thighs. Not too impressed (or bored by my lack of life-threatening injuries), he wrote me a prescription for some Tylenol with codeine and 600mg Ibuprofen, gave me an excuse note for work, and sent me on my way. I was a little surprised by this. No x-rays? No nothing? Seemed strange, but I was so tired and I just wanted to go home (it had been over three hours since I got to the hospital) so I didn’t really care.

When I sat up, I noticed that my thighs had swollen to (at least) twice their normal size. We think that my legs hit the steering wheel when the impact forced the back seat into the front seat. I waited for Brian to put my socks and shoes back on and we headed out to his car. It was at that moment when I realized that I’d never drive my car again. She was dead; I was sure of it. I was sad, but I honestly didn’t think I'd ever want to drive again, so it wasn't that bad. Brian helped me into his car, and drove us home. One thing about Brian – he’s a racecar driver. Not a professional one, but it’s something he does competitively at various events all over the country. He also teaches performance driving and is a really safe driver. But, he likes to drive his car with some oomph. Great husband that he is, he didn’t even think about doing anything but drive at a nice steady pace.

We arrived home, and I was immediately greeted by lots of happy animals. I picked up my dog for the obligatory welcome home licks, then headed into the bedroom. I slowly took off my clothes (finding more broken glass in my bra – WTF?), got into my most comfortable PJs and climbed into bed. Brian headed off to the local 24-hour pharmacy to fill the prescriptions.

I can remember at one point during the whole ordeal feeling like my BG was getting low. Since I didn’t want to wake up in the middle of the night with a low (or worse not wake up because of the drugs), I tested. I was 165 mg/dl – I figured the stress of it all must have really spiked my BG since I was around 110 when I left the office. Just in case, I grabbed a juice box, put it on my nightstand, and turned off the light. Good night Shannon!

Since the accident, I have seen more doctors than I had in the whole five years preceding it (that’s a lot for a diabetic). I’ve had physical therapy for my back, endured a cistoscopy for persistent blood in my urine, had surgery on both legs to remove the grapefruit-sized hematomas on my thighs (which came back and I still have), and undergone numerous other tests and procedures. I’m still not healed from this trauma, both physically and mentally. Every day is a little better, but I don’t think I’ll ever forget what the multiple impacts of the crash felt like.

We bought a new vehicle – a Chevy Tahoe. I just don’t feel safe driving a car anymore. I miss my beemer, but the Tahoe is great, too.

A Long Night

*Originally Posted on 3/16/08*

So, I started on the Minimed CGMS last Wednesday. It's been a pretty telling experience so far. I've learned that my morning commute really makes my BG spike. I did some experiments to see if it was actually coffee, or the stress of driving in a fairly congested area (Baltimore). There are some other factors (a really bad car accident on January 7th - more on that later) that cause me driving stress, but I know the traffic and "bad drivers" is a significant variable.

After having some bad reactions to the IV3000 tape used to secure the sensor and transmitter, I tried Nexcare Tegaderm, and it seems to be working well. Although my CDE said that I can leave the sensor unsecured, I just don't feel comfortable with that. So, if I react badly to the Tegaderm, it's back to the drawing board for me.

Now, on to the drama from last night. My husband and I went to dinner pretty late, which I always hate doing, but somehow Saturdays seem to get away from us. We got to the restaurant at 8:30ish and finished eating by 10:00. I did a dual wave bolus for dinner. When we got home, When I went to bed around 11:30, I was pretty high (high 180s), but I assumed that the second bolus wave would get it.

As I'm sleeping soundly, I hear this faint beeping, but choose to ignore it. Finally, at around 1:30am, I'm awakened by this siren-like alarm. It's one I've heard a few times over the past few days. My husband rolled over and asked "what the @#*&^ is that?" My reply? "It's my thing . . . " I'm not good when I wake up abruptly - I can't even form complete sentences. However, I guess my reply was sufficient because Brian just rolled back over and went back to sleep. I, on the other hand, cancel the alarm and take a peek at my pump (which is also the receiver for the CGMS transmitter). Well, lo and behold, I'm at 248. What the . . . !?! How did that happen? To confirm that the sensor was working properly, I grab my meter from my night stand. Using the light from my pump (which always goes out when I need it most), I insert a test strip, prick my finger, and wait. Sure enough, I'm 235 (the sensor has been pretty accurate so far).

So, I do a correction bolus, and go back to sleep until I hear the dreaded beep-beep-beep a few hours later. My first thought was that I must be going low because of the bolus, but that wasn't the low alarm, it was the high one. I grabbed my pump, checked the screen, and sure enough, I'm 198. Now, I'm really confused (and completely awake). I grab my meter, which proves sensor correct once again. Thinking something must be wrong with my infusion site, I head into the bathroom to take a look. Everything seems fine, so I bolus lightly and go back to sleep.

Beep-beep-beep. Okay, at this point, I was annoyed (and completely exhausted). I looked at the clock to see that it was 6:30am (I get up at 6am during the work week). Uh-oh, I knew that all the pets would think it was time to get up if I even moved, but I knew that I had to see what was going on. I checked the pump, which showed my BG at 184. Here's the thing - I knew I was supposed to change my infusion site at that point because it was probably bad, but I was just too tired. Instead, I bolused again, grabbed a juice box from my nightstand drawer (just in case I drop unexpectedly), and had to fight a dog and a cat for my place on the bed. The other two cats just looked at me expectantly, but I was NOT getting up for anything.

Finally, I wake up (on my own) around 9:30. My husband had been up for a while, and managed to clear all the animals out of our bedroom when he got up (he's really good about that). First thing I did was look to see how I did the rest of the night (morning). After that last bolus, I gently managed to drop down to 102 by 9:00am. I guess my infusion set wasn't bad after all, so why was I high all night?

After almost 10 years of living with this disease, I've come to the conclusion that some things are beyond my control. This drives me absolutely crazy, though. It should be simple math - eat X number of carbs, take Y units of insulin, but we all know that it doesn't work like that. Frustrating, but true . . . I just need to get a better handle on this if I ever hope to achieve that golden A1c (low 7s to mid 6s) needed to have a baby.

Has anyone had any experience with a low-carb diet (like Atkins)? I'm just worried about the possibility of lows associated with doing this. My doctor is not opposed to it, but I would really like to "real world" opinions.

Catching Up

Since I've had multiple blogs at different sites, I'm going to start off by bringing in all of those old posts.

They'll be imported in chronological order.