Wednesday, July 30, 2014

Wordless Wednesday: Broken Sensor

Yeah,  so I wear my Dexcom sensor on my thigh and this has never happened.  I go to changed and my pants get caught and cause the side to break.  Now granted, it is almost 2 weeks old,  thank God it's not a new one!

Tuesday, July 8, 2014

Endo Search Is Over!!!!


And the winner is…………. Dr. Carmichael!

I have to admit that I’ve been pretty stressed for the past week whenever I have thought about my appointment for this morning with a new endo. Not only have I been apprehensive due to past bad experiences but also the location. He is out of Barnes Jewish Washington University medical research hospital in downtown St. Louis, not too far from my house but  I’m so not accustom to driving in the city for one, and for two, it’s a HUGE hospital! So many buildings, so many facilities, so many wings, so much traffic and just dang huge on top of not being sure where I was going. I had been referred to him by a couple of the women at the Diabetic Divas group that I’ve been to a couple times. He was one of two doctors that these ladies raved about so I called 4 months ago and made an appointment with the first available doctor. Dr. Carmichael was the lucky winner to get me. I think a lot of my nervousness started a couple weeks ago when I got the new patient paper work in the mail to be filled out and sent in beforehand. One of the things that had me groaning was the in depth meal plan that I was to list. They wanted me to list what I eat on a daily basis including snacks and carbs and asking if I follow a diabetic diet. I eat just about the same thing every day for breakfast, although I have been switching it up a bit lately. I mean, I count carbs, skip out on ice cream when everyone else around me is eating it and I know it’s a bad move at the time for me to indulge, so yeah, I’d classify that as a diabetic diet. Wasn’t so sure that they would see it that way.

 My appointment was at 8:40 but all the paperwork said to arrive no later than 8:10. I left the house at 7:30 to be sure I didn’t run into traffic or parking issues and I’m so glad I left when I did. Parking was a bit of an event in itself. Then there was going from the 4th floor that I was parked on to the 3rd floor to get to the elevators for the medical buildings I needed to be at in order to get to the 13th floor. When I got up there it was just a wall of windows that the diabetes center was facing, such a beautiful view of the city, one that I’ve never seen.



It was impressive, as well as the diabetes center office. It was bright and friendly feeling just like the staff and nurses.



 I was feeling more at ease as I talked to the receptionist and even as I waited in the waiting room. I spent a total of a little over 2 hours there with only about 30 minutes of it waiting. Considering past experiences this is a huge plus! I spent about 5 minutes with a nurse who took my vitals, weight and A1C, then 5 minutes with another nurse who took blood to get labs done, another huge perk in my book that they will do that in the office and send it to the lab of my insurance choice and I don’t have to make another trip to a lab. All the rest of the time I spent with the doctor himself! He was knowledgeable, had good bedside manner, and was very happy with what my Dexcom, meter and pump graphs showed. He was happy with what Deb my CDE at the perinatologist office has been doing, he encouraged me that I’m not OCD on checking my blood sugars and that I’m not paranoid, I just want to be healthy and that I’m doing a great job at it. When I told him about how the last doctor told me that I was OCD about checking my BGs he looked at me and said, "When it comes to diabetes, when it comes to your life there is no such thing as OCD. I have patients that have told me that they have had days that they have had to check 20+ times and that happens. When you are having a day of highs and need to get down you will check check check. When you are low for hours you will check multiple times in an hour to be sure you are not going to end up in a hypoglycemic episode. Also, especially since you have been trying to get pregnant it's important for you to check check check." Hearing this was very comforting.  He really had no changes to make to my pump settings, he did a very thorough exam of my feet and going over all my past medical history and records from the other doctors that I had sent. He made sure that he covered all my questions and treated me with respect when I asked a question or made a statement about something that I clearly know what I was talking about. He even printed me a copy of his notes and said that he would send them over to my primary and parinatologist. One thing he said he isn’t completely convinced of is that I truly have Diabetes Insipidus or DI.  He is getting all the records including the MRI I had done in 2011 from my nephrologists and he said he would look over them and see if it’s truly conclusive that I do in fact have DI. He mentioned that it might be possible that I have another very rare autoimmune disease of the pituitary gland that is not DI. Dr. Carmichael will be treating me from now on for that since it’s really another endocrine issue and not a kidney issue. That will be one less doctor to deal with which is nice.

Oh and more good news! I don’t necessarily like to write about what my A1C is because I really have no tips on how to get it to this point and knowing that others in the DOC work so hard to get it down I don’t like to write about mine and seem like I’m bragging, because, well I’m not. But I have to share this time because this is a huge thing! I’ve not been so low since the diabetes! I was sure that I had gone up and not down since my last A1C check in April. I was just hoping I hadn’t gone above 6, so I was totally and completely shocked when he told me that I was at 5.6!!! WHAT!!! That’s like almost non diabetic! Whoooooo hooooooo!!!!!!!!!!!!!! I did ask if he was sure that was correct and after looking at all my graphs and logs more he said yes, he didn’t see that there was any discrepancy of any sort. For any of you that are reading this and trying so hard to reach whatever your goal may be, I really wish I had some great advice how to get there. All I can say is that in my mind I think I am pretty anal about checking my BGs and constantly looking at my Dexcom to see what direction they are heading. I can be pretty obsessive and strict on when and what I do eat. Not saying I never indulge, as a matter of fact I did treat myself to a Dairy Queen chocolate extreme mini blizzard this afternoon. But I have set up certain rules for myself when I know how certain things affect my BGs. For one, I don’t eat ice cream after 6pm. I know that even if I bolus the correct amount of insulin ahead of time and wait 15-20 minutes before eating it, it will usually be 6 hours or so before it fully hits me and my BGs will rise. That’s something I can’t be on top of the way I like in the middle of the night. Same thing with other certain sweets in the evening. I also know that when I’m swagging, I can tend to over estimate my carbs in order to keep from going high, so then it results in lows. I’m not down playing my A1C by any means, just giving the only tips I can think of as to why it’s gotten to this point. I’ve also been so anal about it since trying to get my body baby ready. If I wasn’t trying so hard for that I don’t know what my A1C would be, but quite honestly, I doubt that it would be so low.

So peeps, looks like I have found a good doctor after almost 6 years of T1. This makes me so happy!

Monday, July 7, 2014

BBQ, Fireworks and Too Much or Too Little Food & Activity?

Friday, the 4th of July was a weird roller coaster of a day for my BGs. I’m having a heck of a time lately getting things to be even for any amount of time it seems like. At least even in the way I’d like. I’m either high for hours or low for hours. I’m on the verge of trying to see if it will help if I start doing much lower carb meals, although I really don’t feel I eat a huge amount of carbs at any of my meals or snacks anyway..... My morning on the 4th I woke up within range, after breakfast I climbed a little higher than I would have liked and then early afternoon I was hanging out higher than I ever like to be. Between 170-200 range. Did plenty of correction bolusing and temp basals and couldn’t come down. Went to a BBQ and ate some appetizers around 4 because I was starving because I had missed lunch, I pre-bolused and that didn’t do anything. We ate dinner around 6:30, I pre-bolused then as well, waited the 15-20 minutes to eat and still didn’t seem to want to drop below 160. Not long after dinner I decided to walk the mile with my hubby and his cousin over to see his aunt and uncle’s new house that they were working on. I knew that the walk would do me good. By the time we got there I had dropped to 60. I ate a pack of fruit snacks, my hubby’s cousin’s wife gave a us a ride back to the house were we had been for the BBQ. When we got back I was still running a little low. We were going to be walking 2 ½ or so miles to the city’s main park were the big 4th of July fair was going on. Since I knew we had a bit to walk just to get to the park and then once we got there we would have a bit to walk to get to where the fair was and for a good spot to see the fireworks I ate a piece of cake and did not take any insulin for it. I was afraid that I would regret the no insulin later, yet at the same time between my low sticking and know I was about to walk a lot I decided to chance it without the insulin. I’m glad I did because I stayed low. Having highs that I could not get rid of all afternoon sucked and then that night being low and not coming up was just a pain. During the walk to the park I had to have a juice box and a pack of fruit snacks and even then a couple hours later when the fireworks were ending I was 60 again. I had another juice box and a pack of fruit snacks both one right after the other in hopes that would bring me up knowing I had another long walk ahead of me. We started walking and after a few minutes I had to tell Brad I just couldn’t do it. We walked off the side of the path and sat down on the grass. One of the cousins in the group, she is a nurse and she was not feeling good about me walking the entire way back, and neither was I. There had been cops in golf carts all over the place all night so she suggested that they would walk to the security check point not too far away and she would get a golf cart to come pick us up and take us to the shuttle and her hubby and some of the others would make the walk home and he would get the car and come pick us up from the shuttle drop off point. Brad and I waited it out and I did the whole wait 15, check and if no sign of going up eat more sugar. I had just checked before they got back and I was only at 60. They came back with a lady who was with the fair security and she was asking me all kinds of questions that were confusing me. Come to find out, they couldn’t get a golf cart to come to our area, they were all in the main area of the park trying to usher people out, all they could back to us was an ambulance! No way was I having an ambulance come get me when I was fairly with it and not on the verge of passing out. She was very nice, she seemed to understand a little bit of how diabetes works, but even though I was fairly clear headed I was in no mind to really get into how much she knew. After a few minutes I checked again and I had dropped again to 53. I’m not sure how long we sat there waiting and checking, eating fruit snacks and waiting and checking. I thought I had over done it by bringing 2 juice boxes and 6 packs of fruit snacks, but thanks God I had all of that! I needed it. When I finally was able to start walking again I think I was in the 80’s. I had a bad feeling that all the sugar was going to finally hit and I’d end up high all night, so even though we did get to a shuttle we didn’t take one that would take us directly to the place we needed to get picked up from. When the shuttle dropped us off I was 121 and my Dexom showed a straight up arrow. At that point as tired I was from the BG roller coaster I was glad to have a bit of a walk again hoping I wouldn’t keep rising. Unfortunately I did, I had another rough night of highs, I was in the 170’s all the rest of the night, but as frustrating as that was, I’m very glad that there was no need for that ambulance ride.  

Wednesday, June 25, 2014

Target Lows

When I get lows in public, Target seems to be the worst place for it!

 For lunch today I had a leftover fried buffalo chicken salad. I had gone out to dinner with some girls friends last night for a birthday and when I’d had the salad last night I climbed up to 199 and didn’t come down for a few hours. That swaging didn’t go so well and it didn’t go so well today either. I estimated the carbs higher than last night hoping to avoid the highs, especially since I was above 170 most of the morning. Well, I avoided the highs alright. I ate my salad at about 11:45 and by 12:20 I had gone down to 62. I drank a juice box, gave it 15, checked and I was 95. Great! So I left work for my 30 minute break and drove across the street to Target. When I was on my way out the door my supervisor said he was heading there shortly himself. So I get my shopping done and get in line. There were only 2 lines open and as usual both are stupid long. I choose the line that had the register that was open in the front and my supervisor was ahead of me by 2 people. Since I could tell I was going to be late by a few minutes back to work I texted one of the girls in my department to let her know I would be late. I had set my basket on the closed register belt next to me so I could text my co-worker and right after I sent the text I started to get hot. Really HOT, like dripping down my back with sweat hot. Then came the shakiness and foggy head. While I was trying to comprehend that a bad low was hitting a Target employee came up to the register that my basket was sitting on and he opened the register and started ringing my stuff out. From what I remember I swear he had said “Hi, how are you today?” and that I had responded with “Good thanks, how are you?”. I’m not sure that’s really what happened because he turned around and asked me again how I was, at least I think he did. At that point I just didn’t answer and acted like I didn’t hear him because really, I was having a tough time comprehending what was being said and what was going on and wondering what I had already responded with originally and how quickly I could get a sugary substance into my mouth. I just wanted to get out of there. I made my way to my hot car as quickly as I could praying in my fogginess I’d make it. I got in my car, blasted the air and sucked down a juice box as I checked my BG. I was 65. Not as low as I thought so I was really surprised, and Lexie hadn't warned me. She was saying I was 81. It was after sitting in my car a few minutes that she finally alerted me to a low.

 


It was a lovely afternoon of lows as you can see from Lexie’s screen, and yes I did confirm with finger sticks before shoving food in my face. It took the two juice boxes after lunch, a granola bar, a couple pieces of brownie brittle and a spoonful of peanut butter for me to finally get myself out of the afternoon valleys.

 I  know that after I paid and was starting to walk away the lady in front of me that had been waiting before me in the original line I had been in was pissed. She was not one of those nice people who have a cart full of stuff and then see that the person behind has 5 items and lets them go first. She was being snippy about the Target employee not asking who was next or the fact that I didn’t speak up and let her go first even though she had a cart full of crap and I had 5 items. I do remember hearing part of that and that’s what my supervisor told me when I got back to work. He thought it was funny that people can get so irritated, and I apologized and explained what had happened . I did feel bad, I felt like I had cut several people off but when a girls got a low hitting then a girls gotta do what a girls gotta do even if that means coming across as rude. If it comes to saving my own life or sparing someone else feelings over my rudeness I’ll choose to be rude if I have to. Sorry lady, my life depended on it.   

Friday, June 13, 2014

Friday’s 5! A Day/Week In the Life of A Pumping/CGM Using T1 (Oopsies!)


Friday’s 5! A Day/Week In the Life of A Pumping/CGM Using T1 (Oopsies!)
1.       So this really happened. At work the other day my pump tubing got caught around the bathroom stall door handle (this happened only 1 other time maybe last summer, although it has gotten caught around other door handles) and I didn’t realize it until it yanked out a brand new infusion site that I had just put in a few hours earlier. Since I had done the replacement at work on my lunch break I didn’t have a back up infusion set therefore I had to run home and change it. I had 2 hours of work left and couldn’t go that amount of time without insulin. Thank God for understanding coworkers and living close enough to work I could make it home and back in about 30 minutes.
2.       When I got home and put another site in I must have hit a blood vessel because the cannula immediately filled up with blood. It took me a minute to decide if I wanted to chance it or see if I would still get insulin through it, but then decided against it. When I pulled out the blood filled site it gushed like a geyser.  Even I was pretty grossed out. That was a first. Nothing like going through and throwing away 2 brand new infusion sites in just a couple hours.
3.       It’s been 6 months since starting on a CGM and after 6 months it’s recommended to order a new transmitter because the battery starts to die. Well the last two sensors that I’ve worn have not been up to par for me. At the same time, the last two have also bled when I put them in. Now this third one did not bleed when I put it in and the readings have been holding pretty steady with my finger sticks. I guess maybe it’s because of the bleeding that the other two were not as accurate? I kind of wish I would have realized that before ordering a new transmitter, then again I’d rather have a new transmitter before this one gives out I guess.
4.       When I had talked to hubby the other day about ordering the new transmitter I had given him the cost of what it looked like it would be before meeting my health insurance deductable. Well guess what! I met my deductable! In 3 months I met it due to all the pump/CGm supplies. Now we are at the 80/20% of costs. I wonder how long or if we will meet my out of pocket. That’s a pretty huge chunk of change.
5.       This one is for diabetics in general. Why is it that I can eat the exact same thing two days in a row and both days the way blood sugars react are completely different? I know that there are a ton of variables that are practically impossible to calculate to figure this out…Two days this week I had turkey bacon, spinach, avocado and light mayo on whole wheat bread for lunch. On the first day my blood sugars went straight up and hung out close to 200 for a little bit. Then the next day I had the same exact thing and they dropped not even an hour after eating so I had to turn around and eat a pack of fruit snacks.  2 hours later I ate a handful of grapes. I did give 1 extra unit of insulin since I was high after the same thing the day before because I have a feeling the nutrition label on the bread may not be accurate, but really???



Happy Friday everyone!  Enjoy your weekend! 

Thursday, June 5, 2014

My New Purple Friend.....Is Not a Dinosaur


Nope, my new friend is not a big purple dinosaur named Barney. It’s my new purple Minimed Pardigm insulin pump.




 Now I know what you’re thinking, it’s only been a year since I’ve been on a pump how do I have a new one already? Well, here is why......

Pete, as I named my original smoky grey pump, yes I did name it but have never called him by his name out loud, only in my mind. No I’m not crazy. You try having a couple of medical devices that help keep you alive and take the place of a dead organ that floats around inside your body and see if you end up naming them. Anyway, that’s beside the point. I noticed last week when I was changing Pete’s reservoir out that it wouldn’t go in very smoothly but it was in a dimly light room and I just chalked it up to the reservoir/infusion set. Then on Tuesday of this week when I changed it out at work there is a little plastic piece on the top of the infusion set that connects to the reservoir that broke off and flew across my desk. I started looking at my pump more closely and in better lighting and noticed a hairline crack looked like it was starting at the rim of where the reservoir is inserted.



As I looked more closely and took the belt clip off of the pump I noticed a little crack in the plastic on each side where the belt clip goes. Then I took the cap off of where the battery goes and there is what looks like the slightest little cracking going on there as well. 



For all I know these may be no big deal but better to be safe than sorry, especially since this is after all dealing with my health and potentially my life. I called Medtronic right away expecting to be given a pitch about upgrading to the new Minimed Enlight and their sensor and all that mumbo jumbo. I was prepared to put up a fight if I was told that I had to upgrade that they no longer supplied Minimed Paradigm pumps. I’ve heard/read that some people have had that issue when they have called to get a replacement pump when still under warranty and they were given no choice but to go with the new one. I was very surprised that I wasn’t given any kind of pitch like that and it wasn’t even mentioned. Thank the good Lord for that! I’m perfectly happy with the one I have now as well as my Dexcom CGM and have no desire for a Medtronic pump sensor combo or their pump that suspends when a low blood sugar is detected. Anyway, the nice girl helped me out, said that it was a really good thing that I called because even the slightest hairline crack can make the pump susceptible to water damage. Even sweat or humidity can be an issue. Wowza! Okay. I was also pleasantly surprised that I wasn’t questioned up and down as to any sports that could have damaged it or if I had dropped it or anything else. I have to say I am surprised that Pete developed these cracked because the most I do is house/yard work and 2 mile or so walks as often as I can. Sports are nowhere in my life and as clumsy as I can be I have never dropped it. I may have walked into a door jam a time or two, I’m sure I have but other than that, that’s it.  So they overnighted  me a replacement  pump.



 They did not have black or clear left, my only options were blue, pink and purple. So purple was really the only option for me. Green is my favorite so if they had a green one I totally would have been all over it, but purple is my next fav. Whenever if God ever decides to bless us with a little one I’ve already got the nursery planned out in my head. Girl: Grey, white and purple; Boy: Grey, white and green. I’m already in love with the nursery…. We just need the wee one for it…… Anyway…………



So here they are Pete will be going back, cracks and all. Maybe they will fix him and he will go to another loving owner, maybe it’s the end of his short life span. I really don’t know. I’ve decided on the name Layla for my new purple pancreatic replacement. I really don't know what my deal is with L names.  Lexie my CGM and now Layla.  It won’t be Barney, I think Lexie my CGM needs another girl friend. Hopefully she will be a little tougher than Pete was. 

Wednesday, June 4, 2014

Summer Time Recipe: Fish Tacos


I absolutely love summer! I don’t know if there is really a single thing that I don’t love about it. Even the heat I will take over the cold. I love the fun things to do around town, the food, the weather, gardening, flowers, bbq, pools, fishing, eating, going to restaurant and sitting on the patio. It doesn’t sound like I like food at all do I? Well I do and the summer foods are so great. Between the grilling and fresh produce from our own garden or the farmers market what’s not to love?!

One of my favorite summer time meals to make is a fish taco recipe that I found on Pinterest that I have made my own. Last night I made these and I think I finally made the recipe my own with the tweaking and adding and removing items that I like don’t like over the last few times I have made them. I wish I had a beautiful picture to share, but alas… I couldn’t really get a good enough picture that I thought would be good to share.  Now that I have nailed this down I think these were the best yet and too good for me not to share! If you make them I hope you enjoy them as much as we did!

 
Fish tacos

Serves 2 at 2 tacos each

Carb count is basically whatever the tortilla package says and I add about 2 carbs per taco for the honey and I’ve personally not had an issue with a spike or drop.

 
Marinade
1/4 cup olive oil
2 tablespoons white vinegar

2 tablespoons water
1 Lime for juice and zest
1 1/2 teaspoons honey
2 cloves garlic, minced
1/2 teaspoon chili powder
1 teaspoon blackened seasoning
1/2 teaspoon pepper
4 pieces tilapia fillets, cut into chunks

Dressing
1 (8 ounce) light sour cream or plain free Greek yogurt
1/
4 cup adobo
1/4 cup hot sauce
Juice and zest from 1 lime
1/4 teaspoon chili powder

1 tablespoon cumin
1 handful dried cilantro
1/2 teaspoon blackened seasoning, salt and pepper to taste

Toppings
Tortillas
Plane no dressing bagged slaw (I like to use broccoli slaw) or small head of shredded cabbage
Handful or so of fresh cilantro or half cup of dried cilantro

Shredded cheddar cheese
Salsa
Avocado

 

Directions

To make the marinade, whisk together the olive oil, vinegar, lime juice, lime zest, honey, garlic, chili powder, blackened seasoning and black pepper in a bowl. Place the tilapia in a shallow dish, and pour the marinade over the fish. Cover, and refrigerate 30 minutes to 1 hour.


To make the dressing, combine the sour cream or Greek yogurt and adobo/hot sauce in a bowl. Stir in the lime juice, lime zest, chili powder, and blackened seasoning. Add salt, and pepper in desired amounts. In a separate dish combine your desired amount of slaw and dressing and mix well. Cover, and refrigerate slaw and
leftover dressing until needed. (Note: dressing may taste pretty hot on its own or mixed with the slaw/cabbage but once it’s on the taco between the fish, tortilla, toppings and everything it’s just right.)

 

To cook fish:  Remove fish from marinade and pour marinade into stove top skillet on medium high heat. Oil from marinade will coat the pan enough to keep the fish from sticking to the pan. Place fish in pan and cook fish pieces until easily flaked with a fork, turning once, about 6-8 minutes depending on how thick your fish is. Assemble tacos by placing fish pieces in the center of tortillas with desired amounts of cheese, avocado, salsa, cilantro, slaw mixture; drizzle with additional dressing if desired.