Archive for February 2010

The Rundown: Baby Gear, Blood Sugars, and Dexcom

February 25, 2010

I have lots of different things to share today, but no good way to bring them all together. So here they are, in no particular order.

We purchased our first piece of baby gear: a travel system (AKA stroller, car seat, and carrier all in one.) Walmart was having a “Baby Days” sale over the weekend, and we found a travel system on their Website that was a pretty good price and that gets decent reviews. It’s the Evenflo Aura in “Georgia Stripe”. We like that the carrier is lighter than some of the others, and that the carrier handle is easier to grip. Also, the brown color should be good for hiding the “baby dirt” that we expect to accumulate. We were not particularly impressed with the maneuverability of the Evenflow strollers, but for the price, we were willing to compromise on that. Speak up if you know anything about this thing. Walmart has a 90 day return policy, so we can return it if we find out it’s a death trap or something.

So far our baby stash includes the travel system, two picture books, a baby monitor, and two bibs. Sounds like we better get shopping!

My belly is getting bigger. There is no denying that I’m pregnant now. And I have become an even bigger clutz, running into chairs, doorways, countertops, and doorknobs with my protruding midsection.

My appetite is at an all-time high. This is a far cry from the first four months or so when I had to force myself to eat most of the time. Yesterday we had a catered, Italian-themed lunch at work. Normally I would skip the pasta and just have a big bowl of salad. Yesterday I also had garlic bread and fettucine alfredo — two servings! I think it’s been years since I last ate garlic bread and I normally avoid fettucine alfredo for the obvious reasons. Luckily, my new, reved-up insulin-to-carb ratio took care of the carbs, so I did not suffer from the dreaded high BG spike two hours later.

Speaking of blood sugars, they seem to have leveled out a bit this week, which is a welcome relief after the roller coaster last week. I’m still treating one or two lows per day, on average, but they are mostly less severe than the previous ones. I still get the occasional high in the upper 100’s or low 200’s, usually because I miscalculated a bolus or over-treated a low, but I am aggressively treating those with insulin.

I re-started my trial Dexcom sensor on Tuesday morning and it’s still doing its thing. I think this might be part of why my blood sugar roller coaster is less extreme this week. The adhesive is starting to curl up around the edges, but the sensor is still holding on pretty firmly. Last night the device finally woke me up with a false alarm. It thought I was low, but I was actually 119. I was tempted to just eat 5 Dots and fall back asleep, but I’m really glad that I decided to actually test instead. This is the first time the device has done that.

A rep from Dexcom called yesterday to see if I wanted to move forward with a purchase. It turns out that I qualify for the device because of my pregnancy and hypoglycemia unawareness. My coverage is really good, too (90/10 for both the device and the sensors,) but I also have to pay my $200 deductible. So I am looking at about $300 for the start-up package and then $27 per month for the sensors. I realize this is much less than some of you pay, but it is still a big chunk out of my pocketbook right now. I am back on the fence. I told the rep that I would make a decision within the month.

This afternoon I am off to the Ophthalmologist to get my retinas checked out. The last time I went, everything was great and they told me that I could actually wait two years until my next exam, but that all changed when I became pregnant. Now we have to check them out again to make sure the pregnancy hasn’t caused any damage. This appointment always makes me nervous even though I’ve never had any eye problems. Still, after 27 years of this, it just feels like my eyes are a time bomb waiting to explode. according to the American Diabetes Association’s Eye Complications Web page, “Almost everyone with type 1 diabetes will eventually have nonproliferative retinopathy.” I wish I knew how much time was left on that timer!

President Obama Joins the Health Care Reform Fray

February 24, 2010

I was quick to click the link in my reader when I saw it: US President Obama pushes to revive healthcare reform.  Interestingly, the alert was from my BBC feed, not my CNN feed. I did not find the article on the US news site until the next morning when I went looking for it (It wasn’t even one of the headlines. I had to scroll to find it buried in the Health section). Seems that the Brits understand the urgency of our crisis better than we do.

The president’s proposal comes just days before the Bipartisan Meeting on Health Reform that the president arranged for tomorrow, Thursday, February 25 at 10:00 AM EST. The meeting will be open to the press and will be streamed live at WhiteHouse.gov/live.

According to the BBC story, the highlights of Obama’s proposal are:

  • It gives state and federal government the authority to deny substantial premium increases, to limit them, and to demand rebates for consumers.
  • It requires most Americans to take out health insurance coverage and provides federal subsidies to help many people afford the premiums.
  • It prohibits insurance companies from denying coverage to people with the dreaded “pre-existing condition” and also bars them from charging these people more.

According to the White House’s Website, Putting Americans In Control of Their Health Care, the proposal “… will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable …”

Sounds good, no?

Well, maybe not to everyone. There has been some critical banter about the proposal and the bipartisan meeting lately, primarily from the Republican party. In particular, House Minority Leader John Boehner has been critical of the proposal because it is too short. At just eleven pages, the proposal is barely a fraction of the roughly 2,000 page bills that the House and Senate drafted. Interestingly, Boehner was also critical of the length of the House and Senate bills, stating that they were too long.

Republicans also seem reluctant to attend the bipartisan meeting, indicating in their discussions with the press that they fear the meeting is a political trap designed to make their health care proposals appear thin.

Additionally, many Republicans have asked the president to scrap the current House and Senate proposals and move forward into the bipartisan meeting with a blank slate. The president has said he would not do that. This leads his critics to argue that Obama is not sincere in his push to drive through a plausible solution.

Speaking of Putting Americans In Control of Their Health Care, the Website appears to be a pretty comprehensive collection of straight-forward information all dedicated to  the White House’s efforts to push through a meaningful health care reform bill. It is complete with the text of the president’s actual proposal, a list of Republican ideas that are included in the proposal, and a wealth of information about the bipartisan meeting. As I type this, the site is hosting a live streaming video chat with Nancy-Ann DeParle, Director of White House Office of Health Reform. The video chat addresses questions that members of the American public have raised about the president’s proposal. There is a wealth of information available on this site, and even some opportunities to interact. Pretty impressive.

Here’s hoping that the president is able to move things in the right direction. His proposal, unlike the House and Senate proposals, seems to actually address the needs of the US population in a clear and direct way. I will be keeping tabs on the bipartisan meeting. While I’m not all that optimistic, I am hopeful. My bank account can’t sustain a 47% increase in health care costs every year. And I’m tired of living with the what ifs — What if I lose my job (and consequently my insurance coverage)? What if my insurance rates skyrocket again next year? What if my insurance company denies my claim? What if my prior authorization request gets “lost in the mail” … again?

Mr. Obama, I’m pulling for you. We need this. All 23.6 million of us.

Resources

US President Obama pushes to revive healthcare reform from BBC News, http://news.bbc.co.uk/2/hi/americas/8528100.stm

White House unveils compromise health care bill from CNN, http://www.cnn.com/2010/POLITICS/02/22/obama.health.care/index.html?hpt=C2

Boehner: Obama’s Health Care Proposal Is Too Short from TPM, http://tpmdc.talkingpointsmemo.com/2010/02/boehner-obamas-health-care-proposal-is-too-short.php

Putting Americans In Control Of Their Health Care from the White House, http://www.whitehouse.gov/health-care-meeting

Full Text: Obama’s Health Care Proposal from Kaiser Health News, http://www.kaiserhealthnews.org/Stories/2010/February/22/Obama-Health-Care-Proposal.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn%2Fstories+%28Kaiser+Health+News+-+Stories%29

GOP skeptical of Obama’s health care summit from The Washington Times, http://www.washingtontimes.com/news/2010/feb/09/gop-wary-pitfalls-obamas-health-care-summit/

Top House Republicans throw cold water on health-care summit from The Washington Post’s 44 Politics and Policy, http://voices.washingtonpost.com/44/2010/02/top-house-republicans-throw-co.html

Diabetes Statistics from the American Diabetes Association, http://www.diabetes.org/diabetes-basics/diabetes-statistics/

His heart is in the right place

February 23, 2010

This morning I drove to the children’s hospital in a nearby city to have a fetal echocardiogram. The children’s hospital is just around the corner from the hospital where I see my high-risk OB, so you would think that I would have no problem navigating my way around the area, but as usual, I got lost. It took me an extra 15 minutes to get out of the city and onto the highway. I somehow managed to drive all the way around the hospital twice before I found an (unmarked) road that led to the highway. If you’ve read my previous posts about driving in this city, you’ll remember that this is a reoccurring theme for me.

On the plus side, I managed to arrive on time, despite a struggle with the ticket machine in the parking garage and an overturned semi on the highway. Also, on the way out, the parking attendant was walking away from his little hut and waved me on out without paying the fee. Yay for small victories.

The fetal echocardiogram is a specialized ultrasound where a pediatric cardiologist examines the heart to look for abnormalities including congenital heart disease and arrhythmias. The cardiologist also told me that high blood sugars often lead to thickening of the heart walls on the left side, so this is one thing that they are particularly looking for.

The nurse was astounded that I have been having lows in the 20’s and 30’s. I showed her the Dexcom I am trialing, and she was pretty impressed. She’d never seen one before. The doctor nearly fell out of his chair when I told him that I’ve had diabetes for 27 years. I don’t think they get many Type 1s in there.

Thankfully, baby boy came through with flying colors. The doctor said his heart is “perfect.” The doctor also took a ton of pictures of the heart, including some with lots of colors on them (mostly red and blue.) I think these are to check for blood pumping through the veins, arteries, and chambers, but honestly, I am not sure and I did not ask. After he told me that everything was fine, I finally started to breath again and just lay back and enjoyed the views of my little one bouncing around in there.

Afterward, I scheduled a follow-up appointment for 10 weeks from today. The doctor will take another look then and will want to check things out again when the baby is born. Seems kind of like overkill, but I guess it is better to err on the side of caution. Besides, who knows how the blood sugar fairies will treat me and baby boy over the course of the next couple of months?

Dexcom trial part 2: the highs and the lows

February 22, 2010

This Dexcom trial has been a roller coaster. Sometimes it is spot on, which is awesome, and sometimes it is WAY off, which drives me absolutely bonkers.

On the plus side, the other night it woke me up four times to warn me of low blood sugar and while I wasn’t always as low as it said I was, I was dropping. So it helped me  treat before I became a shaking, sweating, irrational mess. That is a huge bonus. Two nights ago, it woke me from a deep sleep when I was 27. That’s pretty scary … I was 27 and still snoozing away.

My husband commented that he liked that it was catching the lows before they became super-low, and that maybe the extra, inaccurate alerts were worth it because at least it is also catching the real lows. Although the alert is sometimes delayed, I don’t think I’ve had a low that it didn’t catch.

On the negative side, I have noticed that the trending arrows disappear with disappointing regularity. These are probably the best part of the system, and when they’re not there, I kind of wonder whether the device is worth all of the trouble. In addition, the device often gives me the ??? symbol overnight, sometimes for several hours at a time. This symbol means that the sensor can’t read my glucose at the time. The rep tells me that this happens due to some sort of weirdness with my biology … hormones or something are changing the interstitial fluid. This it a real bummer as I am finding that the alerts at night are another of the biggest assets of the device.

I put the sensor in my arm and, while the adhesive is really hanging on, the site is sometimes sore or irritated, especially if I bump it or roll over on it in bed. I was surprised to find that the adhesive is still super-sticky even after an hour in the pool on Saturday. I am actually a little apprehensive about removing this thing given the strong hold of the adhesive and the irritation at the site. I really dislike having another hole in my skin, too. I sure wish they could figure out a way to put the sensor and the infusion site all in one hole.

Did you know that you can’t take Tylenol when you use the Dexcom? If you take it, the device can’t read your glucose. Instead, it just gives you a 400 mg/dL reading until the Tylenol works its way out of your system (usually about 3 hours.) Tylenol is just about the only thing I can take for the headaches and achiness that come along with pregnancy, so this is also a pretty big disappointment.

Today is day seven of my trial and the Dexcom rep tells me that the sensor will start to fail tomorrow. After it completely peters out, I will try to restart it and see if I can’t get another couple of days out of it. She says most people get 10-14 days out of one sensor.

Also, I wanted to thank all of you who commented on my last Dexcom post. I got some good ideas from you, including changing the high and low alerts. Right now I am using 180 for high and 70 for low. I can see how playing with these from day to day or maybe changing them for overnight could be really beneficial.

Needless to say, I am still on the fence about actually purchasing a CGM. It’s a lot of money, and the hassles are real. But are the improvements to my quality of life, to my health, and to my baby’s health large enough to outweigh the cons?

Highs are Kicking my Butt

February 19, 2010

Wednesday night was a long, sleepless night. It started out innocently enough, with a typical low blood sugar around 8:00pm. I treated, then ate a carb-free dinner and went to bed. That’s when the “fun” began.

By 11:00 pm I was at 184. I bolused in a generous correction and went back to sleep.

At 1:30, I struggled out of a deep sleep because I had to pee. Bad. And then I felt it — the dry, cottony mouth, the throbbing headache, and the general sense of sluggishness. My sugar was 271. Angry, I quickly bolused the 3.5 units my pump suggested, made a quick trip to the bathroom and fell back into bed.

By 4:00 am I had to pee again. And the number was even worse: 304. Holy crap. This time I ignored the pump’s suggestion and instead dialed in 5 units. For good measure, I set a temp basal for 150%.

I tossed and turned until 6:00 when it was time to get up for work. Again, I needed to pee, and I felt even worse. The meter did not mince words; 281 blinked back at me in big, bold, black letters. A quick trip to the bathroom gave me even more cause for concern: Dark purple “extra-large” ketones. Well, at least I knew why I felt so bad.

I pulled out my trusty supply of syringes and injected a whopping 10 units. Then I changed my site (thankfully, it was time to change it anyway,) adjusted my temp basal rate to 200%, and forced down a big glass of water.

Getting ready for work was pure torture. I’m not sure I’ve ever actually spilled that many ketones before. Boy, does it take a lot out of you. I was exhausted, sweating, and nauseated. Every movement made me ache.

By 8:00, I was down to 190, but still spilling those dark purple ketones. I called the doctor’s office on the way to work and left a message with the nurse.

The doctor called back with less concern than I had hoped for. He is pretty convinced that the problem was a faulty infusion site, but I am not so sure. This site had been a “good one”, and I was reluctant to pull it this morning. But he insisted that the insulin resistance that comes with pregnancy comes on gradually, not all at once. I mentioned that I had struggled with 160’s and low 200’s the night before, and he knows about my recent struggles to reign in the spikes, but he did not seem convinced. He did kick my overnight basal up by .1, but that may have been just to pacify me.

On Thursday, things were better, but not awesome. The ketones subsided around 10:00 am, but after a lunch that I over-bolused for, I jumped up to 292. I quickly bolused ANOTHER correction, and luckily the high dropped quickly, but I am still not anywhere near that magic 90 number.

I was still exhausted, cranky, and sluggish. My mouth was still dry and my head was still pounding. The good news is that Baby Boy was still kicking around in there, so I can only assume he was taking this all in stride. I sure hope I can figure this out soon, though. I don’t imagine he can take much more of this. And neither can I.

Will He Get it Too?

February 17, 2010

There are a lot of nagging little thoughts rolling around in the back of my mind these days. I try to keep them there in the back, where I can avoid thinking about them, but occasionally I let my guard down and one of them slips to the front of my brain where I am forced to confront it.

Last week, the thought that slipped through was about the occasional high blood sugar spikes. In particular, it centered on how these spikes were affecting my baby.

This week the thought is about the odds of passing diabetes on to my son. Of course, I have thought about this one a lot over the years, but it never really bothered me that much. I’ve always felt like I was able to lead a full and productive life even with diabetes and, at least in my eyes, my childhood was exceptionally normal. So what’s the big deal if my child develops this disease, too?

But it’s a little different now. I can’t put my finger on exactly what changed, but now that my son is actually growing (and moving!) inside me, I am starting to feel a sense of anxiety over this possibility.

Being the compulsive researcher that I am, I’ve scoured the Web for information about the odds of passing the disease on, but there is not a whole lot out there and it is not very definite. I’ve read that the chances are a slim as 1 in 100 and as high as one in two. Being the scaredy cat that I am, I’ve hesitated to ask my doctors. Maybe I don’t want to hear what they’ll say.

My mom and I used to talk about the odds, too. She is also a type one diabetic and in the late 70’s when she was pregnant with me, her doctors told her that the chances of me developing the disease were one in two, or 50%. She recounted to me that she was devastated that day when my Grandma called her at work to tell her that I was running to the bathroom every five minutes. I was just four years old. Two days later I was in a hospital bed at Children’s Hospital and my parents were down the hall in the nurse’s office injecting carefully measured doses of saline into oranges.

So I’ve always just sort of assumed that my child would develop the disease. The genetic tendency is clearly there, and it’s all I’ve ever known, after all. Maybe this has been my way of coping with the possibility: hoping for the best, but planning for the worst.

Things are different today than they were in the early 80’s, though. Medical costs are sky-rocketing and insurance is harder and harder to come by. While information has made managing the disease easier, we are also faced with so many more day-to-day worries and stressors; we spend more time testing and adjusting, counting and estimating, fighting with our insurance carriers, and wondering how we will pay for it all. We are living longer, but we are facing more complications. Is it fair for me to bring this load to bear on another human being? And I’m not just bringing the burden to bear on my son, but on my husband, too. He will be the one learning to draw up a shot and learning to inject saline into an orange. And then there’s the selfish thought: Will I be capable of caring for two individuals with this high-maintenance disease?

Usually, I am able to just push this thought out of my mind. It’s not like I can do anything to control whether or not my son inherits my bad genes, and even if he does, we will just figure it out as we go. But every now and then, the thought lingers, and I start to wonder “what if …”

I am hopeful that my husbands genes will prevail and this little guy will make it through life without experiencing nauseating low blood sugar reactions, dehydrating ketones, and painful site changes. But if he doesn’t, I guess I am one of the best prepared people on the planet to help him find the right path through life with this disease. After all, my mother was the perfect role model and mentor for me and, hopefully, I can be the same for him.

Dexcom trial: A mixed bag

February 16, 2010

Today is my first day on the Dexcom trial. And it’s a mixed bag.

I inserted the sensor this morning. It took a little help from my husband, because I put it on my upper arm and we couldn’t figure out how to detach the applicator portion from the sensor pod. After a bit of fumbling, we finally figured out that we did not have the transmitter latch all the way down against my arm, so the pod would not release the applicator. Once we figured that out, it came a part easily enough.

The actual insertion was not too bad, although I did feel it. I think I would get better at it with practice, though, so the pain issue is not a big concern. The applicator really helps with this. It is kind of awkward, but once you use it once or twice, I think that you probably get pretty good at it, and it helps get the sensor at the right angle, keep it going in straight, etc. An added bonus is that it sort of hides the REALLY long inserter needle from you. Now, about eight hours after insertion, I can still feel the sensor under my skin, but it is not too bad. Occasionally I will turn my arm just right and it will pinch a bit, but mostly it just sort of feels like an infusion set.

The sensor pod and sensor are pretty low profile, but being the klutz that I am, I managed to get it caught in both my sports bra and my shirt sleeve this morning when I was getting ready for work. The tugging was a bit uncomfortable, but the adhesive held firm. I imagine you get used to having the thing attached to you, though, and automatically compensate during these sort of maneuvers.

The bad news is that it has been pretty inaccurate all day. It has been off by as little as 10 mg/dL (this was nice, but unfortunately fleeting) and by as much as 50 mg/dL. The worst part is that it is constantly buzzing to tell me that I am either low or dropping, even though my sugar has been primarily in range. I even changed the low alert to 70 (the default is 80,) but this has not really helped. I have been calibrating quite often in the hopes that this would help the sensor find the right level … this seems to be helping a smidge.

Another con is the size of the receiver. This thing is huge, and I am struggling to find a good place to stash it. You might remember from my maternity clothes post that most of these clothes do not have good pockets and certainly don’t have waistbands. So it is difficult to find a place to attach the receiver. Also, the receiver itself does not have a clip, so you have to use the case if you want to clip it to something. The case that came with the loaner that the Dexcom rep sent me for the trial absolutely wreaks of cigarette smoke, so I am not using it. Instead, I am carrying the receiver around with me, leaving it lay out on my desk, or tucking it into my sock (although it keeps trying to pop out.)

Perhaps the best part about the CGM is the trending arrows, which tell me if I am heading up or down and at what rate. I’m finding that this helps me decide when to test and treat. That is, if I am heading up or down fast (one or two arrows straight up or straight down), I will test and, most likely treat with either insulin or food. This is helping me treat before I get too low or too high.

All-in-all, I am not sure how impressed I am. It is still early, but, as I suspected, the inaccuracy is downright annoying. I’m definitely going to ride it out, though. Maybe I will get used to it, or maybe it will get better. The main goal here, of course, is to stay in range more often. After this trial, I will have to compare my BGs during the trial to my pre-trial BGs and see how they look. If I was able to stay in range more often, than maybe it is worth both the investment and the annoyance, at least during the pregnancy.