Archive for May 2010

Why I Didn’t Buy a Dexcom

May 21, 2010

I had my monthly prenatal appointment with my Endocrinologist last week. We have seen each other once a month and traded e-mails once a week for eight months now, so we seem to sort of “get” each other now. My appointments are friendly and chatty. This month, he gave me a good ribbing for choosing not to purchase the Dexcom after my trial. He says I am the only person he’s ever met who decided that she didn’t really need it.

While he is right that I did choose not to purchase the Dexcom after my trial, his understanding of my reasons for doing so are a little off.

Let me start by saying that the device is impressive. I tested a Medtronic MiniMed CGMS several years ago when it was in trials. It was clunky, was not remote, and was not waterproof. You had to put the thing in a little waterproof shower pouch that you could hang around your neck in the shower. Really? You had to go to the doctor’s office to have the sensor inserted. To top it all off, the thing was testy. The first time I trialed it, it crapped out after just a day. The second time, the result were better, but you could only wear it for three days. Probably the worst part about the device was that it did not communicate any of its information to me, the patient. Instead, all of the information was stored in the device until the doctor downloaded it. So much for catching highs and lows.

Today’s CGMs are in another realm completely. The Dexcom sensor was really pretty simple to “install” and the user interface on the device itself, while basic, was relatively easy to figure out and was functional. The sensors are now remote, so I was not tethered to the device, and they’re also waterproof, so I could attend water aerobics and take a shower without worrying about a shower pouch. Perhaps most importantly, this new generation shares its information with me, so I have “real time” information about whether my BG is trending up or down, or is out of range. I’ve got to admit, that’s pretty helpful.

When I trialed the Dexcom, I managed to get over 14 days out of one sensor, although by the end, I was seeing a lot of ??? screens. The low and high warnings were a bit annoying in the beginning, especially when I was recovering from a low and it was STILL beeping at me. The lag-time was frustrating. But once I got the alarms set to the right levels (60 and 160 worked well for me,) this annoyance was somewhat tempered. Of course, the fact that it caught untold numbers of pending highs and lows during the trial is not lost on me. My graphs and charts from the second week, once I got used to the thing, were amazing.

So why didn’t I buy? It basically comes down to a sort of psychological burden. I really felt like the thing just put too much of my focus on this damn disease. Before the Dexcom, I was already testing 16 times a day. Now I had to do even more finger sticks either to calibrate, or because Dexcom thought I was high or low and I needed to confirm. It was like the thing was whispering in my ear all day, “Hey you … you’re diabetic. Don’t forget.”

I’m also really hung up on the idea of yet another hole in my skin. I don’t like wearing all of these devices on my body. When the pros outweigh the cons, I’m willing to do it, but otherwise, I’d like to get away from sensors and infusion sites. If they ever figure out how to put the two together into one site, then I would be really interested.

The device is big and cumbersome, too. It did not fit in most of my pants pockets, and the clip was worthless. The size and shape were a constant reminder … when the darn thing popped out of my pocket in the bathroom … when I would leave it on my desk at work during a meeting … when it took up precious real estate on my nightstand where it was jockeying for position with my tester and my juice boxes and my box of Dots.

In the end, I looked at my current diabetes regime, the fact that my A1C’s have been amazing throughout my pregnancy, that my baby is healthy, and that my non-pregnant A1C typically hovers in the 6.0 range, and I decided that the slight improvement in my control was just not worth the psychological pressure.

The day I returned the device to the sales rep, I caught a low in the 20’s only because I tested. I didn’t feel it. I wondered if I should have bought the Dexcom. I still wonder sometimes. And maybe I will change my mind one day, when my A1Cs are not as good, or the lows and highs are more frequent. But diabetes, and life in general, is all about balance. We need to find a way to manage this disease while staying mentally healthy, too. And the best way to do that is different for every one of us. For now, I think this is the best decision for me.

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Happy Belated Diabetes Blog Week

May 18, 2010

So I totally dropped the ball on Diabetes Blog Week last week. I only managed to write two days all week, an all time low for me. Unfortunately, life just keeps getting in the way of my blogging.

Case in point: things at work are getting busy. I work as a Technical Writer for a software company. We have a new release coming out in a couple of weeks, and that means A LOT of work for the Technical Publications department. I spent all day Saturday at work – so not my idea of a nice weekend.

And the doctor appointments just keep coming. Between the non-stress tests, the physical therapy visits, and the “meet the pediatrician” appointments, I feel like I am spending more time in doctors’ offices than I spend in my own home. I’m pretty sure my High-Risk OB sees me more than my husband does.

I finally finished the spring semester of my Masters program at the end of April, but I quickly had to enroll for the summer course, too. It is the final course in my degree, and the professor has agreed to let me finish the course in the fall as an independent study project, but I still have to attend the first couple of classes. So that started up again last night.

The good news is that Baby NoName is doing great. I had an ultrasound last week, and he was weighing in at just over 4 pounds – right on target. I’m so proud of him! Last week, he “dropped” into my pelvis, so I can finally breathe a little bit again. He is definitely getting stronger and more active, too. He spends most of the day twisting and kicking and punching at my internal organs. Things must be getting tight in there. On the outside, my belly feels tight and stretched to the limit. Occasionally, I see a stray limb or rump poking out of my belly before he swims off to the other corner of his home. Oftentimes, I catch a glance of my belly bouncing all around as he continues his dancing and maneuvering.

My husband and I have now visited three pediatricians. We have one more to interview. We are nothing if not thorough! So far, I am leaning toward one who is affiliated with the Children’s Hospital in the “big city” nearby. They have a Pediatric Endo who services their office and would be available to answer my never-ending questions about things like diabetes triggers and formula and vitamin D drops. Plus she seemed like she had a nice mix of a friendly bedside manner and a down-to-earth, tell-it-like it is approach.

I’ve also contacted four daycare providers and I have one more on my list. Some work in their homes and some are large daycare centers. We won’t need anyone until I go back to work sometime in October, but I’ve heard that the “good ones” book up fast, so you have to reserve your spot in advance. I’m learning that interviewing daycare providers is a difficult task. It’s hard to even know what to ask them. I’ve found that the phone calls have allowed me to weed out a few, but I am nervous about the actual visits that will help me make an ultimate decision. For those of you with children in daycare, how did you decide on a provider? What questions am I forgetting to ask?

My husband keeps hounding me to pack my hospital bag, so I started a pile of things to pack: Test strips, insulin pump supplies, insulin, juice boxes, robe, bathroom essentials, etc. What am I forgetting? I’m sure we will get there and I will have forgotten something really obvious like my toothbrush. Is there one thing that you wished you had packed that you didn’t? Or something that you did pack that turned out to be indispensible?

Slowly but surely, we’re inching toward the finish line of this journey. I am full of emotions; I’m ready, anxious, excited, scared, tired, and energized all at the same time.

Making the Low Go: Over the Years

May 12, 2010

So I’m a day late with this post, but they always say better late than never, right? I spent most of the day in bed yesterday fighting some sort of stomach disturbance. I am on the mend, though, and ready to continue with Diabetes Blog Week

Here’s the topic du jour:

Making the low go. Tell us about your favorite way to treat a low. Juice? Glucose tabs? Secret candy stash? What’s your favorite thing to indulge in when you are low? What do you find brings your blood sugar up fast without spiking it too high?

This topic got me thinking about all of the different ways I’ve treated low over the years. And reminded me of one reason why I have such a weird relationship with food.

Back in my early days of being diabetic, some 25 years ago or so, my lows were much more severe than they are now. Thanks to the peaking effect of NPH insulin and the less-accurate BG testing methods we used, I would sometimes end up passed out, then convulsing. This usually happened in the middle of the night, although I did once have a “reaction” in the cafeteria at school. I was in the fourth grade. My friend told me later that I dropped my lunch tray and that some kid stole my milk. So not cool.

In the beginning, we treated these lows with glucose gel that came in a clear bottle that looked a lot like an Elmer’s glue bottle. It had a twist-open lid that was red and white. The “doses” of glucose were marked on the side of the bottle. Later we upgraded to “Insta-Glucose,” an awful-tasting pink gel that comes in one-serving squeezable tubes, kind of like toothpaste containers. Eventually, we added Glucagon to the mix. This shot was part powder, part liquid, had to be stored in the refrigerator, and could not be mixed in advance. The routine was that my mom would force the pink goo into my mouth, while I kicked and fought and spit, and then she would run to the kitchen to pull the Glucagon shot from the refrigerator and mix it while my dad stood by my bed to make sure I didn’t flop out.

Of course, I remember very little of this seeing as I was unconscious. But the evidence was there when I came to: pink goo all over me – in my hair, on my face, on my pajamas, and an aching sensation in whichever extremity my mom could get a hand on to give me the Glucagon shot.

After I was coherent, she would force Coca-Cola on me. She would beg and plead and finally threaten: “If you don’t drink this Coke, I’m going to have to call an ambulance.”

The Glucagon shot left me with an incredible case of nausea, so if I felt that aching sensation in one of my extremities, I knew that the night would not end without a trip to the toilet to empty the contents of my stomach: mostly Coke.

And then there is orange juice. Whenever I had a close call in public, and needed the help of a friendly waitress or shop clerk, or teacher, I usually ended up with orange juice. Because the general public seems to think that the only thing that helps a low blood sugar is orange juice. Of course I was grateful for the help, but I sure would have appreciated a glass of apple juice every now and again.

Needless to say, as a result of these traumatic memories, there are a lot of ways that I choose NOT to treat lows these days. Despite my doctors’ warnings and reprimands, I do not keep Glucagon in my house. I never treat with Coke unless it is an absolute dire emergency, and I do not treat with anything resembling Insta-Glucose, including those squeezable icing packs and those sports “shots” of dextrose gel. I also avoid orange juice like it’s the plague.

I have hung onto a couple of those early low-treaters, though. When I was a kid, I always carried a bike pouch or make-up bag full of granola bars and lifesavers. By the time I needed them, they were usually smashed and stale, but who really cares when you can hardly think straight? When I was on the soccer team in high school, my water bottle had a false bottom in it. It screwed off to reveal a granola bar, a roll of lifesavers and a couple of quarters. You might think that the quarters were for a pay phone (These were pre-cell phone days, after all,) but they were actually for the nearest vending machine.

These days I’ve abandoned the granola bars because of the slow-digesting fat, but I keep rolls of lifesavers everywhere: in my purse, in the glove box in both my car and my husband’s car, in my laptop bag for work, in my desk, and in all of my coat pockets.

When I’m at home, I use those small, toddler-sized boxes of juice (berry and grape are my favorite,) and Dots (five of them is 15 grams of carb.) When I was in the first trimester, I was low ALL of the time. I treated with Jelly Belly jelly beans because they were just about the only thing I could stomach. When I’m out and about and there’s time, I will order a smoothie, because let’s face it, if you have to go through a low, it’s always nice to end it with a little treat.

A Day in the Life of a Diabetic Mom-to-Be

May 10, 2010

In response to Karen’s great Diabetes Blog Week idea, and also in response to Saffy’s question about how I fit in all of the pregnancy-stuff around work, here is my contribution. The topic is “A Day in the life . . . with diabetes.”

5:45 AM: Can’t wait any longer. Have to pee. I’m dancing in front of the toilet while I fight with the vial of ketone strips. Finally.

6:00 AM: My husband stumbles into the bedroom headed for the shower. Seeing as I have been up at all hours of the night for months now, he usually sleeps on the couch. One of us might as well get a little sleep, right? “Are you done in bathroom?” he asks. I mumble “yes” from under my pile of pillows. I can’t believe it’s time to get up already.

6:30 AM: My husband leaves for work. I do a test: 97. I crank up the laptop and upload my BG readings out of my pump, then print them for my doctor.

7:00 AM: Into the shower. A frantic hour of readying myself for the day ensues: shower, hair, teeth, breakfast, packed lunch.

8:15 AM: Another test: 98. I’m late. I throw everything into my laptop bag and rush out the door. Along the way, I discuss this BG reading with my inner self: “It’s only been an hour since breakfast. Will I be low at the two-hour mark? Maybe not … I did have peanut butter with breakfast. I stuff my meter in my coat pocket and pull out of the garage.

9:05 AM: I’m late for my non-stress test. I roll into the parking garage and make a mad dash for the fetal evaluation center. They hook me up to the monitors, and Baby NoName sleeps. We give him a little jiggle, I drink a glass of ice water, and we use the “alarm clock” to try to wake him up. Finally he startles and starts dancing in there. The peaks and valleys are recorded on the red and white graph paper. A half hour later, the nurse is satisfied. She permits me to move on to the next appointment of the day.

9:45 AM: I arrive on the other side of the hospital at my High-risk OB’s office. I am making good time. Sometimes the non-stress test takes an hour. The office manager smiles and calls me by name from behind the sign-in desk.  I sign in, pee in a cup, and weigh myself. It turns out that the Ultrasound Tech is ready for me already. I do a quick test while I’m sitting on the exam table. The Ultrasound Tech has to wait for me and I feel guilty. 156. Damn peanut butter. I ignore the “insulin on board” recommendation of my pump and dial in a .7 unit correction. Let the ultrasound begin.

Baby NoName is doing great, although the tech discovers for the first time that the umbilical cord is a two-vessel cord, not a three-vessel cord as we originally thought. The doctor assures me that it is nothing to be concerned about, but I make a mental note to google the difference later.

I realize that I left my BG readings on the kitchen counter … or somewhere. Pregnancy brain again. I will have to fax them in tomorrow.

10:45 AM: I finally arrive at work. Another test: 93. Much better. On to e-mails and meeting preparations. I sneak in a quick glance at a couple of DOC blogs between projects. I’m starving, so I eat my mid-morning snack.

12:30 PM: Lunch break. BG is 115. I head out to my car for a thirty-minute cat-nap. I am absolutely exhausted.

1:00 PM: Back in the office, I get back to work, and nosh on my packed lunch. Sometimes it’s one of those “healthy” frozen dinners. Today it’s a ham and swiss sandwich and an apple. Due to digestive woes, low blood sugars, and cravings, my pregnancy diet contains a lot more carbs than my non-pregnancy diet. BG is 62, a little low, so I take a little less insulin than the pump suggests.

4:30 PM: The office is starting to clear out. BG is 55. I peel an orange and start to munch on it while I work on one of many never-ending projects. For whatever reason, my BGs have been plummeting in the evenings, so the 4:30 snack has become a normal part of my pregnancy routine.

6:30 PM: One final test before I hit the road: 83. Afraid that my sugar might be dropping, I grab a handful of M&Ms from the office candy dish. I pack up and leave because the “late shift” support rep is locking up, even though I don’t have all of my hours in for the day. This means tomorrow will be an extra long day.

7:30 PM: I am at home, collapsed on the couch. My husband and I are trying to think of something to eat for dinner. All I want to do is sleep, but my BG is low AGAIN. We settle on grilled cheese sandwiches. I am delighted because he is doing the cooking AND the cleaning up. We watch a little TV while we eat and catch up.

9:00 PM: I can hardly hold my eyes open. I get ready for bed, do a test, take my pills, and double-check my stash of juice boxes and gum drops on the nightstand. Satisfied that I have enough sugar to make it through the night, I fall into bed. Because I under-bolused for dinner in fear of another low, I am at 180 now. I take a small correction bolus and settle in under my pile of pillows.

11:00 PM: My husband is on his way to bed. He wakes me up to test. 105. The number barely registers before I roll over and fall back asleep.

2:00 AM: I have to pee. Again. And my hip is killing me. While I’m up, I test. 65. Eyes closed, I slurp down a juice box and then drop it on the floor in the general vicinity of the trash can. Close enough.

4:00 AM: Again with the peeing and the testing. Luckily, my BG is in the “safe range.”

6:00 AM: My husband stumbles into the bedroom … another day begins!

There are a bunch of other D-bloggers participating in Diabetes Blog Week, too. Check out the list on Karen’s blog here.

Washington D.C. Council Approves Stricter School Lunch and Exercise Standards

May 6, 2010

Things have been pretty hectic around here lately, what with the SIX doctor appointments I have this week, so I’ve been kind of slacking on the blogging front.  I read an interesting story about a possible improvement to school lunches, though, so here is a quick review.

The article, from the Washington Post, reports that the Washington D.C. Council approved stricter school lunch and exercise standards for the school district.

In particular, the standard requires public and charter schools in the district to add more fresh fruits and vegetables and whole grains to school meals. In addition, the standard encourages schools to buy their food from organic farms, and to triple the amount of time that students spend exercising. The schools are also required to serve a different fruit and vegetable every day, to only offer low-fat or nonfat milk and whole grains, to ban trans fats, and to limit sodium and saturated fats.

While the measure is definitely a huge step in the right direction, it does fall flat on a couple of levels. In particular, the original measure also limited calories in the meals, but this stipulation was removed at the request of the USDA, even though the Institute of Medicine issued guidelines last fall that recommended calorie limitations.  You might remember from my first post about school lunches that the USDA establishes a minimum requirement for calories, but no maximum. My guess is that the USDA does not want to limit calories because this could potentially limit the amount of food purchased as part of the school lunch program. Luckily, the article reports that health professionals and nutrition advocates are working to get federal calorie limits lowered.

In addition, the measure limits milk to low-fat and nonfat, but does not restrict flavored milks. And we all know that 2% milk, so-called “low-fat,” is actually not low in fat at all. In fact, a half-pint serving of 2% white milk contains 120 calories and a full 5 grams of fat – a whole fat serving. In comparison, the same amount of skim milk contains 80 calories and no fat, while still providing the same amount of Vitamins A, D, C, and Iron as its 2% brother.

The measure also does not re-define a vegetable. So it seems that corn, peas, beans, and potatoes will still qualify as vegetables and will meet the new requirements as long as they are fresh.

Perhaps the most troubling issue is that the council has not yet decided how to pay for the upgrades to the lunch program. Estimated at nearly $6 million per year, the sponsor of the legislation, Mary M. Cheh, proposed a one-cent per ounce tax on canned and bottled soda to cover the increased costs. This tax would generate $16 million annually, but was rejected by other council members.

Nevertheless, it goes without saying that fresh fruits and vegetables, lower-fat animal products, reduced-sodium meals, and the return of exercise to the curriculum are definite improvements over the status quo. Hopefully the D.C. school district will succeed with this measure, and more schools will follow suit.

US rank drops in annual State of the World’s Mothers Report

May 4, 2010

Save the Children released their annual State of the World’s Mothers Report today.  The report indicates the best places for mothers to live and is based on indicators of women’s and children’s health and well-being, including access to education, access to health care, maternity leave policies, and economic opportunities.

Topping the list as the best places for mothers to live (in order from best to worst) are Norway, Australia, Sweden, Denmark, New Zealand, Finland, the Netherlands, Belgium, and Germany.

The United States fell one position, from 27th place in 2009 to 28th place in 2010, largely as a result of its mortality rate – 1 in 4,800. This rate is one of the highest in the developed world. The press release also points out that the US “also ranks behind many other wealthy nations in terms of generosity of maternity leave policies.” Boy, don’t I know it .

Why did I move away from Germany, again?

It could always be worse, though. At least I don’t live in Afghanistan. According to the report, this is the worst place in the world to live if you are a mother.

In Afghanistan, child mortality rates are 1 in 4. In comparison, in Finland, Iceland, Luxembourg, and Sweden, only 1 child in 333 dies before his or her fifth birthday. Most females in Afghanistan receive less than five years of education, compared to more than 20 years in New Zealand and Australia. The risk of dying during childbirth is 1 in 8 in Afghanistan. Meanwhile, in Ireland, the risk is 1 in 47,600.

You can read the press release here, and the full report here

Review: Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby

May 3, 2010

If you’ve been paying attention to the DOC for the last couple of years, you are probably familiar with this book’s author, Cheryl Alkon. You might know her better by her moniker: Lyrehca, or by her blog: Managing the Sweetness Within, where she chronicled her journey through infertility and a successful pregnancy all against the backdrop of pre-existing type 1 diabetes.

I have been anxiously awaiting my copy of this book for months now. In fact, I first placed my order with Amazon in February when I was a mere 21 weeks pregnant. For some reason, Amazon kept delaying my shipment, so it wasn’t until last Friday that it arrived on my doorstep. Finally!

Cheryl noted recently that you can avoid the delivery delay by ordering straight from her. She uses Paypal, and, as an added bonus, she will autograph the book, and you’ll be putting more of your valuable dollars into her pocket, instead of the pockets of the distributors and publishers. If only I’d known!

Now that I am EIGHT MONTHS pregnant, I was worried that the book would not be a very good resource for me, but I was SO wrong. I decided to start into the book from the end instead of from the beginning. I figured that this tactic would allow me to skip to the parts that deal with the later stages of pregnancy.

Right off the bat, I found valuable information. For example, lately I’ve been stressing about breast-feeding. What if it doesn’t work? How will I handle the frequent feedings? And the low blood sugars? What if I have to resort to formula? I was freaked out about the potential connection between formula in the early months and Type 1 diabetes.

Thankfully, Cheryl devotes nearly ten pages to the topics of breast-feeding and formula feeding and her writing style and content put me at ease right away. A mix of scientific evidence, quotations from doctors, and first-hand accounts from REAL diabetic moms, the book helped me realize that there are lots of ways to “skin a cat,” as they say, and provided me with the information and knowledge I need to make informed choices.

In the case of breast-feeding, I am still nervous, but feeling much more confident because I now understand the  potential connection between formula and type 1 diabetes, and am armed with the information necessary to make the best choices for my baby. Whew! What a relief!

I was also really impressed with the sections that deal with delivery and the postpartum period. There are first-hand accounts of birth stories ranging from the very natural to the emergency c-section, and everything in between. Cheryl also tackles topics like sleep deprivation, birth control, infertility, and loss, and how the big D plays a part in all of it.

I was also surprised to find that the earlier sections of the book were also useful for me. For example, it was nice to get a refresher on advocating for my health and my baby’s well-being in the medical community as I am preparing to hand over some of my control to doctors and nurses at the hospital. And as I read the section on morning sickness and low blood sugar, it was nice to be able to relate to the stories. Finally, I felt like I was not the only one who struggled with these issues.

The book was an easy but informative read — kind of like a cross between a conversation with a good friend and an appointment with a doctor who just happens to have diabetes. I’m so glad that Cheryl took on this project. I would recommend the book to anyone with diabetes who is considering pregnancy now, or in the future, and even for those who are already pregnant.