Tuesday, December 29, 2015

Sugar Surfing For Good Blood Sugar Control

I'm not a huge fan of carb counting and never have been.  Many years ago, when I was newly diagnosed with Type1, like all good diabetics do, I began weighing and measuring my food, figuring out the carbohydrate amount, and then dosing my insulin injections based on that. But at best, my carb counting has always felt like a guessing game. I can eat the exact same thing and have the exact same amount of insulin with great results one day, and repeat it on a different day with either high or low post meal blood sugars- Neither of which feels good at all.

Obviously, when I have low blood sugar, I have to react and treat it.  So although it feels awful, and is often embarrassing and a burden, it never stays low for an indefinite period of time.

But with high blood sugars... Well, I USE to just wait until my next meal to take a shot. In the past, I'd been told by my doctors to not stack insulin doses, and I was also told to only take insulin before eating a meal. I held on to those rules for many years.

Which means... I would have hours of high blood sugars when my insulin coverage wasn't enough.  But over the past year or so, I've learned by trial and error how to avoid staying in a high range for more than just a short amount of time.  On my best days, when I'm really on my A game, I can avoid those high blood sugars all together.

I still obviously sort of count carbs (I "eye-ball" things, but I don't weigh and measure), but I don't worry too much about being spot on with my calculations- I can make adjustments when I see my Dexcom CGM trend graph start to head in the wrong direction. Sometimes, like after eating a high protein meal, my blood sugar is fine the first few hours. But around 3-5 hours post meal, I get a little rise.  When I see that upward trend begin, I just take a little insulin to cover it.  And that line on my Dexcom that was rising, dips back down and straightens- right where I want it.

One day, I received an email from JDRF about an author coming to Dallas to talk about Sugar Surfing.  I had heard the term "Sugar Surfing" mentioned on a few Type 1 Facebook groups that I belong to.  I knew very little of what it was all about, but I knew it sounded like something I was interested in.  So I signed up for the event.

It was a very motivating presentation.  Dr. Ponder, who is an endocrinologist that has Type 1 himself, went over many graphs that explain how he uses his CGM to maintain tight blood sugar control.  He makes it easy to understand and also interesting.
Dr. Stephen W. Ponder at a "Sugar Surfing" talk in Dallas
He definitely motivated me to do a better job keeping track of what I do. Since attending his event, I've started using the Dexcom 5 app as a spot to quickly and easily record how much insulin I take and when I take it.  That way, if I've forgotten the amount or exactly when I last took a dose, it's all right there so I can easily take a look.

So the myth that stacking insulin, or taking insulin between meals is a bad thing is officially dispelled. Instead, it turns out to be a huge reason why my A1C is currently under 6%. And I plan on keeping it there, by the way!

And yes... I do run into low blood sugars a fair amount of time, but nothing overly dramatic.  In fact, often, I can just eat about 5-10 grams of carbs and I'm right back up in the 80s.

There's a Facebook group for Sugar Surfing you can check out.  Dr. Ponder posts tips, his CGM graphs, and mentions when he'll be out speaking about his Sugar Surfing book.  The talks he gives, by the way, are free of charge.  When I went to the one in Dallas, I intended to buy his book, but the line was pretty long and I had another meeting to get to. So instead, I went home and ordered it online from Amazon.
Sugar Surfing by Dr. Stephen W. Ponder

I haven't actually finished the book- but it's a great reference tool for how to use your CGM to tighten your blood sugar control.

Anytime I make changes in my plan for managing my blood sugar, I do it gradually.  That way, I'm not taking any big risks. I've learned that when I make drastic changes, it never seems to go over very well.  So, please...be safe! 

Now that many of us are lucky enough to have a CGM, we can manage our blood sugars so much more effectively.

Sunday, December 13, 2015

Getting the Most Out of My Dexcom CGM

Can I just say thank you so much, to all the nice people that read my last blog post and sent me supportive comments?!  That totally and completely made my day. And it was already an awesome day to begin with.

So, I definitely wanted to get started on sharing a few of the things I've done to get that A1C to my all time lowest- and best.  Like I mentioned in that last post, an A1C is just a number.  But all of us Type 1s care a lot about it!  We all want it as low as we can get it without having to suffer through a lot of low blood sugars.

My style of blogging, which I'm sure you've noticed if you've read a few previous posts, is to keep things pretty short and sweet.  So although I've got a whole list of things I've been implementing and unimplementing (that is a word I just made up, and obviously, it's meaning is: v. the opposite of implementing) I'll just focus on one thing at a time.

Today, I want to start with the biggest game changer that's come into my life over the past few years:
My Dexcom continuous glucose monitoring system.
Dexcom G4.  My first CGM.  And a total game changer for me.
It's been over 20 years since I was diagnosed with Type 1 diabetes.  So 20 years ago, I was on a big learning curve.  I read every book about Type 1 I could get my hands on.  And I went to a few (very depressing) "support group" meetings.  I learned as much as I could about my brand new disease from my doctors and those books. (Because the internet wasn't around back then!)

And then, once I got my blood sugars relatively under control, I just kept doing what I was doing.  I sort of forgot that new information was probably coming out all the time.  And because I've been coasting along, and doing okay with my blood sugar control over the years, my doctors sorta kept me on auto pilot.  For 20 freaking years.

But fortunately, I have a friend named Tanya, that also is a Type 1.  And she is constantly trying new things like pumps, and meters, and medications that other than through her, I never even would have heard about. To be honest, although I love hearing about anything she has told me, I personally didn't have a big interest in it for myself until she showed her Dexcom to me one night at dinner. My A1C had started slowly creeping up over the years- nothing super alarming, but getting to see a graph of my blood sugar over a 24 hour period sounded like something that would be helpful.

I didn't know if my insurance would cover such a thing, back when Dexcom was new on the scene.  I actually volunteered to be in a clinical trial in which I would've had to use a Dexcom, and would have gotten to keep it- that I didn't qualify for.  Boo hoo. But then I thought, "Hey, I should at least ask my insurance if they could help cover it."

As the saying goes, "Ask and you shall receive."  I asked and I got my first Dexcom free- well, technically, I had already met my deductible.  I think I had to pay 10% of the cost.  But it felt free enough, and I was very happy.

I thought I would just use my Dexcom here and there- like maybe one week every month or two, just to get an idea what my blood sugars were doing over a 24/7 period.  I also (wrongly) thought the big appeal of using a Dexcom was not having to prick my finger as often for a glucometer reading.

From Day 1 of inserting my first Dexcom sensor, I haven't gone a single day without it.  As advised by the Diabetic Educator that showed me the ropes so to speak, in the beginning, all I did was look at the trend graphs.

I just watched for a few weeks.  But then, once I understood a few things like how long it seemed to take my insulin to make a move on my blood sugar before a meal, and what my blood sugars were doing a couple of hours after eating and while I slept, I couldn't help but make changes.  Little ones at first.  And I got bolder and bolder with my insulin dosages as I became more knowledgeable based on the knowledge Dexcom gave me- Knowledge that I was never privy to before.  Now I don't just take shots before a meal or bedtime.  I will take small doses of insulin throughout the day when I notice it going too high.  I'm not at all scared of lows, because my doses are very small (1/2 unit doses with my insulin pen) and because I know the Dexcom will show me what's going on as my blood sugar is falling.  I can take a small amount of carbohydrate if necessary.
Dexcom G5 on the iPhone

So I have to say... Of all of the things that have allowed me to make a positive change in my overall diabetes care Dexcom is number 1.

It also piqued a whole new interest in this disease that I'm not sure I ever had, at least to this extent, before. Looking at my trend graph throughout the day is a huge motivator.  I can't help but react to the numbers.

I'm now using the Dexcom G5.  I like having it on my phone, but sometimes, I prefer the little meter Dexcom provides.  (If you're interested in my comparisons of the G4 and G5, I wrote a blog post about it, which you can read about by clicking right HERE.)

In my next post, I'll talk about Sugar Surfing, which is my other huge discovery as of late.  There's no way I could do "sugar surfing" without having the data that a Dexcom provides.

Thanks so much for reading my post today, and for visiting my blog.  Please leave a comment if you have anything at all to say and add to the conversation because that's what makes for a good blog, and I am sure aiming for having a great blog focused on Type 1!  Please don't be shy- I'd love to hear anything you have to say, and I'm sure other readers would as well.  

Monday, December 7, 2015

My Lowest A1C EVER

Well... I got my A1c results back from last week's endocrinologist appointment.

And I'm super duper happy. 

It wasn't quite as low as the Dexcom Clarity app had predicted (although, I suspect, given a little more time- it could be!) but it was the lowest it's ever been since I was diagnosed as a Type 1 over 20 years ago.

So give me a drum roll please, because this feels like a very important announcement and a very proud moment for me....

Ready?! 

5.7%!  FIVE. POINT. SEVEN. PERCENT.


I've heard it before, and you probably have too...But it bears repeating. This A1C is really just a number.  In fact, at my last appointment, when I told my endo I was shooting for an A1C of 6% or lower, he warned me, "Don't get too caught up in your number."  First of all, everyone's disease (and body!) is different.  Secondly, it's way more important to avoid extreme high and low blood sugars than it is to have a low A1C. If I was having a bunch of lows, this number most certainly wouldn't be worth all my trouble.  Thirdly, one can become a little obsessed trying to achieve a low A1C.  (I, however, find my particular obsession pretty manageable.  My world doesn't absolutely revolve around it.)

Cheerleader #1, Lucy!
Cheerleader #2, Ricky Ricardo!
Still, I'm yelling out my number to anyone who gives a shit.  Which, come to find out, actually isn't too many people.  Lucy and Ricky, of course, were thrilled for me and gave me loads of kisses for all the hard work it took for me to achieve that 5.7.  I called my husband while he was working and although I'm sure he was happy for me, I don't think he really gets it. And I sure don't expect him to. I have just a couple of Type 1 friends that I texted with my results, even though it may have been a little braggy.  But I couldn't help myself.  I knew they would get it and feel happy for me.  Like I said, there's just not that many people to tell. 

I know this A1c is an ever-changing thing.  And although I've worked really hard to get it this low, I'm sure I had luck on my side as well.  Next time I go in for labs, who knows?  But maybe I can keep hovering around 6% for a while, now that I've proven to myself that it's possible!

I'll obviously post more (and more) very soon about little adjustments I've made that for me, have made a big difference in my blood sugar control.  As well as currently having this 5.7% A1C, I have far less problems with highs and lows than I was having in the past because of these little changes I've made.

But today... It's just a brag.  It's not every day I feel like bragging.  But holy guacamole, today I do!  So thank you for indulging me!

Monday, November 30, 2015

How Accurate is Dexcom Clarity?

I decided to brag a little today, because after tomorrow, I might find out that my brag is based on misinformation.

I downloaded the Clarity app for my phone when I first received my Dexcom G5. For the first few weeks that I had it, it didn't show what my "estimated A1C" was.  I think it has to collect a couple of weeks of data before it can come up with an estimation.  Within a few weeks, it started spitting out an estimated A1C along with a average glucose number. I felt pretty happy with the numbers I saw in the beginning.  But then felt motivated to make it even lower and better. So I've been trying my best, and doing a few things differently.  And the A1C number keeps getting lower as time goes on.  The other thing is my percentage of time spent "in range" has gotten longer.  It almost seems too good to be true.

Tomorrow will be my first appointment at with my endo since using this Clarity app.  If it's accurate, and I sure hope it is, this will be my best A1c EVER in my life. 

I will not, however, celebrate with ice cream!  Or a bowl of pasta!  Or even a real Coke!

I'll just feel happy- and lucky- that for now, I've got pretty tight control on this mysterious disease that keeps me on my toes, that keeps me learning and trying knew approaches all the time. And that will be enough for me.

Please check back- I will reveal how the endo lab results compare with the Dexcom Clarity app in the next few days.  My fingers are crossed...

Wednesday, November 25, 2015

Why I'm Thankful to Have Type 1 Diabetes

Since it's Thanksgiving Day, and it's the time of year I generally like to count my blessings more than usual, I wanted to make this post all about my gratitude for Type 1 Diabetes and the impact it's had on my life.

That may sound a little strange, because having any ongoing health "situation" isn't necessarily awesome.  But I'm one for looking for the silver lining.  So here goes.

I secretly like having a disease that most people don't understand or even know about. I feel special and I feel smart.  I know a lot more about how food, stress, exercise, hormones, etc effect my body than most people do.  I'm doing calculations throughout the day,everyday. And all that calculating keeps me sharp.

I make healthy choices all the time, just because I know how it all effects my blood sugars.  I rarely over indulge (food or drink-wise) and I'm active a good amount of each day.  Somedays, I don't necessarily feel like running or going on a long walk, but because of my diabetes, I just make myself.  And then, I'm alway glad I did.  I've often thought I'm probably healthier because I have diabetes, all things considered.

I'm so grateful for insulin. Although I had a big fear of needles as a kid, I got over that pretty quickly when I realized my alternative if I didn't take multiple daily shots for the rest of my life.  These days, the shots don't bother me one single bit. Shots seem to be a more-than-fair trade off for staying alive. I know there are plenty of people with far worse diseases out there that wish they had it so good.

In the past couple of years, my interest in my blood sugar control has become more extreme- bordering on obsession- thanks to Dexcom.  Seeing what my blood sugars do throughout the day and night leave me with no reason to ever let things stay in a bad range for too long.  I told my husband the other day that it's sort of fun- like some strange and challenging game.  Just when I think I have it all figured out, something goes wrong and I have to try again.  And weirdly, I like that.  I guess I just like a good challenge and diabetes provides that.

I also love that I have a disease that I'm pretty much in charge of.  I don't have to wait for my doctor to advise me on what to do, ever.  I switch things up all the time and honestly I feel like I know more than most endocrinologists do.  I can't necessarily explain how it all works as well as a good medical doctor can, but intrinsically, I know how my body reacts to things, and I know how to make adjustments when things get "off".

So seriously- Like I said, I'm thankful.  I knew nothing about Type 1 Diabetes prior to my diagnosis over 20 years ago.  But now, I'm an expert. And even better, I still continue to learn knew things about it all the time.  And I'm still interested and challenged by it after all these years.  Sounds like a pretty good marriage to me.

Happy Thanksgiving, to my beloved Type 1.


Carbo Loading in Disneyworld

Ok, so now I have my new computer- Yay!
And I'm back from Disney- Hooray!
And I connected with another Type 1 blogger that lives here in Dallas also- and we challenged each other to resume our blogs, which we had both been neglecting as of late.  She's so on-the-ball, she already posted something the day following our discussion. (Check out her blog HERE- it's great!) Now about a week later, I'm ready to jump in as well!

During this past week, when I was at Disneyworld, falling blood sugars were an ongoing problem.
Maybe that was due to constant walking, or not being able to find decent food or even get my hands on indecent food quickly because of long lines.

Anyway, my sugar of choice is always Mentos.  Not the minty ones, but the fruity flavored ones.  But there are only so many Mentos one girl can tolerate over the course of 3 days.  I'm not one to ever pull the "I have diabetes" card out, but fortunately, in a time of need, my friend did it for me.  She asked an employee at one of the restaurants if they could just get me some crackers adding, "...because she's diabetic!"  And it totally worked.  We received very friendly and quick service, as well as a few packs of stale Saltine crackers- and they did the trick.  They provided me with enough carbs to survive and got the ongoing tart flavor from the Mentos out of my mouth for a while.

Thank you, Goofy.
But just for a while.  Eventually, I ran out of the crackers, and had to resort back to the Mentos.  Finally, I ran out of those too. I was then forced to buy an overpriced family sized bag of gummies in the shape of various Disney characters.  The bag was huge, and barely fit in my purse, but they made me feel safe again. I actually never even opened the package! Now they are yet one more memento of my trip to Disneyland.
My first and last day in the Magic Kingdom of DisneyWorld

Monday, November 9, 2015

Third World Problems

It was not at all my intention to go silent here...

But I've had a few technical difficulties lately.  I'm currently only able to use my super duper old desk top computer.   And I just can't bring myself to publish a post (beyond this ONE) without photos to accompany words, but on this computer, I don't have access to my photos.

It's just a matter of time before I can start blogging again.  I've finally ordered my brand spanking new computer (YEEEEHAWWW) and it should be arriving by week's end.

So thank you for being patient...
Please check back next week.  I have high hopes.  Good things are coming.

Monday, October 19, 2015

Dexcom Clarity

On my previous post, I compared the Dexcom G4 and G5. I mentioned how unimpressed I was with the Clarity app that I was told was suppose to be so great.

Not only is the phone app hard to view since it can't be turned to landscape, but the only info I can see is the the "overview" which looks like this:
Other than getting super excited to see that, according to this app, my estimated A1C is a 5.6% (more on that in my next post!) I don't really understand or care much about that graph below. The info provided seems to be very negligible.

But today, I finally went to Clarity.Dexcom.com online.  There's a lot more to see and manipulate when you view it on a computer.  There's also a "user guide" that explains everything. I haven't read through all of that yet, but I get the general idea, because it's pretty user friendly once you just start clicking around.

With Clarity online, I can view all my CGM data, compare blood sugar readings by days and time of day, and I can even set the parameters on that graph pictured above to the numbers of my choosing. Oh... AND, a big bonus, all the graphs are actually large enough on a computer screen that I can see them!

Like I said, I haven't read the user guide, and I have only spent a little time on Clarity online, but it's WAY better than the phone app for me already.  Why they can't just improve the phone app, I don't know. It sure would be a lot more convenient since now I do everything on my phone.  But maybe that's coming down the pipeline.  I suspect it is!

So, if you haven't already, go check it out if you're a Dexcom G5 user.  Clarity.Dexcom.com  You'll be asked for you username and password and then, voila!  You'll have all sorts of numbers and graphs to obsess over- if you're anything like me.

Monday, October 5, 2015

Comparing the New Dexcom G5 to the G4

Because I no longer use this site for my blog, this post can now be found on my new blog called My T1 Diabetes.  To find the post comparing the Dexcom G5 to the G4 please click the link HERE. Thank you so much for taking the time to visit my new blog. 
DEXCOM G5

Friday, September 18, 2015

What Do I Know?!

You'd think that having had diabetes for over 20 years, I'd know everything about it. 

But there's little things I'm learning (and sometimes, just RE learning) now that I'm back to having a beginner's interest in it all again. 

When I was first diagnosed all those ages ago, I remember some nutritionist telling me that eating protein and fat with your carbs slows down the absorption rate of the carbohydrate. I was told it was important, therefore, to balance out my snacks and meals with whatever the proper fat/protein/carb suggestion was, especially before I went to bed.  However, like so many nutritional facts, apparently, the thinking on this one has changed over the years.  Now, they're saying, carbs get in there on their schedule, and proteins get in there on their schedule, and the same goes for the fats. One doesn't really effect the other.  Proteins and fats do effect blood sugars way later (and much less so) than carbs, but this explains why Mexican food can cause a very late spike in my blood sugars.  As in 4 hours later... 

Another little thing I've never heard until recently is that if you're insulin injection seems to not having an effect your blood sugar, it could be caused from dehydration.  So sometimes, if you just drink a glass of water, you might start to see the effect of the insulin getting in there and battling it out with a rising, or just sitting idly blood sugar. I've tried that and it's TRUE! I'm outside in this Texas heat a lot, and so water is my best friend.  But sometimes, I forget to call her. 


My third recently learned factoid is this: if you inject 7 or more units in one shot, it doesn't absorb as well.  So the suggestion is, for example, when I take my 10 units of Lantas for the day, it's better to break it into two shots, 5 units each, in a different injection site.  I've tried this the past two mornings.  Who knows if it's making a difference because with the amount of insulin I take, it's a little hard to tell, but things have been especially good the past couple of days.

But seriously- what do I know?

Not all that much.  Some days I think I've totally got my diabetes all figured out.  Other days, I'm completely pissed at spikes I can't explain.
So, I just keep reading books, blogs and listening to podcasts and experimenting with whatever sounds logical.  I like a good challenge.  And I'm fortunate to have a life long one...

Friday, September 4, 2015

Sometimes I Can't Even Remember Shooting Up!

Yes, the above is true.  I take multiple daily injections of insulin each day, every day.  I'm a junkie for my insulin and I can't live without it.

Because I shoot up so often, half the time I'm not even paying attention.  Sometimes, 5 minutes after taking a shot I'll wonder, "Wait, how much insulin did I take?!"  Other times, I'll notice a severe spike in my blood sugar after a meal and wonder, "Did I take my shot?"  It's super annoying, and it sounds ridiculous, but it is not an uncommon problem for a Type 1 diabetic. There's a lot to keep track of, and sometimes, the mind gets jumbled.

Because of that,  drug companies make a few pens that have a time stamp on them, like this one I use for my "fast" acting insulin.
Novo Echo Pen
It reminds you of how much insulin you took, and how many hours ago you took it.

I asked my doctor if they made a pen like that for the Lantus that I take only once a day, in the morning.  He said that although they used to, they stopped because since you only take it once a day, most people can keep it straight.

That is a lie. That is coming from a doctor who is not a Type 1 diabetic.  First of all, things that are daily habits, don't require much thought.  So it's not that hard to occasionally forget- especially if you're routine is disrupted.  Secondly, there is in fact a product made for the "few" people that can't remember shit- like me! It's a cap you can put on an insulin pen that keeps track of it for you.  I bought it online recently, after my doctor told me there was no such thing. 
There is such a thing!  It's called Timesulin. And you can order it online for around $30.

Usually during my sleeping hours, I have a steady line in a happy blood sugar range through the night.  It tends to dip a little low, but I rarely, if ever, have problems with it going too high.  But this morning I looked at my Dexcom and saw that my blood sugar had hovered around a steady 200 all night.  WHAT?!  That sucks!! I even took some insulin right before bed to get it down.  I thought if anything, I'd wake up during the night with a LOW blood sugar reading.  Not high.  What in the world was going on?

It's easy to forget what you forget.  I wondered if it was possible I had skipped my shot yesterday morning.  I really couldn't remember, I just knew I had a stressful morning, rushed around, and had an appointment I was really anxious about.  But I couldn't remember if I had taken my shot.  Or if I had brushed my teeth.  Or if I had turned off the light in my closet.  All little mundane habits I don't usually think that much about.

But, thanks to my Timesulin, I looked at my pen, and sure enough, it let me know it had been over 40 hours since my last shot of Lantas.  That totally explained the high readings.  I just thought for some reason, my insulin requirements were a little high the previous day due to stress or whatever.  But nope.  I needed more fast acting insulin all day because I didn't taken my shot of Lantas that morning.

Once I took my Lantas, and my fast acting insulin, and I ran 3 miles, and drank my Vitamix,and I walked my dogs another 3 1/2 miles, this is what happened to my blood sugar. 
High to a great feeling low.
Yay!!
And it's been nice and steady throughout the whole day.

Not only do I shoot up daily to avoid getting high, sometimes I can't even remember doing it.  So it helps so much to have tools that help me with that.


Monday, August 17, 2015

I Have Diabetes and I Can Eat a Donut

Over the years, many people have said things to me like, "Oh- you have diabetes?  So you can't have sugar, right?"

Or they'll walk into a party with some delicious looking dessert but then look at me and say, "Oh sorry, I know you can't eat this because of your DIABEETUS."  Out of frustration, I've occasionally answered their statement by saying, "Well, if I really wanted to, I could eat that plus a whole bag of sugar.  I'd just need to take more insulin to cover it."  But of course, I wouldn't eat an entire bag of sugar.

But a donut?  Yes.  I can and I sometimes will eat a donut.  But if we're being honest, no one really should eat them. Not someone like me who's a Type 1.  And not a Type 2.  And not even a non-diabetic person! So I generally stay away from them, only eating them on a rare but delicious morning.  But it's not my Type 1 that stops me from eating sugar.  It's my overall desire for good health.
Proceed With Caution- EVERYBODY!

But I confess. Today I indulged.  I ate a donut. And of course it wasn't a  healthy choice.  But, oh my gee, was it delicious!

I took my typical morning shot of insulin- although not a donut dose- thinking I could get away with it by running an extra couple miles during my morning run.

Sometimes that works for me.  I notice that when I do a more intense aerobic exercise, even if it only lasts about 20 minutes, it often drops my blood sugar more than walking for an hour does.  I think of it like my blood is moving that insulin into my body that much faster. Like I said, sometimes that works. (And I'd rather err on the side of not quite enough insulin prior to a workout, than too much. That's not advice, that's just how I like do it.) 

It didn't work for me today though.  After a 20 minute run, followed by a 1 hour and 15 minute walk, my blood sugar was still higher than I wanted it to be.

Thanks to my Dexcom, I could see what was happening~My blood sugar was stuck around 180 for nearly 2 hours while I was running and then walking my dogs, and it never really dropped.  So, I felt comfortable taking another small dose of insulin to knock it down another 90 points or so.  For a while, it was looking good...


 Then quickly, it started looking like it was going to go a little too low.
If all I knew was that my blood sugar was 88, and I didn't have the Dexcom to tell me it was falling fast by that straight arrow down, I might not have corrected until I was feeling a low blood sugar a little while later.

But thanks to my Dexcom, I ate handful of grapes...
The Grapes of the Donut's Wrath
and soon, I had an arrow that wasn't going up or down, but straight across.  Just how I like it.
Blood Sugar Recovery Post Donut
So yes, I have Type 1 Diabetes. And also yes, I CAN eat a donut.




Friday, August 14, 2015

Squeak.

A couple of weeks ago, when one of my friends read on my blog that I was using the Aviva Plus Accu-Chek glucometer, she passed along her test strips she no longer needed since she had switched to a different meter. Lucky me!

On top of that, I just recieved my first 3 month supply of the test strips from my on-line pharmacy.  The day they arrived, I put them in my cabinet where I had the other boxes of test strips. I felt like I had hit the jack pot with all these boxes.

And it was a beautiful, beautiful thing.  Maybe the kind of beauty that only another diabetic can understand.  But beautiful, no less.  So I couldn't resist posting the picture below on a Dexcom group I belong to on Facebook. 

My jackpot of Accu-Chek Aviva Plus Test Strips
I wasn't bragging, or trying to make anyone jealous.  I was just happy.  But after I read some of the comments people left on that posted photo, I felt sort of guilty for my own good fortune. 

Although I think everyone that saw it did understand my excitement, I was made very aware that not everyone is so lucky.  (For the record, I'm not usually this lucky either- in the world of diabetic supplies.) I got lots of "Jealous! :)" comments.  And several "Wow"s.  One women said, "So so so jealous! We don't even get enough to make it through the month with our 4 yr old! Your stash is beautiful". 

Insurance companies can be rough.  Sometimes, they pretend to know more than we do about how many times a day we need to check our blood sugar to maintain tight control over our disease.  And now with the Dexcom, some insurance companies seem to think calibrating it 2 times a day is all the test strips they need to provide us with. 

They're totally wrong.

They should be encouraging us to check more, not less! Down the road, it will save everybody money. But it's a world of short-term thinking, unfortunately.

For now, my insurance is covering the amount of test strips my doctor and I asked them to... And I am so grateful.  And I do not take it for granted.  I know not everyone is so lucky.  And I also know I might not be this lucky next time we go through another round of insurance policy changes.

But we need to keep sharing this information with each other, and with anyone who will listen, and even with those who won't. The squeaky wheel gets the grease!  So keep on squeaking.  Squeak to your doctor! Squeak to your insurance company! Squeak on forum groups!  And keep squeaking until we all get the things we need to take care of our health.

Thursday, August 6, 2015

Trying Out a Few Diabetes Cookbooks- Stay Tuned!

When I was very first diagnosed with Type 1 diabetes, a few well intentioned people gave me cookbooks written specifically for diabetics.  I tried using them, but I didn't like any of them.  The recipes were not tasty, and most of them called for artificial sweeteners. 

Whenever I'm cooking dinner, I attempt to add up the various ingredient's carb counts, but I tend to ignore everything but the very obvious carbs- sugars and starches.  I don't bother to factor in how many carbs are in veggies and other fibrous foods like beans- because usually, it's not that many.  But little by little, it can add up and make a difference on my blood sugar for sure.

So, I decided to check out a couple of current diabetic cookbooks from my local library- hopefully better than those I tried 20 years ago! Since I'm checking them out from the library, if I don't like them, I've lost nothing.  If I do like them, it can only help me in my quest for tighter control.  Besides the fact that the give the carb count with each recipe, they also are most likely low carb meals. Win/Win.

Here are the 2 diabetic cook books I have checked out and get to keep for the next 3 weeks.

I really haven't even looked at them at this point- So I'm not yet recommending either one, yet.  But I'll look thru them, and try some things, and let you know what I think!  If you have any great cookbooks you like to use, please leave them in the comment section below so others can take a look! Thank you- :)

Tuesday, August 4, 2015

Diabetes America- My Follow Up Appointment

Well, there's not a whole lot to report regarding my follow up appointment with my new endocrinologist at Diabetes America.

But that's not necessarily a bad thing.

Those small adjustments I made since my last appointment, which I wrote about in my previous post, have started making small positive shifts in my blood sugar control.

While the diabetic educator was looking over my Dexcom graph, she was commenting on how good everything looked.  "But look at all those highs and lows!" I said.  She told me that my highs aren't really that high (around 200) and they don't stay there long.  And the lows, thanks to the Dexcom, aren't all that low either. She said there's not that much to tighten up regarding my overall blood sugar control.  But still, I would like to see a larger percentage of my day spent in my ideal blood sugar range, and I really want my A1C to get back down to the very low 6% range. And by low, I mean 6.0%. I know it can be done.

The only suggestion my doctor made for me is to lower my Lantus by one more unit, so that I'm taking 10 units before bedtime.  This, he thinks, will help my problem of the falling blood sugars during sleep.  And I concur!  I had already lowered it by a unit the last week. Now, upon his suggestion, I'll go ahead and lower it one more.

Initially, when I first made my appointment with a new doctor at Diabetes America, I was hoping to be put on one of the drugs that makes you pee out excess sugar when your blood sugar gets high. It sounded at first like such an easy and logical "fix".  But to be honest, I haven't researched it at all, and I know that all drugs have side effects.  So if I can avoid new drugs, I realize, that is best.

I told the doctor I want my next A1C  (which which will be done in 2 months) to be 6%, or very close.  He told me not to obsess about the number.  I think his exact words were, "Don't be ruled by the number." 

And I said, "Oh really?!"
He said he'd much rather me have a steady 6.5%, than a roller coaster of highs and lows of 6%. I get what he's saying, but I think I can have both- An A1C of 6%, without a lot of erratic highs and lows.  So I probably will continue to be ruled by the number.  Isn't that kind of what the game of T1 Diabetes is all about?!

Like I said, not a whole lot to report.  But little by little, I'm making strides in the right direction.

Monday, August 3, 2015

Small Changes To Tighten My Blood Sugar Control

This week I go back to my new endocrinologist for a follow up appointment.  It's only been 3 weeks since my initial appointment at Diabetes America.  When I went last time, the doctor suggested I do the following:
1. Use the Aviva Expert meter- which means I really count my carbs (as opposed to my "eye ball" method I have discussed in previous posts), because I have to enter that info into the meter for it to spit out it's recommended insulin dosage to cover my meal.  I thought at first it seemed a little silly.  I'm able to figure out the math in my head, since my ratio is 1 unit of insulin for every 20 grams of carbs I take in. As it turns out, the meter is really helpful when making a correction a couple of hours after taking insulin if my blood sugars are still running a little (or a lot) high. The meter knows how much insulin is still "on board" and can calculate a good dosage for me to get my blood sugar in my target range safely.
2. Switch to the NovoPen Echo- so I can give my shots in 1/2 unit increments.

Type 1 diabetes is very much a self managed condition when you get down to it.  I have- and will- absolutely try implementing whatever my doctor suggests, but I thought of a few other things to implement to further tighten my control:
1. Reducing carbs.  I don't eat a ton of carbs anyway, but I know the less I can eat, the better.  So little by little, I keep peeling away at how much I feel like I must have.  I think having to document all that I consume really motivates me to reduce my consumption!
2. I'm taking my Lantus (long acting/non-peaking insulin) in the morning now instead of at night.  I was having so many lows during the night.  I learned at the Type One Nation weekend that although Lantus lasts for 24 hours, it tapers off and you get a slightly larger percentage of it during the first 12 hours.  This change has helped my lows somewhat during the early morning hours.  Sometimes I don't even have to eat a snack before bedtime! And honestly, sometimes that makes me sad.  Ha!
3. I've been (usually) taking my insulin a good 30 minutes before eating my meal. Sometimes even more if my blood sugar is high.

Over the last few weeks, since making these changes, I've noticed only a subtle change in my blood sugars- I'd say reducing carbs is the most impactful thing I know to do right now.  I wish I didn't love them so much and could just give them up completely.  Sometimes my stomach just feels like it needs a little bread, or a cracker... And then what about fruit? How can I give that up?  Do I have to?  Would I want to? My head and my heart and my stomach are all telling me "No!  Please, no!"  And I'm listening... at least for now.

My biggest challenge currently seems to be my night time blood sugars.  Unless I go to bed with them a little high (150-180), I still often wake up by 3am with my Dexcom beeping at me because my bs is below 60.  I am sick of 3am snacks!!!  It's funny, when I first switched my Lantas shot from 10pm to 10 am, I thought I had solved the problem.  But after about a week, I went right back to the early morning blood sugar dips. I think it might be slightly less of a dip, but it's still problematic.

My appointment is tomorrow, so I'm excited to see what's next!

Wednesday, July 29, 2015

Why I Went Looking for a New Endocrinologist

Over the course of my 20 or so years living with diabetes, I've gone to 3 different endocrinologists.

Upon my diagnosis, the endocrinologist I was sent to helped me get things under control fairly quickly.  For the first several years, I had very good luck with my blood sugars. Perhaps I was in the honeymoon period.  But I also was (and still am) disciplined when it comes to diet, exercise and taking 4 shots of insulin daily.

When Fermin (my husband) and I moved from Coppell to Dallas, I decided to go to a different endocrinologist that would be closer to my new neighborhood.  He was rated one of the top doctors in his field in the area.  I didn't personally like him as much as my first doctor, but he was fine.  I mainly needed an endocrinologist for the sole purpose of prescribing my insulins and testing supplies because I was doing a relatively fine job staying in control of everything diabetes related.

But after a few years, I got tired of sitting in that stupid waiting room 1 1/2 - 2 hours each time I had an appointment.  I remember one day in particular, I had been waiting well over an hour.  The receptionist opened the little window and said, "Kerri, you can come on back to the room even though Dr. L is still at lunch.  He should be in shortly."  He wasn't even there all that time I had been waiting??  I was so mad.  While I was in that tiny room, waiting for him, I was getting more and more furious.  After an additional half hour or so, I walked out and told them I had to leave. Right at that moment, he walked in the door and said, "Ok, you ready?" and I replied meekly, "Yes..." without complaint.  But I never went back to his office again. 

I've going to my 3rd endocrinologist for the past 7 years or so.  I haven't really asked for much help, because I didn't think I needed it.  Again, this doctor was fine, but I didn't love him either.  To be honest, I hadn't even seen him in the last several years, but was instead just making all of my appointments with his PA.  I liked that guy personally- But.

But I've come to realize that just because my A1C has hovered from 6-6.8% the last few years, my blood sugar is not in good control at all.  Thanks to the Dexcom, I've become very aware of how often I'm in a range that's either too high or too low.  And it's way too often!

I think because of that decent looking A1c, my endocrinologists have left me on autopilot assuming I'm doing a good job keeping things related to my diabetes controlled. But that A1c is only a small window, and it only shows part of the picture.  The Dexcom has shown me so much more.     
my highs and lows during a typical day shown on my Dexcom cgm
I asked my last doctor for a prescription to get a Dexcom about a year ago, after my friend Tanya told me about it.  Not because my doctor told me about it, or suggested it.  I had to ask him about it.  And that was when I first started feeling like maybe it was time for a change.

A few months ago, I attended Type 1 Nation event hosted by JDRF, which was an all day event with different speakers about all things diabetes.  I learned so much that day.  I heard about new types of drugs being used with Type 1 diabetics, tips about when to take insulin prior to eating, about insulin pens that have 1/2 unit dosages and come with a memory, etc.  Most importantly, I learned that some of these new things weren't even that new- I just hadn't heard about them.  

I decided it was definitely time for a change.  I really think, if given all the information and tools possible, I can get my diabetes in better control than it has been the past few years.  I am ready to find a "team" who is eager to help me.

And I just may have found them.

I wrote about my first appointment a couple of weeks ago at Diabetes America in a previous blog post.

My previous 3 endocrinologists were all fine and they were what I needed at the time.  But now, I want more! I want cutting edge!  I want someone giving me suggestions! I want someone to partner up with me! Like  it says in the forward of Think Like a Pancreas by Gary Scheiner (which I'm reading now and loving it-- more on that in a future post for sure!), "The nice thing about teamwork is that you always have others on your side."


And ultimately, that is why I went looking for a new endocrinologist.

Friday, July 24, 2015

A Case for My Glucometer

Although I'm liking my new glucometer, the Accu-Chek Aviva Expert, I am hating the case it came in.  It's similar to all the stupid, boring, black cases my glucometers of the past have come in. But even slightly worse.

The elastic that is suppose to hold the test strips, as well as the one that holds the lancet device are just way too tight to easily fit them in and out for each use. Additionally annoying, the elastic that holds the glucometer in place covers the buttons I need when logging in my data information.  I'm pretty sure the designers of these lame cases are not users of the glucometer.  It's such a hassle to try dealing with the elastic straps, that I just let the strips and lancet device run free.  So, they tend to fall into my lap or onto the ground when I unzip the case. Not only that, but it's very hard to see it in my purse, also known as "the black hole". I often have a brief moment (or more) of panic wondering if I accidentally left my meter at home before finally finding it.
the elastic straps are useless and annoying.
After years and years and years of hating these lame cases, it finally occurred to me that I can use any freakin' case I want.  My friend gave me this adorable little hedgehog coin purse about a year ago.I've just been keeping extra guitar picks in it, and although I love it, it wasn't really put to much use.  UNTIL TODAY.
glucometer case- new and greatly improved
Now it's my brand new glucometer case!!! It's the perfect size, things don't fall out of it since the zipper is on the top, and it's very easy to find in my purse---Not just it's color, but also by it's feel.  So even if I'm in a dark place digging around for it, no problem! Yay!!! Problem solved.
all of my glucometer supplies are safe and sound in this case
Little things like this can make such a difference in the daily life of a diabetic.  If something this simple is bothering you, change it! Don't wait 20 years like I did.
The choice is so obvious, right?!





Thursday, July 23, 2015

Back To Diabetes Basics

I don't remember exactly when I was diagnosed with diabetes, or how old I was.  Which is maybe a little weird.  So many people remember the exact date they were diagnosed.  But no, that's not a detail I've held onto.  It was somewhere during my early to mid-twenties.

What I've have been remembering lately, is the beginning struggle I had, counting carbohydrates so that I would know how much insulin to take.  I would look at labels, but once I started having to add all the different foods and amounts together, it got a little confusing.  I remember trying to make some pasta dish one night, and I figured out the carbs in the pasta. But then I was trying to figure out the carbs in the tomato sauce. And just how much of the tomato sauce I would actually eat.  Then I had to figure out how many carbs were in the little piece of french bread I wanted to eat with it. It was just too much. (I know, it was too much carbs as well- but I was TWENTY-SOMETHING!!!)  I had had a long day at work and was just hangry (*hangry- hungry to the point of anger).  I didn't feel like adding all those numbers together to figure out how much insulin I needed to take. The dramatic actress in me threw the package of pasta across the kitchen and rigatoni went flying everywhere.  I burst into tears, and stormed out of the kitchen. Nice work.

But eventually, after many many meals of carb counting, it became so second nature that I knew how much insulin to take just by looking at food.  In a way, I sorta stopped carb counting.  Based on what my blood sugar was upon checking it, how active I was going to be after I ate, and the general amount of carbs I was eating, I almost intrinsically knew how much insulin to take. It didn't stress me out, and it worked for me.  Until it didn't.

Lately, as I've mentioned on the blog before, my blood sugars have gotten more and more erratic and I've decided I either need to give up all carbs completely (NO!!!!) or at least, start counting them meticulously.

Back to the basics.  I'm reading food labels, and I'm using all the carb counting phone apps like crazy. I'm currently taking 1 unit of insulin for every 20 carbs I eat.  I find myself wanting to eat less carbs the more I have to count them.  Sometimes, I even want to lie to my meter and tell it I'm only eating 30 carbs when I know I'm really eating 40.  It's weird.  It's like lying to your doctor. Why? What's the point and who am I trying to impress here?

So far, counting carbs hasn't really been enlightening or surprising.  I'm taking pretty much the same amounts of insulin I would have when I was using my other method. But it does having me being very conscious about what I put into my mouth.  And that, in itself, is surely a benefit.

Like I mentioned, I've been using different phone apps for carb counting.  There are just so many, and so far, each one I've tried has been a little annoying but also helpful.  Do you use one?  Do you have a favorite one to recommend?  Please share in the comment section below if you do!

Monday, July 20, 2015

I AM TYPE 1

When I was newly diagnosed and hospitalized with diabetes back in my early 20s, I knew absolutely nothing about the disease that would forever more, be mine. The extent of my knowledge about diabetes was largely based on what I had seen of Julia Roberts' character in Steel Magnolias.  I remember my main thought upon hearing my diagnosis was, "Oh my God!!! I'll never have babies!! And my life won't be long."

Like I said, I didn't know anything. I didn't even know there was a Type 1 and a Type 2 diabetes, and that they were actually totally different diseases.  Apparently, the nurses in the hospital weren't real clear on the facts of diabetes either.  I remember one nurse in particular saying to me, "Well, you don't look like you have diabetes! Maybe you just ate a little too much birthday cake."  I turned to my husband (who had recently had a birthday, and yes, I had been eating way too much of his cake because I was just starving-- and so thirsty!) and said, "Oh my God- Maybe she's right.  Maybe this isn't diabetes but just some weird reaction to something I've eaten.  This doctor is probably crazy."

No one in my family had ever had diabetes. I didn't really know anyone with diabetes.  And isn't Juvenile Diabetes something you get when you're a juvenile?  I was an adult in my 20s!

This was 20 years ago, and now 20 years later, there is still a lot of misunderstanding and confusion to the general public about my type of diabetes... Type 1. 

So, before we go any further along on this blog, please watch this excellent- and funny- video about the misconceptions about T1 Diabetes!


Tuesday, July 14, 2015

Diabetes America!- My First Appointment

Yesterday I went to my first appointment with Dr. Mora at Diabetes America!  (Which, by the way, I feel must me said with a cheerleader shout whenever I say it.)

I was so excited to be going to a new place, and to a new endocrinologist, to hopefully get some new ideas on wrangling in these roller coaster blood sugars I've been seeing on my Dexcom over the past year that I've been using it.

my dexcom meter. this is what a bad day looks like. less of this, please.
So excited, that when I stopped in at the restroom to wash my hands when I first arrived, I threw my glucometer in the toilet.

It was an accident.  Because the sink didn't have surrounding counter space, it seemed that the most logical and safe place to set down my meter was on the back of the toilet. I didn't realize there was a slight slope, just the perfect amount of slope, that as I turned to wash my hands, my glucometer fell right into the toilet water.  I tried drying it off and using it, but it had already drowned and was beyond saving.

I told the receptionist about my mishap, and she gave me a brand new meter, just like the one I tossed in their toilet.
old "one touch" glucometer that fell in the toilet/ new replacement glucometer
When it was time for my dreaded labwork, I took deep breaths, preparing to have blood taken from my vein.  That's how any endo I've ever been to in the past has done lab work.  And I hate it.  I've gotten faint plenty of times. I never gotten used to it, even though I've had it done way too many times to count.  But at Diabetes America! they just use a finger prick to get your A1c and cholesterol levels.  Annually, they do a more thorough blood panel which does require getting the blood from the vein, but not for this visit.  Yahoo! Already, I was in love with this place.

Also, the lab results were just about immediate, so by the time I met with the diabetic educator, we knew my results.  This makes a lot more sense than getting lab work results 3-5 days after my actual doctor appointment!  So we looked at not only my Dexcom results over the last week, but at my A1c as well.

After speaking with the educator, (which you have the option to do, or can forgo if you prefer) I met with Dr. Mora.  He had already been filled in on what I was wanting to address, medications I had asked about, and had an idea of my goals.

NovoPen Echo
Although I had asked about, and was hoping to try Farxiga or Invokana (drugs that to my understanding make you pee out excess sugar once your blood sugars go above 120 --please read more about it HERE because I'm not claiming that I got those facts exactly right!), Dr. Mora wants me to first just simply start using a new insulin pen that allows me to give shots in half unit increments due to my sensitivity to insulin.
Often, I have to opt to take a little too much, or a little too little insulin- but now, with the 1/2 unit options- POW!- this could really help me tighten up my control. Not only does the NovoPen Echo give me the ability to delivery in 1/2 unit increments, it also has a memory that tells me when I last took a shot, and how much I took.  Sometimes, even right after injecting insulin I'll think "Wait, how much did I just put in there?" So this added feature sure is nice. I trust the pen's memory better than my own.

He also suggested that I use a new glucometer.  It's one that not only give you a blood sugar reading, but also advises you on how much insulin to take,  based on how many carbs you tell it you're about to ingest. It's the Accu-Chek Aviva Expert.
accu-chek aviva expert
Obviously, this little calculation be done in my head, but I confessed to the diabetic educator that I don't really carb count, but instead use a very scientific method I call "Eye Balling".  I just sorta look at my meal and decide if I should take 1, 2, 3 or the occasional 4 units of insulin.  It usually works. When it doesn't I make a correction by either eating a little more, or taking a little more insulin.  I realize this method is slightly flawed and probably sounds crazy (or at the very least, lazy) to a medical team.  So, I think rather than trusting me, they want me to use a meter where they can actually see how much insulin I'm taking in relation to the amount of carbs I'm eating.

So for now, that's it.  A new meter that calculates my carb/insulin ratio, and a new pen that delivers 1/2 units of insulin. Hopefully, these two minor adjustments will make a difference and I'll have a little roller coaster that looks more like the "Mini-Mine Train" than the "Shock Wave".

an ideal day on the dexcom.  more of this, please.



Monday, July 13, 2015

A New Type 1 Diabetes Blog

Although I've had Type 1 Diabetes for around 20 years, and I've been a blogger for over 10 years, I'm only just now starting a blog specifically for sharing my trials and tribulations with diabetes, and hopefully connecting with other adult Type 1 diabetics.


Now that I'm in my mid-40s, my blood sugars have begun to challenge me in new ways that I'm very motivated to figure out.  I've had pretty tight control since my diagnosis, but gradually, my A1Cs have begun to creep up, and my last lab had me in a new range that I didn't like at all.

I have my first appointment with a brand new endo today. (I'll write a post soon about why I'm choosing to try out a new doctor.) I wanted to start my blog right now, at what feels like the beginning of a new journey.

So here goes!...