Pumplandia: Violet's Diabetes Blog

In which certain complications ensue

2010-08-19T15:29:00.000-07:00

It’s been so long since I wrote about diabetes that in order to make this post I had to hack into an ancient email account to retrieve my Blogger password. Funny how things ebb and flow: Other health problems, and plain old semi-normal life, have held my attention for some time. But diabetes has reclaimed the spotlight, and how.

I started this blog a few months after my diagnosis, less than six years ago. I’ve written about fear, hope, apathy, determination. I’ve tried to maintain good control, to focus on the Now, to adapt. Always to adapt.

Now I find myself adapting again. This summer I’ve found out that I have mild nonproliferative retinopathy and gastroparesis. Two complications diagnosed within two months. And certain evidence suggests they are probably not the only ones.

Mild retinopathy is practically ho-hum. Almost all of us get it sooner or later; if it remains “mild” it won’t even require treatment. But gastroparesis is life-changing (more on that later). It’s also a form of autonomic neuropathy—irreversible nerve damage that can happen in one or multiple systems of the body. Some of that damage isn’t especially significant; some of it can erode quality of life; and some of it can kill us.

I’m not here to whine about these issues, though I can guarantee that I will whine occasionally. I’m here because writing helps me with the work of adapting. Telling my story—and connecting with others around theirs—becomes a way of understanding who I am, which in turn helps me to live the most aware life I can. I can’t be healthy or happy without that kind of awareness. And I can’t be healthy or happy in isolation, either.

So here I am.

Head pats

2008-04-27T15:43:00.002-07:00

1. Am now the owner and daily wearer of a medical ID. This time around I went with a much simpler look.

2. Am seeing eye doctor in May.

3. Am seeing endo in June. (She's too busy to see me sooner. Will try not to back out over the next, uh, two months.)

I am cautiously proud.

Illumination

2008-04-15T13:36:00.003-07:00

Whoa, Violet. Interesting last post there. Dark much?

Okay, here’s my excuse. The path to the light must traverse the darkness. Right? Right?

And, uh, there’s no way out but through. Yeah. That.

Actually, I do believe those things, though I certainly wasn’t thinking about them when I wrote Grim Post. Sunrise dispels the night, though, whether the night intends to be dispelled or not. Holding up my junk to the light is a good way to, at the very least, see it a bit more clearly.

What I see is that I’ve gotten stuck. I knew that already, but wow. When I reread that post, I *know* it, in that deep-in-the-bones kind of way.

What I feel, rereading that post, is that I’d like to unstick myself.

I would?

Yeah. Reasons for unsticking abound, as a matter of fact.

Aha. Going to the endo because I want to is much, much different than going to the endo because I’m supposed to, or because I’m afraid, or because I feel guilty, or because Mrs. Violet is chastising me about it. I can handle going to the endo because I want to--much as I just handled eating two scoops of ice cream because I wanted to. (Peanut butter & chocolate and mint chocolate chip. I regret nothing.)

So. I’ll go. Meemeep will go with me. We will report back.

Comfortably Numb: A Confessional of Immaturity

2008-04-09T06:44:00.001-07:00

This month marks 3.5 years since my dx. My primary question is how it could possibly be only 3.5 years as opposed to, say, 35.

I’m bored. Diabetes is boring. This post will be boring too: It resays things others have said already, things I’ve said already.

These days I pretend to be as undiabetic as I feel I can possibly get away with. I test, I count, I treat lows and highs, I carry juice. I change the set every fifth or sixth day, I order supplies occasionally, I send Medtronic a few bucks as necessary to maintain the flow of said supplies. I eat pastries and ice cream in significant quantities. I drink more alcohol than is probably advisable for a person who takes insulin.

I don’t exercise beyond walking around the city. I don’t go to the endo. I don’t have my kidneys or eyes or any other parts of me checked for complications. I don’t wear a medical ID since my pretty one broke many moons ago. I don’t read the research, I don’t read blogs, I don’t send money to the ADA or the JDRF or any other acronyms. I don’t craft my diabetic experiences into small sparkling gems of creative nonfiction.

I just don’t.

Most of the time, most of me feels okay with all that. I don’t know my a1C, but then neither does the NYC Department of Health, which suits me fine. My control seems as good as it did when I did know my a1C. I screw up the insulin occasionally, but we all do now and then. I’m here. I’m okay.

I like pretending. It’s more comfortable than the alternative. It isn’t less boring, but it requires less engagement with the boredom, as well as less engagement with the parts that aren’t boring because they’re just plain scary.

Still, there’s a small corner of my brain that cannot repress the occasional flicker of recognition that I’m being Bad, to say nothing of childish, in a way that is not in the long-term interests of Violet. Hence this post.

My prescriptions are about to run out, and last time around the refill authorizations came through with a stern admonishment, delivered via the pharmacist, that I’d have to see the endo to have them extended. And if memory serves, my friends at Medtronic will be looking for a prescription renewal come July as well.

Fine, fine. I’ll go. But I refuse to be interested.

They can’t make me.

An unsent letter from Medtronic Customer Service

2008-02-04T09:50:00.000-07:00

Dear Valued Customer Violet:

Thanks for your recent order of lifesaving medical supplies. In filling your order, we noticed that payments on your account have fallen behind.

We understand that many people have times of financial difficulty. Heck, we aren’t perfect either! We remember those minor and major inconveniences we’ve caused you in the past. For example:

Sometimes we’ve sent supplies to your home address instead of your work address, despite your request for the latter. And one time we sent them to your old work address—you know, the one that’s halfway across the country from your current one! Sorry about that. When you have as many customers as we do, this kind of stuff gets hard to keep track of.

We also remember the time our accounting department mysteriously set up a second account in your name and started double-billing you on your pump payments. Good thing you gave us a call before we put that extra account into collections! Seriously, though, that one was definitely our bad.

Then there's the undeniable fact that not one but two of your pumps have broken during your three years as a Medtronic customer. (Please accept our condolences on the recent demise of Nellie.) That’s an unfortunate failure rate, to say the least. We’re as glad as you are that you still have one year left on your warranty! Better luck with pump #3.

You’ve been very understanding about these bumps on the road of your diabetes management. That’s why we’re writing to reassure you that even though you owe us several hundred dollars--a significant amount of money to company with $13 billion in sales in 2007--we would never dream of freezing your account and refusing to send you supplies. In particular, we would never, ever tell you that your lifesaving medical supplies are on the way and then freeze your account without informing you for, say, ten days or so. After all, that could put your health at risk! And that’s just not what we’re about here at Medtronic.

So how about it, Violet? Could we set up a payment plan?

Yours in healthful solidarity,

Medtronic Customer Service
Your Partner in Diabetes Care

Nellie vs. the Absolute Bagel

2007-11-09T12:06:00.000-07:00

Longtime readers may recall my early attempts to conquer the bagel with cream cheese. An update is long overdue. Here is Violet's Strategy for Fatty, Bad-for-Violet Treats:

1. Estimate carbs. A generous NYC bagel tends to be 65-70 grams.

2. Tell Nellie.

3. Select dual bolus.

4. Manually add 20% to the amount of insulin Nellie suggests. This is to compensate for the Fatty Treat's tendency to slow digestion, requiring more insulin over a longer period of time.

5. Take 2/3 of the total now. Square the remaining 1/3 over 3 hours.

6. Luxuriate in everything + cream cheese.

7. Brush teeth.

This method also handles egg sammiches well and is modestly effective for pizza.

Important: Your mileage may vary and probably will. Experiment with care.

P.S. Absolute Bagels, 107th and Broadway, are the bomb. Bonus: They have a bulletin board covered with photos of happy, bagel-fed babies.

I’m Too Sexy for My Pump, part III

2007-11-07T06:29:00.000-07:00

What? Still?!

It’s true. Even 2.7 years after first exploring this topic here and here. (Apparently I am growing sexier as I age, huzzah. Or at least holding steady.)

I know that I remain too sexy for my pump because over the course of 2007, I’ve been rejected not once but twice by potential dates who were squicked by Nellie.

A provocative statement, I know. Keep reading, gentle blog friends. I shall explain all.

It seems worthwhile to note, for purposes of anthropological interest, that both NRDs (Nellie-Rejecting Dorks) were absurdly good-looking. And I do mean absurdly. My admittedly limited experience with such individuals is that, as if in karmic recompense for their Clooneyesque appearance, they are developmentally delayed in the category of general human decency. These two fellows proved to be no exception.

I didn’t meet either NRD in person. I’ve spent much of the year in that special purgatory known as the Land of Online Dating, where I encountered NRDs One and Two. In each case Nellie came up during the correspondence stage.

Why, you ask, did Nellie come up during the correspondence stage? After all, I could’ve kept her existence concealed until my suitors were so entirely captivated by my sundry violetine charms that not even bionic breasts would have turned them away. (Eww. Hope no one from Medtronic R&D is reading this post.)

Well, Nellie became an issue during correspondence because I, um, used her as bait. This is a practice I’ve implemented when a fellow makes multiple statements that ping on my Superficiality Radar. The idea is that a great deal of time and energy can be saved by screening out NRDs before the dating process begins. It’s true that such screening has the potential to eliminate someone who would not, in fact, turn out to be NRDy if he met me in person (and was therefore captivated by my sundry violetine charms) before learning about the pump. But I wouldn’t want to date such a person, now would I?

No, no I would not.

It works like this. After three or four pings on the radar, I make casual mention of having diabetes and using a pump. If questions ensue, I send a photo—not of me, but of a kindly anonymous soul who is wearing a cousin of Nellie’s. The infusion set is visible in the photo. I write a brief but honest passage about the magnificence of the pump.

Then I wait.

NRD One very abruptly had to walk his dog—this exchange took place during an online chat—and promised to be in touch straight away the next day. Never heard from him again.

NRD Two sent an email thanking me for my honesty and explaining that he would need to think about whether he wanted to continue our conversation. Never heard from him again.

Wow. Imagine a pumpless (or a more reserved, ahem) Violet wasting her precious time and energy on either of these cretins. I might’ve gone out with them. I might even have unknowingly kissed one of them. Ewww! NRD cooties!

Who knew that Nellie would not only preserve my health and happiness but also function as an anti-NRD screening device? Not I. Maybe I should send Medtronic a testimonial for their website…

Reclamation

2007-10-19T12:07:00.000-07:00

Hello, Violet here.

I've missed this space and what it used to mean to me. I've missed all you people, too.

I'm making this blog public again, as I'm no longer willing to sacrifice new connections with the OC out of fear.

It's raining in New York today. The notably tall building in which I work is surrounded by a cloud.

Nevertheless, things--all kinds of things--are looking sunshiney.

It's good to be back.

Notes to self, March 2007

2007-03-07T13:27:00.000-07:00

1. Withdrawal from the blogosphere is a symptom of resurgence of the Other D.

2. Try very hard not to take eight weeks to figure this out.

3. The oven is not really an appropriate place to hide dirty dishes so that the cat sitter doesn’t see them.

4. Forgetting to pay the phone bill has noteworthy and negative consequences.

5. Dr. Two-Fifty can help. Not with the telephone, though. Or the dishes.

Hyponostalgia

2006-12-09T16:39:00.000-07:00

I am staring at trash bags. Hmm. Trash bags.

No, I don’t need trash bags.

Do I need paper towels? Yes. Yes, I do. But I don’t feel like carrying them. Paper towels are big.

The bottles of Windex are merging into one another. It’s funny how they make Windex in lots of colors now. Something about that seems kind of un-American, even to a lefty chick like me.

I remember that what I really need is dinner. Yes. That’s why I’m in this store, even though the clerks are rude and the prices staggering. I’m very hungry. I would really like some pot roast.

I don’t know how to make pot roast. Well, I did make it once. It was good. But I don’t remember how I did it, except that it took a long time. I’d better just get something to microwave.

I need milk, too. And something else. What was it?

I’m not sure. Maybe I’ll get some brie cheese. Yes. Oh, this is expensive. Is there a small one? Why are all the numbers fuzzy? Here’s a small one. I’m really hungry. Is it okay to eat brie cheese for dinner?

Something isn’t quite right. Something.

Oh.

Oh!

Yes. I prop the test kit on a display of crackers. I don’t feel low. Maybe I’m too high.

61. Pish. That’s nothing.

Hey. I’m low in a grocery store.

Woo hoo! I’m low in a grocery store!

I can eat anything, anything at all.

These opportunities are rare. It seems very important to select the Best Possible Treat.

I wonder where the dark chocolate is. I picture myself blogging later about dark chocolate. You will all nod appreciatively and comment on your favorite low-busting indulgences.

I can’t find the chocolate. Maybe I should just eat something, anything. No, I should drink something. I should drink some juice. Where is the juice?

The front of the store has a cooler with bottles of everything. There should be juice there.

I wander in that direction. It’s crowded. The cooler is blocked by a line of people. I look at them. I know there are words, words I could say that would prompt these people to move. Then I could reach the juice.

Other people don’t have trouble thinking of words. I remember K and her 27 at the movie theater. That's a lot lower than I am now, but she had all the words she needed.

If I were K, I’d have words too. But I’m not K. I’m V, which is usually fine but at the moment seems a little inconvenient.

Happily, the line of people moves while I am trying to string together a few syllables. The first bottle my hand grasps is cherry Coke. Though speechless, I have the wherewithal to check to see if it’s diet. It is not. I open it and drink.

Gods. This stuff is good. So good. So effing good! I’d forgotten.

Briefly I’m thirteen again. Cherry Coke has just been invented. I am watching Monty Python & the Holy Grail for the first time ever, with my first-time-ever boyfriend. We’re eating Rocky Rococo’s pepperoni pizza.

Life is resplendent with laughter, possibilities, and carbohydrates.

I pull out of the flashback before the part where Zoot’s twin sister begs Sir Galahad for a spanking. (Way too embarrassing. Folks did not joke about such things in West Des Moines, Iowa, in 1985.) Already I feel a little steadier. I pay for my randomly selected comestibles, including the half-bottle of soda. I even remember my PIN number in the checkout line.

At home I clock in at 96. The brie is splendid.

Is That an Insulin Pump in Your Pocket, or…

2006-12-03T17:02:00.000-07:00

…Are You Just Happy to Text Me?

(a play in three brief acts)

Dramatis Personae (in order of appearance)

Nellie: a purple Minimed Paradigm 515; successor to Charlotte

Dinner Companion: one of Violet’s recent one-date wonders

Violet: devoted owner of Nellie

Thanksgiving Ladies: Violet’s charming holiday hostess and her guests, each some thirty years Violet’s senior

Movie Companion: an entertainment-oriented version of Dinner Companion

Act I
Scene: a chic Italian restaurant in Chelsea, NYC

Nellie: Beep. [pause.] Beep. [pause] Beep.

Dinner Companion [slightly annoyed]: Texting?

Violet: Insulin.

Nellie: Beep.

Act II
Scene: a holiday meal at a beautiful colonial farmhouse in Orange, Connecticut

Nellie: Beep.

Thanksgiving Lady #1 [peering into Violet’s lap]: What is that thing?

Nellie: Beep. [pause] Beep.

Violet: It’s an insulin pump…

Nellie: Beep.

Violet: …for diabetes.

TL #2: Oh, I thought it was a cell phone!

TL #1: So did I.

TL #3: So did I!

TL #4: Is it all right that you’re eating pie, dear?

Act III
Scene: a movie theater in Gramercy

Movie Companion: [yawns, stretches, and casually drops arm around Violet. Very high school.]

Violet: (!)

Nellie: …

Movie Companion: [unintentionally gropes Nellie, who is clipped to Violet’s waist]

Violet: [face contorts as she suppresses urge to snort]

Movie Companion: …

Movie Companion: [removes arm from around Violet]

Nellie: Beep!

Transition

2006-11-27T13:25:00.000-07:00

And to make an end is to make a beginning.
The end is where we start from.

--T. S. Eliot, "Little Gidding"

For almost two years Pumplandia has served as an outlet for my frustrations and hopes as they pertain to diabetes and to life in general. It has helped me connect with brilliant writers and compassionate human beings--and even, almost miraculously, a few individuals who are both. To some extent, I hope, this site has also been a public resource for PWDs and those who care about them.

Recently, the actions of one person have presented me with a difficult choice between writing this blog privately or not at all. (This individual isn't part of the OC; it's a personal matter.)

Discontinuing the writing isn't an option; my connections to this community are too important to give up. Pumplandia will therefore be shifting to an invitation-only format over the next week. Friends and known members of the OC will receive an invitation via e-mail with instructions on how to access this page. (Unfortunately, use of the invitation requires a Google account, which is free but may be irritating to some folks.) I am also happy to share access with verified medical personnel, researchers, industry types, ADA/JDRF folks, and so forth.

If we’re pals and you don’t receive an invite by 12/4, please drop me a line, as it’s surely an oversight.

If you’d like to continue to read Pumplandia but are not known to me by an e-mail address, please write to violetgirlz@hotmail.com and introduce yourself. If we aren't already acquainted, please include a reference to a mutual friend or active member of the OC who will vouch for your identity, or a verifiable professional credential related to diabetes. I regret that I cannot invite readers who lack a reference of this sort.

My hope is that all the people who are meant to read Pumplandia will find their way back to it over time. Thanks for your interest and support.

Moderation in all things...

2006-11-12T07:32:00.000-07:00

...including moderation.

I realized this morning that the reason I haven’t posted for a while is that I’ve been feeling sheepish.

Lately I can’t seem to follow the rules. Recent posts include the occasional reference to donuts. I left out mention of the scones, pancakes with syrup, dark chocolate, toffee, fried everything, Chinese food with luscious sweet sauces, pecan pie...

Pecan pie!

I hadn’t eaten pecan pie for more than two years. (It’s still good.)

These various excesses have left me of late with numbers somewhat above average, to put it gently. It’s partly the choice of foods and partly the sheer difficulty of guessing how to cover them. Which reminds me of another interesting phenomenon: my usual habit of estimating carbs on the high side out of preference for lows over highs has fled. I keep taking too little.

I could chalk all this up to stress or travel, but I’ve had plenty of periods of stress and/or travel in the past. I’ve kept pretty well to my food guidelines for most of them. Something different’s going on.

I think there’s a need to rebel now and then, even for compliant Violet. Maybe especially for compliant Violet. Truth is, if I had to believe that I could never binge again for the rest of my life, I don’t know how I’d cope. The world of food is too replete with pleasures to concede them all forever.

It’s a better strategy, I know, to have a little treat now and then as opposed to an enormous one every day (or twice a day, ahem). The former is my usual way, and I’ll get back to it soon, if for no other reason than that I’m starting to feel binged out. Yet I think there’s something to be said for claiming an audacious freedom now and then. It reminds me that I’m still alive in ways that can be measured by means other than an a1C test. It reminds me that control is a choice—yeah, the right choice, but still a choice, not an absolute, not a prison.

It reminds me that while I may have this silly disease, it doesn’t have me. Huzzah! And I mean that in a most immoderate way.

Notes to self

2006-10-26T11:35:00.000-07:00

1. Do not transport POC meter in bag next to frozen lunch entrée. POC meter refuses to operate at temperatures below [insert random number between room temperature and that of a frozen lunch entrée]. When you find yourself going low on the subway, you will be unable to test and will have to make a random guess as to how many glucose tablets are needed to retrieve yourself from the hypoglycemic brink. By the time POC meter regains room temperature, it will mock you with a number well over 200.

2. Stop eating donuts.

3. Remember to take insulin with carbohydrates. (Ahem? Hello? Diabetes, anyone?) You do this by pushing the buttons on that purple thing. You know, the life-saving medical device attached to your body? Yeah, that one.

Two

2006-10-21T08:53:00.000-07:00

When you truly possess all you have been and done, which may take some time, you are fierce with reality.

--Florida Scott-Maxwell

How I love that phrase: fierce with reality. Fierce! Check that out. Yeah, I’d like to get me some of that.

Okay, what do I do again? Truly possess all I’ve been and done?

Well.

That sounds uncomfortable, to say the least. Just for starters, I’d have to acknowledge that I ate a not insubstantial donut yesterday. (75 g of carbs. 75!) And it’s a pretty slippery slope from there, believe me.

Still...fierce. Hmm.

Hmm.

Donut jests aside, this fierceness project has preoccupied me ever since my ex and I split up. What I've wanted is to reach a new understanding of myself, a more profound and nuanced sense than I currently have of how I came to be at this funny little crossroads in my funny little life.

I didn’t have sufficiently apt words for this quest until last weekend, when I started rereading William Bridges’s The Way of Transition and found the above quote used as an epigraph. Aha, I thought. Here’s the thing I’m trying to do. And how gentle a caveat: “may take some time.” Yes. It does.

In a perhaps unsurprising way, given whose brain we're considering here, I find it’s easier to possess the things of which I’m ashamed than those of which I’m proud. Gargantuan Mistake #16, Shameful Error #42, Self-Absorbed Foolishness #23--these and others stand out in sharp relief against the occasional Violetine accomplishment or act of kindness. The myriad ways in which I’ve hurt myself and others simply WILL make themselves known at every opportunity. What cacophonous voices those little buggers have. They yell a lot.

Which brings me to today.

Two years ago today, I was diagnosed with diabetes. (The story of that week is archived in three parts: here, here, and here.) Looking back over these two little years that feel like ten--two years during which, not so incidentally, I made a new life and then participated in its crash-and-burn free fall--I realize that possessing all I’ve been and done in relation to this one small area of diabetes entails much more pride than shame.

There, I said it.

Pride because: I read and learned; I changed my diet not to the point of perfection (witness the aforementioned donut) but at least to a point where I could thrive physically and mentally; I found a way to connect with others that not only feels true to my natural introversion but even nurtures it; I started on the pump despite its numerous accompanying anxieties; I was afraid; I was brave; I persevered.

These aren't small things to have done and been. They're rather significant. A lot of them are choices I could have made differently.

Diabetes being only one small part of my life, I have many other things to ponder, understand, possess. But today I'm willing to celebrate a few small victories and to feel a bit fiercer thereby.

In which I overthink a new topic

2006-10-17T14:56:00.000-07:00

Pursuant to #11 below, I’ve been looking into volunteer possibilities.

Well, there’s no place to start like the glaringly obvious: diabetes. The OC is full of people who are doing their part. Am I?

If by “doing my part” you mean whining periodically or perhaps chronicling my awkwardness, then yes--yes, I am. Otherwise, well...not as such.

It’s clearly the right thing to do, to contribute time and energy toward the causes of helping people cope, helping to raise money for the search for the Shmure, and so forth. Couldn’t begin to argue against it. But there’s a wall of (self-centered, irritated, irritating) resistance within me.

I think it’s an internal tension similar to the one described here. There’s a continual negotiation between Diabetic Violet and the Rest of Violet over how many of my waking hours I’m willing to sign over to this disease.

Diabetic Violet (hmm, perhaps she should be Violet with Diabetes out of respect for folks who hate “diabetic”?) knows that making a positive contribution to D-related causes would be a healthy—dare I say mature?—adaptation to my circumstances.

The Rest of Violet does not want to be quite that diabetic (have quite that much diabetes???), thank you very much. She’s shooting for the middle ground.

VWD points out that I’m always whining about isolation, about not knowing enough nonvirtual people who are tackling the same issues I am. D-related volunteer work is an obvious way to change that.

ROV does not want diabetes to become the mainstay of my interactions with other humans. Period.

VWD thinks ROV is in denial.

ROV thinks VWD is a priss.

OCers, where are you on this subject? (Um, not the question of whether VWD is a priss. The volunteering thing.)

Happily for both Violets, one can have a positive impact on the world in quite a few ways, huzzah! So for now I am shelving the question. I’m attracted to working with animals or maybe, if I can pull together the emotional fortitude, something like this program, which provides companionship to people at the end of life.

ROV figures diabetes will be around a while longer, after all. She will still be needed when she's ready.

Commitment to reality

2006-10-07T09:56:00.000-07:00

I’ve been pretending to myself, these days, that I’m not paying attention to research. I pretend I’ve accepted and adapted. Cure, shmure. I’ll be delighted if it happens, but I’m not holding my breath. I am fine; I am strong. I cope, I manage, I deal. I am Getting On With My Life; I possess a Healthy Detachment.

Hmm.

It’s come to my attention that what I actually do, these days, is to glance sidelong at the research news, pretending not to look but in fact making quiet note of every development. (It’s an interesting talent, reading websites without consciously acknowledging that I do so.)

I’ve had to confront my tendency toward surreptitious monitoring after last week’s news that the Edmonton protocol is essentially a flop.

In a nutshell for the non-D-obsessed, this experimental procedure entails a noninvasive transplant of islets, those little jobbers in the pancreas that make insulin in a healthy person. In type 1, the immune system mistakenly eradicates the insulin-producing cells, leaving their former owner with diabetes.

So: insert happy, functional islets from organ donors, salt liberally with immunosuppressant drugs, cross fingers.

Variations on this procedure have been attempted for years with limited efficacy, but the most recent study had encouraging results at 1 year following transplantation. About half of patients were manufacturing all the insulin they needed, and a large percentage of the other half were manufacturing some and achieving improved blood glucose control thereby.

Last week brought the news that at the 2-year mark, only 16% of patients were still functioning without insulin injections. It seems that the immune system continues to recognize the islets as invader cells and systematically destroys them. Unless/until more effective immunosuppressant drugs can be found, the Edmonton protocol is not a viable cure.

Certainly I had no conscious fantasy of ever receiving a transplant and a cure via this process. I’m more realistic than that.

But...crap.

I’ve written elsewhere about my mind’s habit of making contracts with the universe. What I realized this week is that I’ve done it in this area as well: If I do my job as a patient and forge ahead with gentle optimism and courage and blah blah blah, if I extend myself toward other PWDs and do my bit to help us all cope, I (and the rest of you) will be rewarded someday, someday, with the cure.

Truth be told, there is no such contract. There are no guarantees. Optimism may be mentally healthier than pessimism(?), but none of us can know if or when a cure may be found. There’s a tightrope to walk here—I suppose it’s properly called realism—that lacks the comforting safety net of my previous subconscious understanding with the universe.

So it’s time to renegotiate. What it must be, all it can be, is something like: If I do my best to take vigilant care of my diabetes, if I do my best to connect with others in my situation, I will be as physically and mentally healthy as I can be for as long as possible. In the meantime, a cure may or may not be found.

Bah. I liked the old contract a lot better.

Sixlandia

2006-10-01T08:32:00.000-07:00

I recognized her from the back: a logically impossible feat because, as Kerri observed moments later, there are no butt shots posted over at Six Until Me.

Maybe it was the hair. Maybe it was the “oh crap, I’m looking for someone I’ve never met in Grand Central Station at rush hour” posture. Somehow I just knew: here she was, the gifted writer and sensitive, hysterically funny soul whose blog has enriched my life for what must surely be hundreds of posts by now.

I hurried over and said her name. She turned. “Violet?” My name isn’t really Violet, as K knows, but who I could really be other than Violet, to her? (For me it was a moment of secret wish fulfillment, as my nom de keyboard is what I would have named myself, had the choice been mine.)

Being of a quiet disposition, I had wondered if this meeting would feel awkward. No such thing. We hugged and babbled and laughed as we forged our way through the crowd to an exit. Wandered down Lexington, found a diner. I was on Day Five of my attempt at vegetarianism, so I ordered a portobello mushroom and cheese sandwich. For the balance of the evening, I glanced enviously at the bits of turkey on K’s chef salad. (I made it, for the record, to Day Seven, then capitulated to carnivorous longings. Last night I actually dreamed of steak. Medium rare.)

We talked and talked, nonstop. I described the Winter, Spring, and Summer of My Discontent and their numerous reverberations. We discussed the challenges of moving to a new place. We pondered the exhilarating weirdness of New York. We talked about blogging, what it means to each of us.

And of course we talked about diabetes. K had received bad news. I admired her attitude: frank, honest, unsettled but absolutely unwilling to be defeated.

The legendarily cool and compassionate Chris joined us for the last half hour. He’s real, girlfriends! My gosh. It’s not often in my current life situation that I’m around people whose love for one another simply shows in all their words and gestures. K and Chris are two such people. Meeting them both was a gift, a warm and heartening interlude during a time that’s been, often, less than reassuring about the questions that plague me around true love (is it even possible, does it last, how will I ever find it for myself, etc etc, ad nauseam).

Isolation is one of the hardest aspects of this disease for me. Here’s to its eradication.

Subject line: Feet

2006-09-24T09:08:00.000-07:00

Since I began living alone again, my mom has called almost every day—so often, in fact, that when I don’t hear from her I wonder why.

She likes to keep in touch. And she wants to know how the transition is unfolding, how I’m liking the new neighborhood, whether the money part is going okay.

But mostly she calls so often because she’s haunted. She can’t shake the fear that I’ll have a nighttime hypo I can’t wake up from, no one will know I need help, and I’ll end up dead in bed.

“Just checking to see if you’re on your feet,” she often says to my answering machine, usually after calling me at the office and not getting an answer for some reason or other. Her voice—a lilting Virginian singsong that’s always signaled “home” to me, even though I’ve never lived in Virginia—sounds just a little more cheerful than necessary. “Give me a call.”

It’s been not even two years for Mrs. Violet, just as it has for me. We’re still neophytes in several respects, including how to cope with the mercurial nature of this disease. But I don’t have trouble with hypo unawareness. And I follow the drills we all know: test before bed, eat snack if needed, test during the night now and then. I watch my basals (currently 0.15 overnight, what the hell?) and tweak as needed.

I take care of myself, I’m not afraid, and I’m not about to die in my sleep. (We all have to believe that, right?) That works for me. But for a parent? Harder, much harder, it seems. And Mrs. Violet is a person for whom the wolf is always at the door.

I think I’ll begin a practice of daily morning e-mail. Subject line: feet. Text: Good morning, I’m on them, I love you.

It’s the least I can do for the one person in my life whose voice sounds like home.

Change is complex, or, A conversation with my colon

2006-09-20T19:22:00.000-07:00

Violet's colon: Rumble. Grumble.

Violet [concerned]: Everything OK down there?

V's C: Rumble. Rumble. Grumble.

V: Hmm. I sense a disturbance.

V's C: We are displeased.

V: We?

V's C: We do not like some of the gifts recently offered to us.

V: Us? What are you, a collective? Like the Borg?

V's C: We accept the offering of bread. The oatmeal we also accept. Meats and cheeses we acknowledge as appropriate gifts.

V: ...

V's C: But what is this thing called "fruit"?

V: Ohh. That. Right. Well, fruit is tasty and full of nutrients and fiber. It's good for us. Err, good for me.

V's C: We do not like this "fruit."

V: You'll get used to it. I promise.

V's C: It disturbs us. It causes distress.

V: Well, that's really my fault. You see, I didn't eat much fruit for a long time, so you got out of the habit of dealing with it, and now I'm trying to make changes--

V's C: Fruit is your fault?

V [alarmed]: Um--

V's C: We do not accept the gift of "fruit."

V: Well, you have to. It's your job.

V's C: Grumble. Rumble. Rumble.

V: Aww, come on. Fruit is Nature's Dessert!

V's C: WE DO NOT ACCEPT THE GIFT OF "FRUIT."

V: ...

V's C: GRUMBLE. RUMBLE. GRUMBLE!

And so the negotiations unfold. I guess this may complexify my recent interest in vegetarianism...

Things I learned this evening

2006-09-17T17:44:00.000-07:00

1. I may be bionic, but I am not in the Universe for the purpose of using power tools.

2. Especially drills.

3. A crooked coat rack is better than none.

Breakthrough?

2006-09-15T07:28:00.000-07:00

In a continuation of our assualt on the Other D, Dr. Two-Fifty graduated me to a Big Girl dosage of generic Zoloft 10 days ago. (It’s pale yellow, for anyone who shares my fascination with the antidepressant rainbow.)

A lot has changed:

1. What is this current of vitality flowing through my body? How come I keep thinking about going dancing at Culture Club, the cheesiest club in New York? Oh, right: energy. That thing that makes walking places enjoyable instead of a truncated death march.

2. Aha, I AM creative. Who knew? I, for one, had entirely forgotten.

3. Hello, intellectual curiosity. I remember you.

4. Greetings, sex drive. I remember you too. Vaguely.

5. Nonbloggable thoughts, don’t let the door smack you on the ass on your way out.

6. I can name my emotions and inhabit the painful ones without feeling instantly compelled to numb them via external means (TV, food, glass of wine, computer games).

7. I feel gentle toward myself.

Whoosh. This is a lot of change. Am I, for lack of a better term, hopped up on goofballs? I phone Dr. Two-Fifty to present my concerns.

“I think maybe we need to decrease the dosage,” I say. She asks why; I present the above.

“Are you behaving impulsively?” she inquires. “Spending a lot of money, or making sudden decisions, or placing yourself in dangerous situations?” She’s wondering if I might be having a manic episode, which is not part of my history but could be triggered by an excess of this type of medication.

“No,” I say. “Nothing like that. But I feel kind of buzzy.”

“Here’s what I think.” Dr. Two-Fifty sounds quite perky. “Maybe the dosage is too high. But all the things you describe are suggestive of recovery from depression.”

“Oh,” I say. “Right.”

“The buzziness may go away in a few days. If it doesn’t, we can reduce the dosage—but I don’t want to reduce it unless we have to, because it sounds like it’s helping you. Call me on Monday and we’ll see how you’re doing.”

Sure enough, two days later I am feeling less buzzy.

I’m not giving the medication all the credit for these transformations. I’ve been working hard to help myself in other ways—therapy, writing, making huge and painful life-changing decisions, opening up to people more than before. Maybe it’s all beginning to come together.

I worried about the trampling of my personality, of some essential Violetness, via antidepressant medication. But I don’t feel less like myself. I feel more like myself. I feel connected to myself and to other people. I feel aware.

It’s pretty cool, to put it mildly.

No poetic title comes to mind

2006-09-13T11:46:00.000-07:00

Mrs. Violet has prediabetes.

Son of a b*tch!

Already I feel this irrational (?) urge to defend my mother from the blamers. No, she’s not obese. Yes, she struggles with her weight and with exercise. No, she doesn’t pig out on a daily basis. Yes, she overeats now and then. Piss off.

I know two other people who have been faced with this situation. One of them, my oldest friend, made major, very challenging changes in her diet and exercise patterns and got her fasting BG down to 80ish. The other, my ex, has ignored the problem for a year and a half, though he has type 2 on both sides of his family and lost his dad to complications.

Two paths, two sets of choices.

I wonder about other paths. Is there a path in which the PWP tries her damnedest, but her efforts cannot stave off deterioration into D-Land? Yeah, I bet there is. How about a path in which supreme effort leads to only temporary improvement? I bet that path exists too.

Then again, at least there’s a chance, however uncertain, for Mom to make a difference through her own efforts. As a type 1, I didn’t have that opportunity. I wish I had.

When I was diagnosed, the words tumbled out of her mouth like a confession: “Diabetes is the disease I’m most frightened of."

A few months later, she apologized. “That probably wasn’t what you needed to hear at the time,” she observed.

“Well,” I answered, “I needed to take it very seriously, and you helped me do that.” And she did. Maybe I can do the same for her now.

Food for brain & soul

2006-09-12T16:48:00.000-07:00

Pursuant to #5 below, some nonfiction I’m reading:

Five Flights Up and Other New York Apartment Stories by Toni Schlessinger: an anthology of her Shelter columns from the Village Voice. Interviews with denizens of the city in and about their homes. At once fascinating, comical, and comforting as I adjust to my new quarters.

The Hard Questions for an Authentic Life by Susan Piver: bought long ago and allowed to collect dust on bookshelves in two states. Its time has come. Fantastic, thought-provoking questions about many areas: family, friendship, love, spirituality. Very clarifying.

On Becoming a Person by Carl R. Rogers: Published in 1961 by one of the revolutionaries of modern psychology, an argument in favor of what Rogers terms “client-centered therapy,” in which the patient and therapist build a healing relationship. This is hardly news 45 years later, but it was radical stuff when written. What intrigues me most about this book is (1) how courageously yet humbly Rogers puts forth his ideas and (2) how the journey of self-discovery he describes brilliantly articulates what I hope to gain from my own therapeutic process.

And pursuant to #14, after considerable overspending on iTunes, I offer a few songs for inspiration of many kinds:

Colin Hay, Beautiful World: a paradoxically melancholy celebration of simple pleasures. I'm so charmed by this song that I listened to it at least 6 times before I realized/remembered (well, okay, I actually read it online, but then I remembered, truly I did) that Colin Hay was the lead singer of Men at Work. How mortifying to my distinguished lineage as an 80s pop junkie that I didn't make the connection immediately! Bonus: one of the verses is about tea, my favorite nonalcoholic beverage.

Joey Ramone, What a Wonderful World: Whoa, this song rocks. Irresistible. NB: Not for gentle moments.

REM, Find the River: Opposite mood. "You have to go to task in the city, where people drown and people serve...Don't be shy, your just deserve is only just light years to go." This song was mysteriously written about Violet’s journey to New York to open an office for her company years before the fact. Isn’t that remarkable? If I could be reborn as any psychic gay man on the planet, hands down I would pick Michael Stipe.

Smashing Pumpkins, Tonight: “Believe, believe in me, believe...that life can change, that you’re not stuck in vain, we’re not the same, we’re different tonight…We’ll crucify the insincere tonight...Believe in me as I believe in you tonight.” Wow. Sign me up.

The Slip, Even Rats: Click the link to hear this beauty for free. Then go pay Apple a buck to download it. It's only fair! Confession: my exposure to this one came via Guitar Hero. (Yeah, I beat it on Expert. I’m not at all sure what this says about me, but there it is.) I absolutely love this song. Something brilliant going on in the brain of whoever wrote it. A spot-on political message, too.

10,000 Maniacs, These Are Days: “These days you might feel a shaft of light make its way across your face...and when you do, you’ll know how it was meant to be, see the signs and know their meaning...it’s true, you’ll know how it was meant to be, hear the signs and know they’re speaking to you.” Natalie, she can seriously tap into those agnostic yearnings, yes indeed.

Finally, three delectably fluffy treats from my growing-up years:

Big Country, In a Big Country: Does anybody else remember how frickin' cute the lead singer of this Scottish band was? You know, in the video with the gorgeous green fields and cliffs and suchlike? Tell me I'm not the only one who remembers.

Nenah Cherry, Buffalo Stance: "No moneyman can win my love, it's sweetness that I'm thinkin of." Love this beat. Ten points to anyone who can explain to me what a buffalo stance is. I was never cool enough to know.

Tom Tom Club, Genius of Love: Just. Plain. Fun.

Any suggestions for my next reads/downloads?

Reasons for blooming

2006-09-12T10:30:00.000-07:00

I used to blog almost exclusively about diabetes and other health issues. I shared my ideas about other topics in different ways. Or I didn’t share them at all.

I liked the compartmentalization: it felt safe, tidy, to do most of my diabetes-related processing in cyberspace, anonymously. In the 20 months since my first post, only three people who had met me in real life knew that this was my blog. One is a close friend. Another is Scott, whom I met in my pumpers’ support group in Minnesota and whose blog inspired this one. The third, my ex, never read anything I wrote here, seemingly because he felt so much anxiety in relation to all issues medical.

Grow or die, right? OK, fine! I pick growth. The landscape of Pumplandia, as a blog and as my way of living, is changing. I’m starting to meet D-bloggers in person for the first time. Those folks already know the online me, and soon they’ll know the “real” me as well. I’m also sharing my blog with a small number of other people, some new to me and some not at all new, for the sake of openness and authenticity.

With these shifts and the many other changes in my life, I no longer want Pumplandia to be so compartmentalized. I’m remaining anonymous, and diabetes will always be a major focus here. But I’ll no longer limit my posts to issues relating to health. As in my recent posts, a lot more of the Whole Violet will appear. I’m a little freaked out about this--who gives a rip about your weird-ass life, says an evil, simpering little voice in my brain--but I’m mainly looking forward to sharing more of myself with the kind and brilliant OC, in all its richness and variety. Thanks for reading this far. You guys are helping me stay sane.

Violet, Subway Spy

2006-09-12T06:33:00.000-07:00

This happened a number of weeks ago, not long after the Mr. Bright Eyes episode, but I didn’t manage to post about it at the time:

On the F train again, morning commute, sleepy but lucky: today I have a seat. One of the things New York has taught me is that my sense of personal space is, or rather can become, considerably more flexible than I once realized. When I first began taking the train during rush hour, it killed me to be squashed up against other passengers. Now it only kills me if the people I’m squashed up against are screaming at or (actually, if you’re a stickler for accuracy: and/or) making out with each other, happily an uncommon occurrence.

My adjustments to the demands of rush hour notwithstanding, any train ride with a seat is a ride that begins well. Today I am squashed only in the sense that I’m between two men who can’t really help that they are larger than the 16-inch ass space allotted by the geniuses who designed the subway cars. Oh, and in that the woman standing in front of me, pole-hanging, is on the verge of depositing her briefcase in my lap. This makes it a little hard to solve my sudoku puzzle.

I give up and start people watching. Foggy, peculiar Violet isn’t terribly good at sudoku anyhow. (NB for readers sharing the battle against the Other D: the regained ability to complete sudoku puzzles in the hard and expert categories could be a sign that your antidepressant is working! Stay tuned for further updates.) Next to me is a youngish fellow, early 20s, with an Eddie Bauer vibe: semi-casual but neat, khakis freshly pressed, highly presentable. I commence a game of What Job Is This Person Going To? and decide he’s a summer intern at some corporate entity where he is permitted not to wear a tie. He looks like the kind of fellow my mother wishes I had dated in my young adult years instead of, well, the fellows I did date.

Along with his smart workday-casual ensemble, Eddie Bauer has on one of those rubber bracelets that hipper-than-Violet people wear in support of their favorite causes. I strain to make out the lettering without seeming to be staring: ETES.

Hmm. As in…? Yes. When my neighbor turns the page of his New York Post, the message reveals itself: CURE DIABETES. How agreeable.

There are many reasons, I suppose, that a young, Eddie Bauerish guy might be wearing a diabetes bracelet. But one reason in particular comes to mind. I check out the opposing wrist. Aha. A chunky gold medical ID. And there, twining out from his pants pocket over his belt and back under his clothing, too subtle to be detected by anyone not looking for it, is a teeny-tiny length of tubing.

Eddie Bauer, it appears, is a pumper who prefers not to cut tubing holes in the linings of his pockets.

Immediately I feel a bizarre but earnest solidarity with my fellow traveler. Here we are, a pair of strangers on the same path, bumping into one another by chance. It’s been so long since I spoke in person with a PWD other than my therapist that I consider the Big Reveal. But I remember, too, how disconcerting and invasive it was for me to have my diabetes called out in public at a moment when I wasn’t ready for it. Eddie Bauer, with his sporty bracelet, might not see it that way, but I’m not about to presume.

Nor can I connect with him more subtly via taking out my own pump, as it’s tucked away under my skirt. I briefly ponder a gratuitous revelatory blood test, but the proximity of Pole Hanger with Briefcase would make that extremely awkward.

Instead, I sit quietly amidst the roars and rattles of the train, enjoying this moment of proof that I am not alone, not at all alone, even in the thick anonymous crowds of the rush hour.

For those who are wondering, by the way, Eddie Bauer was considerably cuter than Mr. Bright Eyes. Score one for Team D!

24 Things That (Mostly) Do Not Fit in Boxes, or, Recultivating a Violet

2006-09-08T16:01:00.000-07:00

Goals, small and large, short term and long, for my life in my new home. Like the things that do fit in boxes, these appear in no particular order of importance:

1. Diabetes: see Walking, Food below. Visit blogosphere more consistently. Find support group?
2. Cats: pet numerous times daily
3. Dogs: visit dog park near office whenever possible
4. Brain: read some fiction every day. Try to pick something not related to work.
5. Brain II: read some nonfiction every day, also not related to work
6. Sunlight: ½ hour of natural light per day is proven to help combat the Other D
7. Therapy: obviously still called for, ahem
8. Exercise: buy athletic shoes that Do Not Hurt. Attempt to walk in them regularly.
9. Food: fruits, veggies must return
10. Creative work: do The Artist's Way, for real this time
11. Service: start a consistent practice of doing something helpful to my new neighborhood/its residents
12. Political: contribute time, money, ANYTHING to the effort to keep this guy’s cronies from succeeding him in office
13. Spiritual: ponder. Investigate.
14. Music: more & new urgently needed. iPod on subway = happier Violet.
15. Work: catch up (heh).
16. Money: send that stuff in for insurance reimbursement. Use budget software. Think about needs vs. wants in spending. Contribute to a worthy cause.
17. Home: sweep up the cat hair a little more often. Hang the coat rack. Enjoy the quiet.
18. Culture: partake regularly of New York. Find freebies.
19. Family: call Mrs. & Brother Violet more often. E-mail that cousin who lives in NY. (Why? Well, to get Mrs. Violet to quit bugging me about it, if nothing else.)
20. Friendships: take active approach to nurturing
21. Sex: not at the moment, thanks for asking.
22. Gratitude: increase. Not the stuffy, forced kind. The real, joyful, “Morning Has Broken” kind.
23. Awareness: increase exponentially. Remember relationship between journaling & consciousness.
24. Fun: will hopefully follow naturally from all of the above?

24 boxes

2006-08-31T08:44:00.000-07:00

If you had to put your worldly goods into 24 boxes, what would make the cut? (Not counting pets. Or litter boxes. Or cat carriers.) Here are mine, fresh from moving to a new studio apartment this week and not in any order of importance, as will quickly become obvious:

1. clothes (big huge wardrobe box)
2. clothes, shoes, purses (ditto above)
3. things Mrs. Violet, my mother, calls “linens” (and I call towels & sheets)
4. 4 big plates, 4 small plates, 4 tea mugs, some Tupperware, utensils, a few wine glasses
5. a cookie sheet, a casserole dish, a stock pot, a skillet, canned food
6. books to keep nearby at all times
7. more of same
8. books to store up in the loft
9. more of same
10. more of same
11. diabetes supplies & sundry medicine cabinet junk
12. CDs & DVDs
13. stuff that belonged to my dad before he died
14. letters & photos
15. precious objects (commonly referred to by the highly inadequate term “knickknacks,” humph. Include little animal figurines kept since childhood, candle holders, incense-burning equipment, & my house fairy from cherished friend & blog reader V.)
16. more precious objects
17. dolls & stuffed animals kept since childhood
18. journals written sporadically since 5th grade, which Mrs. Violet is charged with burning (NOT READING) in the event of my death
19. more journals
20. more journals
21. computer & associated gizmos
22. cat supplies + misc stuff such as extension cords
23. pictures, the hang on the wall kind
24. misc stuff (my one screwdriver, cleaning supplies, jewelry box, batteries, flashlight, all the stuff I now have nowhere to put)

Things that didn’t make the cut:

1. About a third of my clothes, maybe half
2. Half of my books
3. Most of my kitchen stuff and all of Mr. Brooklyn’s, since he didn’t take his when he moved out
4. Some CDs & movies
5. The wedding china & crystal & flatware I have dragged around the country since getting divorced (that would be the ex before Mr. Brooklyn)—not because I wanted them but out of mom-related guilt, as Mrs. Violet loves them & never had her own. (She’s taking the crystal.)
6. Certain precious objects that weren’t really all that precious and/or made me cry to look at them (reference #3 & 5 above)
7. A LOT of misc stuff that I really just didn’t need, such as the flute I hadn’t played for 15 years, board games that never got played at all, snow boots from my Minnesotan days

Finally, things I learned:

1. I need less than I thought. I hope.
2. It’s more fun than tragic to have a moving sale. My moving sale suggestions: Price things very low for good karma. If you live in a melting pot area, count the number of languages and accents you hear at the sale. Observe that it feels better to see your things go to people who will use them (or resell them for a profit, ahem) than to hoard them. Invite your most heart-tugging customer to come back at the end and take unsold things for free.
3. A moving sale can be cathartic. You can free yourself of baggage of various sorts by removing objects from your life.
4. Even so, there is a real and sometimes deep sadness to divesting oneself of things that hold or once held significance. This should be named and honored along with the other aspects of the process.

Psychopharmacological-istic-whatever, Part II

2006-08-17T07:41:00.000-07:00

Thank you all for the supportive comments below. It’s very heartening to reconnect with the OC.

The kind Dr. Two-Fifty, after much nodding and compassionate murmuring, is switching me to Zoloft. It’s light blue, so I’m immediately biased in its favor vs. the pea green hue of Cymbalta. (Yeah, I do realize the inherent absurdity of ranking antidepressants by color. It’s just something I have to do.)

The next four weeks will be wacky, as they include tapering down Cymbalta + ramping up Zoloft at the same time. Dr. Two-Fifty instructs me to expect to feel a little weird and not to give up hope. Okey-dokey.

I’ll be distracted during the interim by the process of moving, as my oversized cats and I are heading for Manhattan. We have rented 150 cozy square feet of studio apartment in a charming, eclectic neighborhood. The rent is a mere (ahem) $350 more per month than I paid in 2005 for 600 square feet in Minneapolis. For New York, this is considered a steal. Mrs. Violet (my mom) is coming to help, and I can’t wait to see her.

My numbers are a little weird, trending to the low side. Is it really possible for an adult to need less than .20 units per hour for overnight basals? I guess it is. I forget, too, that I’ve been doing a lot of walking for the apartment search. That’s probably a huge factor. I’m grateful not to be running high, but I did test at 67 at 3 AM the other night. That hasn’t happened since I lived alone, pre-Mr. Brooklyn, so I’m a little anxious. I had a good snack last night and woke up at 83. It would be nice, wouldn’t it, to not have to worry about this stuff during big stressful life changes?

Trials and errors

2006-08-13T13:24:00.000-07:00

This has been a fairly rough [insert block of time of your choice: week, month, season, year, century] so far, and I find myself—no surprise here—struggling with small and large tasks relating to the physical world. This is a longstanding Violetine trait; it simply gets a little worse when I’m stressed. Today, for example, not long after burning myself over the eye (literally: on the eyelid & surrounding territory) with the curling iron, I took a peek at Nellie’s status screen. I found, much to my chagrin, that I had gone six days without changing my set. Six! Hmm. I had no idea. I need to set up a reminder system on my calendar (ha) or take some other constructive action (heh). Otherwise I’ll wind up with some kind of hideous infection.

I went off the pill recently. Not trying to have baby; just not in need of the pill. Enough said? Yes. As noted here, the use of BC pills has a significant effect on my insulin needs. Basals & carb ratios have gone down for 2/3 of each day. I’m now using a remarkable 25% less insulin over the course of a typical 24 hours, and I still woke up at 78 this morning. (NB: I am NOT complaining. I am delighted.) I have yet to figure out how unusual/usual this phenomenon is among PWDs, but my first appointment at Naomi Berrie is coming up soon, so I’ll throw this question at them and see what they think.

Meanwhile, my adventures with Cymbalta are coming to a close. Dr. Two-Fifty and I have concluded that it isn’t helping enough with the other D. She’s going to put me on something else, but she wants to see me in person first. I’m sure she’ll be impressed with the curling iron burn, which looks like someone relatively feeble tried to give me a shiner.

Last but definitely not least, I send bouquets of flowery purple support to Lyrehca, who awaits very important news this week. Send her your good thoughts, please.

Guesswork

2006-06-19T09:21:00.000-07:00

This morning at work I was feeling a trifle low, so I went digging in my bag for my piece-of-crap meter. It wasn’t there.

Hmm. I reviewed my steps that morning. Had the meter gone into my bag? I couldn’t be sure. I looked in the bag again, ferreting through its many pockets. No meter, piece of crap or otherwise.

Well, for crying out loud.

I’ve done this before, of course. I’ve left my meter at home, at work, in an airport. (I have a backup at home, none at the office. Foggy, peculiar Violet in action.)

I’d never been in a situation where I felt low and couldn’t test. The most straightforward solution--consume a lot of carbs--would probably leave me over 300 by the time I got home or obtained another meter. So I tried to assess my lowness by feel. It wasn’t a bad one, at least not yet. Just a little shaky. Reminded me of when I get symptomatic in the 70s.

I ate two Milk Duds (4 g). That was all I had in the box. I ate one glucose tablet (4 g). I contemplated going to the fridge for juice. Decided to wait.

A few minutes later, I felt normal again. Then I felt a little nauseated. Maybe I hadn’t been low after all, in which case I should take some insulin. No, no. Foolishness.

Online, I researched the NIP formulary. Hardly any brands of test strips are approved. I decided to buy a One Touch Ultra Smart. Looked for coupons online. No luck.

I spent the next two hours feeling sorry for myself (well, also working a bit). Meters aren’t cheap. I know better than to go out without my meter. Stupid diabetes. Stupid forgetfulness. Stupid everything.

Finally, I dragged my ass down to Walgreens. The meter of choice happened to be not only in stock, but hugely on sale. It only cost $30, plus $26 for test strips. Maybe NIP will reimburse me, though I don't have a prescription yet.

The OTUS is clearly much better than the piece of crap, with many customizable features that I will probably never use. POC will become my office backup.

I tested at 105. Phew.

Observed on the F train

2006-06-02T06:25:00.000-07:00

Yesterday, while hanging on to a pole during the subway ride to work, I noticed a shiny-eyed young fellow in a business suit watching me with a rather animated expression on his face.

I am not, to place this event in context, of an appearance or personality that generally attracts the attention of men on trains. I have my charms, I think, but they are the subtle, quiet kind. I move through the world relatively unnoticed most of the time.

I glanced away from Mr. Bright Eyes, then back again. He looked away quickly. Caught!

A moment later, it happened again.

Hmm, I mused. Perhaps this is not such a bad hair day as I’d thought. Or maybe the Cymbalta has already added a mood-disorder-treatment-in-progress glow to my countenance.

Then I realized that the man wasn’t looking at me. He was looking at Nellie.

When I wear a dress, I usually stash my pump in a thigh pouch I got from Minimed, which has an elasticky band with an adjustable Velcro closure. But I have a few dresses that are cut such that I can conceal the pump in the side of my bra, under the strappy part that goes around the ribcage. It’s easy to pull out (in private) for dosing, and when I’m standing, sitting, or lying down, my arm covers the pump, rendering it almost invisible.

When I am hanging on to a subway pole high above my head, however, I appear to have an absurd rectangular attachment bulging under my clothing, inches to the right of my not-quite-so-bulging breasts. It was this protrusion that had caught the eye of my observer. He was trying to figure out what the hell it was.

Realizing this, I felt a little mortified at my vanity. Foggy, peculiar Violet has an admirer! Ahem. Not.

Some of you, I know, would have taken the opportunity to educate Mr. Bright Eyes as to the nature of Nellie. I’m not so bold. However, for the sake of pride, I did refrain from switching arms to conceal the pump. (Actually, the persons surrounding me were so closely packed in that I couldn’t switch arms, making it expedient to decide that I wouldn’t even if I could. So there, Mr. Bright Eyes.)

On the plus side, this small adventure made me realize how completely accustomed I’ve become to wearing the pump. I used to be very focused on concealing it from people to avoid just the sort of attention I received from my subway companion, but it’s so much less of a Thing now that, apparently, I’m able to forget it completely--at least on a train full of way too many humans and way too few seats. This may symbolize a form of progress. Or it may just be another example of what it’s like to be Foggy, Peculiar Violet, who also forgot to put on her medical ID bracelet yesterday and nearly took twice the correct insulin dose with her dinner due to misreading the nutritional info on a box...

Psychopharmacologicalistic-expi-ali-docious

2006-06-01T03:15:00.000-07:00

I feel pretty sheepish now about Dr. Two-Fifty's moniker. I really ought to make it a policy to meet the docs before I take the gloves off in the naming process. Dr. Two-Fifty, had I met her first, would be properly named something spirited and optimistic (such as Dr. Pluck), for reasons I'll explain below. But for the sake of continuity, Dr. Two-Fifty she shall remain.

The waiting room of Dr. Two-Fifty's office is filled with flowers. There are six vases full. (It's a large waiting room.) It smells a little like a funeral home, but it looks very nice. Dr. Two-Fifty emerges to greet me. She is smiley, quirkily dressed (for a shrink working in a hospital, anyway), and has a firm handshake.

She spends an hour with me, during which we cover my recent life history (egads), discuss the workings of insulin pumps (with which she was not familiar), factor in family-related issues, and talk about drugs. Particularly the latter, of course, since that's why I am there. Dr. Two-Fifty feels very confident that I am experiencing a biological depression. She has a lot of interest in prescribing Cymbalta for me. Three things point that direction: the clear compatibility with diabetes; the fact that it's a chemical cousin of Effexor, which Mrs. Violet (my mom) has used with great success, meaning that it might work for me as well; and the possibility of side benefits with a (non-diabetes-related) pain condition I've had for many years. Cymbalta is good for unhappy nerves of all sorts--it's used for diabetic neuropathic pain as well as depression--so it might be soothing to more of Violet than just the brain.

Ah, but then there is the problem of the NIP drug formulary, which, as noted below, classifies Cymbalta as a "step" drug. I bring out the formulary list of brain meds and show it Dr. Two-Fifty.

She wrinkles her nose. "What does 'step' mean?" she asks.

"It means that before they would approve Cymbalta, you would have to tell them that we tried other meds and they didn't work."

"Outrageous," Dr. Two-Fifty declares. "Well, that's no problem. I can do that."

"You can?"

"Sure. It'll take a few phone calls, so you probably wouldn't get the prescription for a few days, that's all."

I am impressed. This must be what part of those two hundred-fifty dollars are for.

Then I have a small light-bulb moment. It is 7 PM on May 31. The NIP insurance goes into effect at midnight on--yes--June 1. All I need to do is get the prescription filled tonight, assuming GOI (Gentle Old Insurance) will approve Cymbalta. Then I will have my pills. And NIP is supposed to honor all transferring prescriptions as long as the doc says it's okay.

Moments later, Dr. Two-Fifty is googling Walgreens. We find a 24-hour pharmacy 4 blocks away, and off I go.

I took the first dose this morning, GOI having been quite cooperative. I miss them already. Cymbalta is a small capsule the color of canned peas. (Ouch. I was hoping for purple.) I'm starting on half the usual starting dose, as Dr. Two-Fifty believes a gradual transition is much more comfortable and safe. I hope that doesn't mean it will take longer to work (if it works at all), but of course it might. Meanwhile, I have the satisfaction of thwarting NIP, which has improved my current mood considerably. A good start.

Roof repair

2006-05-31T06:28:00.000-07:00

Today I’m seeing Dr. Two-Fifty (as in hundreds of dollars per session). She’s not my new therapist; she’s the shrink the therapist is sending me to for meds for the Other D.

I’ve thought and read and fretted a lot about taking this step. This kind of internal debate is a cliché of postmodern American life, yes? Medicate the problem vs. staying with it (whatever that means) in search of personal growth or insight or at least some nonchemical cure. There’s a faction out there that posits the choice of medication for depression as the easy road, a turning away from the harder, worthier path of dealing with one’s shit head-on and with authenticity.

I thought about personality (what is it and why and whether medicating my brain will undermine some essential Violetness that I won’t want to lose and whether, if I do lose it, I will be able to get it back). I thought about how, before resorting to medication, I should probably explore exercise or yoga or at least not lying around on the couch all the time. I thought about how an antidepressant could mess up my BGs--from what I can learn, almost all of 'em have the potential to do so, though they often don't. (Cymbalta, one of the newer ones that does not, is a "step" drug on the NIP formulary, meaning that Dr. Two-Fifty has to try me on other drugs first and turn to Cymbalta only if they don't work.) I read about the myriad other side effects to which I can look forward, depending on the drug of Dr. Two-Fifty’s choice and my body’s personal, idiosyncratic response thereto.

Then I thought about my other thoughts, the nonbloggable ones, and I came to understand that sometimes you reach a moment when you have, say, a large and gaping hole in the roof of your home, caused maybe by the antics of squirrels or your roommate's fondness for illegal fireworks or the mediocrities of bargain-priced shingles or the little kid next door who likes to hit his baseball up onto your roof several times every Saturday--the cause is not the point; the point is that the hole is there--and outside the thunder is clapping and the lightning is sparking, and you know that the rain on the way is not just any ordinary storm but the kind that generates Significant Media Attention. At such a time you do not look into your toolbox and say to yourself, I will work alone, using only the small nails and the small hammer to repair this hole because by doing so, I will grow immeasurably in my knowledge of carpentry, and that will make me a better person. No, you pull out every tool that might help, small, large, and in between, and you give one to your roommate, another to the kid next door, and whatever remains to the squirrels, and you all go to work on the damn hole.

In other words, you Take. The. Freaking. Drug.

Of nickels and NIPs

2006-05-25T03:32:00.000-07:00

First, my thanks to the commenters who offered feedback below on the Naomi Berrie Diabetes Center. I really appreciate the input. I'm looking at other options, though in the meantime I may end up there for a maintenance appointment. Foggy, Peculiar Violet also entertains a vague hope that her doctor there will be Miraculously Different.

Meanwhile, my company has changed insurance providers. A very strong plus is that I now have a network here in NY, whereas previously all my medical stuff was out of network and had to be paid up front, then reimbursed. (Ow.) Some of the other changes are more complex:

1. The highly-recommended-by-multiple-trustworthy-persons Dr. Carol Levy is not in the network. Rats. I could pay her up front, but I'll only get 60% back from the New Insurance Punks (NIPs). Multiply by 4x a year, and you see why I may end up at Naomi Berrie (whose providers are NIPpers).

2. I have a deductible now of $300. (Previously, I paid a higher premium to avoid a deductible, but that option is no longer available.) It doesn't apply to office visits or prescriptions, but it does apply to test strips and pump supplies. That means my first batch of strips, normally $90, will cost around $330, every year. After that, though, I will have 80% coverage, same as I previously did.

3. My current test strips aren't on the formulary. So I need to change to a different brand. That's okay; my meter is a piece of crap anyway. But now I need a new prescription. Maybe Dr. Reassurance will give me one. Hopefully this will be okay even though Dr. Reassurance is not (you guessed it) in the NIP network.

4. Luck of the diabetic: my current insulin, Novolog, IS on the formulary. Woo hoo! If I were still on Humalog, I'd have to change. It's not the end of the world, for me, to change between those insulins, but I do need more H than N, so I'd have to rework all my ratios, using many of the precious $330 test strips.

5. Lab work is 100% covered if conducted within the doctor's office. If not, it is 80% covered. Huh? What difference does it make where it happens, as long as the doc has ordered it? To NIP, the difference is apparently critical. (I think this is a ploy to get patients to come to the all-in-one NIP clinics, which adorn the city and suburbs of Minneapolis much as Starbucks coffee shops adorn Manhattan.) Of course, there are no NIP clinics in New York, and as noted below, it seems to be rather unusual to have blood work done in a doc's office here. Maybe they will do it at Naomi Berrie. Otherwise, I'll be paying 20% for my A1C, thyroid, cholesterol, etc. etc.

6. That said, if I keep my diabetic butt properly NIPped by remaining in the network, my annual out-of-pocket max is $1500 (plus my premiums, of course). Hey, that's not bad! And easier to attain with the jumpstart offered by the $330 test strips! Throw in some pump supplies and a few prescriptions (plus some lab work), and I should hit the max around September or so--not this year, when I'm starting at $0 on June 1, but in the future. Then it will be freebies through New Year's, huzzah.

My quiet ranting aside, this is good coverage based on what I know so far. I don't think I have much to complain about, assuming (major assumption) that I can get acceptable care from the NIPpers. One of the first experiments will occur next month, when I will visit a gynecologist whom I chose based on her office location, gender, and the fact that we have the same first name. (I had to draw the line somehow...)

All this makes me terribly curious about the diabetes costs incurred by the OC. How does your insurance treat you? And if you don't have insurance, how (the hell) do you manage?

Plan C

2006-05-11T14:19:00.000-07:00

I can’t get into the Naomi Berrie Diabetes Center until the end of August. Ouch, but no surprise to Realistic Violet, who makes an appearance only rarely these days, and usually after the fact of some disappointment or other. (Foggy, Peculiar Violet is the star of the season; she was somehow sure that the clinic would welcome me with open arms within 2 weeks.)

I guess I’d better get that bloodwork done at Procrastination Lab in the meantime. Hmm.

Meanwhile, the OC has revealed its graciousness yet again, this time in the form of Lyrehca, who has offered a referral to a therapist who has type 1 and works with many PWDs. Said therapist is actually fitting me into her schedule tomorrow. Score five automatic points for therapist. Double points for Lyrehca.

(Wow, I managed as a New Yorker for 7.4 months without requiring mental health services!)

I can’t afford this, of course. But even more, I can’t afford not to go. So: off I go.

Plan B

2006-05-06T17:45:00.000-07:00

For the record: I tried.

My sense of sheepishness about the neglected bloodwork finally caught up with me. I trotted myself to the lab early this morning, only to discover that the information sheet I'd been given did not match the actual hours of the facility. It's not, in fact, open on Saturdays.

Bemused, hungry, and annoyed, though not necessarily in that order, I returned home, ate some toast, and put myself back to bed. I accidentally slept until almost 1 P.M.

It's occurred to me this week, finally, that a number of my behaviors and feelings of late--difficulty coping with the demands of daily life, insomnia and/or oversleeping, thoughts of worthlessness, extreme mood swings, etc. etc. etc.--align perhaps more than coincidentally with the symptoms of depression.

And are we all aware that there is a higher than average association of diabetes and depression? Yes? Good. If not, take a look here.

This isn't to suggest that anybody who's having trouble handling self-care is necessarily suffering from depression. There's more than that going on with me, as noted above. These issues run in my family, too. So I think I need to seek more information, evaluation, blah blah blah.

In her comment on the post below, Julia mentioned the Naomi Berrie Diabetes Center. Anyone out there have experience with this clinic? I've had my eye on it for a couple of months, and I think it's time to make an appointment. The staff includes a psychologist, so maybe they can advise me in a manner that doesn't require my rechecking each piece of information in triplicate. (Though--who are we kidding here?--I probably will anyway...)

A confession

2006-05-02T20:16:00.000-07:00

One of the several quirks of the office of my new endo, Dr. Reassurance, is that it has no laboratory for drawing blood.

Actually, I really can't judge whether this is a quirk in the larger scheme of medical care in the U.S., or whether I was just lucky/spoiled in Minnesota. My old endo had a miniature lab with a trio of technicians who could draw blood faster than I could sit down in the chair, almost. My old primary care doc did too. The blood was sent elsewhere for analysis, but it was drawn then and there, on the premises, no escape.

Dr. Reassurance, whom I saw in March, gave me a form with orders for the bloodwork she wanted done and a list of the places I could go to make my donation of bodily fluids. One of them is 8 blocks from my home. It's even open on Saturday. All I have to do is call the day before, fast that morning, and show up.

The form is still sitting on the kitchen counter. It's been 7 weeks.

What the hell is my problem? I haven't had my A1C done since November. I know better than this. I'm mortified and ashamed.

Am I afraid of the number? A little. Not a lot. It will be somewhat worse than the last number, and Dr. Reassurance will probably call. I know a lot more about pumping than she does, though, so I rather doubt she'll have much to tell me that I haven't read or heard before.

Am I resistant to entering New York City's draconian new diabetes tracking system, in which my a1C will be reported to the city health department, which will monitor my results and conduct voluntary interventions of its own devise? Yeah, somewhat. That whole deal pisses me off more than I can articulate at this hour of the night. Others in the blogosphere have already said it better than I can, anyhow. (Hint to NYC: if you want people to control their diabetes better, put some fucking blood labs inside the offices of health care providers so that patients don't have to make 4 (or more) annual trips to the lab PLUS 4 to the endo PLUS 1 to the primary care doc PLUS 1 to the OB/GYN for chicks PLUS 12 to the pharmacy.)

That's a grand total of 22 health-related voyages I'll be making per year as a New Yorker, if anyone's counting, assuming I have no problems of any kind other than diabetes. Oh, wait. Forgot the eye doctor. Dr. Reassurance also wants me to see a podiatrist. (Yeah, right. Suck my toes.) So now we're up to 24.

And therein lies the real reason, I think, that the damn bloodwork form is nesting so comfortably on my kitchen counter. Am I lazy? Yes. Whiny and ungrateful too. Also just damn tired of marching myself all over creation for the sake of the disease, even after only 20 months.

I guess I'm a little burned out right now.

I didn't have this problem during my first year after dx, when I poured endless energy into self-education, self-help, self-everything. I was a little diabetes-managing machine.

Year Two has lost that shiny, luminous glow. I'm still two+ years from trying for a baby, so my A1C is not currently the magic beacon to motherhood I once imagined. It's not that I don't care. I do. I'm testing and watching the sugars and the boluses and all that daily stuff, with reasonable success. I just can't seem to manage this lab thing. And now I'm mortified that the date on the form is almost two months old. They're going to yell at me at the lab, I just know it. Or else Dr. Reassurance will.

Maybe I can find a new endo and start all over, with a clean slate and a pure soul. And maybe I can relocate my sense of humor, which I think I left behind on the F train a few weeks ago. (It's really hard to check your blood sugar while standing in a packed and moving subway car.)

Meanwhile, maybe I can use the back of the form to chart my recent blood sugars. Err...that is...I could if I'd been writing them down. Ahem.

Travels with Nellie

2006-04-13T04:00:00.000-07:00

A few brief notes on overseas travel:

1. I always worry about security issues when I take my pump and supplies through new airports. Nellie and I navigated the airports of Rome, Bologna, and Brussels without disruption.

2. That said, for the first time ever, I was asked to produce documentation of my need to carry diabetes supplies. This was in the Brussels airport, pre-boarding for my flight to return to the U.S. I had my endo's letter with me, and it was accepted without question. (The agent was also willing to accept something called a "health card," whatever that is.) The letter was briefly taken from me, and I was told that it would be shown to the pilot. It was returned to me within a few minutes and I was allowed to board.

3. The same agent asked me in a rather pointed way, "You are carrying only the supplies you need for this flight, correct?" She was tipping me off as to what to say, it seemed: she practically winked at me as she spoke.

I was carrying a lot more than that, of course--to be specific, my entire stash of leftover pump supplies and backup syringes from a week-long trip. Nobody in their right mind would board an overseas flight with exactly 8 hours worth of supplies and no more. Imagine if the plane were diverted or had mechanical problems or who knows what. I bring all my supplies in my carry-on, period.

I answered, "I'm carrying what I need plus backup in case my pump has problems." Technically true, depending on how broadly one defines "problem."

That worked for the agent.

4. Had I followed the advice of Dr. Reassurance (see post below) on adjusting the pump clock for the 6- to 7-hour time change--she said to simply update the time when I arrived and watch for trouble, my body would catch right up--I would have had serious lows.

Insulin needs are indeed closely related to physical activity, so it makes sense that over a period of a few days the body would adjust to a time zone change. But I hadn't wanted to make such a drastic change all at once because it would have placed my highest basals, which are more than double the lowest, right smack in the middle of the period when my body was expecting the lowest dose. It seemed moronic to blithely change the time on a delicately calibrated medical device without making ANY compensation for the fact that my body, for the first couple days, was pretty sure it was 11 PM even though the actual local time was 6 AM.

One of my pump resources, SMART PUMPING (published by the ADA), recommends that for a time zone change longer than a couple hours, you should adjust the pump clock by 1.5 per DAY until you're caught up to local time. That made a lot more sense. In the end, I took a sort of middle road and made up my own adjusted basal regimen with the main premise being that I really couldn't handle a major low on this business trip. I allowed myself to run slightly high until I felt very confident that my body had decided to catch up to local time.

I also had to adjust for my different insulin-to-carb ratios throughout the day, a topic not addressed in any of my books. I went a conservative route here too, using my lunchtime ratio for both breakfast and lunch (instead of taking significantly more insulin at breakfast as I normally would). As far as I could tell, over 7 days my meal ratios NEVER normalized to local time. Again, had I reset the pump clock per the advice of Dr. Reassurance, I would have seriously screwed myself.

Hmm, a very practical post for Violet. I'll navel-gaze more next time so that you can all feel confident the real Violet hasn't been kidnapped by aliens and replaced with a stoic number cruncher...

Ruminations, month 18

2006-03-12T17:10:00.000-07:00

Well, I'm trying to think about coming back here. It's not feeling great.

I'm bored and angry and eye-rollingly apathetic, almost simultaneously (though I realize that isn't quite possible), with having diabetes. Somehow the idea of participating in my online D-existence feels like acquiescence--which is in another person's parlance simply "healthy adjustment" to reality, but there you are. I'd like a few months or a year of denial, thanks.

The zillion finger sticks a day: mind-numbing. The set changes, hauling crap around everywhere I go, crunching tablets on the subway, feeling guilty about keeping shoddy records: yawn, yawn, ennui. I don't mean to sound pathetic or self-pitying: what I'd really like to feel is neither, but just normal.

That said, I also know I should be grateful for a little boredom. Nonboredom for the diabetic typically means loss of control, complications, hypo unawareness, or some charming combination thereof. Boredom means your life is not currently, immediately threatened. Huzzah.

Another reason I'm cranky, a perhaps less boring one, is that I'm getting ready to go overseas for the first time--for business, alas, rather than pleasure--and I'm more than a little anxious about the D ramifications of the six-time-zone change combined with an intense work schedule. My new endo, Dr. Reassurance (she's a separate post), says all I need to do is reset the pump's clock and expect a bad day while I adjust. Um. Okay. That seems weird somehow. I need to research this further during the next, eek, 12 days. I'm so sick of diabetes that for the first time since dx I am entirely behind the curve in researching how to take of it and myself. Normally I am all over this kind of shit.

Anyhow, the tests and suchlike (hmm, I initially typed "sucklike," heh heh) from January turned out mostly okay, and the follow-ups to the not-quite-okay one turned out okay too. So I still don't really know what's been up, but the meds are continuing to help me overall. This is a good thing.

I feel like I've veered off the trajectory of the hegemonic narrative, to borrow some English grad student BS lingo, of the adult-onset diabetic. Shouldn't I be well on my way, at this point, to sunshiney gratitude for the gifts my disease has brought, as dissected in numerous posts across the blogosphere a few months back? Shouldn't I be philosophically wry, in a charming, admiration-invoking way, about how much worse off I could be, and also how if I'd been born a century ago I would already be dead? Well: I do have times when I feel philosophical in a positive sense, but right now it seems mainly clear that the whole business of having a chronic disease Just Never Goes Away and is Terminally Tiresome. Which makes inhabiting this online world, as full of grace and support as it often is, in some ways very sad for me. I would like to be less centered on diabetes, not more, and I don't know how to balance that with the positive aspects of writing here and allowing myself to care about others who are writing their stories as well.

Six points for Dr. Bruce

2006-01-11T07:19:00.000-07:00

The reception area of Dr. Unknown is shabby: carpet worn through, paint chipped and filthy. A sign requests my patience during a time of building-wide renovation.

BAM BAM BAM BAM BAM BAM BAM. RAT A TAT A TAT A TAT A TAT. BAM BAM BAM BAM BAM BAM.

Along with my other symptoms, I now have a headache. Wait, didn't I already have a headache? Yes, yes I did.

I've arrived early in anticipation of filling out numerous forms. There is only one, with four lines, plus a privacy disclosure.

BAM BAM BAM BAM BAM BAM BAM. RAT A TAT A TAT A TAT A TAT. BAM BAM BAM BAM BAM BAM.

Dr. Unknown's receptionists, an ethnically diverse triad of chattiness, are discussing the romantic misfortunes of one of their group. "What you need to do," one advises, "is get your OWN apartment, your OWN condo, and tell him to..."

BAM BAM BAM BAM BAM BAM BAM. RAT A TAT A TAT A TAT A TAT. BAM BAM BAM BAM BAM BAM.

The triad is interrupted not only by the hammering above but by a male voice. They address the speaker as Bruce.

Bruce, I recall, is the first name of Dr. Unknown. Hmm. First-name basis with the desk staff? Chalk up one for him. And for the triad, for that matter.

I wait a while longer. Dr. Bruce personally fetches the patient ahead of me. And then he fetches me. "Ms. Violet?" he inquires and shakes my hand.

Another point for Dr. Bruce.

We go to his office, a crowded but neat room featuring pictures of his family, a teddy bear, various physicians manuals, a Monet print, a book about Tibetan healing, and a volume of Margaret Bourke-White's photographs.

We talk for a long time about why I'm there. He asks questions and takes notes. He doesn't rush me. My history raises no eyebrows: he is familiar with an adult getting type 1 diabetes, he understands my obscure gynecological problems, and he seems to know insulin pumps, too. I grudgingly award him another point.

He suggests that there may be various explanations for my symptoms, not only fibromyalgia, and that we will keep open minds for the time being.

Then there is an exam. Dr. Bruce takes my blood pressure himself. Is his nurse absent? Or is he just incredibly self-sufficient? I've never seen a doctor do the "nurse" stuff. He seems very natural about it. Okay, one more point.

Dr. Bruce: 4. Anti-Dr. Bruce: 0.

After the exam, we return to his office and talk further. He explains that fibromyalgia is not a hasty diagnosis. First we must rule out other possibilities, of which there are many. He will do scads of bloodwork to this end. I shouldn't be frightened, but one of things he'll check for is lupus. He doesn't think I have lupus, but as it's an autoimmune disease that can cause symptoms like mine, he would be remiss in not checking. But he really thinks I have a virus, something that will go away as I heal over the next few weeks. Many viruses, he says, can cause muscle and joint pain and terrible fatigue. One is parvovirus, which usually strikes kids, but in adults can cause symptoms much like mine. The bloodwork might tell us, or might not. Time will also tell us a lot. If I still feel this way in 6 months, he will be more inclined to consider fibromyalgia.

I'm cranky. He's making sense. But I'm supposed to sit around and feel like crap until he decides I've been sick long enough to be diagnosed? I am on the verge of subtracting a point.

"Of course," Dr. Bruce continues, "what you probably want is to feel better right away. We can address that."

Oh.

Dr. Bruce prescribes a muscle relaxant for bedtime, which will help me fall sleep and should assist with the problem of pain awakening me. I will also take an anti-inflammatory twice a day for pain. There's one that's prescribed more often than the one he's giving me, he says, but it can affect blood sugar, so we don't want to use it.

Two more points.

I am to call next week and report on how I feel. He'll tell me about the bloodwork and we'll decide what to do next. Unless something of concern shows up, in which case he will call me first.

I fill my prescriptions, return home, and google parvovirus. Hmm. Could be. Not sure. Meanwhile, the drugs do help. I had less pain last night. It was hard to fall asleep, but once I did I slept almost all the way through the night for the first time in weeks. This morning I'm feeling pretty good, some small pains but not much. A huge improvement.

Woo hoo. Woo hoo hoo!

Stree, or where I've been

2006-01-08T20:09:00.000-07:00

1. Really tired. Tireder than tired. Grocery-shopping-leads-to-mandatory-napping tired. Missing-out-on-going-to-bookstore-with-Animegirl-because-too-tired tired.

2. Really sore. Freakishly sore in muscles not being used and some I didn’t know I had. Bizarrely sore in joints that don’t look swollen. Made sore by slicing chicken and by doing nothing at all. Sore enough to lose sleep, worsening #1.

3. Really fuzzy in the head. Unable to concentrate for large chunks of the day. Language-related cognitive errors, e.g., typing the wrong words in memos, such as publishing interesting when my brain was thinking publishing industry. Awkward lapses for an editor, these are.

4. Really anxious about the above, too focused on every bodily sensation. Doing my hypochondriac, excessive researching thing. Full of theories. Current frontrunner is fibromyalgia, which my mom has and which fits my current situation almost exactly in terms of symptoms.

5. Spinning wildly from #4 to an unknown future in which my hopes and plans for work and family are cast into doubt by yet another decline in health.

As all this has been going on for several weeks, I’ve broken down and sought medical intervention at last. Oh good, a new opportunity to be disdained and patronized by health-care professionals! Tuesday I’m seeing a rheumatologist. I can only hope this encounter will lead to numerous suspenseful bloodlettings, diagnostic screenings involving machinery, and multiple follow-up appointments before I’m told nothing is wrong me with

Whoops. I’ll leave that in as a demonstration of #3. Hell, at least I caught it before I hit the “publish” button. I know--everybody does stuff like that all the time. My brain just doesn’t feel like itself. Language is supposed to be my safe area.

Anyhoo…before I’m told nothing is wrong with me that a laboratory can find.

The idea that I may have another chronic medical problem is a little too much for me right now. Maybe it’s all stree. Whoops, I meant stress. Ahem. (What’s stree? Stress induced and/or experienced by a tree?) But I don’t think stress all by itself is supposed to effing hurt this much.

My current goal, energy permitting, is to detail Whatever May Come in the most sardonic possible tone for your amusement and mine. Oh, and to not be ill. That would be cool too.

Five random facts

2005-12-29T10:48:00.000-07:00

I’ve been tagged by Scott, who is among the first type 1 folks I met in person following my diagnosis. He and the good people of our support group helped me through a very hard time and encouraged me in my exploration of Pumplandia. His blog inspired me to start this one, in fact. My 5 random facts:

1. My past pets include three retired racing greyhounds. These remarkable dogs are beautiful, awe-inspiring companions whose care and upkeep are considerably different than many folks imagine. (You don’t have to take them running, for example. And many are good with cats and children.) Check out Northern Lights Greyhound Adoption for more information about these hardworking athletes who deserve to retire to loving homes with big cushy dog beds.

2. I’m quite fascinated by the Myers-Briggs Type Indicator, a system that describes personality as the intersection of four brain functions. MBTI has given me a more profound understanding of my relationships as well as practical tips on how to work with people who function differently than I do and a new way of looking at stress. I’m an INFP, which means I am quiet, creative, and temperamental, among many other things. Here's an interesting page about MBTI: http://www.personalitypage.com/

3. Another, less scientifically validated system of personality is the Enneagram. There’s a lot of kooky writing out there about this way of looking at human psychology. But there’s also very rich material for people who are willing to examine what most frightens them and the ways we structure our lives around those fears. I am a Nine, highly conflict avoidant, which means (again among many other things) that I need to be vigilant about my fierce longing to dodge confrontation at all costs. A good Enneagram resource: http://www.enneagraminstitute.com/

4. My guilty television pleasure is Survivor. I know, I know. I am deeply ashamed.

5. My guilty lifestyle confession is that I don’t read for pleasure anymore. I read all day long for my job, and a lot of "free" time goes to my job as well. I can’t remember the last time I cracked open a book for the sheer pleasure of reading it rather than for work or health-related information. I never thought this could happen to me, a lifelong bookworm, and it is highly suggestive of the possibility that I need to rearrange my priorities.

I hereby tag the following:

Sandra

Dee

Aww, isn't that cute? They're a 1950s movie star!

Progression

2005-12-23T07:58:00.000-07:00

Thanks to the many who commented & sent e-mails in response to the very practical survey. I'm grateful for all the help.

I'm observing the progression of my diabetes from a sometimes clinical and detached, sometimes hyperemotional (as you guys know) stance. Today's post shall tend toward the clinical and detached, Violet style.

When I started on the pump last February as a happy honeymooner (ahem), my basal rates were 0.25-0.30/hour all day long. Crazily small numbers for an adult, I know. But without those teeny droplets of insulin I'd go up and up.

I enjoyed six months of stability and numerical happiness, relatively speaking. In August, I began to need to raise the basals. They leveled off for a while, then needed another small bump in October. They're now on the move again. Tweak, tweak, tweak. Yet I'm still spending fully half of each day at 0.25. This is in contrast to the average post-honeymoon type 1. Check out Skytor's December 16 post about basal rates over at DIA...gonal, a newish blog Kerri highlighted recently.

Based on Skytor's supercool graph, I may still have a long way to go before I'm entirely done honeymooning. The average adult T1 has basal rates of roughly 0.6-1.0. Here's where I am (sorry, I'm not graph capable yet):

5 PM-5 AM 0.25
5:00 AM-6:30 AM 0.60
6:30 AM-9:00 AM 0.65
9:00 AM-10:00 AM 0.50
10:00 AM-3:00 PM 0.40
3:00 PM-5:00 PM 0.35

...for a grand total of 8.60 units per day of basal insulin.

The other new aspect of this period is a change in some of my carb ratios, which has never happened thus far other than changes caused by estrogen. I need more insulin with lunch and dinner than before--about 15% more at lunch and 10% more at dinner. Err, I think. I'm not getting consistent results yet (sometimes going low, sometimes still too high, sometimes just right), so this remains a work in progress.

It's not the numbers themselves that I'm fixated on, actually. My preoccupation is this: How long will the instability continue? Since everyone needs different amounts of insulin, it's impossible to know where I'll end up. I won't be able to tell until things level off and stay leveled, I guess. This unpredictability is so very...diabetesish, if you will. Mercurial. Ephemeral. Etc. Which makes it, really, just another face on a figure we all know well.

A very practical survey

2005-12-21T09:24:00.000-07:00

Some hands-on, nuts-and-bolts inquiries for anyone who uses insulin or cares for someone who does. Feel free to answer only some questions if you prefer. (Some apply only to pumpers or their parents.) Also, I realize that these questions should be discussed with a CDE or endo, which I plan to do. But I’m most interested in the responses of people who are contending with these questions in everyday life.

1. When you disconnect your pump for ½ hour to 1 hour, e.g. for showering, do you adjust for the missed basal insulin? If so, how—by increasing the basal for the next hour? Or do you give yourself a bolus of the missed insulin? Or some other way?

2. What’s your favorite reference for carb counting? And/or what suggestions do you have for building on a basic carb counting education to improve accuracy, especially in a restaurant situation?

3. What are your guidelines for bedtime snacking? Do you always snack if below a certain BG? What’s the BG number, and what kind of snack do you eat? If you’re supposed to snack but aren’t hungry, do you snack anyway? Does anybody try lowering their nighttime basal in lieu of snacking?

4. If you drink alcohol, describe what you drink and your strategy for use of insulin & food to minimize BG chaos. For example, if your drink contains carbs, do you use your standard carb bolus or a reduced one?

5. If you are a woman who takes estrogen, do you see an effect on your insulin resistance? For example, I have different carb ratios (less insulin) for the week when my BC pill is a placebo, and this past month I’ve noted that I’m going to have start lowering my basals that week too.

6. Does your correction factor vary at different times of day? How can one figure this out, given the dozen or so variables at play? Surely I’m not supposed to cause myself to go high at 9 a.m., noon, 3 p.m. etc. on different days to test my correction ratio?

Thanks for your input, everyone!

DOH = doh!

2005-12-16T14:10:00.000-07:00

Over at http://noncompliant.blogspot.com Kassie brings her incisive wit to bear on the NYC Department of Health, which is instituting a program requiring all labs in the city to report all A1C results with the name and contact information of the patient. The DOH’s fantasy is that it can monitor areas and individuals whose "control is poor" and intervene in a positive way, e.g. (I suppose) by sending us greeting cards with photographs of persons connected to dialysis machines as a friendly reminder. Oh, they’re going to call us too. Nice.

Privacy, shmivacy. The government has a huge financial interest in reducing diabetic complications, so they’re taking action based on their understanding of how those complications come about, Bill of Rights be damned. The data will supposedly not be available to insurance companies. Yet. And individual patients will supposedly be able to opt out of the program. I can just picture the feasibility scenario there:

HARRIED LAB WORKER: Must upload data to the DOH, must upload data, must upload data…

HARRIED LAB WORKER #2: Wait, this one is marked "Patient declines to participate. Do not send data."

HARRIED LAB WORKER: Too late.

HARRIED LAB WORKER #2: DOH!

What pisses me off the most is that, as Kassie, Shannon, and other commenters on Kassie’s post have pointed out, this is a really stupid way to expend resources. Anybody who is already going to the doctor to have their A1C done can be given improved education about self care at…um…yeah, the doctor’s office! From medical professionals of the patient’s own choosing! The people who already have access to the private information the city will now be collecting by force of law!
The city should take those funds and use them to ensure that doctors and nurses, especially at primary care practices (where a great many type 2 diabetics in particular get most of their medical care), receive continual updates on all facets of diabetes treatment and patient education.

Oh, wait. That wouldn’t cover the recalcitrant types who get their A1C now and then but not often enough. Yeah, I guess the city is right. A big draconian database is the only solution. It wouldn’t work, for example, to earmark funds for doctor’s offices to do their own follow-up with patients with diabetes. No, that would just be wrong.

Is the ostensible purpose of this program a screen for something else? I wonder how much a list of the name and contact information of every PWD in New York City would be worth to a pharmaceutical company, a health insurance provider (for prescreening applicants? or how about coverage based on how well you're "managing" your disease?), or even major employers who shoulder enormous burdens in health costs. Okay, so I’m straying into X-Files paranoia here. (Hey, that's it! Maybe it’s aliens who want a diabetes database!) But why not? When the government stomps on my privacy, I’m naturally going to wonder why. And I haven’t heard a good explanation yet.

Wonder if she heard the slurping

2005-12-16T06:04:00.000-07:00

3:00 p.m.: 320. Retested, changed set (it was time anyway), took Nellie’s suggested correction.

4:30: 56. In middle of telephone meeting with boss. Drank juice box while talking around the straw about strategy for editorial staffing. Trembled. Ran out of juice. Perspired profusely. Drank Mr. Brooklyn’s coke.

4:45: 127. Wished boss a merry Christmas.

New theory: correction ratio changes during 4th week of BC pill pack (the placebo week, the ones nobody actually bothers to take). This could make sense. All my carb ratios change then too because my insulin resistance plummets when I’m not swallowing estrogen every day. If the correction ratio moves from, say, 1:80 to 1:120 (sheesh), that would account for swinging 264 points in 1.5 freaking hours. (Note to self: evaluate birth control options. This ain’t worth it.)

Why didn’t I terminate the phone meeting until I knew I was okay? I’m afraid to have diabetes interfere with my work. The boss is supportive, but she doesn’t understand the disease well, and I don’t want her to think I’m gonna get clobbered by hypos in the middle of important meetings at random intervals. Which, obviously, can happen. Had I been 56 and unable to reach carbs, I would of course have hung up the phone. Cordless saved me.

Then again, it’s not really a bad idea to be in touch with another human when you’re low. Errr, even if that person has no idea it’s happening? Violet, tired and cranky, does not know.

Patterns

2005-12-06T19:20:00.000-07:00

I want them. I need them. I rely on them to take care of my diabetes.

If it’s 2 p.m., I need X insulin per hour to hold me steady. I take Y units per gram of carbohydrate I consume. At 3:00, everything will change, but that’s okay because Nellie and I know the pattern. We will change too. We are self-informed, resilient, yet flexible. We are in control.

Reread the last paragraph in the past tense.

The patterns of Violet are askew. My body has, it seems, unpatterned itself.

All that basal testing described a few posts below is only helpful if you can find a trend. If the results shift and change, you can’t adjust. Give yourself more insulin, and the next day you might not need it. We all know what happens then.

Right now, for example, nighttime is crazy. One night I get a great 2-hour test after dinner, say 140, then find myself at 240 when bedtime comes (nope, no fat with the meal, but thanks for asking). The next night I fast to see if the basals are too low. They must be, right? No. At least not this time. I’m at 87 when bedtime comes, and I have to have a snack. Hmm.

Another night, like tonight, the 2-hour test is pushing 250 and I’m sick to my stomach. Why? I knew exactly what I was eating, gram for gram. Okay, it must be that my carb ratio is too low. But wait: last night I knew what I was eating too. And I was fine. Tomorrow the only thing I can guarantee is that the result will be yet another iteration: they’re infinite, it seems.

Without patterns I am at sea. I know myself but not how to take care of myself. And that is even more disorienting than moving from Minnesota to Brooklyn.

Incidents with Animegirl

2005-11-30T21:13:00.000-07:00

One:

I am taking Mr. Brooklyn’s daughter, 14-year-old Animegirl*, to the Metropolitan Museum of Art one Sunday. (Mr. Brooklyn's son, Gamerboy, has decided to stay home with Dad for purposes related to his namesake.)

We begin with breakfast at a neighborhood diner. There are four diners within walking distance of the apartment I share with Mr. Brooklyn and, on weekends, his kids. Four we’ve found so far, that is. I’m pretty sure there are others. One of the wonders of the neighborhood.

Animegirl is in a lively mood considering the hour. We discuss various matters teenage as we board the F train to Manhattan. She has an interesting perspective on many things.

A few minutes into the ride I’m startled to feel That Feeling.

Bad. We just ate. If I am low now, it’s probably a nasty one.

I pull out my meter and poke a fingertip as the train bumps along. Animegirl has seen this many times, but we’ve always been with her dad and brother before. Today she has a question.

“Do you have scars on your fingers from doing that?”

“Not really,” I say, showing my hands. “Well, sort of. I get little dots where the blood vessels break sometimes.” Animegirl squints at my fingers. The dots are too small for her to see at this distance.

Meanwhile, my meter has done its job. 67, not a good number for a person with several units of insulin on board.

Grrr, I think. Lousy way to start the day. Stupid diabetes. Well, whatever. I’ll just eat a zillion glucose tablets and I’ll be fine.

I reach into my purse. Immediately I know. There’s a tube-shaped void in the compartment where the tablets normally sit. They’re in your other bag. Idiot.

This has happened before--rarely--but never when I’ve had a serious low. I always carry carbs with me. Always. Well: practically always.

I am on a moving train with a hypo coming on and no food.

“Do you have any candy? Anything to eat at all?” I ask Animegirl with deliberate calm. It seems very important not to freak her out. I don’t want to ruin the day. And she might not want to go places with me if this kind of shit appears to be the result.

She has no food either. I explain that we’ll have to get off the train because my blood sugar is low and I need something to eat. She asks some questions: how does it get too low? What happens if I don’t eat? I answer in what may or may not be intelligible English sentences.

I’m not familiar with the next stop--we’re still in Brooklyn but no longer in the small section I know--but surely there’s a store nearby. This is New York. There’s one of everything near the subway. But this station turns out to be deserted, tomblike, no stores in sight. Only some warehousey structure, maybe a school, in front of us when we emerge from underground. No people at all.

I select a random direction and start walking. Feeling shakier. Within half a block I see a newsstand. Phew. I heart New York.

I choose orange juice; Animegirl gets a strawberry Hershey bar. We return to the train. I retest as it rolls away. 78. The right direction.

“You deal with it well,” Animegirl says.

I feel like I’ve won a medal. “Thanks,” I tell her.

“I don’t think I could do it.”

“Actually,” I answer, “you could. You would adapt just like I have.”

She ponders this for a moment, then nods.

For the next few hours, she periodically offers me a piece of Hershey bar. But I don’t go low again, the art museum is astounding, and we have a wonderful time. Wonderful.

Two:

Animegirl is sick this weekend. She has a lousy cold and menstrual cramps.

I offer cold remedies, Tylenol, Advil. She declines. “I never take anything when I’m sick,” she states in a lofty tone of the sort one might use to announce an ethical stance on, say, the death penalty. “I don’t believe in medicine.”

I have, as you might imagine, a few small observations to offer in response to this. But I bite my tongue. She spoke as she did because she isn’t thinking of me as a person with a chronic disease, which on the whole is very much a Good Thing. And she’s sick. And I adore her. Cut the kid some slack, I instruct myself.

But I can’t. I stew quietly about her words. She’s entitled, of course, to take care of herself (or not) as she wishes. And I can appreciate the desire to thwart our cultural tendency toward overmedication. It’s also a good thing that she’s an active thinker, something of a nonconformist, a young person busily engaged in the work of figuring out who she is. I admire and (frankly) envy her these qualities.

Flip side: To be able to scorn medicine is a luxury that only a person privileged with near-perfect health can indulge--unless one is willing to suffer serious physical decline, which, cold and cramps notwithstanding, Animegirl is not currently at risk of doing. Both her stance and the slight smugness that accompanies it are enabled by good fortune, a good fortune I once had but now lack. Another thing I envy her.

Flip flip side: What’s my role in Animegirl’s life and growth as a young human being? I’m Dad’s live-in girlfriend, not her mother or teacher or counselor. Do I help her develop empathy for the less fortunate (in this case, me)? Am I entitled to decide what empathy might mean for her or whether she needs more of it? Why? Maybe she’s fine the way she is, and I’m simply pissed off because I’m diabetic and I just turned 34 to boot. (Stupid mid-thirties with no baby in the near future. Bah.)

Flip flip flip (it’s a pyramid, you see): Does a person with a chronic illness have an obligation to raise the awareness of others? Can I just be Dad’s girlfriend, or do I also have to be Dad’s girlfriend who has diabetes? If the latter, do I have to be that person all the time or do I get a break now and then? Why should I be stuck with that burden? Or am I just grousing about the burden of being an adult in relation to a child, the burden of trying to help a younger person mature and develop wisdom? Maybe that's it; it's a very new situation for me.

The next morning, Animegirl sneezes vociferously as we walk to breakfast. Deep thinking be damned. I pounce on the opportunity.

“Sure you don’t want something for your cold?”

She shakes her head no.

“You know,” I say, “if I refused to take medicine, I’d be dead by now. Literally dead. So I take insulin.”

She pauses. And ponders. And sees my (unsubtle, ungraceful, and somewhat self-indulgent) point.

“Stick with that,” she says finally. And sniffles.

*anime: Japanese-style animated series and movies

Why Nellie?

2005-11-29T20:31:00.000-07:00

The last chapter of Charlotte’s Web finds Wilbur in a sad state. His beloved Charlotte has died. He has protected her egg sac and watched her babies hatch, only to see them sail away on balloons of spun silk. But three tiny spiders have stayed behind in the barn to remain with him. The first is called Joy, the second Aranea. As for the third:

“How about me?” asked the third spider. “Will you just pick out a nice sensible name for me--something not too long, not too fancy, and not too dumb?”

Wilbur thought hard.

“Nellie?” he suggested.

“Fine, I like that very much,” said the third spider. “You may call me Nellie.” She daintily fastened her orb line to the next spoke of the web.

Wilbur’s heart brimmed with happiness. He felt that he should make a short speech on this very important occasion.

“Joy! Aranea! Nellie!” he began. “Welcome to the barn cellar. You have chosen a hallowed doorway from which to string your webs. I think it is only fair to tell you that I was devoted to your mother. I owe my very life to her. She was brilliant, beautiful, and loyal to the end. To you, her daughters, I pledge my friendship, forever and ever.”

“I pledge mine,” said Joy.

“I do, too,” said Aranea.

“And so do I,” said Nellie, who had just managed to catch a small gnat.

[Yeah, I realize this extended metaphor places me squarely in the role of the pig. What can I say? Diabetes can do that kind of thing to a girl.]

We interrupt this broadcast...

2005-11-29T13:56:00.000-07:00

[Cue dramatic music. Flash obnoxious 24-hour news station logo.]

Announcer:
This is a special report.

[Flash logo: a wilted purple flower almost entirely smothered under a pile of white sugar]

Announcer:
Violet's Honeymoon: The Final Hours?

Ladies and gentlemen, when we last left Violet, she was happily scarfing oatmeal after a lengthy fast. Oatmeal is one of Violet's favorite foods. It has a low glycemic index and high fiber content. It's always been easy on her diabetes. And it makes her feel warm and squishy inside.

Violet had used approximately 10 blood glucose test strips already today, but there's no stopping this spunky patient when she gets going. Two hours after her meal, she faithfully tested again, confident that she would find herself between 120 and 160.

[Cue dramatic music: DUM DA DUM!!!]

[Close-up on BG meter with numbers reading: 346]

Announcer:
Three hundred forty-six! Clearly a testing error. Violet tried again.

[Cue dramatic music: DUM DA DUM DUM!!!!!]

[C/U on meter with numbers reading: 367]

Announcer:
Three hundred sixty-seven! What could this mean? A forgotten bolus? No, Violet's pump indicated the oatmeal bolus had gone through without trouble.

A bubble in the pump tubing? No, Violet checked for bubbles when she began her fasting test. And she'd only used a few units of insulin since then.

A bad set? No, the current set had been working fine since Saturday evening.

An old set? Not really: Violet always goes 3 full days with her sets without running high.

Old insulin? On the contrary, a brand-new bottle.

Miscounted carbs? Upon recount, Violet could not find an error.

Ladies and gentlemen, please remain calm and stay near your television. It is possible that Violet's honeymoon has taken a dramatic turn for the worse. We will continue to update you as more information becomes available.

This has been a special report on...

[Cue mournful music, show logo]

Violet's Honeymoon: The Final Hours?

Numbers

2005-11-29T12:00:00.000-07:00

Results of fasting tests:

7:15 130
8:45 152
9:45 180
10:45 161
11:45 180
12:45 163
1:45 164 (broke down and ate enormous bowl of oatmeal)

Analysis:

1. Why didn't I do the tests on the hour so they match the way Nellie's clock works for basal delivery? Gooberhead.

2. I seem to be scaling up between 7:15 and 9:45, then more or less leveling off.

3. On the other hand, you could look at 7:15-1:45 and observe a 34-point shift, not that much overall. I'm too anal to settle for that, though. I was at 180! 180 is not a happy number! (Of course, meters vary so much that who knows what my BG ever really is...)

4. Back to #2 then. For simplicity, let's say I'm rising between 7 and 10 a.m.

5. It takes 2 hours for a basal change to take effect. So I need to bump my basal between 5 and 8 a.m.

6. Actually, what I really need to do is repeat the whole process one more time to be sure today wasn't an aberration. But I've watched the BG drift upward for a week (though I wasn't fasting) and therefore feel pretty confident about making a small change.

7. Small changes are safest. So I'll try increasing .05 units per hour during this span. I'll tell Nellie to bump me to .60 units per hour. A new record basal rate for Violet, woo hoo!

And so it goes

2005-11-29T06:31:00.000-07:00

How did your honeymoon end?

Mine’s dying off “not with a bang but a whimper,” to appropriate a phrase from an expatriate (that's an edit: sorry, Mr. Eliot) poet unable to defend himself from such abuse (because he's dead, not because he was an expatriate...)

It’s an interesting process from an observational point of view. About 3 months ago--very shortly after my last post here at the beginning of August--I noticed a weird pattern. My morning and post-breakfast numbers were fine, but the BG never finished coming down after breakfast. So at lunch the number would be about the same as the post-breakfast number or sometimes a bit higher. This despite past success with the same foods eaten at the same time, etc., so I decided it couldn’t be the effects of fat or other diabetes bugaboos.

Then the same thing started to happen after lunch.

After enough repeats of this pattern convinced me it probably wasn’t merely stress (which I had in fair amounts at the time and which can certainly affect BG), I started fasting during selected periods to test my basal rates. A tricky business: you have to be sure you start the fast with no residual carbs on board and no extra insulin on board. Then you test, test, test. If your pump (or Lantus or whatever) is giving you sufficient basal insulin, your number shouldn’t move more than 40 points during the test period.

Aha. All those fingersticks showed I was climbing throughout the day. Dr. Patronize, my endo (whom I now rather sorely miss despite his deficiencies), had advised me to watch for this type of change. It signals the end of the honeymoon, the (ahem) blissful post-dx period during which one’s pancreas kicks out enough insulin to have an impact on the BG, albeit not necessarily enough to keep one out of the hospital.

There’s not a lot out there in the diabetes literature that details how honeymoons end. I wanted to know how fast the changes would take place, whether only my basals would change or my carb ratios as well, and what kind of basals I could expect to end up with. The only specific information I could find, though, is that honeymoons end differently for everybody, and at this point no one is sure why. Some people see a drastic skyrocketing in numbers all at once, others a more gradual creeping over time. Some have to adjust basals, some mealtime insulin as well. The point everyone agrees on is that control gets harder, a lot harder, after the honeymoon because the pancreas is Just Not Helping Anymore.

My numbers suggested that I am a creeper. No 400s yet, nothing drastic: 180 when I would have previously been 110, for example. Subtle but meaningful changes. An interesting thing to be grateful for, but there you have it.

The next step was a moment of glory for Pumplandia. Thanks to Nellie, I was able to adjust my basal rates in tiny increments to correct the problem without overcompensating and causing lows. It takes about 2 hours for a basal change to take effect on the BG (all this is from Smart Pumping, a most helpful ADA book by Dr. Howard Wolpert). So I identified the time of day when the numbers started to climb, subtracted 2 hours, and boosted my basal insulin for that hour. In my case, since I was climbing over a period of hours, I made adjustments over many hours.

Then I fasted a lot and tested a lot. Again. What mainly happened is that the numbers improved but not enough. So I kept adjusting. It took a couple of weeks to get it right, and I ended up with 6 basal rates over the course of 24 hours where I’d previously had two. For some parts of the day, my rate doubled, while for others the increase was less drastic, and for still others the rate stayed the same.

A strange business ensued. After these fixes, whenever I ran high and corrected as I previously would have done with happy results, I started going low. In other words, I now needed less insulin than before to fix my highs. I experimented further to find my new correction ratio. Although I can’t be sure why this would happen, I think it’s because the higher basal rate gives me more insulin on board, so I need less to fix a high. (This doesn’t entirely make sense to me, though. A mystery.)

I was stable for the next month or so. And then it happened again: high numbers at lunchtime despite a good post-breakfast reading. This time I didn’t have to tweak quite so drastically, just a bit more morning insulin.

And then I was stable for another month. Today I am fasting because it’s started again and I need to find out why.

Thoughts:

1. Beta cells, please stop dying. I need every one of you.

2. Part of my body is killing another part of my body. I would like this to stop. I have no control over what’s happening to me.

3. Wrong. Pumping gives me the most control I could possibly have. On shots, the best I could do would be to modify my daily Lantus, which can’t come close to rivaling the precision of Nellie.

4. How many times will I go through this before I get to where I’m going and can figure out how to handle full-blown type 1? What will happen then?

5. I’m really hungry. I have to work soon and it’s very hard to work when I’m hungry.

6. I feel like a freak.

7. I’m not a freak. I’m not the first, won’t be the last.

8. In accordance with the above, I would really like to hear the honeymoon-ending stories of the O.C. Share here or link back to your blogs. Thanks, guys.

How we been doin?

2005-11-28T01:29:00.000-07:00

Hello again. I live in Brooklyn now. It’s difficult to know where to start:

The waning of the honeymoon?

The problematic kidneys-might-be-malfunctioning test that turned out to be a false alarm? (The repeat test was normal.)

The hideous first NY primary-care doc visit, endured in order to get my monthly B12 shot? (My mouth is still hanging open, and it’s been weeks since I saw this guy. Actual quotes, delivered after a 1-minute discussion of my diabetes: “You aren’t type 1; they just described it that way because you were insulin dependent at diagnosis. A common confusion. Do you really like that insulin pump? New Yorkers don’t generally use them. How many units a day does it give you? It depends on what you tell it to do? Hmm. So you really don’t mind having that in your stomach? No, you don’t need to see an endocrinologist. You can visit me three times a year and that will be fine.”)

The name of Charlotte’s successor? (Nellie.)

Every time I thought about writing here about any of the above (or any of the myriad other tiny golden diabetic moments of the last 3 months) I felt so freaking tired I wanted to cry. And fairly often did.

Sometimes it helps to write and to put my writing out into the world; sometimes it makes me feel more trapped than ever. How diabetic am I? Enough to write about it every day, every week? Every few weeks? Never again?

Well, all that sounds (a mite) darker than I actually intend. A gentler explanation for my withdrawal is simply that it’s been a preoccupying few months, pulling up roots from my old home and trying to take the first steps toward replanting them here. It’s a complex, exciting, stressful process, and I can’t say I’ve done the greatest job with regard to Things Diabetic. The self-care hasn’t been a disaster on the whole, particularly considering the honeymoon complexities, but my eating has gone to hell and I’m only now trying to start exercising a bit again. Etc. etc. We know the cycles well. I’m at the beginning of an upswing, I think/hope.

Okay. There’s my start. Meanwhile, I have a lot of blog reading to catch up on...More to come here when I seem to be feeling Just Diabetic Enough.

The next thing

2005-08-03T06:34:00.000-07:00

[continued from previous post]

Over the next few days I seesaw through lows and highs until I figure out the new score. Breakfast, which was 1:6, is now 1:9. Lunch has gone from 1:13 to 1:20. Dinner, 1:15 to 1:22. And my correction ratio, formerly 1 unit to lower the BG by 55, is now 1 unit for 80.

All of which will be moot when I return to the pill the following Sunday, but at least I’m back in control for the moment.

That Friday, I’m changing my set as usual. I go through the zillion and one steps until I’m ready to prime the tubing to fill it with insulin.

Charlotte beeps a lot at this point. She’s supposed to, to make sure I’ve remembered to disconnect the pump before I prime. If you prime while connected, you’ll infuse all sorts of unwanted insulin, a Very Bad Thing.

So she beeps as always. Good old Charlotte. But then, just before she starts the prime, she beeps very oddly. A strange sequence. And a strange message appears on her screen: A33.

I’ve never seen this before. I fetch the manual. Clear the alarm, it says, and if it continues to occur, call for assistance.

I clear the alarm. Charlotte’s screen goes completely blank, but restarts. Phew.

Funny, she wants to be rewound again. Okay. I rewind.

BEEP BEEP BEEP BEEP A33

I clear the alarm again. She restarts, asks to be rewound again, and alarms again. And again. She is stuck.

Charlotte?

I call Medtronic’s 800-number. I follow a push-button menu, expecting to be put on hold. I am not put on hold. A tech support guy answers, takes my name, and asks what my last blood glucose reading was.

Grrr. He wants to know if I’m having trouble with my pump because I’m running low & therefore confused. A reasonable, necessary, and patronizing question. “106,” I reply through gritted teeth. Then I describe the problem.

Mr. Medtronic Guy talks me through a diagnostic process that consists of doing exactly what I’d done before I called him. Charlotte remains steadfast in her refusal to leave the rewind cycle.

“Did you possibly drop the pump?” Mr. Medtronic Guy asks. “Or could it have gotten banged somehow?”

I assure him that this is not the case.

“I’m afraid we’ll have to send you a replacement pump,” he says.

I am shocked. Charlotte is dead? She is not even six months old. How could she be dead?

“It’s an internal communication error,” Mr. Medtronic Guy says. “Sometimes these things just happen. We don’t always know why. Do you have a backup plan for insulin delivery?”

I do. Will I get my pump back when it’s fixed?

No, that isn’t how it works. The new pump they’re sending will be mine for good. Mr. Medtronic Guy arranges the shipment, gives me some instructions, and apologizes for the malfunction, all in a timorous tone that suggests he expects me to erupt into rage at any second. His must be a lousy job.

I do not, of course, erupt into rage. I’m too busy trying to stave off panic. After the call, I instruct myself to breathe. It will be all right. I know what to do. It will be all right. Adapt, adapt. That’s what diabetics do; we adapt.

I’m starving. I renuke my dinner and fetch a syringe. Sixty grams of carbohydrate, no problem. I know my ratios like the back of my hand. I will adapt. I draw out four units of Novolog and do the belly stab.

Astute readers may notice a problem at this point.

I eat. I mourn Charlotte. How can she have broken after six short months? Are the pumping naysayers right after all? Is the technology not truly reliable? Have I built my diabetes care on a house of cards?

All that is well and good to ask. But here’s the heart of the matter: CHARLOTTE has broken. She’s dead. My beloved pump, whom I anticipated and welcomed and named and personified, my partner in health whose virtues I extolled throughout cyberspace, has left me. I’m alone with my diabetes.

If all this sounds more than a little neurotic, well, yeah, it is. You do what you have to do to get through the night, if you know what I mean. All that Charlotte business was what I had to do to get through the long dark weeks of adjusting to diabetes at age 33.

We all imagine contracts with the universe. I imagined that if I went on the pump in a way that felt true to me, I would be safer and happier. I was both of those things. Now I don’t know what I am.

But I am, at any rate, well fed. I call the pharmacy and get them to fill the Lantus prescription they had on file for me. I’ll need basal insulin to see me through until the arrival of Charlotte’s so-called replacement.

The pharmacy is just two blocks away, so I walk there, dragging my feet and fretting. I bring the Lantus home and call Mr. Brooklyn. He is startled: he’s put his trust in Charlotte just as I have.

“What do you mean, it broke?” he says. “How can it just break?”

As we talk I feel funny. It’s a slightly familiar feeling, like a low but with its own odd quality. A bit like the office-supply low of the tangerine chairs. It’s the feeling of free fall.

It takes me a few minutes, but then I understand: I took the hussy-on-the-pill dose of insulin with my shot. I should have taken the nimrod-off-the-pill dose.

I do the math. Slowly. I took 4 units for my 60 grams, using a 1:15 ratio. But I should have used 1:22.

I should have taken 2.7 units. Or, given the idiocy of my whole-unit syringes, 3 units and eaten 6 more grams of carbs.

I test and find some candy. 110. I had the insulin an hour ago. Yeah, I’m heading for a big ol’ crash.

I spend the next hour on the phone with Mr. Brooklyn, eating and testing, eating and testing. I keep myself out of the danger range, but the BG won’t seem to level off.

“I want my pump,” I tell him.

The astute reader will realize that this low has nothing to with Charlotte’s death and everything to do with my nimrodity, but I am not feeling astute at the moment.

After 55 grams of carb, the BG does level off. I am fine. But now I am terrified to use the Lantus. I don’t know what my nimrod-off-the-pill Lantus dose ought to be. And once you take Lantus, it’s in your system for 20-24 hours, period.

I could, and perhaps should, contact the endoc-on-call at my clinic. But I can’t imagine explaining that I am off the pill by accident, and my ratios changed, and then my pump broke, and how much Lantus should I take, please?

I know that I need very little basal insulin overnight, as I’m still honeymooning. I make an executive decision to skip the Lantus. I’ll correct periodically until the new pump comes, I decide.

I go to bed, trying to enjoy the feeling of not being attached to a mechanical device. I don’t enjoy it.

In the morning, I’m at 168. Unhealthy but hardly a disaster. I have to work a conference today, doing a presentation in front of 60 people. I decide to let myself run high. There’s no way I can stomach a big low on a day like this.

At lunchtime, I’m at 239. Whoops. I didn’t mean THAT high. Oh well.

The new pump arrives via Fed Ex, Saturday delivery. Kudos to Medtronic. I only needed three shots to see me through, albeit a bit shakily.

The pump looks just like Charlotte. Same color, same model. But it feels like a foreign object. I program it and am up and running within minutes. Then, following the instructions of Mr. Medtronic Guy, I put Charlotte in New Pump’s box to be picked up by UPS on Monday. It’s a tiny box, lined with foam. It’s absurdly like a coffin.

It's been a few days now. I still miss Charlotte; how weird is that? So far, New Pump does not seem like a girl. It doesn’t seem like my partner in self-care. It doesn’t seem like anything. It just does what it does.

I’m working on this attitude. I know it’s all mental. I need to live with this pump just as I needed to live with Charlotte. And New Pump is not, after all, inherently different than Charlotte. I’m the one who’s really changed.

The first thing

2005-08-03T04:52:00.000-07:00

The first interesting thing that happened during my recent travels was that I lost my birth control pills. Well, all right. I did not lose them as such. I left them behind. But “lost” makes me sound like slightly less of a nimrod.

The reason I left the pills behind is that I was very, very nervous, because I was taking Mr. Brooklyn across the country to meet my family for the first time.

No matter. One can replace a lost prescription easily enough, right? Yes, one can. But it is a little more awkward when one’s brother tags along to the drugstore during the key pill-replacement window of opportunity.

Um.

I am sure families exist in which the (unmarried) adult children can acknowledge things like needing to refill a birth control prescription. Hell, mine may well be one of them. But I am not confident it is, and I wasn’t about to test the matter hours after introducing my sweetie for the first time. This was a bit absurd, as Mr. Brooklyn and I were sharing a room in my mother's home, but there you have it.

Off the pill I went, in the middle of the pack, which one is not supposed to do. Annoying and perplexing to my poor confused reproductive system, but whatever, I thought.

Ha ha.

The first couple of days went okay. The fam accepted Mr. Brooklyn with reasonable grace, at least in some cases (which is as good as it may ever get where Brother Violet is concerned). Mr. Brooklyn, naturally, was entirely charming. We returned to NY and sighed a collective sigh.

Then the lows started.

The first was post-pizza, always a dicey time. But I’d had this pizza before, and I thought I knew what I was doing with the insulin.

Two hours after eating, I was 69. Had some glucose tablets.

61. More tablets.

“I feel funny,” I said to Mr. Brooklyn. We were in an office-supply store, and I was sitting in a desk chair on display. It was tangerine orange and had a matching desk made of hard plastic. Nearby sat its counterparts in lime green.

Or maybe I was sitting in the green chair, and the ones nearby were orange. I really don’t remember.

“Am I too nice?” I asked Mr. Brooklyn. “Whenever we’re around your mother I think I’m too nice. She’s awfully tough.”

Mr. Brooklyn made reassuring murmurs about my personality and suggested that he steal some juice for me from the cooler at the cash register. No no, I said. I just ate a million glucose tablets. This next test will show that I am fine.

40.

Mr. Brooklyn hurried off to do his thieving. I drank enormous quantities of the lemonade he brought back. We talked about how the glucagon was in my bag at home. (Yeah, left behind. Who carries glucagon when they go out for pizza?) Or maybe I only think we talked about it. I really don’t remember.

Then I was fine. 78, 96. Hooray. I thought I’d wind up in the 300s after all that lemonade, but no. 164 was as high as I got.

After a scattering of other, less dramatic lows over the next few days, I did some research. Did you know that estrogen and progestin, the hormones found in most birth control pills, increase insulin resistance in some people? I did not know this. None of my various “diabetes team” members ever mentioned it, though they all know I’m on the pill. Maybe it’s a rare phenomenon; I’m not sure. What it means is that when you’re taking these hormones, you may need more insulin to cover your food. And if you leave your pills behind like a nimrod, you may soon need to take less insulin. A lot less.

[to be continued]

Firsts and repeats

2005-07-04T22:45:00.000-07:00

Last week Charlotte and I attended a fancy-shmancy awards banquet at a conference related to my job. Here was an interesting pumping challenge: I needed a formal outfit, but I couldn’t hide the pump under a dress because the dinner was a business function with numerous courses & I wouldn’t be able to politely excuse myself every time I needed to bolus. Nor could I safely estimate the carbs ahead of time because I didn’t have the menu up front. (If I were very organized, I could have gotten it, but I am not.) I’m also not so good at counting carbs while I’m eating them. I need to see the food, count, bolus, and then eat exactly what I've counted if I’m to estimate well.

I ended up trying on most of my wardrobe hours before my flight to the conference. Finally I sorted it out: fancy skirt, Charlotte at hip on waistband of same, fancy blouse hanging down over Charlotte. Which is pretty much what I wear every day of my life, just a more formal version. Go figure.

Anyhow, Charlotte and I happily meandered through the meal. I pushed buttons as needed, chatted with the guests, and so on. Feeling especially free, I even ate dessert, which I seldom do. After the dinner, during a mingly period, I went to talk with the guests who were seated too far away for conversation during the meal. One lady was quite friendly. She wondered many things about me: where was I from, where had I gone to school, how had I come to work for my company, what was the meaning of the medical ID bracelet on my wrist?

Ooh, interesting segueway. In my 8 months of wearing the bracelet, this was the first time anyone who didn’t already know I’m diabetic has noted (at least verbally) that it’s a medical ID. It’s a rather pretty one and relatively subtle as these things go: Minnie

“I have diabetes,” I explained.

“And when did you go on the pump?” my new friend inquired.

Touché. Another first: Charlotte called out in public by someone who is Not Violet.

See, I’m still a child at all this, really. I’m not the bold, brilliant, beautiful K at the beach with Charlene. And you guys with the type 1 kids have been around this block many times already, only you’re coaching kids of 4, 6, 9 on how to answer much less politely phrased questions than this one. I'm still just a neophyte.

I guess what I’m saying here is that I needed my mom.

Mom was not, alas, in the vicinity. So I answered the question, briefly noted my happiness with Charlotte, and waited to see what would happen next.

As I waited I observed to myself: how strange this feels, to have been dining gracefully (I thought) with my pump while this woman across the table was observing me the entire time. How strange to be discussing my medical status with an important guest in a business setting. How strange to have seemingly no control over any of these things. How very diabetes-ish life can be, since I got diabetes.

The woman went on to explain that her son, age 24, has had type 1 since he was 4. (Ohh.) And hasn’t been to the doctor for 3 years (ohhh), though he seems fine, but she worries about him, naturally, it's been 20 years with DM and of course he knows he ought to go to the doctor but still he seems to be doing fine…

Ahhh.

It wasn’t about me at all. Not at all. It was just another one of us, needing to tell a story. That, my friends, I know plenty about.

Normal

2005-07-01T06:43:00.000-07:00

I am not (never have been), but the MRI was. Phew. Thanks for the support, guys. I still have the pricklies, not quite as often, so perhaps the B12 injections are helping. I need to follow up more aggressively. As much as I like Dr. Keeper, her approach to this situation is very "wait and see," which is not to my liking. Consider, for example: if I'm having nerve problems due to B12 malabsorption (unproven), might I not also be malabsorbing other nutrients? I might, depending on the cause of the B12 problem (if there is one). But Dr. Keeper is not checking for this. She's just waiting to see if I get better, which could take "a few months." I'll have to go back in and ask her for more tests if I want to find out if I'm low on any other essential-to-life entities.

Meanwhile, change abounds in Pumplandia. My company is transferring me (at my instigation) to New York.

New York!

Home of Bionic Bagels. Home of Spamalot. Home of very tall bulidings with intriguing shapes.

Oh, yeah--also the home of Mr. Brooklyn and his remarkable children.

More to come...

The needle returneth

2005-06-19T09:44:00.000-07:00

I’m very bored with writing about my health. Is this akin to the malaise expressed by Kerri here? I think kinda sorta.

But anyway: I’m now on injections for possible B12 deficiency. Dr. Keeper says they cannot, regrettably, be self-administered. Must go to clinic to receive. It’s one per day for 4 days, one per week for 4 weeks, 1 per month for…well, forever.

It’s a little strange to be on a permanent medication for something that only might be wrong with me, but Dr. K says it’s much wiser to treat than to disregard, as a B12 deficiency can cause all manner of permanent damage to multiple systems if left to its own devices. This coincides with my research on the subject, so I’ll trot myself to the clinic like a good little possible pernicious anemic.

There’s stuff all over the web about oral treatment for B12 def. rather than injections. Dr. K says we can consider that down the road.

She also says I need an MRI. That’s because this neuropathy sounds a little funny to her. The pain doesn’t stay put in my limbs, which (she says) it generally does with B12 problems. I get the pinpricks mostly in the feet and hands, but also legs, arms, side, face, head. Now and then. Not a lot. But noticeably. And that is weird enough that Dr. K says we ought to rule out MS, which can cause abnormal sensation in all manner of places and ways.

Oh, good.

Of course, having been completely bamboozled by this information when I set up the test, I scheduled it for the ONLY time next week when I CANNOT leave my office. Now I must reschedule. So who knows when it will be or when I’ll get results.

On a considerably lighter note, kudos to Tekakwitha, who has rescued much my summer wardrobe from Goodwill with this comment. I got the Minimed thigh thing T mentions, and it does NOT fall down or require additional contraptions to hold it up. Indeed, it’s so adjustable that one can inflict whatever level of circulatory disruption to the thigh one likes, all in the name of fashion bliss. So Charlotte and I are at peace once again.

Now I just need to decide which dress is appropriate to wear to an MRI. Ahem.

Charlotte vs. the Summer Wardrobe

2005-06-11T10:11:00.000-07:00

She’s winning.

I know the tricks: the thigh thing, the bra thing, the cutesie pouches. I’ve shopped the accessory websites. But there’s a certain category of sundress for which none of the tricks work. I can’t do the bra clippie thing because I’m not, errr, properly built. With many of my clothes I can hide the pump under my arm, in the side of my bra, but with some dresses it sticks out horribly there. Depends on how the dress is cut. And the thigh thing falls down unless I wear it with a garter belt, which shows under lots of fabrics in a very obvious, look-at-me-I’m-wearing-sexually-charged-lingerie-and-might-be-a-harlot-would-you-care-to-find-out? kinda way.

I own, like, six dresses in this category. They are (were) my favorites. Whine, whine, whine.

There’s one thing I haven’t tried. It’s an adjustable garter thingie. Maybe this would stay up without a garter belt? It even comes in two sizes, a brilliant acknowledgment that women do not, in fact, have made-to-order thighs. I will invest the 30 bucks and report back.

In which I have little to say

2005-06-08T20:41:00.000-07:00

EMG = normal. Yay! I still have the symptoms, though. I need to talk to the doctor but can't find the wherewithal to do it. Low low energy on the self-care front right now. The only thing I've accomplished all week is one little tiny bout of exercise. On the plus side, I'm eating like a responsible diabetic again. (The bionic bagels, incidentally, prevailed...That third hour nails me every time. Maybe I have to take an extra bolus then? Hmm, dangerous.)

Aha, I do have one positive story to relate. This will seem like nothing to longtimers, but for me it felt bold: I went dancing while I was in New York. I hadn't been dancing since before my dx six months ago; I was worried about going too low or too high (in an attempt not to go too low) from the funny bits of intense exercise. Actually, Mr. Brooklyn had tried to take me dancing on my birthday, but I messed up my fancy-dinner bolus and wound up at 330, too high for safe physical activity...

Anyhow, I didn't go low, just a smidge high from dropping my basal more than I needed to. And we had a great time. Diabetes, I fart in your general direction! (We also saw Spamalot last week...)

Charlotte vs. the Bionic Bagel

2005-05-31T10:28:00.000-07:00

Well, last week I ran out of time to write about the Evil Matron Glaring who subsequently became Egregiously Mollifed & Gentle--this would be the tech, of course, who performed my EMG and whose behavior during same has contributed to my DUH w/r/t nerve damage. She was quite mean to me at the onset of the exam (I was late and that was NOT okay) but became startingly kind and friendly by the end, without apparent cause. A number of rational, non-DUH-stricken folks have pointed out logical explanations for this shift that have nothing at all to do with the tech having discovered, as I fear she did, that something Extremely Morbid & Grim is occurring within my nervous system. She probably, for example, realized she had behaved inappropriately toward me and figured she'd better compensate in case I decided to complain. Or, even more likely, she was initially upset that I had put her off schedule but calmed down as the test proceeded smoothly and she regained her lost time.

Okay. Sure. Makes sense. I'll keep trying to buy into that.

Meanwhile, the reason I ran out of time last week is that I was getting ready to visit Mr. Brooklyn, hooray. Am now here. I have yet to learn how to behave as well as I should with my eating when I'm in New York. There are many more temptations than I typically encounter during my staid culinary life in Minneapolis. At home, for example, my main stress over carbohydrates is deciding whether I should microwave Amy's Tamale Pie for 27 grams (minus 5 g fiber) or Amy's Shepherd's Pie for 27 grams (minus 4 g fiber). Here it's more like: should I eat delicious but inappropriate restaurant foods for breakfast, lunch, dinner, or all three?

Consider, for example, that quintessential New York pleasure, the bagel. I never believed until I ate one myself that it's true what they say: the bagels here are beyond compare. (Mr. Brooklyn theorizes that there's some magical ingredient in NYC water that makes the difference.) Alas, bagels are especially cruel to the diabetic system. Made of highly refined flour, they hit the BG aggressively. Yet no human I've met can resist consuming them with generous amounts of cream cheese, a fat that slows down digetive processes and results in a sort of double whammy: you get nailed right away AND later, sometimes much later, by the refined carbs.

One of the fine things about modern insulin pumps is they come equipped with tools for addressing problems like these. You can spread out part or all of your insulin over an hour or two or three, for example, to try to cover foods that bite you back later. This requires experimentation, as it's an individualized process. It is my mission to make productive use of my vacation time by deriving a formula for healthful (ahem) bagel consumption.

Mr. Brooklyn buys his bagels at an appropriately named shop called Bionic Bagels. What better opponent for Charlotte's sophisticated gadgetry? Already three encounters have taken place. The first ended in clear victory for the enemy: 2 hours post-bagel 176, 3 hours post-bagel 246, argh. Undaunted, Charlotte and I sent for reinforcements and renewed the attack. We have since gained considerable ground: 2 hours 138, quite respectable, 3 hours 179. The current battle plan is to weigh the bagel, compute insulin, add half a unit, take 60% with bagel and 40% over the next hour. Our strategy for the next engagement is to spread out the 40% over a longer span of time.

My friends, we shall prevail, and the rewards will be great.

Ever More Grist...

2005-05-26T06:24:00.000-07:00

…as Sandra terms it in her comment below. Speaking of which, thank you all for the support. It means an awful lot to me.

The short, not-at-all-witty story of the EMG is that it was ouchie, though not unbearable, and will produce no definitive results (grrr) until next week.

The long story is, well, naturally longer. If time permits, it will appear here soon. It may or may not be witty, but it WILL involve acronyms...

Metablogging & bargaining

2005-05-25T06:31:00.000-07:00

One of the gifts I've found in blogging is that it provides a coping mechanism for my medical experiences not just before and after the event, but during it as well. This is the strategy I will carry with me this afternoon to my EMG, about which I am just a smidge nervous (ahem). Much of the time, I may imagine or pretend that my story is one of courageous self care in the face of chronic illness. Nah. It's really all about gathering material for Pumplandia, see? While I'm being poked and zapped I'll think about creative analogies and, hopefully, Violetish witticisms to capture the moment. If the medical personnel are eccentric, no matter! They will soon become characters in tonight's post, relegating them to a manageable and much more entertaining status. It's all good.

Really, it is.

That said, if the cosmos is listening, I'd be willing to blog instead about TV or literature or video games or amateur psychology or my cats. I'm open to a variety of assignments, in fact. So you can take the diabetes back; I promise to keep writing. I promise!

Pumplandia the Beautiful

2005-05-23T18:43:00.000-07:00

An ode to Charlotte on our 100-day pumpiversary

(Well, I’m a few days early, but who’s counting?)

O beautiful for fewer lows
and not-quite-so-high highs,
for purple cyborg gadgetry,
no needles to despise!

Pumplandia! Pumplandia!
Beep beep beep beep beep beep!
I analyze
then customize
for safety while I sleep!

O beautiful for basal rates
preset by the hour,
for boluses pumped right to me
with painless battery power!

Pumplandia! Pumplandia!
Beep beep beep beep beep beep!
Infusion sets
are my best bet
for a lower A1C!

O beautiful for sleeping late
and snacking between meals,
for your adaptability--
how sweet and free it feels!

Pumplandia! Pumplandia!
Beep beep beep beep beep beep!
Bionic life
of lesser strife—
‘tis the life for me!

Clarity evades

2005-05-21T16:01:00.000-07:00

Have just received and attempted to decipher lab report on blood work. Please join me in gentle laughter as I proclaim: I do not have the big C.

(DUH.)

Cool, my strategy worked. And I’m not blushing at all. Really, I’m not.

I am also pleased to announce the health of my thyroid, probably the only part of my body I wasn’t worried about.

But here is something curious. My B12 level has received a rating I can only describe as “normalish, but please continue to fret.” The normal range is 200-1100 pg/mL (what’s a pg? picogram? piggygrunt?) and I am at 322. Good good. But. There is a prominent message beneath:

PLEASE NOTE: ALTHOUGH THE REFERENCE RANGE FOR VITAMIN B12 IS 200-1100 PG/ML, IT HAS BEEN REPORTED THAT BETWEEN 5 AND 10% OF PATIENTS WITH VALUES BETWEEN 200 AND 400 PG/ML MAY EXPERIENCE NEUROPSYCHIATIC AND HEMATOLOGIC ABNORMALITIES DUE TO OCCULT B12 DEFICIENCY; LESS THAN 1% OF PATIENTS WITH VALUES ABOVE 400 PG/ML WILL HAVE SYMPTOMS.

In other words, I may yet be a few piggygrunts short of a full litter.

Pricklies and numbness are in the category here referred to as “NEUROPSYCHIATRIC.” (This does not imply that they’re only in my head, but that they’re neurological in nature. Psychiatric symptoms of B12 deficiency include mild depression and memory loss. Oh, don’t get me started…)

So I can’t be sure whether the Ps & N are due to diabetes or B12 deficiency (or some as yet unworried-about cause). If the B12 is the problem but is not caused by celiac, it should be correctable by—you’ll never guess—

SHOTS!

Oh, the irony.

Nevertheless I think I want to be among that anomalous 5-10%. I would much rather have to reacquaint myself with syringes than face a diabetes complication already. Maybe the EMR will provide helpful information, and maybe Dr. Keeper can suggest further testing. Until then I’ll go back to waiting. And maybe have a sandwich too. With extra bread.

In which I wait

2005-05-20T07:43:00.000-07:00

The doctor was lovely: respectful, good listener, gentle. A keeper. Woo hoo.

So: blood work being done for a few things, including the big C. I will receive a letter if all is well and a phone call if all is not. I wait.

Meanwhile, she is more attuned than I was to this neuropathy business. I just want to be able to keep eating wheat bread and oatmeal. She actually wants to find out what's wrong with me. Go figure.

So: next Wednesday I will have a pokey, ouchie (or, if you prefer, pokie, ouchey) test on hands and feet. An EMG. This is to assess whether there is nerve damage, and if so, what can be learned about it. Perhaps in conjunction with the blood work this will solve the mystery.

Meanwhile, I wait. And observe a thing I hadn't before, namely that at night the tips of my toes seem to go a bit numb. I can still feel the sensation of my fingers making contact, but in an oddly distanced way. From the point of view of my fingers--err, not view, my fingers have not grown eyes, at least not YET--it feels like I am touching someone else's toes rather than my own. Or that they are slightly dead. Egads.

If this is from diabetes, I am just a freak. You don't wind up this way with 2.5 years of poor control, which is about the span when I might have been diabetic and not known it. Have been wracking my brain to try to remember when the Big Weight Loss began. Maybe it was 2001, not 2002. Even so. 3.5 years of poor control? Still not enough time. Dr. Patronize, my endo, said 5 years. The ADA says 10-20 years, average, for neuropathy to start.

Hmm. Deep breath. This is not constructive. Time will tell, maybe, what's going on.

Meanwhile, I wait.

In which I seek my free gift

2005-05-17T07:40:00.000-07:00

For me, self care has become a tightrope walk between two distinct points. One, it goes without saying, is diabetes. The other I've affectionately named DUH. That, for readers less subject than I am to neurosis, diabetes, or both, stands for Diabetes. Ugh. Hypochondria.

This disease has such a generous (ahem) variety of complications covering such a diverse (blah) array of organs and systems that I find it impossible not to analyze my body’s every minor palpitation in that context. This new habit can certainly comprise an important aspect of stellar self care. You can be vigilant about your health or you can risk missing things you need to know. Cyberpal Kerri, a hero of mine who firmly occupies the vigilant category, has made a recent diabetes-related discovery that’s sending her on a journey through purgatory. But the ultimate truth—not that this is fair, just, or a Good Thing—is that she’s empowered by her newfound knowledge to take action. Yeah, it’s purgatory to know, but not knowing damns you to hell.

That said, the other side of the coin of vigilance is, well, DUH. Recently I found myself beset by a horrible itching. Not only wouldn’t it go away, it spread. I saw some little bumps too. Aha, I thought. I know that diabetes can cause a variety of skin troubles. Some of them are chronic and extremely tormenting. I nervously sounded the alarm at Pins and Needles, where several wise and helpful folks offered a variety of suggestions for me to consider as I tried to figure out what kind of doctor to see.

One of the questions I was asked was whether I had recently changed detergent or perfume. I could, after all, be experiencing contact dermatitis.

Oh. Well. Actually. Yes. Yes, I had changed shampoos a couple of weeks before. I had forgotten that.

Back I changed to the old shampoo. Problem solved. Sometimes, as cyberpal Scott observed on this very blog, an itch is just an itch, a headache is just a headache, and diabetes is just diabetes. DUH.

Then again. (This post, you see, is shaped just like diabetes itself: back and forth, up and down, switcheroo, pulled-a-fast-one-on-ya, betcha-didn’t-see-that-coming!) I feel like a fool at times, but no one can dispute that the diabeastie has horns and claws and warts of all kinds. Among them, as cyberpal Amy explains, is its tendency to come bearing free gifts no one wants. Type 1 frequently coexists with other autoimmune diseases, there being a genetic link among many of these. The one I am worried about right now is celiac, a condition with which Amy is unfortunately very familiar. People with celiac can’t tolerate gluten, a protein found in most grains and a great many processed foods. It tears up the intestine, making one subject to vitamin deficiency, osteoporosis, and stomach cancer. The cure is to stop eating gluten. For good.

I am setting myself up, you see. If I expose my hypochondria here in embarrassing detail, it pretty much ensures that when I visit the doctor I will find that all is well. Then I will have to come back here and say DUH. We can all laugh gently at my poor tormented mind, and life will go on.

Celiac occurs much more often in type 1 diabetics than in the general population. It can present with no symptoms at all, or with a variety of GI symptoms. (Have had a healthy number of these the past few weeks. Could just be stress. Probably stress. Yeah, stress.) Fatigue and weakness are common. (Check. Especially the last couple weeks.) Another sign is evidence of nutrient malabsorption—for example, bone problems or peripheral neuropathy.

Ah. Well. Yes. My bones are sound, as far as I know (but just give me some time to think about it). I do have a funny nerve thing that comes and goes. It’s like being poked with a pin in my feet and hands. Mostly in the evening. This type of neuropathy is, of course, a common complication of diabetes. Back when it began in November, my endo explained (rather dismissively, thus giving me my first DUH moment and coming very close to sending me on a search for a new endo) that neuropathy doesn’t develop in diabetics until at least the 5-year mark. And even if you allow for the years (!) in which I might have been undiagnosed, I’m around 3 years tops. The endo suggested that the problem would go away by itself, and if not, I should get tested for vitamin B12 deficiency.

Well, it did go away for a long time. Now it’s back.

Vitamin deficiency, huh? GI symptoms, fatigue. Hmm. Okay, I'm in. Time to humble myself before a new doctor. Maybe she will smile kindly at me and say, "DUH, Violet. DUH."

How I got here, part 3

2005-05-13T06:49:00.000-07:00

I was unprepared to be hospitalized. I had nothing with me but my purse and coat. I wasn’t even wearing clean clothes. And who would feed my cats? Worse still, who, upon feeding my cats, would witness the condition in which I had left my apartment? Even on good days I’m, um, somewhat messy. And I had barely been functioning for weeks.

The fact that I was able to think of these things at all meant—to my very good fortune, especially considering how long I had ignored my symptoms—that I wasn’t on the verge of a diabetic coma or other disaster. 395, I learned later, is not a typical hospitalization kinda number. But Dr. Ketones hadn’t seen a lot of 395s in newly presenting diabetics, and she wasn’t taking any chances.

Snide commentary aside, I do credit this doctor with ensuring that I entered a controlled environment in which I was well educated, in a newbie sort of way, on the basics of diabetes self care. Still, it was an alarming SIX HOURS after my arrival at the hospital—four days and nine hours after my diagnosis—before I was finally offered my first injection of insulin. Why rush over a teeny tiny 395, I guess…

I gave myself that first shot in the belly after a nurse showed me how to draw insulin from the vial. Five units of Regular, it was. Along with the rest of humanity, I don’t care much for injections. But I wanted that one very, very much. I felt a difference within hours, the tentative return of something resembling not quite strength, but a bit of energy.

The petty indignities of a hospital stay were, I decided, the compromise I would make in exchange for those shots. Okay, this wasn’t so much a decision as a rationalization, considering that I had no choice in the matter unless I wanted to leave without that little glass vial. Nurses, I found, are—like all collectives of humans—a mixed bunch. The best was the one who showed me how to chart my urine output (!) so that I didn’t have to ring for assistance every single time I used the bathroom. The worst was the singsongy, oh-so cheerful one who MADE ME GUESS what my blood glucose was the morning after I started taking insulin. She stood above the bed and hovered, smiling, until I babbled something that may have sounded like a string of numerals. Then she said, “How does 140 sound?” I suppose she thought this was a chipper, uplifting way to deliver medical information to a disempowered patient. Bitch.

Once I’d had some insulin, the thing I most wanted to know was whether I had type 1 or type 2. If it was type 1, I knew I’d be on insulin forever; type 2 might have more flexibility. But the doctors couldn’t agree about my diabetes. The length of time I’d experienced symptoms, as well as my age and the lack of full-blown DKA, pointed toward type 2. But my physical profile (skinniness etc.) pointed toward type 1. Finally, blood work showed that my pancreas had gone on permanent strike. Type 1.

Along the way, I was almost put on Lipitor because my cholesterol was through the roof. The internist who prescribed it told me that the combination of diabetes and high cholesterol meant I was a great candidate for cardiac failure. Oh, good. Later, an endocrinologist came by, and I asked him if the untreated diabetes might be causing elevated cholesterol. Certainly, he said. So could I try to get the diabetes under control before taking the dramatic step of starting on a statin? Why yes, yes I could. Good thing I wasn’t taking a nap when he stopped into my room, I guess.

The very best thing about being in the hospital was that my people came to the rescue. My friends brought me books and magazines. (The most appropriately creepy thing to read while learning to give yourself injections, I found, is a brilliant children’s book called Coraline by Neil Gaiman. Things just aren’t right in that book, which is exactly how I felt.) My mom came all the way from Arizona to help me adjust to my new life. Yeah, she was the one who fed the cats and washed my stacks of neglected dishes. Mr. Brooklyn called constantly. And his mom, whom I’d met only twice, called too to give me a pep talk.

Other skills I acquired during my hospital stay included learning to walk while attached to an IV, the ability to tune out the constant moaning sounds made by my poor roommate, who was plagued with an unfortunate respiratory ailment, and, of course, how to check my own blood glucose so as not to have to rely on singsongy nurses for this information. I muddled through. They let me out on the third day with a pile of prescriptions, a rudimentary lesson in carb counting, and a fixed scale for insulin since I didn’t know my ratios yet. With my mom at my side, I wandered off into a brave new world of syringes, test strips, and Humalog.

And that's what got me here.

How I got here, part 2

2005-05-09T18:31:00.000-07:00

The day I got my diagnosis was a Thursday. Had I received it from a doctor familiar with adult-onset type 1, I would have likely been advised to get treatment immediately, in case I was heading for a serious crisis. This doctor, however, was a gynecologist who also does well-woman care for healthy patients. I respected her then and still do now; it was hardly her fault that I'd come to her with a serious health problem. But as she told me herself, she wasn’t intimately familiar with diabetes. She probably pegged me as a type 2 because I was 32 years old and my fasting BG, while clearly diabetic, was nowhere near an emergency number. Type 2 ain’t no picnic, but in its early stages it’s unlikely to put people in the hospital. So instead of rushing me into treatment, she referred me to a physician in the same clinic with, she said, more diabetes experience. The new doctor, it turned out, couldn’t see me until Monday.

I spent the weekend reading everything I could find about diabetes, obsessing about the grim future that I believed awaited me, cutting back on carbs, and feeling ever more nauseated. I read enough to learn that I might indeed have type 1, and that if I did I might be in danger of a life-threatening condition called DKA. But as long as I wasn’t throwing up or exhaling breath that smelled like Juicy Fruit, I probably didn’t have it yet. (Whee, good news!) Still, I came to feel a deep conviction that whatever type I had, I desperately needed insulin as soon as possible. This was my first real lesson in listening to my body. Now all I wanted was for the doctor to take me seriously on Monday.

It didn’t start out that way. When she came into the examining room, she didn’t know why I was there, not yet having looked at my file or, apparently, spoken with the intake nurse (who also hadn’t known why I was there, again not having looked at my file). I explained the results of the blood test. I described all my symptoms, the horrible thirst, the growing nausea, the weight loss. She said she would have some blood work done. I asked about testing for ketones. The books I had read over the weekend said that evaluation of a newly diagnosed diabetic should always include a check for this poison, a byproduct of the body’s attempts to convert fat into energy, which occurs in the absence of insulin. Ketones are what lead to DKA.

Not necessary, the doctor said, adding that in the early stages of type 2 ketone production is highly unlikely. I pointed out the reasons that I might have type 1 and mentioned the nausea again. She shrugged me off. I’m ashamed to say that I was too ill and exhausted to protest further. Okay, I thought, whatever, just give me the insulin. Please.

Then I donated my blood and waited, a long long time, for the results. At least they didn’t send me home; I sat in a succession of hard plastic chairs in various waiting areas. Then they put me in another examining room, where I slumped against a countertop.

Finally, the doctor came in. “I don’t think I can let you go home today,” she said. Not go home? I made, I think, a confused babbling sound. “Your blood glucose is 395,” she continued, “and you have large ketones.” Guess she changed her mind about running that test. Ahem.

She went on to explain that I might have type 1 after all. I would need to go to a hospital, or to a diabetes center if they could find one that would take me, so that I could be placed on an immediate regimen of insulin.

Aha. NOW I was being taken seriously.

How I got here, part 1

2005-05-08T18:54:00.000-07:00

Several bloggers have recently shared their diagnosis stories. Maybe it sounds strange to say that I’ve enjoyed these, but I have. They are what got us here, after all, and it’s important to tell them and to have them heard. To quote William Bridges as he quotes The Gospel of Thomas (in his incredibly wonderful book The Way of Transition, which I need to reread): “If you call forth that which is in you, it will save you. If you do not call forth what is in you, it will destroy you.”

So here, in honor of my preference for saving myself vs. destruction, is my story.

I had three symptoms of diabetes for a long, long time. This is a strange experience for a type 1, according to conventional wisdom. Type 1 tends to hit fast and furious, putting the recipient in need of emergency care within weeks if it isn’t diagnosed. Quite a large percentage of the medical personnel I’ve talked with aren’t aware that recent research has identified that in some adults, type 1 has a gradual onset that progresses over a period of months or even years. My diabetes probably falls into that category.

I started dropping weight, without dieting, sometime in 2002. I am 5’5” and weighed close to 130 pounds at the time. I worried about the mysterious vanishing of fat but decided that it was a symptom of depression. My dad had died not long before, and it seemed to me that my body was expressing its grief. It didn’t matter what I ate, I still slowly lost a pound or so a month. In a freaky, eating-disorder kinda way, I came to enjoy this oddity. And I didn’t go to a doctor to ask why this was happening to me.

I was seeing plenty of medical types, however, about my other problem, recurrent yeast. Ack. Talk about misery. Eventually, heavy doses of the right antibiotic got rid of it—but I had to stay on the medication religiously or it came right back. It wasn’t really gone; it was just held at bay by a constant influx of meds.

Then I got really, really hungry. All the time, this gnawing fierce need to eat. I’ve always loved food and always needed to eat at rather regular intervals to feel well. But this—well, this was something else. In the morning, at six, I had peanut butter toast and a huge bowl of yogurt. By the time I got to work at eight, I was hungry again, so I had a big bowl of bran cereal with a banana. (Gosh, I miss that.) At eleven I had lunch, followed by a giant cookie or a scone. At two I had a bag of popcorn or a candy bar. Sometimes I had another treat before supper at six. At seven I started the evening snacks. If it was salty and crunchy, I’d eat it. Oh, and I had soda, the regular kind, mixed with some kind of alcohol just about every evening. Easily 3,000 calories a day or more.

But I was still losing weight. Something was obviously very wrong, but I wasn’t used to listening to my body. I looked the other way with the determination that I now try to channel toward taking care of myself.

Then I got thirsty. You know the thirst if you’ve felt it, and if you haven’t, I hope you never will. It's a beast. I remember visiting my boyfriend—this was April 2004—and drinking my glass of water at dinner, then drinking his, then filling them both and drinking them again. And again. At his mom’s house I hid in the bathroom and drank from the faucet because I was embarrassed by how much water I kept asking for. At home, I learned the location of every fountain in downtown Minneapolis—and planned my lunchtime shopping trips based on the availability of water. I bought two gallons of orange juice a week (shudder) plus a gallon and a half of milk. I was never, ever not thirsty unless there was a liquid in my throat. It goes without saying that I spent a great deal of time in the bathroom—because, I thought, I was drinking so much liquid. I didn’t yet know that it was actually the other way around: I was so thirsty because I had to urinate constantly because my body needed to get rid of the excess of glucose in my blood.

My mom saw me that August and told me I needed to go to a doctor. I knew she was right. By the time I managed, in October, to overcome my fright and get myself there, I was in trouble. I had no recollection of what it felt like to have energy, even though I’d added a 10 a.m. power bar to the day’s food supply. I couldn’t climb stairs without losing my breath. Low-grade nausea had become a constant companion.

I was at work on the third day after my blood test, unable to stand the stress of waiting any longer for the results. I put in a call to the doctor’s office. She called back just 10 minutes later. The good news was that my thyroid was fine. The bad news was that my fasting blood glucose was 281. “That means diabetes,” she said. And directed me to another doctor who would be better able to help me.

What do you do with a piece of life-changing information like that? What does anyone do? I have fuzzy memories of calling my boyfriend, calling my mother, my boss walking into my office while I was crying on the phone. And I have a crystal-clear memory of the conviction that my life would never be the same, a conviction that hasn’t abated since.

In which I run very late to work

2005-05-06T08:00:00.000-07:00

This morning I dragged myself out of bed at 5:30 as usual, but for the life of me I could NOT stay awake. I couldn’t begin to conceive of the notion of fixing breakfast, which (along with other opportunities to eat) is normally one of the highlights of my day. I fed the cats, wandered over to the sofa, and dozed off for another hour. When I woke up, I had an annoying headache. I tested. 83.

Hmm. Most of the time when I’m awake, I get symptoms of hypoglycemia at 83. Shakes, sweats, overwhelming hunger, that sort of thing. Of course, meters aren’t perfect, and maybe I was really closer to 90. In any case, all I felt was tired and headachy.

Another strange thing about this 83 is that I can’t remember ever waking up that low. On good mornings I’m at 110-125. Lately, during the April of Unmotivation, I woke up higher that than fairly often.

Sometimes waking with a headache means you went low while you were sleeping. So I’m wondering if I spent part of the night in Hypolandia. Ack. From the descriptions I’ve read, that is nowhere near as lovely a place as Pumplandia.

My CDE (certified diabetes educator) knows I’ve worried about nighttime lows ever since I had one during my first week on insulin. (It wasn’t that bad, but it did scare the bejeebers out of me.) My protocol for bedtime is to test and have a small snack if I’m below 120. The snack sees me through the night without trouble, and I usually wake up around 120ish, an acceptable number for me.

Last night, I was 124 at bedtime, which is awfully close to Snackville. But I wasn’t hungry (for once in my life) so I didn’t eat. Maybe I should have.

I think I need to do some during-the-night testing for the next few nights that I don’t have a snack. Maybe I need to raise the snacking threshold to 130.

Do I need to mention that I am not at peace with the idea of descending into a coma in my sleep? No, I didn’t think so.

Safety and self-worth

2005-05-04T07:40:00.000-07:00

Recently this blog has received some anonymous commentary that gives me pause because it reinforces—not merely empathizes with—anxieties I’ve expressed here about body image. I hate to be unaffirming, as such remarks are quite possibly the genuine writings of people in need of support, and I want this blog to be all about support. But I will not be engaging in dialogue with anonymous posters whose contributions aren’t constructive in some way.

The anonymous comment quoted below falls into a different category. It bears discussion because this writer and anyone who follows her practice IS PUTTING HER LIFE AT RISK:

“Everytime I get in a new realtionship I am so terriofied of exposing my pump. I end up ripping out my infusion set and sacraficing my health. Total self image thing. It is a love/hate relationship with the pump.”

No, no, no. Please do not do this. This is a recipe for DKA, which any person with diabetes should know CAN AND DOES KILL. If you remove your infusion set, have sex with someone who doesn’t even know you depend on a medical device for your very life, and then doze off, you could find yourself 6 hours later in need of emergency medical treatment. And unable to get it because you’re exhausted and ill (or already in a coma) and the person lying next to you has no idea you're even diabetic.

This practice is not only dangerous, it’s entirely unnecessary. You can safely disconnect for a romantic day/weekend/whatever if you return to a regimen of injections that includes basal insulin. (I infer that this poster does not do so because she refers to jeopardizing her health.) This regimen could be in the form of Lantus + short-acting insulin, or multiple shots of short-acting insulin. The key is to work with your diabetes team to determine such a regimen.

All my very heartfelt concerns about intimacy and body image notwithstanding, I would never, ever, ever place myself at risk by compromising my diabetes care in the way this poster describes. Indeed, if you’re engaging in intimacy with a person you don’t know well enough to trust with the sight and experience of your pump, you’re placing your life at risk in another way—by becoming physically vulnerable to an essentially unknown partner. And we all deserve better self care than that.

In which I am my own guinea pig

2005-05-04T06:05:00.000-07:00

Small adventure yesterday: I am eating lunch at work. Cheese sammich, V8 juice, apple. I have dutifully counted, tested, administered bolus. I am a good diabetic, yes I am.

Charlotte, without warning, makes her crankiest beeping sound.

Hello, NO DELIVERY. I remember you . This time the bolus has stopped after 3.8 out of 4.9 units.

I disconnect and study the tubing. Hmm. Looks fine. I see no bubbles or kinks or breaks. Is something wrong with Charlotte? To find out, I dangle the tubing over the wastebasket and do a manual prime. Straight away, my favorite liquid (ahem) drips out.

So. Charlotte is working fine. Must be the infusion set. Boo.

Up goes the “please do not disturb” sign. I thank the gods of work, yet again, for granting me an office with a solid door.

Remove reservoir, rewind, fill new reservoir. Knock the damn bubbles to the top, squirt bubbles back into vial, fill again. Insert reservoir. Prime. Ponder abdomen. Load new infusion set into serter thingie. Ponder abdomen again. Swab. Push buttons. Ow. Manual prime to fill cannula.

I’m getting to be a professional bionic.

Okay, up and running again. Now to remove the old set. Ow. I don’t have baby oil with me to loosen the adhesive. Ow. Stupid sticky stuff. I settle for an alcohol swab.

To my surprise, the old cannula looks just fine. I thought it would be bent or kinked or something that would cause the alarm. Apparently not. And there’s no pool of insulin above the site to suggest that the bolus didn’t make it down the cannula, either.

Hmm. A new dilemma faces me, and it’s far less appealing than the uneaten remains of my lunch. Do I redo the interrupted bolus or not?

A no delivery alarm means, in theory, that insulin delivery has (brilliant, I know) been interrupted at some point. The question is when. Charlotte decided that I wasn’t getting insulin at the 3.8 unit mark. But I might have gotten some up to that point, or all of it, or none of it.

I certainly need at least 1.1 units to finish up the bolus—unless I want to subtract food from my plate. Not an option. As for the rest, I have three options:

1. Assume I didn’t get the insulin and redo the bolus. Problem: if I got the bolus, or part of it, I will go low later. Possibly very low.

2. Assume I got the insulin and take only the 1.1 remaining units. Problem: if I didn’t get the bolus, I will go high later. Possibly very high.

3. Assume I got some portion of the bolus, roll dice to determine how much that portion might be, and take the rest. Problem: see #1 and #2 above. Plus I don’t have any dice at the office.

What would you have done? I picked the least life-threatening of these options, #2. One can always correct for a high later on, but a serious low could leave a diabetic beyond the point of caring, ever again, whether her latest A1C is up or down.

My experiment under way, I finished eating and went for a ferocious walk—which can itself cause lows, of course, but in this case I knew that if anything I was short on insulin. (NB: see, I did repeat the miracle, woo hoo!)

Three hours after the alarm, I tested at 120. Phew.

So why did I get the alarm if nothing was actually wrong? Fellow pumpers have suggested that maybe the tubing was squashed in a funny way under my clothes, or maybe it was a battery problem, or maybe Charlotte was trying to tell me that she wants one of those fancy pump pockets that all the girl pumps are raving about. Could be something else altogether.

Hmm, now where did I put my dice?

One foot in front of the other

2005-05-03T06:08:00.000-07:00

I did it. I went for the walk. This seemingly minor act is all about something much bigger, as anyone who struggles with this stuff knows. It's about overcoming all those forces--exhaustion, entropy, athletic socks left behind at home, depression, stress, the sheer brutal longing to give oneself a break because nothing else in life is, goddamnit--and acknowledging: OK, today is no better day to exercise than yesterday was, but today the costs of not taking care of myself are too high.

Today I will try to repeat the miracle.

Crawling out from under a sugar-coated rock

2005-05-02T06:30:00.000-07:00

Hello, I'm back. Or trying to be. This hasn't been my easiest month of the 6 (ooh, count 'em) since my dx. I've had a lot of stress from various sources, I quit exercising (bad Violet!), and I more or less withdrew from my online existence. Why is it that when bad stuff happens, I lose the energy I need to do the very things that would help me most? Exercise would help; talking & writing would help. Isolation, after the relief of the first couple of days of quietude, does NOT help me. I get lost out there in the big mean world. I succumb to the illusion that I'm on my own with my disease and the rest of my silly life. I see myself as outside the gatherings of like-minded souls, looking in but unable to connect.

That's a lot of self-destructive crap. I am no more alone than I choose to be. So...I'm going to try to write here, or elsewhere in the diabetes community, every day this week. And I'm going to try to walk today. Yes, yes. I can. Small slow walk. I can handle that. I will report back on the results of same. Please hold me accountable, guys.

In which I prove yet again my difficulties with the physical world

2005-04-14T06:59:00.000-07:00

As my friend Scott notes, one of the beauties and perils of the pump is that it obeys its human, to which I would add another: once a person is used to operating it, it's easy. Really, really easy. And things that are easy to do are easy, for a head-in-the-clouds person like me, to forget to do.

Yesterday I hummed along as usual through my morning breakfast-making routine. Tea, check. Toast, check. Peanut butter, check. Oatmeal and milk, check. BG test, check. Carry all to the computer without dropping anything, check. (Is anyone really surprised that I eat at the computer? Didn't think so.) Munch, munch, munch. Happy Violet with her 48 grams of carbs. Just another morning.

Two hours later I did the follow-up BG test: 340.

For many of us, 340 is not an earth-shaking event. It happens for all kinds of reasons: stress, wrong food, certain kinds of exercise, eating too much when you go low and feel like you're gonna die if you don't have cereal NOW. But as a somewhat recently diagnosed type 1, I'm still in the honeymoon period, meaning that my pancreas still makes some insulin. That helps quite a bit with my BG control. I see numbers in the 200s with some regularity, but I don't get higher than that unless something's really out of whack.

So for me, 340 is a freak out, do backup tests on 2 different meters, talk to myself in worried tones kinda number. My first thought was that something had gone wrong with my infusion set. Had Charlotte given me an alarm that I hadn't noticed? No, no alarm. Well, let's try a correction and see what happens. I'll just check to see how much insulin Charlotte says is still in my system from breakfast--

Oh. Charlotte says there is no insulin in my system from breakfast. Well, that's just not possible. I took 8 units 2 hours ago, so there should be at least--

Oh. Charlotte says I didn't take 8 units 2 hours ago. She says I didn't take ANY units 2 hours ago.

She says, in fact, that I haven't taken any insulin (except my usual ongoing trickle) since last night.

Oh.

I forgot my breakfast insulin.

Hello? Earth to Violet? How do you FORGET a life-sustaining drug?

Well, if it's in the form of a shot it's a lot harder. One tends to notice the whole stabbing-one's-abdomen thing, or the absence thereof. But with Charlotte all I have to do is push a few buttons. And in yesterday's oatmeal-induced bliss, I just never pushed em.

340, by the way, turned out to mean a day of nausea and sleepiness. Plus, not surprisingly, a rebound low when I overdid the correction...

In which I get over myself, for unfortunate reasons

2005-04-07T21:30:00.000-07:00

Well. I’m not sure what to say here about my visit with Mr. Brooklyn because it was so packed with intense, unexpected events that my anxieties re: Charlotte fade to nothing in comparison to the non-Charlotte-related things that actually happened. That’s not meant dismissively; the anxiety was a big part of the trip, even though Mr. Brooklyn’s reactions to the pump proved to be much as the kind commenters predicted below. He was utterly unfazed by any aspect of my bionicness—so much so, in fact, that I wondered if he was pretending. Nope, he wasn’t.

So: three cheers for Mr. Brooklyn, yay yay yay! But to my surprise, I nevertheless still had to overcome my own hang-ups about how I feel about my pumping self (damn). I thought they’d evaporate once I knew he was okay with dating a cyborg. In a twisted way, I guess I should celebrate my independence: my conflicted self-esteem is dependent on my OWN feelings, not those of some man! Ha!

Hmm. A dubious victory at best. Anyhow, the aforementioned intense, unexpected events, beside which the body image issues seem pathetic and laughable, are all off topic for this blog except one: Mr. Brooklyn appears to have prediabetes. I say “appears” because we made this discovery through the scientifically invalid process of testing him with my meter. Home BG meters are nowhere near as accurate as laboratory bloodwork. I’ve read, though I can’t recall where, that a home meter can be off as much as 5-10% in normal circumstances, i.e., when the meter is working as it’s supposed to. So it’s an unsound practice, generally speaking, to randomly test your loved ones and conclude that they have medical problems based on those results.

That said…we tested him a lot over several days—fasting, postprandial, etc. And he was well into the prediabetes range for whatever test we did (see the above link to ADA info for those ranges) every time except one, which was slightly into the diabetic range. Given that my meter and test strips appear to be working fine, I think there’s a serious likelihood that he’s prediabetic. In fact, even subtracting a 10% potential error from every test we did, each result still falls into the prediabetes range. Not good.

Those familiar with type 2 know that finding out you have prediabetes is a hell of a lot better than the alternative, which almost inevitably is finding out—often years later, with the onset of complications—that you have the real deal. Prediabetes is a sort of metabolic godsend in that if you take action, through exercise and diet modification, you MAY be able to “prevent or delay” (that’s the ADA again) the onset of type 2. So Mr. Brooklyn has here a warning sign, and if he responds by changing his lifestyle in significant and rather painful ways, he might not develop type 2. That makes him a lot more fortunate than the 16 million Americans who already have it.

OK, there’s the logic. Now the emotion: I don’t feel fortunate and I don’t feel that he’s fortunate either. I am SICK of diabetes affecting me and my people and zillions of other folks as well. I am pissed and frightened and tired. He doesn’t deserve this any more than I deserve my type 1. I want it all to go away. Right now.

I also want, with terrifying fervor, to control his response to this situation, to ensure that he does what needs to be done in spite of how horribly difficult it will be. I can’t do that, of course. All I can do is support him—from very far away—and hope for the best. And realize that we'll deal with it together, if it comes to that.

I'm Too Sexy for My Pump, Part II

2005-03-29T07:49:00.000-07:00

One of the curious and not very likeable aspects (and there are many) of being in a long-distance relationship is that you may find yourself attached for six weeks to a medical device that your beloved person has yet to see. Such is the state of events in Pumplandia, as I last saw my fella the day before I hooked up with Charlotte. This is about to change. I’m off to NY on Thursday, and Charlotte, it goes without saying, will travel with me.

So. Hmm. In a perfect world, this voyage would be without pump-related tension for me. I would be perfectly reconciled to my slightly altered body image, feeling brilliantly attractive, and well equipped with a bevy of pump-compatible girlie outfits. I would be brimming with confidence in my natural sexiness and its ability to carry the day over the, um, visual distractions posed by the infusion set, tubing, and adhesive. But in the imperfect world of diabetes as it intersects with my personality, I only feel/have each of those four things a little bit, some of the time. None at the moment. Even my clothes seem ugly today.

Let me interject at this point that Mr. Brooklyn is and has been as affirming, encouraging, and supportive of my journey into Pumplandia as any partner could be. He has told me in a dozen ways that he isn’t troubled in the least by the concept of those “visual distractions.” I believe him. But I also believe that he can’t really know that for sure, can he, until he sees what I look like with an infusion set stuck in my tummy. Argh. So even though I know on an intellectual level that any worthwhile partner, which Mr. Brooklyn certainly is, would be accepting of the pump, I’m still more distressed than I care to admit.

I keep meaning to post about my experiences telling a coworker about pumping. The exchange reminded me of my own initial feelings about it, when I first heard about the possibility during a period of post-diagnosis shock. Truth is, I was, on an involuntary and visceral level, revolted by the idea of having something attached to me and entering my body. This is hard to acknowledge openly because the last thing I want to do is contribute to anyone’s negative feelings about the gizmo, particularly a prospective pumper (e-mail me!) who is trying to sort through those emotions and needs support. Perhaps for this very reason, I have yet to talk with a person who has a pump who has openly said, yeah, there is something a little gross about it at times, even to me. But that feeling was, for me at that time, a fact. This is the involuntary reaction that I fear in my sweetie, who despite being a very good man cannot help what his brain does with a piece of visual data.

What changed that reaction for me (most of the time) was information. I got to know people who were using pumps, had none of those feelings (or if they had em had dealt with them already!), and were realizing tangible health benefits. And I got a look at actual pumps and infusion sets and decided, okay, I can cope with this. And, maybe most of all, I decided through research that there was an important relationship between my going on the pump and preparing to someday get pregnant and have an optimally healthy pregnancy & baby.

But, as we see, some of the difficulty lingers for me in spite of the progress I’ve made. Honestly, I do believe that my relationship will make the transition just fine. I just wish he had been here, or I there, from the start.

[Insert arse-related pun here]

2005-03-22T21:38:00.000-07:00

I know that deep in your gentle diabetic hearts, what you guys have really been missing since I went offline is further discussion of the relationship between Charlotte and my butt.

Admit it!

Never let it be said that I’ve disappointed a hopeful readership.

Context: During my sojourn outside cyberspace, I got to set change #10. (Woo hoo! Double digits!) Each spot where I place the infusion set, according to my CDE, should ideally have 30 days to heal before I reuse it—

Wait. Reuse? I am reusing myself?

Deep breath. Repeat: I am a woman, not a receptacle for a medical device. I am a woman, not a receptacle for a medical device.

OK. Let me try that again.

Each spot, according to my CDE, should ideally have 30 days to heal before I revisit (ah, better) that location to prevent the buildup of scar tissue. Since I change sets about every 3 days, I need 10 sites to allow for the healing.

Well, I did the ring around the belly button (6, but 1 was the gusher and therefore gave me 3 seconds rather than 3 days but still (I assumed) needed time to heal) and then the squishy above-the-hip love handle spots (2) and then some random sites between the love handles and the belly button ring (2). And that was it. Nine usable sites and I had nowhere else to go.

There are the legs, but I keep hearing that absorption is not as good from the legs—except when one exercises, at which time it can be all TOO good. Hmm. Which to sacrifice: good control or the butt? Control or butt?

I chose the butt. Ow. Ow. OW. I was right, damn it, it DOES hurt more there. (Jeff, maybe your butt has toughened up from years of this kind of abuse???) I tend to have about 2 minutes of stinging at a new tummy site, usually very mild. But this time I felt like a wasp had had its way with my poor hinder. For 3 minutes at least. Three!!! Ow.

And then I was fine. And the set turned out to be perfectly comfortable. And I got the same control as usual. And I felt like a major whiner—until I discovered that more than half my wardrobe is incompatible with the butt site because it SHOWS through soft fabrics. And then I felt like…well…a receptacle for a medical device.

I’m back to the belly.

Return to Pumplandia

2005-03-21T21:21:00.000-07:00

Hello hello! My, it's good to be back. Here are a few things I learned while banished from cyberspace:

1. I'm way too reliant on the Internet for support, information, entertainment, and mind-numbing distraction.

2. Printed materials (yeah...those papery things...the ones with ink...) provide three out of four of the above very nicely.

3. There's no replacing the support. Missed all you cyberpals, your writings, and your wisdom.

4. That said, I am weirdly happier with a less constant influx of diabetes-related info. It's data I'm talking about: diabetes causes this, causes that, might someday be cured via this that or the other, etc. etc. I used to read diabetes news and research every day, half an hour or more each day. I thought I was helping myself by adding to my knowledge. After all, information = empowerment, right? No one could have convinced me otherwise. Then, rather to my surprise, my spirits took a strong upturn when computerlessness forced me to give up that reading.

Am I better off in the dark? I don't believe so, at least not theoretically. I would never want to become ignorant about the disease or about how to care for myself, how to be a strong self-advocate through the health care system, etc. But I wonder if a continual influx of information, much of it negative, is truly helpful for me. Right now I'm experimenting with a narrower focus on self care, leaving aside for the moment the data gathering. I'm trying to read more for pleasure than for diabetes info. I'm trying to surround myself with things that enhance hope.

As for Charlotte and me, we're humming along pretty well. Not perfectly, but well enough. More to come, of course...

Pumpiversary

2005-03-03T00:37:00.000-07:00

Is anyone tired yet of my habit of forming compounds with the prefix “pump”? No? Yay!

God, I love cyberspace. By the time anyone talks back, I’ll be busy reading someone else’s blog...

Today marks 2 weeks of bionic life for Violet. That’s 14 days, 4 set changes (not counting the, ahem, unconsummated attempts), 88 test strips, and 58 uninjected injections. 58! I actually lost count along the way (probably a good thing), but I retallied just now and it’s 58. It is Very Good to not put 58 holes in oneself.

Saw CDE this morning for Pumpiversary celebration. We talked, as we tend to do of late, about my butt. She understands. In fact, she thinks I should try the 6 mm again on the tummy. Is a little worried that with the 9 mm I may be hitting muscle tissue, which causes the insulin to absorb too fast & also causes increased discomfort. While she still says that the 6 mm tend to bend more, she thinks my trouble may have really stemmed from nervousness. (For those unacquainted with the language, that’s Tactful CDE for “It bent cause you put it in wrong, you foolish, clumsy diabetic!”) I’ll have to have some 6 mm sets sent if I want to try them, as I just received a shipment of approximately One Million 9 mms from the good folks at Minimed.

Amy, in a comment below you allude to infection worries. Yes. I’ve had no trouble with this so far; I use the IV preps that Minimed sent me but otherwise take no special steps to avoid infection. Well, I avoid putting peanut butter or cat hair in the infusion set. Does that count? When I’ve taken out my sets, there’s a tiny bump at the site that vanishes within a couple of hours. Discussed this today with CDE after we talked about my butt. She says not a problem unless the bump is the size of a nickel or bigger, or is hard, or doesn’t go away. Some folks do have trouble with this; for them, she prescribes some germ-killin stuff (forgot name) to be swabbed on the skin before the set goes in. CDE is a strong proponent of the 3-day set change to stave off infection, but as others have testified, many go longer with no issues.

In other news, my computer at home has died. Rest in peace, noble grape iMac. I hardly knew ye. (Actually untrue: it lasted 6 years, wow.) If readers are now inferring that I am posting illicitly from my office, they might be correct. Might. I confess nothing! The reason I allude to this at all is that I will have a few days of relative quietude, perhaps, while I resolve this problem. Will try to stay in touch.

Owie

2005-02-28T21:00:00.000-07:00

Well, this set change thing is just as cyberpal Lori (http://brokendump.blogspot.com, why oh why can't I make an HTML link work here?) observes. Some of em are fine and some hurt like the heebie jeebies. So I have a safe, contented tush, but in exchange got the ouchiest set change so far. Maybe a little too high on the tummy, maybe just bad luck. It seems okay now.

Someday the day-to-day events of my life that seem worth recording will have a lot less to do with my ass. I hope.

Jeff, you are so helpful and I will truly continue to ponder the hinder. Err...well, you know what I mean. Thanks so much.

Kathleen, hello, thanks for posting. Yes, nighttime set change, definitely bad. My CDE says I can do a change early in the evening, though, allowing enough time for BG checks before bed. In this case, I had 4.5 hours, which I figured should be time enough to troubleshoot and correct if needed. Of course, if I had to do a replacement set change at 8 p.m., I'd be up kinda late...Right now it's just hard for me mentally to manage it before work, given last week's trouble. I imagine that when I get used to all these processes I'll switch back to the morning.

Finally, a quick plug for a new diabetes blog, www.diabetesmine.com. Let's all say hi to Amy and encourage the posting bliss to perpetuate...

You Want Me to Put That WHERE?

2005-02-28T17:39:00.000-07:00

Can a person be faulted for not wanting to stab herself in the butt with an infusion set? I think not. No, no person can be rightfully blamed for resistance to a needle in the ass. The butt is, well, sensitive in multiple ways. (Hmm, does that sentence win me a prize for Most Bizarre Blog Statement Ever? How about Most Obvious? Most Wow-Did-You-Really-Have-to-Write-That?)

So: I am faultless in my earnest wish to spare my derriere. Yet it is this very location that my CDE (Certified Diabetes Educator) has recommended for my next (that is, 1 hour from now) set change. Ack. It’s not unheard of in my very limited pumping experience. Cyberpal Jeff N. is a butt stabber (no offense, Jeff!) who fully endorses the practice. And the idea did come up when I first met with the CDE for training. Came up and was promptly dismissed by me. Very promptly.

The problem unfolds thusly: Being a skinny type, I have a little bit of discomfort with 9-mm infusion sets in the abdomen. But when I use the gentler 6-mm sets, I tend to wind up with a bent cannula (reference the gusher post below, ahem). So the CDE says that bending is more likely with the 6-mm. Hence she thinks the butt + a 9-mm set sounds ideal for me. Plenty of fat there!

There are so many things about this that suck so much that I don’t know where to begin. I am not ready for the butt stab.

Boudoir de Pump

2005-02-28T08:28:00.000-07:00

The search continues for a comfortable way to sleep with the pump that (a) protects the tubing from cat attack, (b) does not involve shorts or pants, which I find uncomfortable, and (c) does not make me feel like a fugly matron.

The experiment of the weekend involved sleeveless nighties. The pump can be clipped on the armpit—I put the pump inside, against the body, so that the bumpy clip faces out. Of course, depending on how you sleep, this may be uncomfortable. I like to sleep on my tummy, so it sometimes worked pretty well for me. Results varied depending on the nightie material—if it’s too flimsy or lacks a decently thick seam, the pump creates a gigantic sagging armpit hole and also flops around. Now THAT’S sexy…

Today, on a different note, I’m experimenting with changing the set after 3.5 days rather than 3. I have plenty of insulin in the reservoir and the set feels secure; the main question is whether I’ll experience icky skin irritation from pushing the timeline a bit. It’s not so much that I loathe changing the set (though this is not, as noted below, an enjoyable leisure activity); it’s that I’d like to change the set after work rather than before. Hence the need to push it back a few hours today. Am guessing this will be Not a Big Deal.

Practice

2005-02-25T09:33:00.000-07:00

This is so obvious that it’s embarrassing, but then again that emotion is a motif of this blog, so what the hell. After the debacle that was Tuesday, cyberpal tippytoes pointed out to me that you can practice pushing those two stupid buttons on the set insertion device. All you have to do is pull down on the spring-loadie thing and, um, push the buttons. It works even though there’s no infusion set in the device.

Well, duh.

Seriously, I never even thought to try this. I had a list of steps and I was afraid to deviate from it because...yeah, because I’m not so good with the physical world! Hee hee. So. This morning is once again a Time for Change. I decide to practice. Almost immediately (impressive, I know) I make the groundbreaking discovery (ahem) that not only can I practice pushing the buttons, I can even put the serter on the spot where I plan to place the new set and practice at the exact angle I’ll need to use for the set change! Wow!!!

Many, many button pushes later, I change the set for real. I am thinking: Push the buttons at the same time. Push the buttons at the same time. I push the buttons...at the same time.

Thanks for the tip, tip.

Better

2005-02-23T09:27:00.000-07:00

After yesterday’s outpouring of angst (among other things), it seems important to record that the last 18 hours have been better. I am getting good numbers, have heard no unusual noises from Charlotte, and haven’t seen my own blood since yesterday. Woo hoo.

I also think: hmm, that was bad, but I handled it, albeit in my fuddly INFP way. It appears that I can cope. Any day when that sentence holds true is a pretty good one in the twisted universe of diabetes.

Change Is Bad, or, I Destroy Many Infusion Sets, with Blood

2005-02-22T13:10:00.000-07:00

Have I mentioned lately that I’m not so good with the physical world? Yes? Good. Allow me to illustrate.

Set change this morning before work. I put out the supplies, try to fill the reservoir, rewatch training video, fill the reservoir, try to prepare the infusion set, rewatch training video, prepare the infusion set, ponder my abdomen (pumping gives a new twist to the term “navel-gazing”), swab. I am good to go. It’s a little complex because I want to use a 6-mm set, but the only one I have left has 43-inch tubing, and I need the 23-inch tubing, which is attached only to my 9-mm set. So I must attach the 23-inch tubing to the reservoir, attach the 6-mm set to myself, then swap the one for the other.

If you followed that, you have my empathy, as you must have diabetes.

Infusion set count: Two.

Quick-Sets can be used with a handy spring-loaded insertion device (called a serter in aren’t-we-cool-NOT diabetic lingo) that spares the user the terror of driving that thick creepy needle directly into the body. You plop the set into ther serter, remove the sticky tabs, pull down on the spring-loadie part, and off you go. Only something goes wrong. When I pull down the spring-loadie part, the sticky part of the set gets stuck to the serter. In my attempt to free it without impaling myself on the needle I make the problem worse. Soon the set is stuck to itself as well as the serter. I rip the whole thing apart and start over.

Set count: Three.

The serter has a button on each side. You have to press the buttons simultaneously to get the set to go in properly. If you don’t, the cannula might bend, which would be Very Bad. No insulin for you, clumsy diabetic! As a longtime video game addict, I ought to be very good at this button pushing. Not so. I seem to lock up and do it wrong every time. This time, for example, I feel myself pushing the buttons a millisecond apart. But the set goes in fine, and upon removal of the leftover parts I see that the needle is not bent, a good sign according to my trainer. I pat myself on the head and trot off to therapy (ahem, no wonder).

Two hours after changing the set, you are supposed to check your BG. I do so while sitting opposite my therapist, who has learned quite a lot about diabetes since October. 150, seems reasonable. I trot off to work.

Lunchtime. I am chatting with my friend Vicki, to whom I have proudly showed off my pump. I check the BG—163, hmm, that’s a smidge high, but isn’t it cool how Charlotte will calculate the correction I need—punch in the numbers, and sit back while she delivers my bolus. Ah, pumping. So much easier than injections.

BEEP BEEP BEEP BEEP BEEP BEEP.

Charlotte has never spoken to me this way before. I take a look. (Good thing the pump isn’t in the thigh thing today. Ahem.)

NO DELIVERY

Uh-oh. I remember the unmatched button pushing. But I am prepared. I can change the set right here at work. Vicki makes a graceful exit. I place do-not-disturb sign on office door. Suspend. Disconnect. Pull out cannula. It’s a bit liquidy, eww. And the needle is bent at a 90-degree angle. Ah, clumsy diabetic. Not Charlotte’s fault at all.

Set count: Four.

I put my backup set in the serter, ponder abdomen, swab. I am thinking, push the buttons at the same time. Push the buttons at the same time. I push the buttons, not at the same time. The needle goes in. I start to pull the serter off, but something is wrong. It’s not pulling off the set like it’s supposed to.

Oh. I forgot to remove the sticky tabs, so the set is not attached to me. Moron.

It is impossible to remove the sticky tabs when the set is on top of a needle which is already in my belly. I am a little fuzzy on the next details, but I manage to remove the set—along the way it separates from the needle—and then the needle, upon which a veritable river of blood gushes forth. I do mean a river. And I do mean gushes. Much more blood than ought to ever gush from such a tiny hole.

I and my skirt sop up the blood. (At least I wore dark denim.) This was the only set I had at work. I guess I could switch back to injections for the rest of the day. Bah.

Then again, the cannula isn’t bent. Nor is the needle, though it is now stained a charming scarlet. This is probably Very Bad Behavior, but I reassemble the set, grit my teeth, remember to remove the sticky tabs, ponder abdomen, swab. I am thinking: Push the buttons at the same time. Push the buttons at the same time. I push the buttons, not at the same time…

Midterm Report Card

2005-02-21T07:21:00.000-07:00

Today’s big news is that I have gone 36 hours without a low. Woo hoo! I had, hmm, something like 6 lows in the 3 days before that, though none under 60. The only thing that I’ve changed, per my clinic, is the basal rate (from 0.30 to 0.25) and the addition of a bedtime snack when I’m below 120. Actually, I had some of those lows even after lowering the basal, so I’m not confident that I’m entirely out of the hypoglycemic woods yet. But it seems like progress.

I haven’t been exercising, though. This was a conscious, if seductively lazy, choice related to the pump start. I didn’t want to throw in yet another variable before the basals were worked out. So one goal for this week is to start wandering the habitrails (Minneapolis skyways) again.

Numbers: fellow diabetes blogger Scott (my attempt to create a link isn't working, bah, but try http://scotts-dblife.blogspot.com) asked how my grades—err, my BG levels—have been since the pump start. Thanks for saying hi, Scott :-) Given the prevalence of lows, my numbers have been, well, low. I’ve been anywhere from 76 to 120 fasting. One of the things about my CDE’s instructions that surprised me is that she isn’t having me check my 2-hour post-meal numbers. Not necessary, she said, because we already know that my carb ratios work. Hmm. As I’m typing this, I’ve realized that I think that’s hooey and I should have been checking those numbers all the time rather than just when I feel low as I’ve been doing. I have a serious neurosis when it comes to finding my own mind when interacting with medical people. Both the CDE and the dietician at my clinic have made subtle references to my being over-intense w/r/t checking too much and obsessing over my numbers, and I think I’ve internalized that a bit. Of course, neither of them are diabetic. Humph.

Anyhow, I’m not sure how good the post-prandials are, but the pre-prandials have been around 90-135. I got a 168 (oh horrors) one night after I overtreated a low. So…if not for the lows, I’d say these are pretty dreamy numbers. I feel very fortunate. (Thanks, Charlotte.) Put that report card on the fridge!

Change Is Good

2005-02-19T11:03:00.000-07:00

I did it! I changed my set. Details of the physical world not being my strongest area, I am proud. Happily, the videos on the CD that came with my pump were quite helpful. (I found it interesting that Minimed’s online Pump School doesn’t include infusion set videos, while the CD does. Safety precaution maybe?) I’m trying out the 9mm option to see if it’s comfortable; so far, so good. Best of all, that creepy smell seems to be gone, yay yay yay!

Note to self: next time remember to check which way the tubing is pointing before inserting the set…toward the belly button is a somewhat awkward direction! The CDE showed me a sample of a new set—if memory serves, it’s the forthcoming Clio for the Cozmo—that can be rotated so that the tubing can face whatever direction you like even after insertion. That’s an awesome feature, and I hope Minimed will pay attention.

I have also named my pump. She is called Charlotte, mainly for one of my favorite characters in all of children’s literature—the clever, compassionate, bold, creative spider of Charlotte’s Web. Charlotte is a name I wished I’d been given when I was a kid, along with various other girlie names. (I also used to want a nickname, and I liked Lottie for reasons I can no longer fully recall…) I like how it’s feminine yet strong and practical-sounding, very much how I want to imagine my pump. Seems to suit her.

Sniff sniff...

2005-02-18T07:18:00.000-07:00

I smell insulin.

Bad.

There's no problem with the pump or my infusion site. I'm definitely getting insulin--in fact, a little too much; my CDE is helping me adjust the basal rate downward a bit because I've had some lows. I seem to also need a lower basal at night, weirdly, as I went to bed at 103 and was at 83 with shaking for my 2 AM test. Ate a glucose tab (just one, didn't want to overtreat) and woke at 76. I get hypo symptoms in the 70s quite commonly, so we'll have to fix that.

Anyhow, the insulin is reaching me for sure. Why the smell if the connection is okay? Is this an evil pumping thing no one told me about? Am I doomed to reek of Eau de Novolog for the rest of my pumping days? Ack. Talk about a body image issue.

I HATE the smell of insulin. It is, imho, a foul, medicinal, diseasey smell. I'm sure that no one else could smell it on me, probably, except my sweetie (and even he can't smell it from 1200 miles away). But I can smell it. It's nasty. I wonder if some insulin oozed out of the tubing when I was disconnected for showering, maybe, and then got on the tape or something when I reconnected? Pumpers, help. Tell me this is a fluke, please.

Other than this and the itty bitty low, I had a better night last night: pinned the pump inside a roomier T-shirt so it wasn't squashed up against me every time I moved. Also, by folding down the top of the baby sock and pinning both layers I fixed the flopping problem.

My life right now is very, very practically focused. This isn't my normal mode of being--though it has become more so since I got diabetes--and I find it interesting to consider in an abstract way. Like it or not, this experience does ground a person in the body. I'm more connected to my physical self than I've ever been.

Since I started pumping, I've not taken 7 shots that I would have otherwise needed. Unbelievable.

I Become Pumpgirl

2005-02-17T04:42:00.000-07:00

You could express it this way: Tonight I ate dinner for the first time in almost 4 months without giving myself a shot.

Or this way: Tonight I went to bed for the first time in almost 4 months without giving myself a shot.

Or this way: I am Pumpgirl. Hear me beep!

It’s happened at last. I’m pumping. I’m a pumper. I pump. (Picture Bill Murray in “What about Bob?” as he braves the waves, bound hand and foot to the mast: “I’m sailing! I SAIL!!!” That’s me.)

It’s surprisingly difficult to put words to the moment, to tell the truth. The reason I’m trying to do so in the middle of the night is that I needed to wake up at 2 a.m. to test—the idea being that it would be good to know if my pump’s basal rate is sending me crashing into nighttime hypoglycemia, which I am pleased to report it is not—and I can’t go back to sleep for the life of me. I’m much too wound up. Everything is new again. Or newish. Still diabetes, of course, but with a twist. Like diet coke with lemon (semi-obscure cultural ref: this is how Marge Simpson describes kissing the Pie Man, who is of course Homer in his superhero costume).

Biggest Fear Unrealized: that I would feel, as articulated in somewhat mortifying detail below, not quite as feminine as I hope to. So far I actually feel—drumroll please—just as I did before. The set and the tubing aren’t gorgeous, it’s true, but they’re also not overwhelming in a visual sense. Nevertheless, I did stop at Global Village to buy myself a girlie (& pump-friendly) outfit on the way home from my pump start appointment. I also did my nails, LOL, which did not turn out well.

Second Biggest Fear Unrealized: that putting in the infusion set would hurt like heck. It actually felt just like a shot, one of the slightly-ouchier-than-average ones. For the technically curious, I’m using the QuickSet, 6 mm, 23 inches—I got a few samples from the CDE based on her thinking that I’m too skinny to be comfortable with the 9 mm. (My current supply from Minimed is 9 mm, which I may exchange, though I’ll probably try one when I change the set.)

Third Biggest Fear Unrealized: that I’d run low at night and not wake up. My sweetie called right on cue and talked to me while I did my test. Yay sweetie! I was at 90. Yay pump!

Biggest Fear Realized: that I wouldn’t be able to sleep. The darn pump-in-the-baby-sock contraption, currently pinned inside my nightshirt, is a bit annoying. The pump stretches out the sock and dangles down and flops around, for one thing. But that can be fixed by putting the pump in something less stretchy, such as the cute pump pockets I’ve seen online. Or I’ll try a nightshirt with a pocket & cut a hole on the inside for the tubing to run through. Actually I’m guessing the sleep problem is more emotional than physical tonight; I’ll just need to experiment with different ways of handling this.

Biggest Fears Untested (well, the rated-PG ones): Will I remember how to change the set? I’ve already gotten fuzzy on the details. Thank goodness there are videos on the online Pump School. How will I do at the business lunch I have to attend (why, oh why) later today? Also, will I retain poise in explaining the pump to coworkers? It’s not going to be visible, generally, but I know it will come up sooner or later. A topic for another post.

Thing I Haven’t Done Yet: picked the name. I need to spend a little more time with the pump first. I feel that the right name will soon become clear.

Rating for First 12 Hours of Pumping: 9.2 out of 10. It rocks. I’m so glad I did it.

Arrival!

2005-02-03T22:21:00.000-07:00

It’s here! Yay yay yay! Quite a sensation to open the box at last; felt like I was lifting the lid on my future. The pump is quite purply, much darker than the color shown on the Minimed website (well, darker than my monitor indicated, anyway). It’s very pretty, plumlike. I am inundated also with supplies and reading material. The BG meter is back-ordered though, booooo hisssss. Haven’t these people caught on yet that I am Not Patient?

Naturally I’ve been practicing all night—I’m not hooked up yet, of course, and there’s no insulin in the pump, but the functions work. I loved the drama of putting in the battery and watching the pump come to life. A mildly Frankensteinian moment, if you will. Also I was surprised by the appearance of the backlight, which is beautifully eerie. (Am I romanticizing? Uh-huh. But honestly, how often does UPS bring me a truly life-changing present?) The menus are simple and intuitive; so far I’ve learned to do simple boluses and basal settings, check the history, suspend and resume delivery—the easy stuff. The pump makes a very pleasant beeping sound, friendly in tone and not terribly loud.

Figuring out how it works is all well and good, but my preoccupation is—no surprise here—how to wear the gizmo. I tested the Thigh Thing, which is a spandexy band with a pocket to hold the pump. Not bad. Requires a garter belt to hold it up, ooh la la. Currently I have the pump in a sock, safety-pinned to the inside of my pajama top. I experimented with lying down on it; seemed okay. There are several places online where one can order nightshirts and jammies with sewn-in pockets to hold the pump, but for now I’m holding off until I have a more practical understanding of what I want.

Pump name is still pending. But I’ve already started talking to it…

Pumper's Remorse?

2005-02-02T08:14:00.000-07:00

Okay, I'm not a pumper yet, so I guess I can't have pumper's remorse. Pre-pumper's remorse? I'm terrible at waiting for big changes, very fretful and anxious. What if what if what if. Whatever. Ack.

One of the things I'm nervous about is that I live alone--my boyfriend is waaaay across the country--and I'll be starting the pump without someone here to help me. This has been a difficult aspect of my diabetes management all along--e.g., I worry about going severely low when I'm alone, though it hasn't happened yet. I'm sure the pump start won't be as scary as I imagine, right? It ain't brain surgery. Today it seems daunting, but I learned MDI quickly, and I'll learn this as well.

Limbo

2005-01-31T20:46:00.000-07:00

Just waiting, waiting, waiting now. My pump was supposed to ship today, but I'm not sure whether it really did.

The only thing I can think of that this feeling reminds me of is half my lifetime ago, when I was waiting for the day I would leave home to go to college. It's a similar combination of excitement and trepidation, a similar anticipation of big big change. Going to college was more all-encompassing, of course. But then again, diabetes is (for me, for now) so all-encompassing that starting the pump feels rather comparable in scope. Life-changing and all that. Or so I hope.

Name That Pump!

2005-01-28T18:48:00.000-07:00

Pursuant to the post below, and also to get it off the top of my blog :) I thought I would say a bit about my pump-naming aspirations. It seems to me that I'll need to meet my pump before naming it, but the current front-runner is Jamie. What child of the 1970s could forget the beautiful, intrepid Jamie Sommers, television's own Bionic Woman? (Actually, her name was spelled Jaime, but I'm adapting it because I once knew a Jaime--and he was a Latino guy, not a bionic chick...) Anyhow, it seems appropriate for a soon-to-be bionic woman to name her pump after THE Bionic Woman.

Also high on the list, on a very-different-yet-somehow-the-same note, is Brigit. This one is borrowed from Celtic mythology. Brigit is a Triple Goddess; her three aspects include creativity, fertility/healing, and battle (especially the creation of weapons). Wow, talk about a powerful female archetype. I am most impressed with how Brigit brings together such divergent aspects of femininity. I like how this name would link my pump with qualities to which I personally aspire. Well, not so much the weapon making...but you get the idea. Strength.

I also really dig the name Audrey, as well as the most famous Audrey I can think of, Audrey Hepburn (and the less famous Audrey Toutou, who is often compared to the former). So I've thrown that on the list as well.

Nominations for other pump names are welcome...

I'm Too Sexy for My Pump, part 1

2005-01-28T08:41:00.000-07:00

I say “part 1” because this is a Big Huge Issue for me, and it will be an ongoing one as I continue down the pumping path. It’s difficult to write about. Body image stuff is hard for everyone I know who has been brave enough to acknowledge it out loud. I’m no different.

For me, the biggest challenge in starting the pump is that it feels--at least for now, pre-start--disruptive of my sense of myself as a woman. Well, in certain ways. I fully embrace the notion that there are many ways to be feminine, or masculine, or both, and any given person can embody those energies in positive ways that are highly individual. What I’m referring to is a very personal sense of femininity, my own deal. YMMV and I hope it does, as variety is part of what makes us humans so cool.

I’m fairly girlie. I like long, flowy fabrics and stuff with lace. I’m a skirt-wearing chick. There are a variety of reasons for this, and I go other directions at certain times. It’s not about buying into a traditional viewpoint on gender at all. It’s about what speaks to me aesthetically and what feels authentic, more like my true self, if that makes sense. It’s how I feel most attractive, a primal thing really.

Enter the pump. Oh dear. It is just not an inherently feminine creature. It can be cute (see the Cozmo) or cool (see the Animas) or just kinda there (see the Minimed, my choice). It can, happily, be many colors (mine will be purple). But it cannot be girlie. It just isn’t. The infusion set is not a lovely thing. The tubing ain’t pretty either. Indeed, these aspects of the pump have an expressly ungirlie feeling to me. They medicalize the body in a way that I’m finding difficult to reconcile myself with.

Happily, there are many, many practical and spiritual counterpoints to this problem. I have found at least 8 websites that feature pump accessories, some handmade and quite creative, to dress up and/or conceal the pump. I’ll be doing that at least some of the time. And you can, of course, disconnect from the pump for sex. But I’m more concerned with the overall picture, how I feel about my self-image when I’m wearing the pump, as opposed to sex itself. A cyberpal on the Salon Table Talk forum Pins and Needles pointed out, when I raised this question in a tongue-in-cheek way, that anybody with good BG control is much more likely to “sparkle,” hence to feel and look sexy. This seems quite true.

I’m working at revising and reframing my sense of the pump as ungirlie. One helpful aspect of my situation is that I have an inherently female motivation in starting on the pump, which is that I want to obtain the best possible control in order to eventually, I hope, have a healthy baby and be a healthy mama. Can’t get much more feminine than that in my book. Hence my pump will indeed embody female energy for me, as it will help me on my journey to motherhood. So I am thinking of it in a personifying way, as a powerful female entity, and I am planning to give it a name that reflects this energy. (Kinda New Agey, I know, but names hold such power.)

Beyond that, I’m still at a loss. I see this as evolving issue that’s sure to change once I actually start the pump.

Delay and Irony

2005-01-28T08:01:00.000-07:00

My start date has been moved to 2/16, boo. I was aiming for 2/7, but I’m doing some cross-country travel that week, which makes hooking myself up to a life-sustaining electronic device for the first time not such a good idea. The pump is supposed to ship on Monday, so I’ll have it for quite a while before I start using it.

Weirdly, since ordering the pump I’ve had my most stable blood sugars yet. This may be because my clinic switched me to Novolog, which seems to do well in my system. But I’m bemused that having invested in a major (and not at all cheap) lifestyle change in pursuit of good control, I’m now getting…good control. Huh.

Nervous

2005-01-25T07:00:00.000-07:00

If all goes as planned, I'll be starting in 13 days. I had quite a flurry of excitement while I was researching pumps and choosing the right one for me (Minimed Paradigm 515). I was even irritated over having to wait a Whole Three Weeks for my pump start.

Now I feel differently. I'm still up for it, etc., but I'm a little bit wigged out. The name of this blog notwithstanding, I know that pumping isn't gonna be a freakin paradise. I'm not sure I have the energy for another major lifestyle change, following so closely on the heels of the diagnosis, which was 3 months ago this week. Last week, I was sure that I did have that energy, and I imagine that next week I will be again. But today, hmm.

The thing is, it's still diabetes, period. I can't research or purchase myself out of it. Ever. And that, on harder days, is more than a little depressing.

I've gone through a gradual transition at work, letting certain people know as needed about my disease. It's gone okay, mostly, and I think I'm ready for the sometimes-more-visible aspects of the pump. But still I'm afraid. It takes a lot of energy--there's that word again--to talk with people about diabetes. There's enough misinformation out there that the conversation is usually mainly a series of corrections: "Well, I'm sure you'll be able to control it through diet and exercise, that's what my mom does." Actually, no... "You're too thin to have diabetes!" Well, you see... And so on. Which I do NOT mean to sound like sour grapes. People are kind and concerned, which I appreciate very much. And on the flip side, there are a hell of a lot of diseases I know nothing about. It's just the energy it takes, as an introverted person, to talk openly about something so close to my inner self. It's like doing a striptease in the office kitchen.

I guess the gist of all this rambling is that I've opened myself to what are, for me right now, a whole new set of unknowns. And while I'm trying to be brave, I have plenty of qualms. Ack.

Dependency

2005-01-21T15:02:00.000-07:00

Soon I'll be depending on a machine to keep me alive. Scary thought? Yes and no. Sure, I identify with the pumper's nightmare: the gizmo malfunctions while you're asleep, doesn't alarm or the alarm doesn't wake you up, and 8 hours later you have DKA. Happily, pumps have many safeguards to keep that nightmare in the world of bad dreams where it belongs. But to be sure that I can deal with pump stoppage at any given time, I'll be toting around backup batteries, a spare infusion set, and a syringe (plus my trusty BG meter, of course) wherever I go for--well, assuming I like the pump, for the rest of my life. Wow. Bound to technology for decades (I hope) to come.

Then again, diabetes has already made me dependent on a lot of things. I already tote stuff everywhere I go--that meter, my insulin, pen needles or syringes, glucose tabs. I already need every one of those things to stay alive, or at least to stay out of the hospital. What's one more?

There's a certain comforting safety, though, in multiple daily injections. I know them well, even after just a few months. I do the measuring; I do the shooting. I know the insulin enters my body. On the pump, I'll be trusting gadgetry that I can't see. I'll be trusting engineers and manufacturing workers I've never met. But the illusion that I have complete control over my health is something diabetes has already taken from me. Going on the pump is just an extension of that experience.

And in other ways, going on the pump is actually all about reclaiming some of that lost control. Yeah, I'll be dependent on a machine. But that machine has capabilities that will empower me to control my diabetes in ways I can't imagine with injections. Once I'm trained, I'll be the manager of a sophisticated network of dosing options that I can adapt to any situation. I'll be able to reclaim some of the freedom I've had to give up--freedom of scheduling and food choices, for example. And I'll be safer from hypoglycemia and, I hope, complications.

More dependent? Maybe. But also less.