Went Low – whoopsie. 

So, scared the bejeebis out of the new husband Saturday (sorry honey!), I was (am) getting over a cold and as all y’all know sick = ⬆BG = more insulin to bring things closer to normal. But when ya start getting better, more insulin can make ya low. I don’t know how low I was, I just know I felt really warm (in air conditioning) and walked out to make something to eat, and then I felt really tired and sat down in front of the open fridge and apparently decided to take a nap. Next thing I remember is drinking some disgusting thick nasty liquid (a coke) through a straw and realizing how much I need to clean under my (as before unviewed and apparently nasty) stove. Thanks for the assist my love! 

So, for any of y’all who has ever wondered how much insulin could kill you? The answer is probably more than you have available and no matter the dose, is just as likely to leave you with severe brain damage as kill you. 

So, it was the time I woke up in the front yard in 2012 when I finally decided that I was going to train Herbert as a diabetic alert dog because I lived alone and was pretty darn sure I was going to die alone and be eaten by cats. It was a lot of work, but worth it and no matter how hard his loss has been on me the hard-won knowledge I gained during the training process has been invaluable.

Also, it may be time to invest in a t-shirt that says, I’m sorry for what I said when I was low. 😚😜😉😘

New Meds & Dobby Plan

So, I’ve been quiet lately. Not because I’m actively avoiding facebook but because I’ve been rather busy. 

My father came to visit the island and I played tour guide, it was a lot of fun. Now that the visit is over I have actively begun training Dobby as a Diabetic Alert Dog, and hoo-boy do I have a LOT of work to do with him. 

In medical (management) news, my insurance company is annoying me. Remember them making me switch from my preferred AccuChek Aviva Connect to One Touch? yeah, I tried it. I tried THREE different One Touch meters. They were okay, just basic blood glucose meters. But I wasn’t using them nearly as often as I should have and it turns out what motivates me to actually check my blood glucose levels is other people. The connect meter connects to my phone and auto texts my results to anyone I set it up to send it to. Is it perfect? no. does it work better for me? yes. 

So for now I’m paying for strips out of pocket but soon I will be asking my doctor to argue with the insurance folks. 

Speaking of my doctor, she called me the other day and said, “your insurance wants to switch you from Victoza to Byetta or Trulicity? thoughts?” Byetta was out of the question, I was on it before and let’s just say that was 8 months of nausea I don’t want again. So, I told her to give Trulicity a whirl. I just took my first once-weekly injection about 10 minutes ago so I have no idea how it works (yet) but let me tell you this, there is no freaking way in Hell this is a cheaper option. This is an over-engineered auto-injection pen that, while fancy and spiffy, seems excessively wasteful of materials. I peeled the sticker off for your inspection. Think of it as an almost fancier version of an epipen but with a wee little sub-cu needle instead of an IM one. When I read the instructions I laughed out loud at the disposal instructions which can II went online and read two studies comparing the differences between Trulicity and Victoza and, to be honest, they are very similar results-wise. 

I’ll let y’all know how this goes…should be interesting.

Diabetes – insurance hates my meter

….well, that was less than fun. But, that’s one more thing I can check off my list of things to do. was it a blood test? was it an injection? nope. It was the worst and most painful thing anyone with a chronic disease in america ever has to do: call. the. insurance. people.
To be fair, they are usually quite lovely individuals who are just explaining the rules as they are required to – I get it, but I’m 99.7% certain that the “rules” we get to follow are completely dependent on back-room dealings such as, “did one touch or accuchek give us the better kickback? Wait?!? Accu-chek only sent a fruit basket?!?! well, too hell with them! One touch gave me a car! whoo! they are our preferred vendor this year!” Today’s call was a walloping pain in the ass. Allow me to share: I refilled my testing strips and insurance freaked out. Some lovely dude began calling me and leaving me many messages with increasing levels of irritation and snark. I wasn’t avoiding the calls, but unfortunately the dude had rather horrible timing and managed to only call my phone when I was in a meeting/next to my boss/with a client/etc. I’m paraphrasing the many messages that were left for me, but I think they went a little something like, “hey, uh Heather….yeah, listen. AccuChek cheaped out and only sent the president a fruit basket so we don’t use them anymore, but yeah….you are going to need to call me and so we can figure it out or basically, you’re screwed and you can’t check your blood sugar anymore. so…yeah, call me back. or don’t and see what happens.” alrighty then.
Friday – called the insurance people, gave the standard interrogation answers (name, rank, serial number, why are you calling, what’s your phone number, are you sure you are who you say you are, etc.) then insurance people attempted to transfer me to what I now know is called the Alternative Drug Department (hahahaha, ADD) and then the call disconnected. *sigh* Oh well, I’ll try again on Monday.
Monday – called again – gave all the answers. explained the problem(s) and again was transferred to ADD – got disconnected. Shared a few expletives with the universe, figured I would try again on Tuesday.
Tuesday (today) – I’m out of strips and am using an old meter with old strips. Fairly certain its accuracy is wonky as hell, but better than nothing. Work is mostly done for the day and I am going to do it – I am going to check this damn “call stupid insurance strip crap” box off my to do list.
Tuesday – Call One. Answer standard interrogatory; explain repeated disconnections. Get placed on hold. Call disconnects. RAGE! Expletives! More Rage!
Tuesday – Call Two. Answer standard interrogatory – at this point I am answering questions BEFORE THEY ARE ASKED. I know what is coming – I’m using the freaking NATO alphabet correctly n’ shit because, why not? “Yes, my name is Amrhein, that’s Alpha-Mike-Romeo-Hotel-Echo-India-November, but please just call me Heather. Yes, my account is Uniform-three….”blah blah blah-you get the idea. Then I carefully explain that this is the 20 bazillionthy time that I have called and, ahahahaha, before you disconnect me again by putting me on hold…….and then I was put on hold. And epic silence (which I definitely preferred compared to the initial tortuously static-filled hold music)….but then? then? my phone started ringing. well shit, I’m on hold with that number, but that number is calling me. So, I conferenced us all in together! I was rather looking forward to everyone being on the line, but sadly the lady never came back on the phone. So, Mr. Michael from South Dakota informed me that he was my repeated (snarky) caller and that I couldn’t use the meter I had been using (AccuChek Aviva Connect) and that he would be happy to send me a free One Touch meter. I stopped his obviously well-rehearsed speech by laughing loudly and saying in a delicate southern drawl (which came from where!? I have absolutely no idea why I suddenly became southern…or, for that matter, delicate?), “oh honey, if you have enough time and patience almost every one of those big ole companies out there will give you a free meter; the money is in the strips.” (btw: I said “tha mon-ey is en tha stree-ips like one might say, “the money is in oil”; again, no idea where this persona came from) and then, because he called me ever so many times, was still a bit snarky, and was ever so hard to get back in touch with – I shared. Oh yes Mr. Michael from South Dakota insurance company pharmacy place, you add to my to-do list, make my life just a little harder AND get a little snarky about it? Well then, I’mma data dump all over you. I talked to him about the precious metals in the strips and how some people “mine” them but that it could be fairly hazardous so it shouldn’t be undertaken lightly. Then I talked to him about how my accuchek meter connected to my phone via bluetooth and you could set the program to text your result. Mr. Michael asked, “text to where?” and I replied, “why, it texts your blood glucose reading to whomever you set it to text. I currently have the program set to text my results to my mama, my father, my boyfriend, and a close friend! Do any of those one touch meters have that as an option? well, Mr. Michael from South Dakota insurance company pharmacy place, do they?” (no, they don’t) I went on to explain about my recently deceased diabetic alert service dog Herbert, and how his death left a rather large divet in my diabetes care plan that I was attempting to fill with technology – but, then again, it isn’t perfect either because if I have too many bluetooth things connected to my device (don’t judge me, I like gadgets) it bounces the accu-chek aviva connect too low on the priority list and texts don’t send. Then I talked to him about the mysugr program and how it is such a great tool for children and adults but that what we really need is a meter than can input directly into *that* program. Then I said, ya know what Mr. Michael? just send me a continuous glucose monitor to play with and I’ll call it good. (sadly, that is a different department) Poor Mr. Michael – he didn’t want to go to Heather’s (apparently southern) Diabetes Knowledge Camp – but off to camp he went. So we perused the One Touch offerings and I couldn’t decide between a couple of them. So, poor Mr. Michael, seeing a shred of hope that the caller who just wouldn’t stop telling him stuff could possibly be convinced to go away by sending her the two meters she was (deliberately, rather cruelly, and a touch gleefully) dithering over – stated, “both meters are on the way with the strips!!!”
*wicked chuckle* Now that I have his direct line, I’m considering calling him to chat about lancet options and calibration/test liquids.
Lessons Learned:
1. doing sucky things in a southern accent can make them better.
2. don’t give your direct line to someone you have been snarky to on the phone; they may use it.
3. If you can’t make them give you what you originally wanted, enjoy yourself choosing a new option and then write about it hopefully making someone else’s day better cause your karma is rather shit because you enjoyed taunting Mr. Michael so much.
*smooches*

Diabetes Randomness

Happy Monday, check your feet & legs people. No, I’m not kidding; at some point today I want all of you to get your legs and toes nekkid and treat yourself to a little foot massage, everything feel okay? Then, take a look at your feet and legs; everything colored the same? Any odd patches of color could indicate poor blood circulation. Now, wiggle them piggies! 🐖🐖🐖🐖🐖 The more you move them, the better the circulation. If you found anything off–call your doctor! If you found a small boo-boo (small scratch, ingrown hair, etc.) wash it, treat it, and put a bandage on. Keep treating it daily until it gets better; if it shows no signs of getting better after a few days with treatment — call your doctor! Small boo-boos can turn into lost limbs with diabetics. It’s one of the many reasons diabetes (pre-, type 1, type 2, etc) sucks ass. Stupid crap like checking blood sugars and checking our feet is our duty, not just to ourselves, but to those who love us and want us (and our feet) to hang around a while longer.
This message brought to you by me, a dumbass who just realized I’ve had an infected….something (bug bite? pixie stab wound? evil escaping?) on my right calf for over two weeks. It is now clean and bandaged.
Again, if I can’t be your good example, use me as your horrible warning. 😊

Diabetes and a Mildly Crappy Day

Today was a mildly rough day; my body had way too much,

“f*ck you! Remember when you fell on concrete two days ago? Yeah, time to pay!”

And I am paying with swelling and pain. It’s now about a quarter to 1AM and as I lie here flirting with sleep and counting random ouchies I realized that I read a hell of a lot of diabetic inspirational stuff online as well as a lot of truly-horrible-day-almost-died stories; but rarely have I read things about mildly rough days. A mildly rough day for a diabetic is that day where you’re high for no good reason; or you went low, fixed it, and feel rebound-crappy; or even just ongoing inflammation and you just don’t feel well. These mildly crappy days happen to us all; or hell, maybe it’s just me? Regardless, I’m going to assume we all have them. So, here I am – sharing my not-too-horrible levels of suck: I woke up this morning and I couldn’t close my hands into fists–they didn’t look swollen, but my whole body felt overly heavy and my muscles were screeching. I knew the only thing that would help would be to get moving, but moving hurt like a bastard. So I took two aleve and when they kicked in I began puttering around the house. I was intermittently ouchie throughout the day, but when I stopped moving and attempted sleep – the inflammation and pain came back. Sadly, my left hand is now completely numb due to typing this. Don’t worry, I know this might sound scary but the most important thing to remember is that this too shall pass. All of it. Yes, right now I’m uncomfortable and tomorrow morning it is going to be craptastic to try to wake up on time and get to the office. But I’m going to wake up, inject myself with a couple different meds, swallow a couple of other ones, and get moving. Because moving is the best way to keep that diabetes monster  in check.
So, there ya have it – a mildly sucky day for me as a diabetic. It wasn’t pain-free and wonderful and it wasn’t anywhere near death. I sincerely hope everyone else had a wonderful and pain-free Sunday!
…..but so help me, the next (usually drunk) “health” nut to tell me that all I need to do cure my diabetes is drink apple cider vinegar while snorting gluten (or whatever fool-ass thing fools have heard “they” say) I will force my hands to make a fist whether they want to or not and well, then I will provide them with futher information on diabetes.
Ugh. Adulting is HARD.

Diet Soda Info for Diabetics

I’ll admit to having a weakness for diet soda. Whenever anyone gives me crap about it I’m filled with a bit of rage and I usually reply with, “Okay, I don’t smoke, I don’t drink, LET ME HAVE MY VICE!” And I will still verbally destroy someone who says diabetics “can’t” have something. We all make our choices, choices may have consequences, but the choice is ours to make.
Anyhoodle, I do tend to read a lot of studies and I recently went down a Google-hole trying to learn about what specifically is it in say, diet coke, that can cause issues. I learned things.
The biggest “problem” with a any sweet-tasting beverage is that it prepares your body to get ready to DIGEST! You’re mouth hits sweet and your body’s all, that’s right bitch-we EATIN! and our pancreas gets all excited and sends out some insulin (well, it tries!) Our tummy gets all extra acid-ready! Then…..no food? So our bodies react by saying, “we set up the party, no one showed–invite EVERYONE!” and then our livers release a little extra glucagon to counteract that wee bit of insulin and then our blood sugars start to rise and then, then we have some serious HUNGRIES!
So, that’s the scoop on sweetened beverages.
But my precious diet coke? My beautiful fizzy caramel-colored love? Why do I crave that but not other sweetened stuff? Found a study that compared different types of diet sodas (colas vs lemon lime or mountain dew types) and brain chemistry and holy crap, no one is quite sure why exactly, but the colas become addictive whereas the non-colas do not. Wacky huh?
So, I’ve cut out about 80% of my diet cola use (gasp! I know, right?!) And have become a huge drinker of plain fizzy water (and yes, I researched it–plain fizzy water = water. No adverse effects). I don’t plan on giving diet coke up entirely, but I have cut down a LOT.

I feel crappy. *wahhh*

Okay. I have a cold. This means that I am just sick enough to be extremely annoying. When I’m very ill, I will continually insist that I’m fine; when I have the sniffles I will be very vocal about my absolute certainty of my impending demise.
Example: *whiny noise* while flopping dramatically on the bed, “I’m dyyyyying!”

So, I feel craptacular. As anyone who is, or is very involved with someone who is, a diabetic will know – any sickness means your blood glucose will increase. This doesn’t help with the craptacular feeling.
When I have a cold, I crave juice. So I bought this lemonade:

image

Now, because I’m sick (and/or lazy) I didn’t carefully read the label. I assumed this was sugar-free. Or at least extremely low sugar.
I was pretty darn wrong.

image

I mean, it isn’t horrifyingly bad, but considering I drank the first half of the bottle (3.5 servings x 12g per serving = 42 grams of carbs) while grumpily stomping through the grocery store yesterday, and almost finished the rest of the bottle this morning  (3 servings x 12g = 36g) which, combined with my cold, led me to a post breakfast blood sugar of 238mg/dL. Well….crap. I wouldn’t be so annoyed except that the lemonade wasn’t tasty enough to be worth the insulin, ya know? If I’m going to “spend” insulin, it’s going to be on the most delicious thing that I really want. Not a subpar bottle of lemonade.
So, always check the label–even when you’re sick and whiny.
Again, if I can’t be a good example; might as well be a horrible warning.  😉

Chinese Restaurant Effect

Alright, so there is this dude; he is a doctor dude, born in 1937 and he is a type 1 diabetic. He is a very smart man and I believe that at this point in his life – dude has seen some shit.
Please feel free to peruse his information and develop your own opinion about this guy. I respect him greatly, but I’m kinda still gonna eat carbs sometimes ’cause they taste so dang good. Anywhoodle – his wiki page is: https://en.wikipedia.org/wiki/Richard_K._Bernstein
I shared all that ’cause I wanted to share one of his most famous theories:

THE CHINESE RESTAURANT EFFECT
Many years ago a patient asked me why her blood sugar went from 90 mg/dl up to 300 mg/dl every afternoon after she went swimming. I asked what she ate before the swim. “Nothing, just a freebie,” she replied. As it turned out, the “freebie” was lettuce. When I asked her just how much lettuce she was eating before her swims, she replied, “A head.”

A head of lettuce contains about 10 grams of carbohydrate, which can raise a type 1 adult’s blood sugar about 50 mg/dl at most. So what accounts for the other 160 mg/dl rise in her blood sugar?

The explanation lies in what I call the Chinese restaurant effect. Often Chinese restaurant meals contain large amounts of protein or slow-acting, low-carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo shoots, and water chestnuts, that can make you feel full.

How can these low-carbohydrate foods affect blood sugar so dramatically?

The upper part of the small intestine contains cells that release hormones into the bloodstream when they are stretched, as after a meal. These hormones signal the pancreas to produce some insulin to prevent the blood sugar rise that might otherwise follow the digestion of a meal. Large meals will cause greater stretching of the intestinal cells, which in turn will secrete proportionately larger amounts of these hormones. Since a very small amount of insulin released by the pancreas can cause a large drop in blood sugar, the pancreas simultaneously produces the less potent hormone glucagon to offset the potential excess effect of the insulin. If you’re diabetic and deficient in producing insulin, you might not release insulin, but you will still release glucagon, which will cause gluconeogenesis and glycogenolysis and thereby raise your blood sugar. Thus, if you eat enough to feel stuffed, your blood sugar can go up by a large amount, even if you eat something undigestible, such as sawdust.

The first lesson here is: Don’t stuff yourself. The second lesson is:
There’s no such thing as a freebie.* Any solid food that you eat can raise your blood sugar.

Okay, got it? That’s his theory and I don’t believe he is wrong – although I do believe that in addition to his theory that if you don’t have enough usable blood glucose in your body when you workout your body will attempt to fix that by releasing glucagon and thus raising your blood sugar.

Anywhoodle – this is the reason that quite a number of endocrinologists [including Dr. Bernstein] highly recommend and prescribe a GLP-1 drug for Type 2 diabetics and even prescribe them “off-label” for Type 1 diabetics. GLP-1 drugs are also known as incretin mimics and the most common drug names out there right now are Byetta and Victoza. Please know that a GLP-1 drug CANNOT replace insulin and a common way to adjust insulin with a GLP-1 is to keep basal the same and start with the assumption that mealtime boluses can be reduced.

Now, because there is another dude out there in the world who has already shared some great information about these drugs on a forum known as tudiabes; I’m totally copying and pasting:

[Victoza & Byetta] “…are both GLP-1 drugs, a class of drugs that mimic key incretin hormones. The GLP-1 drugs have a key action of inhibiting glucagon and stimulating insulin release in response to eating. For a T1, the insulin stimulation just won’t work, but the glucagon effect can be significant. When we eat, particularly if we eat something big, our bodies will release glucagon and insulin in response to simply the act of eating. Bernstein calls this the Chinese Restaurant Effect. This is different than insulin being released in response to a high blood sugar and instead is focused on enabling a complex dance of preemptive control of blood sugar in response to meals. That being said, even as a T1, when you eat you can and will release glucagon and that can result in a contribution to your mealtime blood sugar. So a GLP-1 may help a T1 get better mealtime control, perhaps using less insulin or just improving postprandial levels.

It is also true that the GLP-1 drugs lower both hunger and appetite and have been shown to help people lose weight. My observation is the GLP-1 drugs are mostly being prescribed to T1s for their effect on hunger, appetite and weight loss. That being said, the use of GLP-1 drugs for T1 is not FDA approved and while doctors can prescribe it off-label there is apparently lots of confusion. The prescribing information on Victozabasically says not to use it for T1 and provides absolutely no information on how to adjust insulin dosing with Victoza. There are ongoing studies on T1 use of GLP-1 drugs and I would anticipate FDA approval for their use in T1 in the near future….”

Forum Link: http://www.tudiabetes.org/forum/t/victoza-for-t1s/46883/10
Author: http://www.tudiabetes.org/forum/users/Brian_BSC/activity 

Okie dokie, that was some diabetic learning for the day – if anyone has any questions, comments, concerns, stories, photos, whatever…..please feel free to comment.
**smooches**

Diabetes & Alcohol

Dear FLC, I’m hungover. I’m not a drinker, mainly because alcohol is just *such* a shitty drug that has too many side effects (case-in-point: hungovered-ness). Last night I heard that there was a place in town that had power so I found shoes and off I went. The bartender had her thumb on the diet coke button when a Cruzan pineapple rum with cranberry juice was ordered – coulda knocked that poor girl over with a feather (Heather? drinking?!). We had some snacks as well and by the time we were home (10PM) the power was back on. All in all, it was a good night.
See, the problem with drinking for all diabetics (Type 1, Type 2, and every other kind) is that the human body prioritizes. So, our livers go from working at a normal pace: process this, release sugar now, filter that, rinse, repeat, etc. When we throw some alcohol into the mix, the liver does the equivalent to sweeping its desk clean and focusing only on the alcohol; basically ignoring everything else.
That’s when our diabetic medications can get us into trouble–see, the medications aren’t thinkers, they are just up in there doing there jobs like a computer driven vacuum cleaner (or a Roomba) sucking up sugar. Well, if the liver doesn’t provide sugar on its normal schedule then the vacuum cleaner can suck up sugar we may have needed thus leading to potentially scary lows. The lows can be extra scary because if you add enough alcohol then you cannot feel the low happening. Then, the next day, my LEAST favorite thing in the world can happen–rebound highs. After finishing the alcohol project your liver PANICS at all of the work he pushed off his desk and just dumps a bunch of sugar at the problem leading to random HIGH blood sugars.
*shrugs*
There is no perfect answer and I will happily smack down the first person who says Diabetics shouldn’t drink. It’s our bodies; we get to make choices about what makes us happy. I just don’t like anyone making an uniformed choice; know what your body does and why it does it. Make your choices accordingly and be happy with your life.

For anyone curious about what Herbert did last night, he did a great (and annoying(ly awesome)) alert where he stood on the picnic table to tell me that I was was trending high. I took a couple units of regular insulin to counteract the juice (but less than I normally would have to account for the alcohol). All was well. Today, despite feeling generally crappy (yes. after 1 1/2 alcoholic beverages I get a hangover) my blood sugar was a lovely 108 mg/dL.
*smooches*
-H

Diabetic Stuffs – An Odd Herbert Alert

Just had an odd Herbert alert while sitting at my desk reading a draft review of our program and getting *super* annoyed. It is a 21 page report.  After reading 9 pages and putting in 16 comments while loudly chewing gum and grumbling many “ughs!”, “hell no’s”, and a variety of other profanities, I look over at a Herbert giving me the death-stare from a perfect sit (a/k/a an alert) and I said, “Oh! okay…?” and checked my blood sugar (92mg/dL). As soon as I pulled out my kit he went back to floppy sleepy Herbert – so, was he alerting me to an upcoming low (possible – haven’t eaten lunch) or has he just decided once I start radiating irritated rage he should probably pop up to remind me that it’s just a stupid report and to calm the hell down? Don’t know, don’t care. Either way – Good Herbie – here’s a biscuit.  As you can see, his under-desk snooze has returned to his non-alert status. *grin*

Herbert Under Desk