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.


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:

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.

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.
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.

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

Diabetic Randomness

If you’re anything like most people who check their blood sugar (glucose) you are a big fan of your non-dominant hand’s middle and ring fingers. Why? Because it is easiest to use your dominant hand to hold the pokey and your middle and ring fingers are the least painful to receive the pokey; it is not a surprise this is the choice of the many. So after badgering y’all to poke yourself more often – now I’m going to be all judgy mcjudgerson on the where?!? Nope. But I will give you some tricks I have heard/read/learned over the years. One way to make sure you move lancet sites is to choose your Finger of the Day. This is not my system, but I am going to give it a whirl.

  • Odd days – Left Hand
  • Even days – Right Hand
  • Start on the lower side of the finger pad and continue in an arc pattern
    • don’t do more than 6 pokes on one finger pad per day (move to next finger if needed)
    • this allows each finger pad a week to heal between poke days.

Hope this helps!

FoodLady Chronicles – oops, he was right edition:

Woke up drenched in sweat with Herbert snoring on my pillow. Grumped about “damn slacker diabetic alert dogs,” blearily used one open eye to find my kit and test……huh, 109mg/dL.
Oh, that’s right! I live in the damn tropics in June.
Dear Herbert, I’m sorry I besmirched your good name. Snore on my good dog, snore on. [but get off my damn pillow 😉 ]

Diabetic Randomness: where do you put your blood?

Good morning y’all, please remember I am not a medical professional and I don’t even play one on tv. Any of the medical crapola I ramble on about is strictly my medical crapola and shouldn’t be taken as any sort of advice. The internets are chock full of people telling other people what to do and I will not do that. I may share moments of my own stupidity, but that is to hopefully  make you laugh. Anything you learn is at your own risk! 


So, after you stick your finger to test your blood sugar…where do you wipe the blood?

Back in the days of yore when the standard recommended all diabetics wipe their fingers with an alcohol swab before testing your blood sugar it was easy–you wiped the leftover blood on the used alcohol swabbie. But, the standard changed and people realized that wiping with alcohol didn’t really help all that much and actually dried out the fingertips a wee bit too much which led to further damage later on. So, la de da…we are now to wash our hands before taking our blood sugar and if no handwashing is available THEN we use our alcohol swabbies. I’m going to assume that the current standard just wants us to get up and go wash our hands after we test our blood sugar and get rid of the blood that way….but damn, especially when our blood sugar is wonky….moving can be blegh.  Or maybe you just don’t wanna go back into the bathroom or maybe you just have a thousand other things to do – doesn’t matter…there are other wiping options available that don’t put yourself or anyone else at risk.

anyone else I say? Yep. We as diabetics have to hold ourselves to a higher standard of knowledge about blood-borne pathogens than our naive brethren “the public”.  There is a famous advice columnist who fell into the the naive brethren category and she attempted to shame diabetics back into the public bathroom to which most of us diabetics said, “uh, hell no….ew!” and quickly wrote her advice back into the stone age. In other words, inject your meds wherever you like and check your blood sugar wherever  you like. I have to add to that – make freaking sure you keep track of your sharps and your blood! Not because I am worried about you or think you are a hotbed of contagious disease, but because I’m worried about the public.

Imagine for a second you are a 16 year old waitress with a cut on your hand and when you are cleaning off your table that just left you drop the dirty napkins you gathered onto your tray and you realize one of the napkins you dropped had some blood on it. crap, you think your cut reopened. You inspect the cut and nope…not healed, but not actively bleeding. Crap, you just held someone else’s blood against a wound…..and potential panic ensues. 

So, what I am saying is…if you bleed on it, you own it and it goes with you and/or is disposed of properly. Wherever you wipe your blood is your business, just don’t make it anyone else’s problem.

So, where do I wipe my blood?  My hair. Yes, I know it’s weird. No, I never started doing it on purpose. It just seemed normal to me and it meant that I wasn’t staining my clothes or leaving my blood around willy nilly. It has worked for me pretty well now for many years. A few people I know vampire theirs, you know…just lick it off their finger. For some reason that doesn’t appeal to me personally, but it isn’t offensive to me.