An Enjoyable Eye Exam

I think I just had the best doctor’s appointment of my life (so far).

And the most incredible part about that statement? This was my very first appointment with this particular doctor and she absolutely nailed it. I’m almost bummed that I only have to see her annually…

Let me back up a bit. This doctor is my new ophthalmologist (eye care specialist). I switched to her because I’d seen my previous one for just about my entire life, and while he was unquestionably an excellent and knowledgeable doctor, we had some…personality clashes that made my yearly visits with him not so great. It wasn’t like we had a breaking point or anything during my last appointment with him, I just decided that now was the time to make the switch to someone else.

So I did. In August, I contacted the new doctor’s office and set up an appointment. I also wrote to my old doctor and requested the last few years’ worth of notes to be faxed to the new doctor. I’d never written a formal letter like that before, but I kept it short, sweet, and professional by informing him that I’d be seeing a new doctor, providing him with her location and fax number, and thanking him for taking great care of me over the years.

An Enjoyable eye exam
I totally snagged this picture of the exam equipment during the few minutes I was in the room alone. 

Making the switch was as simple as those steps – I had nothing else to do but show up for my appointment on September 1.

When I arrived to the office, I took note of all the social distancing protocol in place. There were only a dozen or so chairs spread out throughout the waiting room. There were dividers in place and stickers on the floor to mark six or more feet apart from the next person in line. The receptionist took my temperature with a contact-less thermometer and of course, nobody was allowed into the area without a mask.

Pleased with the careful measurements the office had taken, I waited for a few minutes before being called into an exam room. A nurse gave me a brief exam and had me read an eye chart using my current glasses prescription, then she dilated my eyes before leaving to go get the doctor.

Within a couple minutes, the doctor entered…and it was nonstop chatter from the moment she came in to the moment I left the practice. Her bubbly energy was infectious and it was obvious I was speaking to someone who truly loves her job. She let me know straightaway that her son is also a T1D right around my age, so she’s more than familiar with every facet of caring for it (with, of course, a special focus on eye health).

We talked a little about everything from insulin pumps, careers, CGMs, my broken bone (she was rocking a brace on her foot, so we shared a laugh over our injuries), and our studies in college. And yes, eventually we did get to the eye exam component, which took barely 60 seconds. She exclaimed with enthusiasm over my “gorgeous” eye health and told me that she is a T1D cheerleader, meaning she recognizes how hard we work to take the best possible care of ourselves.

Absolutely amazing, right?!

The appointment ended with me mentioning my appearance in Dexcom G6 advertisements, and she requested that I send her a clip via email. I did so shortly after I got home, and received the loveliest response back:

“You are spectacular. See you next year!”

I swear, I’ve never left a doctor’s appointment feeling so wonderful about myself. It’s a credit to all physicians like this one, who are passionate about what they do, happy to really engage with patients, and demonstrate in-depth knowledge of medicine and the human body.

It’s Not Always Diabetes’ Fault

“OMG, it sounds like you have super brittle bones. What’s up with that? Is it because of your diabetes?”

I sighed into the phone, grateful that the telehealth professional couldn’t see my annoyed facial expression.

“Oh no, it’s nothing like that. I’m just clumsy!” I tried to keep my tone light and threw in a little laugh for good measure. She went on to say something about how I might want to consider taking calcium and/or vitamin D supplements, but while she went off on her tangent, my mind wandered.

What does bone health have to do with diabetes? And why does it seem like everyone assumes that all of my health issues are directly related to my diabetes?

it's not always diabetes' fault
When it comes to blaming diabetes for other conditions, some people have their heads in the clouds…

Truthfully, it’s a safe assumption – the vast majority of the time, anyways – that my diabetes does have some sort of influence over the rest of my health. Plenty of studies indicate that comorbidity is common with type 1 diabetes (in other words, other conditions are diagnosed alongside the primary condition, in this case, diabetes).

But is my diabetes the cause for my seasonal asthma? Is it the reason I’m allergic to cats and dogs? Did my diabetes create the digestive issues I’ve faced since childhood? I don’t know, maybe. There could be a tenuous connection there.

On the flip-side, is my diabetes responsible for my (almost always) excellent blood pressure? Does it have anything to do with my slight arrhythmia? It’s not as clear-cut in those areas; in fact, I’d be hard-pressed to find a real cause-and-effect relationship when it comes to those things.

So do I blame my diabetes for “brittle bones”? Heck no. I blame my breaks in the last couple of years purely on myself and my tendency to rush around in an uncoordinated manner. And on top of that, based on how quickly I healed from my last break, I expect my recovery to go as well this time around, and I doubt that’d be the case if I genuinely had brittle bones.

This time around, it’s not my diabetes’ fault, that much is clear. And it’s also pretty obvious that I need to exercise a little more patience with health professionals who 1) don’t know me well and 2) are just trying to help me improve my overall health.

It’s a gentle reminder to be a touch more graceful in how I move…and how I respond to innocent queries about my diabetes and other health conditions.

How a Broken Bone Affects my ‘Betes

I still can’t believe that I broke my wrist…again. At least I changed it up a little this time and broke my left one instead!

A broken bone is a broken bone, but my healing experience has been very different compared to last time.

For starters, when I broke my right wrist a couple of years ago, it was in the middle of winter (I slipped and fell on ice in the driveway). I was put into a cast that I wore for 4-6 weeks that felt like 4-6 months because of the challenges I faced. Between attempting to become ambidextrous as I built up strength in my left hand and taking a solo trip to Atlanta, Georgia to film a commercial for Dexcom, I did my best to work around my injury…even though I felt incredibly defeated in the face of the limitations it imposed; specifically, I felt that I couldn’t keep up with the exercise regimen I’d worked so hard to establish. I feared that I’d exacerbate the injury, so I didn’t even try to work around it.

This time around, it’s summer. The break happened after I tripped and fell down some stairs (klutz, much?). I’m wearing a brace for 3-6 weeks instead of a cast: My orthopedist said it’d be much more comfortable versus a cast, which can get seriously stinky and sweaty in the warm weather. And rather than stressing about how I’ll continue to exercise while also allowing myself to heal, I’ve made modifications that have kept my body, broken bone, and ‘betes happy.

How a Broken Bone Affects my 'Betes
Can anyone else spot the lone strand of fur, courtesy of my dog, stuck to my brace?!

I guess I learned from the last broken bone that it’s better to keep moving in some way, shape, or form than dwell too much on the injury itself. In other words, I’ve been trying hard to focus on the things I can still do while I’m wearing a brace as opposed to the things I cannot do. For example, my broken wrist can’t stop me from taking daily walks or, when I’m feeling more ambitious, going for an occasional run. It can’t stop me from making the shift to lower-body-focused workouts or core strengthening routines. I refuse to let this injury be the reason that I get sloppy with my nutrition or workout routines, and it certainly isn’t an excuse to become unmotivated in terms of my diabetes care. If anything, it might just be the reason that I tighten things up and make some much-needed improvements.

They say that when life gives you lemons, make lemonade…so I’m going to try, because a broken wrist won’t stop me from getting something good out of this less-than-ideal situation.

 

 

 

 

Insulin Pumps and X-Rays: What’s the Protocol?

I’m re-upping this post that I initially published on February 5, 2018, because…it’s happened again. I have another broken bone! This time, it’s a chauffeur’s fracture, which is just a fancy way of saying that I have a break along my radius due to falling on my outstretched hand. Fortunately, the X-ray process went much smoother this time around – I actually referred to this blog post so I could remember exactly what I was told about insulin pumps and X-rays! Hopefully, this helps other people who had the same questions as me. 

“You have to remove your insulin pump before we can take your X-rays,” the technician said to me. I stared at him, and responded point-blank, “What? No, I can’t take it off.” I tried to hide the panic in my voice, but it quavered as tears stung my eyes.

“Well, let me check our insulin pump protocol…” his voice trailed off as he left me in the dark room with my right arm held up in the air in an attempt to mitigate the throbbing sensation going up and down my forearm.

Insulin Pumps and X-Rays_ What's the Protocol_
Here you can see an X-ray that shows where the break is (follow the yellow arrow), me looking miserable in the doctor’s office but still rocking my #insulin4all face mask, and my lovely new brace which I get to wear for 3-6 weeks.

When I fell and broke my ulna a couple weeks ago, my insulin pump was one of the last things to cross my mind as I was shuffled from doctor to doctor and one medical facility after the other. All I could concentrate on was the injury – how severe was it? Would I be able to work? Could I keep up my exercise regimen? Was I going to need surgery? My diabetes, for once, was far from my thoughts.

But this instantly changed when I went to get an X-ray. When the technician told me that I’d have to remove my pump, I wanted to shout at him, “No! If I do that, my blood sugar will skyrocket! You can’t expect me to do that!” It was hard to keep calm, and my emotions were already running amok due to the chaos of the morning so far. So even as I tried to fight the tears, a couple escaped and ran down my cheeks. When he came back into the room, the X-ray technician’s expression changed. He looked at me empathetically.

“It’ll be okay. Come on, let’s call your endocrinologist. We’ll see what she has to say and get this all figured out.”

Twenty minutes later, after a series of phone calls and a few accidental hang-ups, we received confirmation that I could, indeed, wear my pump for the X-ray. The nurse practitioner who I spoke with at my endo’s office said that it was safe as long as I wore the protective vest. “It’s really only a problem if you’re going in for an MRI or a CAT scan, because those involve magnets,” he told me.

Once I got off the phone, I ran over to the X-ray technician and explained it to him. He smiled at me and said, “Got it. Let’s get these pictures over with – you’ve already had quite a day so far.”

I nodded and thanked him for his patience. He was right, I was overwhelmed from the events of the day – it wasn’t even noon yet – but in hindsight, I’m glad that the technician didn’t try to fight me when I said I couldn’t remove my pump. His willingness to hear me out was huge. It’s not easy to be your own advocate in a high-stress situation like that. But I’m proud of myself for speaking up and getting the answers we needed. Everything worked out in the end – well, except for that pesky broken-bone bit.

 

4 Ways Diabetes Makes it Difficult to Sleep

I’ll never forget the first time I saw my mother’s bio in her high school yearbook: She’d listed “sleep” as one of her favorite past times. I though it was hysterically funny then, and I still do now, but I also think it makes her incredibly relatable. Who doesn’t love catching some z’s?

I may not be unique to others when I say that I love a good night of sleep, but only people with diabetes know the real struggles that we, without functioning pancreases, face virtually every night at bedtime.

Because that’s right, diabetes doesn’t just make life hard for us when we’re awake, it also disrupts our precious slumbers. How dare you, diabetes!

Here’s four ways in which diabetes can make it difficult to sleep:

1 – Beeping and buzzing devices. Nobody actually likes waking up to a blaring alarm clock. Imagine not only having to contend with that, but also the possibility of low and/or high alarms going off at any hour of the night. The shrill alarms built into my Dexcom are very rude awakenings and definitely serve as an extra incentive to do everything possible to try to stay in range overnight, but we all know that diabetes can be unpredictable, so this isn’t always possible.

2 – Rolling over on uncomfortable sites. I toss and turn throughout the night: Usually, I fall asleep on my back, then switch to my side, and roll over on my stomach…multiple times throughout the night. And I never seem to be able to do it without rubbing up on a site. It doesn’t matter where it is – my arms, legs, stomach, or back – any rockin’ and rollin’ I do in my sleep is almost always bound to push my CGM sensor or pod uncomfortably harder into my body, and it can be the reason why I wake up in the middle of the night to make yet another adjustment in how I’m sleeping.

4 Ways Diabetes Makes it Difficult to Sleep
At least my diabetes has zero impact on Clarence’s ability to sleep. Was this another excuse to use my adorable dog as a good photo for this post? I shall neither confirm nor deny.

3 – Waiting for a high to come down. There have been a handful of occasions in the last year of life with diabetes ALONE in which I’ve been so, very tired but too afraid to go to sleep until my blood sugar has come down to a “safe” level. It doesn’t matter if the high was caused by incorrect carb calculations or a site that I’m not sure is working properly – I just want to avoid sleeping knowing that I have a hyperglycemic blood sugar because waking up to one in the morning is bound to start my day off on the wrong foot. And it even resulted in a trip to the ER one time, which I don’t want to experience again.

4 – Waking up to a low. Just like high blood sugar, low blood sugar can also delay and/or interrupt sleep. Whether the low happens just after brushing my teeth and I’m forced to ruin my fresh breath with something sugary (just thinking about the orange juice and mint flavor combination makes me wanna yak) or if it wakes me up from a sound slumber and I proceed down the stairs to eat the entire kitchen because I’ve run out of low supplies on the nightstand next to my bed…you get the picture. It’s downright annoying and honestly I bet that I’ve had at least a couple hundred nights of sleep in my 22+ years of diabetes disrupted to a low.

So you see, as much as a person with diabetes like me enjoys a full night of sleep, I’m always aware of the fact that my diabetes doesn’t sleep…and instead keeps me on toes.

 

From Anxiety to Adrenaline Rushes: How Extreme Emotions Affect My Blood Sugar

You know that feeling you get in the pit of your stomach when you receive bad news? It’s like your heart falls to the floor and your stomach starts swirling from the perceived sensation.

That’s unpleasant enough on its own, but for me, it can also cause blood sugar issues.

The same thing can be said for when I’m on a literal roller coaster (which doesn’t happen often, but when it does, involves extreme coercion from family or friends) – I get that awful swooping sensation on top of some sort of blood sugar impact.

Every leaf speaks bliss to me, fluttering from the autumn tree.
Do you know how difficult it is to find a picture depicting an adrenaline rush that isn’t a cliche shot of a roller coaster or skydiver? Hence…a slew of moody “smiley” faces.

Whether it’s anxiety, adrenaline, fear, or just a rush of unidentifiable feelings, there’s no doubt about it: Extreme emotions tend to make my blood sugar unhappy by causing it to spike.

I’ve always been somewhat aware of this phenomenon, but I started thinking about it more last week when I got some upsetting news. (I’m okay, please don’t start to speculate on what it was…just a personal matter that I don’t care to discuss in greater detail here. Love y’all for understanding and respecting that.)

Actually, it’s kind of interesting to think about how the sequence of events unfolded last Thursday. I received a message that caused me to instantly panic. I was going to learn the context behind the message about a half hour after I got it, so in the interim, I was pacing all around the house and trying to figure out what exactly was going on. My stomach was roiling, my palms were coated in a light sheen of sweat, and my already-unruly hair frizzed out even more….

…and my CGM trend started going up, up, up, ever so slowly but noticeably.

I didn’t do anything to correct my blood sugar – at least, not right away. I waited until after I heard the specific news that had gotten me so worked up to really pay attention to my rising levels. I probably could have made my high blood sugar less severe by running a temporary basal increase right after I initially freaked out, but obviously, I had other things on my mind than my diabetes at that moment in time.

The whole experience was a stark reminder that food and insulin are far from the only things that impact blood sugar levels. Raw human emotion did that to me, and it will do that to me again in the future.

It sucks, but isn’t it also fascinating to think about how diabetes is totally a physical and emotional chronic condition, in every possible way?

The Periodic Problem

I thought about how I was going to write this post many, many times. I so wanted to come up with a cute or clever euphemism for what I’m about to discuss, but really, that old “Ant Flo” cliche is all I could come up with, and that’s so overplayed.

If that didn’t give you a clue as to what this is all about, then look at the title again.

Still nothing?

Okay, this post is about my period.

Yep, the menstrual cycle, that time of the month, the curse…whatever name you want to call it, I’m talking about it today. And if you’re already cringing, chill. I promise there’s no need to, I’m not about to get graphic on you or anything.

Rather, I’m about to write about a reality that many women with diabetes face: The week leading up to a period, or the week that it starts, can be hell. And I’m not just referring to cramps or mood swings.

The Periodic Problem
This picture is actually a pretty accurate cartoon version of me…cacti plants, GameBoy, and pink included.

I’m talking about blood sugars, of course. I’ve thought about how my period and my diabetes interact more and more lately because of an “interesting” (that’s the nice way to put it) pattern that I’ve noticed each week leading up to my period for the last few months, and that’s how insulin essentially becomes as effective as water when I get it pumping through me: That is to say, my insulin intake has nearly doubled the week leading up to my period, and it’s something I never really noticed until recently.

I think I caught onto the trend in April. The week before my period started, I blamed my bad blood sugars and higher insulin intake on the fact that we were only a few weeks into quarantine, so it was natural that my body was having a tough time adjusting.

In May, I wondered whether I was dealing with faulty pods or bolusing incorrectly for my foods.

By the time June rolled around, though, I realized that there was something different at play here.

Last month, I dealt with the issue by raising my temp basal for most of the day – a 95% increase for 6-8 hours through the morning and afternoon – and giving myself 2-3 units more than I normally would at mealtimes. I still didn’t have great numbers, but they were better, and that was all that mattered to me.

But this month? I’m totally confused because this “periodic problem” did the opposite of what I expected it to do…the week before my period, it seemed like I need LESS insulin! It was simultaneously bemusing but exciting. I’ll never necessarily complain about having to take less insulin, or being able to eat an entire blueberry muffin without needing to bolus for it (yes, that really happened), but damn…some consistency here would be nice.

Who knows what my body will decide to do next month. At least I feel a little bit better knowing that there is some sort of pattern going on here that I need to pay attention to, so I’ll continue to monitor so I can try to anticipate what the week before my period will look like for my blood sugars.

Just one more reason why I kind of dread “that time of the month”, but also another justification to eat more chocolate in order to cope with it when it does come ’round.

Doctors Who Just “Get It”

Doctors who just “get” diabetes are the best.

And I’m not exclusively talking about endocrinologists here, because really, they’re the ones who specialize in diabetes…so, you know, they are supposed to just get it.

I’m talking about the other medical professionals that people with diabetes might see in addition to their endocrinologist.

Take me, for example…I see a primary care physician, a dentist, an allergist, an OB/GYN, and an ophthalmologist.

And only a couple of those specialists really understand what it means to have a T1D patient in their care.

Doctors Who Just _Get It_
It’s really nice when my doctors don’t question my authority on my own diabetes.

For example, I saw my allergist back in February (before all this COVID stuff) to see if she could switch me to a nasal spray that cost less than the $45 per month I was paying (because let’s be real, if I can save money on a prescription, I’m going to do it). The appointment was supposed to be quick and easy, but it turned into a two-hour affair (!) because she was concerned about my asthma.

I highlighted my issues with asthma in a post from January. The big takeaway from my most recent spells of wheeziness is that the inhaled steroid I was taking to deal with it at the time was making my blood sugar skyrocket, and I felt like I had to choose between breathing comfortably and maintaining healthy blood sugar levels…not an ideal this-or-that scenario by any standards.

So when my allergist detected some “squeakiness” (her words, not mine, and it makes me laugh because that’s a cute way to refer to the rasping gasping of asthma) in my lungs when she was listening to my breathing with a stethoscope, she asked me to catch her up on my history with asthma. When I did, she immediately understood my reluctance about taking the inhaled steroid, and prescribed me a new medication that will reduce my asthma symptoms as well as some of my allergy symptoms.

I’m never going to be thrilled, per se, about adding yet another medication into the mix: It’s just one more thing that I have to remember to do each day at a certain time. But what did excite me about this prescription is that I’ve noticed a real difference since I’ve started taking it. And more importantly, I felt heard by my allergist. She didn’t write off my concerns about the inhaled steroid, she took extra time during the appointment to run tests, and we had a back-and-forth dialogue in order to get to the bottom of things.

It was a stark contrast to the appointment I’d had with a nurse practitioner from my PCP’s office in which I was prescribed the inhaled steroid DESPITE having voiced my concerns, and the appointment was over within minutes.

It’s a bummer that not all medical professionals “get” diabetes, but it’s also a reminder that as patients, we can make a difference by continuing to advocate for ourselves until they do understand.

A Source of Toe-tal Stress

I don’t like horror stories.

I’m not big on scary things, in general (besides Halloween…I love dressing up)…but horror stories, in the form of tales told ’round the campfire or in media such as television or film, have never been my cup of tea. Probably because I’m a giant scaredy-cat, but I digress.

My disdain for horror doesn’t mean I’ve been able to successfully avoid it over the years. I’ve traipsed through my share of haunted houses, watched countless scary movies (with my hands over my eyes for a good portion of all films), and listened to spooky ghost stories.

The scariest story of all that I’ve heard over and over again has to do with…

Diabetes. And feet. Without going into more detail – because I’m shuddering at the mere thought – diabetes complications could lead to, um, amputations.

I’m not trying to make light of a very serious subject here: Let me be crystal clear when I say that diabetes complications are real and terrible, I wouldn’t wish them on anyone. They also frighten me so much that I tend to avoid blogging or even talking about them altogether. The slightest blur in my vision or tingling in my toes can send waves of panic through my brain that are so intense that I convince myself that I’m experiencing my first diabetes complications.

So when I discovered a cut on my toe several weeks ago, I couldn’t help but totally freak out, especially when I noticed blood around the site.

Need help_ (1)
As a person with diabetes, you’d never catch me barefoot and surrounded by all those rocks. OUCH.

For most people, a cut on the toe sounds like no big deal – you just put some antibiotic cream on it, wrap a Band-Aid around it, and let it heal. But for someone like me who has diabetes, a little cut triggers fears of serious issues like cellulitis or other infections that could lead to major problems.

It might sound ridiculous, but in the first couple days after I noticed my cut (it was a bit like a split in my skin), I had horrifying visions of my toe turning black and falling off. I became hyper-aware of every sensation I could and couldn’t feel in that area, and when I felt a slight stinging around the area a few times, I imagined that it meant that my days with all of my toes were numbered.

Was it silly for me to jump to such dramatic conclusions? Probably. Was I being paranoid? Definitely. But my overactive imagination was enough to convince me to at least consult my primary care physician about the matter.

I’m glad that I did. Over a two-week span, I had two virtual appointments with my doctor who took my concerns seriously. I described the issues and he gave me advice as to how to treat the cut (stop putting Neosporin and a Band-Aid around it each day, let it breathe, use a nail file to very gently proximate the wound, make sure I wear socks and shoes for all forms of exercise to better protect my feet). He agreed with my overarching concern: to heal it in order to prevent it from getting worse.

My toe is doing much better now, and after all that, I feel a bit (okay, a lot) sheepish that I made such a big deal about it in my head when I initially spotted the split in my skin. But in life with diabetes, everything related to my health has to be taken seriously, even if it means dealing with an added source of toe-tal stress.

 

My Thoughts on Returning to Work (and this “New Normal”)

We all know that 2020 hasn’t exactly gone to plan so far, largely thanks to COVID-19.

In a word, the last 8-10 weeks or so have been…weird. Collectively, the world experienced a lot of things: shock, rapid-fire adjustments, loss, and more than anything else, change.

It goes without saying that I’ve been very fortunate given the circumstances. I’ve had my job throughout this whole ordeal, and I’ve had experience working from home before which arguably made my transition to full-time remote work a little easier. While each week has come with its own unique set of challenges and emotions, there’s no denying that I’ve had it pretty good, overall, these last couple of months.

But now, along with everyone else, I’m about to enter a “new normal” (gosh I hate that term) as states begin to re-open. And with this “new normal” comes the possibility of returning to a physical office building each workweek.

I’ll admit that the sheer thought of it simultaneously excites and terrifies me.

My Thoughts on Returning to Work (and this _New Normal_)
My thoughts on re-entering the workplace are…complicated.

On the one hand, I’m yearning to go back to work in an office space. I miss my little cubicle, office camaraderie, and meetings that are held in-person, in conference rooms, as opposed to virtually.

On the other hand, I’ve never felt more anxious about returning to a space that is shared by people other than my family members.

There are a LOT of people that enter and exit my company’s building throughout the typical workday. There are at least a dozen other companies besides mine that occupy the other floors in the building. Tons of deliveries are made to these office suites each day. While there are custodial staff who do their best to keep the building clean, it can be…a challenge, as anyone who has seen our bathrooms can attest to.

Basically, I suppose that I’m feeling incredibly nervous about the exposure to germs that is bound to happen upon my return to the office.

Even if I didn’t have diabetes and wasn’t considered at a higher risk for COVID, I’m sure I’d still feel worried because it’s not just about me: It’s also about the people I live with. I’d never want to bring anything harmful into my family’s home, period, bottom line, end of story. And while the odds are pretty damn high that PPE (personal protective equipment) will become standard when re-entering the workplace, it does little to placate me because I’ve seen firsthand how sloppy people can be when it comes to wearing it or disposing of it properly.

And so, with much still unknown about COVID, it just seems like a giant gamble to resume working in an office environment when I can’t be sure that I won’t be exposed to anything.

As it stands right now, I don’t have a concrete “return to work” date. And I don’t know what exactly it will take in order for me to feel totally comfortable about returning to the office. But I do know that I’m cautiously optimistic for a smooth transition to a “new normal” that is safe for all.