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.

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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.

3 Things I’ve Learned Since Switching to my Own Health Insurance Last Year

Just over 365 days ago, I made the switch from my parents’ health insurance plan to my own plan, provided by my employer.

In the last year, I’ve learned some important lessons about being responsible for my own healthcare coverage. Some lessons were easier to learn than others. I figured it might be helpful to others who just made the switch themselves (or who will be doing so in the near future) for me to sum up three big takeaways I’ve discovered along the way in the hopes that it makes the transition a little easier for those individuals, or at least saves them some time down the road.

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Navigating the confusing world of health insurance has taught me quite a few lessons in the last year.
  1. Take advantage of a flexible spending account (FSA), if the option is available. I grew up knowing that FSAs exist – my parents would always bring their FSA account cards to all my doctor’s appointments and pay for all of my supplies using those cards – but I had no idea what the big deal was about them until I switched to my own health insurance plan. Basically, FSAs are a great employer-sponsored benefit because they allow account holders to pay for eligible medical expenses on a pre-tax basis. So those who have an FSA are able to pay for things they need tax-free, and the money is typically available to account holders on the first day of the health insurance plan year. My current health insurance plan allows a maximum contribution of $2,300, so I was able to put up to that amount on my account for 2020. It really comes in handy because my wallet doesn’t take as much of a beating from all of my necessary (and very expensive) diabetes supplies, and unlike the last half of 2019, I’m not paying as much out of pocket after my deductible is met.
  2. Keep records of everything. It might seem fussy to hold onto any and all receipts or transaction records, but there might come a day when one is needed. Case in point? At the end of 2019, my company announced during open enrollment that our FSA administrator was changing…which, at the time, I didn’t think was a big deal. I knew what the maximum contribution was, and I figured I’d only need to log into my FSA account sporadically to see how much money I had left for the year. Well…I was wrong about that. Back in February, I got a notification that I needed to submit verification of purchases of my regular OmniPod shipment, Dexcom sensors and transmitters, and my Humalog prescription. And you can bet your bottom dollar I didn’t have receipts for all three of those transactions because, well, my old FSA provider never once asked for receipts. As silly as it sounds now, I guess the thought never crossed my mind that my new FSA administrator would need purchase records. Long story short, I was able to submit an explanation of benefits in lieu of the receipts, but it would’ve been easier just to hold onto the original records (and I can assure you I’ve done that since this whole incident).
  3. Don’t be afraid to ask questions when things don’t add up. I had my annual physical in January and I had quite the shock when I was billed over $300 for all of the lab work that my primary care physician had me do. The moment I got that charge, I knew something wasn’t right – never before in my life have I been charged that much for a standard battery of tests that I take for my physical. So I wrote in to my PCP’s billing department and asked about the charges. That’s when I learned that I was mistakenly charged this amount and that I needed to reach out to my health insurance provider to re-run the charges. Although it was a little annoying to have to go back and forth between my health insurance provider and my PCP’s office, it was worth it because I saved myself $300 that I never actually owed in the first place. This taught me the importance of asking questions and following up with people until I understand, well, anything that’s confusing to me when it comes to my health insurance.

 

A Problematic Post

I am not the kind of person who scrolls through social media looking for posts that will make me angry. And I’m certainly not the kind of person who likes the idea of calling someone out on their perceived wrongs via social media (or any other medium) because I think that it’s usually not constructive.

But I am the kind of person who thinks that word choice matters. So when I saw Autumn Calabrese, a celebrity fitness and nutrition expert, post the following text on Instagram, I got pretty upset. (Click photos to see them more clearly).

I’m not going to lie, I was pretty upset by this post. I’ve followed Autumn on Instagram for almost two and a half years now, ever since I subscribed to the popular Beachbody workout app. I really like her 21 Day Fix workout program because it kicks my butt every time in just 30 minutes. She comes across as a fun person who is really passionate about her job and enjoys the opportunity to help others, which is why I decided to follow her Instagram profile. Normally, I enjoy her posts because they’re filled with motivating fitness and eating tips that promote a healthier lifestyle. She definitely knows what she’s talking about when it comes to exercise and eating properly.

But after seeing this post, I think that Autumn – and people like her who are not educated in the minutiae chronic conditions like diabetes – needs to step off her soapbox.

She is using her post to say that diabetes – mind you, just generic “diabetes”, there’s no mention of any of the many types – is a lifestyle killer. She says that “the worst part about it is that you are 100% in control of if it happens to you.”

OMG. No, no, NO.

Forget that she was using the current coronavirus outbreak to promote her healthy eating plan (which in itself is a pretty weird way to advertise something) – she came after the diabetes community with this post. Now, I’ll never know what her true intent was, and I don’t care if Autumn was talking about a specific type of diabetes here. That doesn’t make a damn difference. The problem with this post is that she is perpetuating diabetes stigma and alluding to a myth that an individual has control over whether or not they get diabetes. Posts like this are the reason why there is so much confusion and misunderstanding when it comes to all types of diabetes, and I think she should be ashamed of herself for putting this on her profile.

It’s even more upsetting that she immediately got defensive when people started writing comments under her post, trying to inform and educate her. I was one of those people, and I think that I kindly and respectfully directed her to learn more by visiting beyondtype1.org so she could be better informed on all types of diabetes and maybe find out why what she wrote was harmful. Sadly, I never got a response, and her post remains on her profile, unchanged.

You can lead a horse to water, but you can’t make it drink. You can also unfollow a person on social media and write a blog post to get your feelings out there, so that’s just what I’ll do here.

 

COVID-19, Chronic Conditions, and…Telecommuting?

First, let me apologize for adding to what seems like a never-ending cycle of news and media about COVID-19, a.k.a. the coronavirus. But I wanted to write this post because a friend of mine works for a company that sent out a communication about it that I found…interesting, to say the least.

The email in question was about the company’s current coronavirus protocol. The following is an excerpt from the email, provided by my friend:

If you have or live with someone who has a medical condition that the WHO has highlighted as being at higher risk for complications from the virus (elderly, immunocompromised state, chronic conditions such as diabetes, chronic lung disease, and cardiovascular disease), you are strongly urged to work from home if possible with your job function. If you cannot work from home, please consult with your manager.

So…the wording of this email struck me as a little odd for a few reasons. If I worked for this company, I’d wonder: 1) Just because I have one of the named chronic conditions, does this mean I must seriously reconsider my present working environment even though nobody in my office travels internationally? 2) What exactly does “strongly urged” mean, anyways? and 3) What is a manager expected to do if someone cannot work from home, for whatever reason? Make up their own set of rules? Force someone to come in or not come in? And if the latter is the case…would a paycheck have to be forfeited?

hugging the cactus - a t1d blog
I’m absolutely amazed that I managed to find a stock image that wasn’t terrifying for this particular blog post and topic…

As I pondered the answers to these questions, I also started to think that there was a chance I was overreacting to the wording of the email. So I asked other friends how they felt about it and they reacted the same way I did. Everyone was generally confused by the message that this was saying (or not saying) about people living with chronic conditions and how they should handle a situation like this.

Plus, I can’t shake the feeling that emails like this just add to all the hype/panic that we’re already being inundated with, and if I were to receive something like this, it certainly wouldn’t do anything to ease my normally-anxious mind. It’s getting more and more challenging to tune it all out…

…but on the bright side, at least I know how to properly wash my hands and sneeze/cough into my elbow. So I’ll continue those common-sense practices every day, and when I’m doing my own work, I’ll be glad it’s from the comfort of my own cubicle.

“Real People” Sick

I’m sick. I’ve just got a cold, but my throat and head are aching so much that it’s knocked the wind out of me.

I spent the weekend confined to my bed, only getting up to blow my nose, use the bathroom, and eat something every now and then…not that I’ve had much of an appetite.

I think this is my body’s way of punishing me. It’s trying to force me to slow down, and I have no choice but to heed its commands.

I guess I shouldn’t be surprised…I’ve purposely kept myself as busy as possible in the last month. I’m always involved in something, whether it’s making plans with people, distracting myself with a new pet betta fish (his name is Tyrion and I love him), or crafting up a storm (I’m almost done knitting my first sweater and I’ve made two hats within the last two weeks). I’ve had a rough start to the year and unconsciously decided at some point or another that the best way to cope was to not cope at all. Hence, my body is rebelling against me, making it impossible for me to engage in any of the activities that would keep me busy.

And I’m annoyed.

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A sick PWD must have these essentials: a fully loaded test kit and a cup of tea made with honey and lemon. (Don’t forget to bolus.)

The silver lining is that my blood sugar/my diabetes don’t seem to be bothered by the cold. I’m sure my numbers would be better if I was exercising regularly, but that’s to be expected.

So I’m what we, people with diabetes, call “real people” sick: I’m definitely fighting something, but since it’s not affecting my blood sugars, it doesn’t have anything to do with my diabetes. And that’s a relief. Because handling sickness ON TOP OF out-of-control blood sugars/diabetes would be enough to drive me insane right now.

It’s almost nice that my blood sugar isn’t the first thing I’m worried about at the moment; instead, my priority is on relieving the pressure in my head and catching up on sleep. But I admit that it’s also frustrating because slowing down means that all of my other concerns, bothers, and feelings have time to catch up with me.

I guess all I can do now is practice being patient with myself (ha) so I can resume my routine of going from one thing to the next as soon as possible. And hey, I’ve had a genuine excuse to lay in bed and binge-watch Sex and the City for hours, so it can’t be all that bad, right?

Managing Diabetes When Sick

This post initially appeared on Hugging the Cactus on February 26, 2018. Since I’ve already dealt with two bouts of congestion and coughing this cold and flu season, I figured it was appropriate to republish this post to remind myself of my philosophy when I’m run down with illness: Don’t push myself and give my body time to rest as much as it needs in order to get better faster. 

The inevitable finally happened: I caught a cold. It really didn’t surprise me, because 1) it’s cold season and 2) I’ve been running around like a mad woman the past couple weeks and missing out on sleep.

Though it was expected, it certainly wasn’t welcome. I can’t stand being limited with my activity levels, and it’s been tough enough to get by recently due to my broken arm. Alas, I spent about three full days doing nothing but sleeping and binge watching Gilmore Girls as I nursed myself back to health.

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My best friend during my cold? This box of tissues.

During this time, I was extra concerned about my blood sugar levels. They tend to be better when I’m active, so I was worried about how they would fare when I was moving so little.

I admit that I probably did the wrong thing by not eating much during this time. It seemed like I needed to pump myself up with a heftier dose of insulin any time I was eating a meal, likely to compensate for the lack of movement. Even so, I seemed to spike a little too much for my liking after meals. So I really cut back on food. In hindsight, it wasn’t my best move, because even when I did eat it was not healthy (few fruits/veggies, mostly breads and fats).

But I do give myself credit for staying hydrated – a crucial step in getting better. I drank so much water, Powerade, and tea that I felt like I was constantly taking trips to the bathroom. It was worth it, though, because it’s easy to become dehydrated when sick and make a bad situation worse.

Also, I think I made the right move by taking some sick time from work. The day I woke up with a tingly throat, I thought I could soldier on and work a full day, but it became clear the moment I sat down at my desk and couldn’t focus that it would be best to just go home. I took a sick day the following day and was able to work from home the day after that, so I’m grateful that I have a flexible and understanding employer who knows that health is a priority over everything else.

As much as I loathed being mostly confined to my room for 72 hours, it was the smart call. It reminded me how important it is to listen to my body and to not push it when I’m not feeling 100%. There’s no shame in self-care.

When Diabetes Isn’t Responsible for an ER Trip

If something unexpected happens to me in terms of my health, I can almost always safely blame diabetes for causing whatever it may be. But when I absolutely, definitely cannot blame my diabetes, I can’t help but feel angry at my body for rebelling at me in ways that it shouldn’t. Particularly when those ways end up with me making a trip to the emergency room.

Let me set the scene: It was a Tuesday evening, around 7:45 P.M. My partner and I were watching an episode of Stranger Things (we’re not caught up yet so please, don’t spoil it for me). Suddenly, I felt an itch on my upper left arm. Like anyone would, I scratched it. But then it got more intense. Like, really, seriously itchy. I rolled up my sleeve so I would be able to scratch with greater ease, and was surprised to feel some bumps emerging on the itchy patch of skin.

I peeled off my sweater and stepped into better lighting in the bathroom so I could examine the area better. There was a large patch of red, inflamed skin on my arm that was covered with bumps that looked like hives. I was dumbfounded. Unsure of what triggered the hives, but alarmed by how swollen and irritated my arm looked, I shot a couple text messages to my EMT father and nurse best friend, who both advised me to get my arm looked at stat.

HUGGING THE CACTUS - A T1D BLOG
Stranger things have happened in my life with diabetes (just had to sneak a pun in there)

And that’s how I found myself in a crowded emergency room, tearful and furious at my body, on a random weeknight. Part of me was relieved that my diabetes didn’t seem to have anything to do with this (but see my recent post on Metformin and you’ll understand that I have some theories about that being the cause). But the other part of me was so pissed off that my body just couldn’t be normal for once. I felt that my body was lashing out at me like an unruly child, declaring its anger towards me in the form of an incredibly itchy, ugly rash. I couldn’t help but stew over the whole situation the entire time I waited to see a doctor.

Long story short, a dose of Benadryl cleared up the hives within an hour. The doctor was unable to determine a cause, since I couldn’t think of anything new introduced to my diet or any new scents/lotions/detergents used in my household. And insect bites got ruled out because the doctor was certain that a bite would be more localized and not spread in a giant patch on my arm. I’m still perplexed at how it happened, but I guess I just have to make peace with the fact that it did and be grateful for 1) making a total recovery from it and 2) not experiencing any issues with my blood sugars as a result of it.

When diabetes isn’t responsible for an ER trip, it means that it’s okay to still be upset about it, but also glad for not having to explain the intricacies of diabetes to every doctor and nurse that walks into the room…because I can’t think of a single PWD that would ever feel happy about taking on that happy task.

Starting Off on the Wrong Foot

“How are you today, ma’am?” The man behind the Dunkin’ Donuts counter smiled and looked at me expectantly, as I started back at him blankly.

I wasn’t sure how to answer. My mental state wasn’t great, that was for sure. I’d just come from a visit to a walk-in clinic, where I’d had X-rays of my foot taken to see whether or not it was fractured.

The previous 24 hours had been a bit of a whirlwind. I’d worked and gone to my first-ever kickboxing class, which was an awesome experience. I’d had dinner with my partner and started playing video games soon after as a way to unwind after the long day. That’s when pain in my foot flared up, suddenly and significantly.

Could I have injured it in the kickboxing class, without even knowing it? Was I overdoing it on exercising, in general? How and why did the pain just start up like that? Almost immediately, I plopped myself down onto the couch with an ice pack and extra cushions, hoping that I could stop the pain as quickly as it started.

No such luck. I went to bed early that night, but the pain was so severe that sleep was virtually impossible. I tossed and turned for hours, wondering what the hell was going on and coming up with a plan to get it checked out A.S.A.P.

That’s how I found myself at a walk-in clinic, a little over 12 hours after I first felt the pain. I was evaluated by a nurse practitioner who told me that “the likelihood of a fracture was low” (thank goodness) and that it was “probably tendinitis.” I was given instructions to rest, ice, and elevate my foot for the weekend, and take non-steroidal anti-inflammatory drugs (otherwise known as NSAIDs, like Ibuprofen or Aspirin) as needed.

Hugging the cactus - a t1d blog
I’m trying to put my best foot forward as I deal with this injury.

That meant hours and hours of being sedentary.

That meant no exercise of any kind – I even had to keep walking at a minimum.

That meant my spirits were crushed.

I was glad that it wasn’t worse, and proud of myself for not waiting to seek medical treatment. But that didn’t mean I was thrilled with the outcome. Basically, I had to take the wait-and-see approach. Time will tell how long the pain lasts, and I can’t stand not knowing. I also can’t stand not being able to be active. Daily exercise is a key element to maintaining good blood sugars. Sitting around idle doesn’t do my diabetes any favors, but it’s not like I had any other choice.

I left the clinic, trying to process this information. This certainly wasn’t the way I wanted to kick off the long Memorial Day weekend. It definitely could have gotten off on a better foot. (Okay, okay, I’ll stop with the puns.) I found myself at a nearby Dunkin’ Donuts minutes later. I hobbled in, hoping that an iced coffee might lift my spirits somewhat.

I blinked, bringing myself back into the moment, and smiled wryly at the Dunkin’ cashier. “I’m okay,” I said to him. It wasn’t just a response to his question, it was also a reassurance to myself. I’m okay and I will be okay. I won’t let this get me down.