An Endo Update

So I’ve got an update on my whole I-haven’t-seen-my-endocrinologist-in-8-months situation.

It’s not exactly the update I was hoping for, but it’s one that I believe just might push me into making some positive change around my diabetes care.

As it turns out, my endocrinologist is on leave and not taking appointments until February 2022, at the earliest.

What’s even crazier than that February 2022 wait time? The fact that I haven’t been at an in-person endo appointment since 2019.

I found this out after contacting her office and receiving a message back that I could either wait until that time to see her, or I could schedule an appointment with a doctor at a different location that the office would suggest to me.

At first, I wasn’t sure what the right move was. I was almost certain that I couldn’t (and shouldn’t) wait another 4 months to see someone about my diabetes; after all, I’ve been unhappy with my management for most of this year. But even though I have been similarly unhappy about my relationship with my current endo (it’s practically nonexistent), I admit that I felt fear over the prospect of seeing someone new because any other provider would only know me based on the information available to them in my records. In other words, they would only know me based on numbers, not based on who I am and my personal diabetes management style/beliefs.

So I sat on this news for a few days as I pondered whether or not to take this as a sign that it’s time for me to find a new permanent endo, despite the mere thought being incredibly daunting to me.

During my pondering period, I happened to get a call from my endo’s office that wound up making my mind up for me.

They called to let me know about an available appointment with the nurse practitioner who works closely with my endo – an appointment that I could get this week.

I hesitated for a moment (I really hadn’t anticipated getting an appointment before the end of the month) before agreeing to take the open slot. And I’m glad that’s what I decided to do, because 1) at least I can talk to someone about what I think I’m lacking in terms of my current diabetes management; 2) I might end up getting some quality advice that will redeem my endo’s office in my eyes; and 3) even if I don’t see eye to eye with this person, it will be the push I need to start actively pursuing a new endo that will more closely match my diabetes care style.

We’ll see what happens.

The Worst Diabetes-Related Customer Service I’ve Ever Experienced

Roughly six months ago, I wrote a blog post in which I gave diabetes supply company Byram Healthcare a glowing review.

Now, I take back everything I said then (and have since updated the post with a preface).

I truly believe that Byram gave me the worst customer service that I’ve ever experienced as it relates to my diabetes…and maybe that I’ve ever had in life, in general.

I take back every nice thing I had to say about Byram six months ago.

It’s a long, messy story – one that spans half of this year – but I’ll break it down for you.

Basically, I found it in January 2021 that Dexcom would no longer be directly supplying their products to customers. I’d be automatically transferred to Byram Healthcare, a medical equipment distributer. However, I didn’t want to use Byram and called them after I got my first order in the mail a few months later to see if I could 1) return the supplies to them, 2) get a refund for said supplies once they were returned, and 3) cancel my account because I wasn’t going to be using them.

At that time, I was told yes to all three of those things. I got a return label from them so I could mail back the supplies, which I did within days of making that phone call to customer support. That way back in early May.

Imagine my surprise when I started receiving bills from Byram in June that stated I owed them $263 for those same Dexcom supplies that I had mailed back and was told I wouldn’t have to pay for because I never used them – I never even opened the original box!

So of course I contacted Byram. I was told to ignore the bill, that a note would be made on my account (mind you, the account that I’d closed) that I didn’t owe any money. Sounds like it was simple and easy to take care of, right? Oh, so very wrong. I received at least two more bills in the mail from them (which immediately reignited my anger both times). Naturally, I called on both of those occasions and was assured TWO MORE TIMES that I didn’t owe money and that I should ignore those bills because they were being automatically generated by their billing system, which was being falsely triggered because my mailed-back supplies weren’t checked in at the warehouse yet.

Stupidly, I believed them and assumed that the whole nightmare was over when the bills stopped coming in the mail…but everything changed the day that I got the collection notice.

Yup, that’s right – Byram had a collection agency COMING AFTER ME because according to them, I had failed to pay the $263 bill THAT I NEVER OWED IN THE FIRST PLACE. The moment I read that notice, I felt pure rage roiling in my core. I couldn’t believe my eyes. I thought this whole saga ended months ago! Now I’d have to use time I didn’t have – because it was a workday afternoon and I was trying to get real-life stuff done before the weekend – to sort this mess out.

I was beyond upset. Life with diabetes is hard enough, but throw this BS into it and it’s just not fair that getting my regular 90-day supply of a key component of my diabetes toolkit turned into something so stressful and potentially expensive. I was determined to get answers and get reassurance once and for all that they were in the wrong here, not me.

I was able to look up the USPS tracking number for the mailed-back supplies which turned into the proof I needed for both Byram and their collections agency that I had, indeed, done my end of the bargain this past May. When I finally got into contact with their billing department after nearly 30 minutes of being on hold (oh, and after a first attempt to call them during which I “held my place in line” using that option on the service line, only to never get a damn phone call back), I heard the lamest excuse for the whole thing about how they’d recently switched warehouses for this sort of thing, which explained why the billing system wasn’t registering my returned order…

…how do you think I reacted to that news? Like that’s MY fault for their company’s obvious disorganization!?

Needless to say, I didn’t care about excuses, I just wanted assurance that this whole nightmare would go away as soon as possible and they’d do everything possible to accomplish that…which I received in a short amount of time after speaking with the customer service rep.

So yeah, to say that I am displeased and untrusting of Byram Healthcare is a bit of an understatement. I thought it was important to share this story here on Hugging the Cactus not because I want to damage this company’s reputation, but because I want to help anyone else with diabetes who gets Dexcom supplies to avoid going through anything similar. Take my experience as a reminder to advocate for yourself and always hold onto records and receipts from your supply distributors…

…because you never know when you might need them to defend yourself.

Apple-ing Blood Sugars Post-Apple Picking and Pie Baking

I’m gonna forewarn you now – this blog post is gonna have a bushelful amount of puns. If you don’t find that appealing, then it might be fruitful for you to walk away now – I’ll seed you out.

OKAY JUST KIDDING, I actually think I used up all of my good apple puns in that opening paragraph. I can’t think of any evercrisp ones at the moment…

For real, I’m done now (at least for the time being).

So the title of this blog post (and all the ridiculous puns) will indicate to you that I recently went apple picking! And turned some of those apples into yummy pies!

But that’s not all, folks – I did both of those activities, in addition to actually eating slices from those pies, while maintaining excellent blood sugars!!

Pictured above: the brown sugar bourbon apple pie that is the best kind of apple pie I’ve ever had, hands down.

To this day, I still don’t really understand the sorcery that must’ve been at work in order for me to accomplish such a feat. I have a theory when it comes to the apple picking – I was walking all around a large orchard for like an hour, on a quest for the most perfect apples possible – and all that roaming up and down the rows of apple trees kept my blood sugar levels steady, even as I sampled upwards of 10 different types of apples (and I even had to eat an entire apple as I exited the orchard because my blood sugar was, in fact, beginning to dip). So that helps to explain why my blood sugars were so good when I was picking the apples.

But with the baking and eating of the pies…I have no idea how I dodged a high blood sugar. My boyfriend and I made the most decadent apple pies we could think of – one had a peanut butter crumble topping and the other was a brown sugar bourbon apple pie with an ooey gooey caramel sauce. Surely, I thought as we chopped apples, folded ingredients together, and did latticework with our crusts, my blood sugar is gonna suffer when we dig into these pies later tonight.

Much to my utter befuddlement and delight, though, my blood sugar never rose above 150, even after I had two decently portioned slices of pie with caramel sauce generously drizzled over them.

Maybe I nailed the carb counts. Maybe I know my body’s reaction to pies – which I only ever eat at Thanksgiving, normally – better than I thought I did. Who knows, but there’s one thing that’s for sure…

I was happy to my core over my delicious pies and sweet blood sugars!

Way Overdue for An Endo Appointment

By chance, I was looking through some old lab results on my endocrinologist’s online patient portal when I noticed something.

I was (and still am, as of this writing) way overdue for an endo appointment.

The last time I saw my doctor was at a virtual appointment back in February – more than 8 months ago. This gap in time between appointments feel especially significant because most of my life with diabetes, I’ve gone to the endocrinologist 4 times per year. It was only when I started seeing this new endocrinologist (who I’m not a particularly big fan of, BTW) a couple of years ago, and it was at her suggestion that I dropped down to twice yearly appointments.

From the beginning, I haven’t loved that recommendation.

I’ve realized that I am the type of person who kind of relies on regular visits with my endocrinologist in order to keep my diabetes (and myself) in check. This doesn’t mean I actually enjoying going to see my endo – because who honestly likes to go see any doctor – but it does mean that I feel like there’s been a missing component to my diabetes care lately.

I guess I’ve just been too busy (traveling, working, trying to maintain a semblance of a social life) to slow down and really notice the absence in my diabetes care and management.

But what bothers me more is that my endo’s office hasn’t even tried to contact me to schedule an appointment. What gives?! The moment I knew that I was way past due for an appointment, I messaged their office, and I still haven’t received a response back.

So in addition to it being time for my endocrinology appointment, it may also be time for a new endocrinologist, period.

3 Tips for Maintaining Good Blood Sugars on Vacation

As promised in my last blog post, I’m going to share how I kept my blood sugars (mostly) in range while I was on my trip to California a few weeks ago!

I’m not going to lie and say it was easy; in fact, I had a couple of not-so-fun nights where I was stacking insulin like crazy due to some post-dinner highs. But the vast majority of the time, I was really proud of my diabetes management when I was away. It can be tough to take good care of diabetes when in a new place and thrown off schedule, but it can be done, and these are the three biggest tips that I used that were most helpful to me:

Pro tip – Going on long scenic hikes where you can take in views like the one above AFTER eating a huge breakfast is an amazing way to keep blood sugar in range.
  1. Split meals with travel partner(s). I don’t know about you, but when I’m on vacation, any self-control as well as the idea of eating super healthy/clean goes out the window. I want to indulge when I’m in a new place! I want to try new foods and enjoy them rather than stress over how they might impact my blood sugar levels. So I was thrilled when my partner suggested we split any meals that we ate out at restaurants. We figured this was a smart strategy because most restaurants serve ridiculous portions of food anyways, and this also meant that I could order a carb-heavy item from the menu and automatically split the carb count in half because I was sharing the dish. This worked out so well and I got to eat foods that I normally don’t dare to touch, such as a fisherman’s platter (consisting of 3 different kinds of fried seafood) and garlic french fries (these were beyond incredible).
  2. Stay as active as possible. This is kind of a no-brainer – most vacations that I’ve ever gone on have involved lots of walking in order to sightsee and get from point A to point B. But it’s worth mentioning that getting in any other types of activity in addition to walking can reap benefits on blood sugar. For example, I started off one morning with a 25-minute yoga practice soon after I ate a heavy breakfast and my blood sugar levels were stellar for hours. On the night of the wedding that we flew out there for, I balanced sampling every dessert at the reception with hitting the dance floor, which worked wonders for my blood sugars. And generally speaking, I found that sneaking in at least 15 minutes or so of extra exercise after meals was a great way to keep my blood sugars in check, even if it was just walking around the block for a bit.
  3. Keep a consistent eating schedule. Traveling can make it difficult to maintain a regular meal schedule, but with a little extra effort it can be done. Within hours of landing in California, we made a trip to Target to stock up on a bunch of extra snacks and drinks so that we would always have something within reach, whether my blood sugar was going low or one of us just needed an extra energy boost. We also made sure to take advantage of complimentary breakfast provided by the hotel we stayed at for the first couple of nights – the fact that they stopped serving it at 10 A.M. automatically put us on some type of schedule. And on the day of our friends’ wedding, we ordered pizza and timed it so that we’d have it about an hour before we were due to leave for the ceremony…because as anyone who’s ever been to a wedding before knows, guests sometimes have to wait a looooong time before they’re served food. I didn’t want either of us to have an empty stomach for potentially hours on end, so ordering food before the wedding pulled double-duty as a late lunch and as something that would keep our bellies full until we were served dinner at the reception.

But what made it the easiest to take care of my diabetes while on vacation was the support from my partner, who always put me and my blood sugars first and checked in on me frequently (but without being overbearing). That alone goes a long way in making diabetes management a breeze when my normal routine is disrupted, but when combined with all the tips above, it’s practically like taking a vacation from diabetes itself.

The Biggest Diabetes Mistake I Made on My Trip to California

A couple weeks ago, I shared about my fears over flying again for the first time since before the pandemic.

Fast-forward to now and I’m happy to report that basically none of those fears came to fruition over the course of my trip…

…but of course I did experience one snafu that was definitely avoidable.

All smiles in scenic California in this pic, but I definitely wasn’t grinning like this when I made my mistake.

The biggest diabetes mistake I made on my trip to California was neglecting to charge my OmniPod DASH PDM as often as it (apparently) needs to be charged.

I’m not going to make excuses for myself because I should’ve planned better, but I will say that I’ve only been on this system for about six weeks or so now…and I’m still getting used to some of the PDM’s quirks. In particular, I have yet to figure out exactly how often I need to charge my PDM. It runs on a lithium ion battery, which is the same thing that most cell phones use. So one might make the assumption that I’d need to charge the PDM daily, but that’s definitely excessive – I’d guess that I only use about 20% of the PDM’s battery each day, but of course that depends on how frequently I need to bolus or play around with my basal rates. However, using that rationale, I’ve been charging the PDM every 3-4 days, or whenever I notice the battery falling to a 20% or less charge.

My logic failed me, though, when I falsely assumed that my PDM’s battery would last a day trip into San Francisco when it had a 40% charge.

I still have no idea what happened – all throughout my day walking the hilly streets of San Fran, I was careful to turn off my PDM screen whenever I wasn’t actively looking at it, and I was only turning it on to bolus slightly more than usual (I was basically snacking my way through the city the whole afternoon).

I consider myself pretty lucky, though, because I made the discovery that my PDM battery was dead towards the end of our day, right when we were headed on the subway back to our Airbnb: If there was a time for this to happen, it’s definitely better at the end of the day’s activities rather than at the beginning or somewhere totally inconvenient.

At least, this was what I tried to futilely tell myself in an attempt to feel better about my negligence.

Instead of feeling better, I was beating myself up over making what felt like a rookie mistake. I should’ve charged the PDM because, after all, there was no way that I was about to go into a brand new city for the first time with my phone battery at 40%, so why on earth did I think it was okay to do that with my PDM? Moreover, how the heck did this happen in the first place – does the battery really just drain super quickly and/or easily?

I knew there was no point in trying to figure out why it happened at that point in time – it was more important for me to charge the PDM as soon as possible so that my partner and I could experience In-N’-Out for the first time on our way back to the Airbnb as we had planned.

So, because he is brilliant and calm in “emergency” situations (unlike me), he came up with a plan: I’d head over to In-N’-Out, order our food, and wait for him in our rental car while he ran up the street to a nearby CVS to see if they sold any USB cables (you know, the types of charging cables that everyone has because most electronics are charged with those). And his strategy worked out beautifully. Soon after I had our bag of In-N’-Out in hand, he arrived at the car with the charging cable and I was able to plug my PDM into it so I could bolus for dinner right then and there instead of having to delay it. (We could’ve just waited until we were back at our Airbnb, but then I would’ve either had to eat a cold burger [blech] or eaten it fresh and run the risk of my blood sugar jumping up without the necessary insulin in my system. Obviously, we went with the more appealing option.)

All things considered, if that was the biggest diabetes mistake I made in California, then I’d say I did pretty good – more to come soon on my strategies for maintaining decent blood sugars while on vacation.

As for now, I’ll leave you with this – In-N’-Out is kinda overrated.

Hugging the Cactus Turns 4!

Today is this blog’s fourth birthday.

Four whole years of Hugging the Cactus! I can hardly believe it.

As I think about 1,460 days of running my blog, other milestone numbers related to it come to mind:

  • 605 blog posts that I’ve written
  • 595 comments from readers (you guys are the best)
  • 51,276 unique visitors – WOW
  • 71,662 total views – OMG what
  • 100 dollars earned (one month ago, WordPress paid me my first $100 for featuring ads on my blog. The honest-to-goodness truth is that I never intended to earn money from my blog, but the fact that I have is pretty cool considering the following bullet point…)
  • INNUMERABLE HOURS spent writing new blog posts and coming up with graphics to accompany them – if I even attempted to calculate the amount of time, then I think my head would explode

It’s not surprising I’m thinking of the numbers behind Hugging the Cactus; after all, diabetes is a chronic condition based on numbers. People with diabetes spend all day long monitoring, calculating, and thinking about numbers. So it feels pretty natural to me to think about the numbers that have built Hugging the Cactus from a tiny little passion project to a bigger, more meaningful passion project.

And I can’t help but feel extraordinary gratitude for the numbers of people that have motivated, encouraged, and supported me and this blog – people who read this blog daily, weekly, or every once in a blue moon all fuel my desire to keep maintaining this blog and keep proving to me, time and time again, the power of the community that diabetes created. It’s a very special thing to be a part of.

With that said…here’s to four years, and plenty more to come.

My Pharmacy Mailed Me a Broken Vial of Insulin. Here’s How I Handled It.

This post originally appeared on Hugging the Cactus on September 23, 2020. Just over one year later, I’m sharing it again because it’s a reminder that life with diabetes is filled with the unexpected, and it’s important to be proactive when dealing with these curveballs. Read on to find out how I handled the broken insulin vial…

As soon as I opened the package, I knew something was wrong.

The contents of said package were five vials of insulin – my regular 90-day supply. On the surface, nothing seemed wrong. They arrived in their usual styrofoam cooler that was taped shut. After removing the tape, I saw four ice packs next to the plastic packaging containing the insulin vials; again, this was all expected.

When I picked up the plastic package and used scissors to cut it open, though, a pungent odor greeted my nose.

A medicinal, harsh, familiar scent…the smell of insulin.

Upon further investigation, I discovered that one of the five cardboard boxes encasing the vials was totally damp to the touch. Gingerly, I opened it from the bottom flap, which was sticking out slightly due to the wetness. That’s when I saw the shattered insulin vial: Somehow, the bottom part of the vial had broken, spilling and wasting all of its contents.

This image has an empty alt attribute; its file name is my-pharmacy-mailed-me-a-broken-vial-of-insulin.-heres-how-i-handled-it..png
I wish that smell-o-vision was a thing, because OMG…the smell coming from this was STRONG.

I was shocked. In all my years of diabetes, nothing like this had ever happened to me before!

I didn’t really give my next step a second thought: Immediately, I jumped on the phone with Express Scripts, which is the mail order pharmacy that I use for my insulin and some other medications. I spoke with and explained the issue to a customer service representative, who connected me with a technician that promised a replacement vial would be mailed to me at no additional cost to make up for the broken one. I asked if they needed me to send the broken one back to them, but I was reassured that it wouldn’t be necessary because I had called them so they could document the incident.

My issue was resolved, just like that, in fewer than 15 minutes. While it was annoying to have to take time out of my day to figure that out, I’m very happy that I got a replacement quickly and easily. But really, where was quality control on this one?!

Insulin is expensive, as we all know. And to see that a perfectly good vial full of it was rendered useless due to defective packaging was a major punch to the gut, indeed.

How Time Travel Affected My Blood Sugar

This was originally published on Hugging the Cactus on May 25, 2018. I decided to share it again today because in light of my travels last week and this week, I thought it’d be fun to revisit how my blood sugar was impacted by a long flight. Read on to learn more about my last long flight experience…

I traveled through time last week.

No, I didn’t use a magical device or step through a portal. It’s much more boring than that: I flew across the country, east coast to west coast, to spend a few days in Las Vegas.

Okay, there’s no way in hell that I could justifiably describe my Vegas trip as BORING.

But my point here is that flying through a couple different time zones is totally trippy. And, of course, it impacted my blood sugar. Because why wouldn’t diabetes just cooperatively come along for the ride?

Travelbetes is guaranteed to keep me on my toes.

I knew I should anticipate some sort of blood sugar swings going to and from my destination, I just wasn’t sure of when and how they’d hit. But I did know that when I landed in Vegas, the first thing I needed to do was adjust the time on my PDM (my insulin pump). Surely, my blood sugar would not react kindly to thinking that it was three hours later than it truly was in my new time zone. My question, though, was when should I do this? On the plane? After we landed? Should I adjust it slowly, in one-hour increments? Or should I dial it back entirely in one go?

Normally, I would’ve asked my endocrinologist what to do – but I forgot to bring it up during my last appointment with her a few weeks ago. So naturally, I asked the next best source: the Diabetes Online Community (DOC).

The answers I received were varied; nevertheless, I appreciated the immediate replies. I decided to quit stressing about it so much and focus on getting to the actual destination, vowing to keep an eye on my blood sugar for any suspicious trends while on the flight.

Five and a half long hours later, my travel companions and I arrived at our hotel. While in line for check in, I fixed the time on my pump and glanced at my CGM (which I didn’t bother adjusting, since none of the settings on it or my meter were dependent on time). I was steady at 97 mg/dL…not too shabby at all. And I’m pleased to say that I maintained that decent graph for the next day or so. I was nonplussed by the phenomenon, but I couldn’t complain about it.

The next few days are a different story, due to some “lifestyle choices” I made while in Vegas (c’mon, you know all I mean by that is eating junk food and imbibing alcohol). But that’s a tale for another post, coming soon.

This one’s about time travel, and while I had no issues flying TO Vegas, I did encounter trouble flying home FROM Vegas. My friends and I chose to a red-eye flight, which I don’t regret per se, but I’d never done one before and didn’t realize how much trouble I’d have falling asleep on the plane. It was disorienting enough leaving one place at 9 P.M. to arrive in another at 5 A.M., but add a freezing cold aircraft, turbulence, and an unsettled stomach to the mix, and you’ve got a recipe for disaster. As I tossed and turned in my seat, violently shivering a few times, my blood sugar was very slowly, incrementally, rising. I didn’t realize how much until we landed and drove home, where I had to bolus for an out-of-the-blue 308 mg/dL. I was so bloody tired, yet sleep evaded me further as I anxiously waited for my blood sugar to budge – which it did, but not for several, agonizingly long hours.

It definitely didn’t help matters that I wasn’t eating regularly; at the time of our arrival home, I hadn’t eaten real food in about 36 hours due to nausea that wouldn’t seem to leave me alone. I’d muscled down toast and a couple of granola bars, but not much else. I’d like to think that my entire body was just rebelling against me for spending the weekend eating too much pizza, staying up too late, and drinking a little too much whiskey, because that train of thought at least helps me make sense of my lack of appetite and recurring high blood sugars.

I’ve been back on the east coast for a couple days now, and I’m relieved to report that things have settled down. I’m eating regular meals (and I actually feel hungry for them), and besides a few flukes in my CGM graph, my blood sugars are mostly back to normal. I wish I could say that there was some big takeaway from this all: that I know exactly what to do next time I travel through time zones, or that I know just what to do to prevent it. But that’d be silly, because with diabetes, there are just too many variables. At least I CAN say that I know to take it in stride next time, to roll with the punches. Monitor my blood sugar like a hawk, correct as often as needed, eat normal meals as much as possible, and drink plenty of WATER. In any case, isn’t that what diabetes is all about…

…regardless of time travel and/or sorcery?

Travel Time

Tomorrow, I’m boarding a plane again for the first time in more than a year and a half.

I’m having some feelings about it.

According to my calculations, it’s been 629 days since I last boarded a plane. That’s wild considering I used to fly a couple times a month in 2019.

The primary feeling is excitement. I’ve missed traveling – not the flying part – but I’ve missed the opportunity to see new sights and experience new things. I’ve been extra excited for this trip because my partner and I are both going to California for the first time for a friend’s wedding, so we definitely have a lot to look forward to regarding our plans.

But the secondary feeling is anxiety. A whole lot of it. I don’t quite know what to expect when it comes to traveling in this weird, not-so-new normal we’ve got going on. The only thing I do know is that I’m going to take as many precautions as possible (including masking up, carrying hand sanitizer, eating outdoors whenever possible, etc.) and try my best to quell my anxieties by taking comfort in knowing that I’m doing what I can to protect myself and others.

Of course, it’s easier said than done to conquer these anxious thoughts, and my pre-existing worries about traveling with diabetes complicate matters. For example, I’ve always had concerns about managing my blood sugars on flights. I’ve never been on one this long before (it’ll be about 6 hours), so I’m a bit stressed about that. Other pain points linger in the back of my mind: What will I do about meals? Will I have enough back-up supplies? Will I remember all my devices (and their respective charging cables)? Are my nerves going to drive my partner bananas? (He’s the most patient person I’ve ever met so I will be putting that to the test on this trip!)

So staying healthy and well, in addition to making sure I take good care of my diabetes, are top of mind. It makes me long for the days when getting from point A to point B was the most pressing part of planning a trip…

Through writing this blog post, though, I think I’ve come to realize that I’ve got to keep a third thing top of mind: having fun. The first two things are obviously important, but so is enjoying every minute of this vacation.

And that’s exactly what I plan to do.