Tag: diabetes

Insulin Access Issues Affect People From All Walks of Life – A Post by Laura Nally, MD

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This post originally appeared on the T1International blog on March 16, 2020. I wanted to share it here today because it’s a stark reminder that insulin access issues affect all kinds of people: those who do and do not have health insurance, stable jobs, and so forth. Thank you to Dr. Laura Nally for sharing her story about what happened when she went without insulin for a mere four hours, illustrating the serious nature of access to insulin for all.

In 1990, when I was 6 years old, I was diagnosed with insulin dependent type 1 diabetes. In 1996, I could purchase 1 vial of insulin for about $20 without insurance. Today, a vial of the same insulin that I have taken for 24 years costs somewhere between $250 and $400 in the United States. There is no logical or scientific reason for this. To put things in perspective, in Canada, the same insulin costs about 1/10th of the price.

I am a physician and I have health insurance. However, just because I have health insurance does not mean that I can always access affordable insulin when I need it. Recently, at my cousin’s wedding, my insulin pump became disconnected from my body. It had probably become disconnected when I went to the bathroom 2 hours earlier. It was an accident, and this sometimes happens when you sweat a lot. This honest mistake led to a serious medical problem.

I called my doctor immediately to get a prescription sent to the nearest pharmacy. When I went to the pharmacy, I wasn’t due for a refill, so I paid $369 out of pocket for 1 vial of insulin. I didn’t have a choice. I took a large dose of insulin immediately. Unfortunately, it can take up to 3 hours for insulin to work, and in the meantime, I became very sick.

Four hours after I had become disconnected from my insulin pump, I was vomiting on the bathroom floor at the wedding and falling asleep between vomiting episodes. I was confused, my thoughts were clouded, and I could not take care of myself. All of this happened after going just 4 HOURS without insulin!

Why was I so sick? I was starting to develop diabetic ketoacidosis, a life-threatening condition that prevented me from being able to think clearly. I see patients with diabetic ketoacidosis in the hospital frequently; they may be disoriented, confused, combative, sleepy, and even comatose. Even though I was able to recognize the early signs and symptoms, I still became extremely sick within 4 hours. It took me 12 hours to fully recover from this episode. My family woke me up to check my blood sugars, drink water, and take insulin every 2-3 hours overnight.

I am lucky because I knew what to do to treat this condition and that my family was able to help me.

I did not have time to call insulin manufacturers and ask for support.

I did not have time to figure out how to get a coupon for my insulin online, like many have proposed is a solution.

I did not have time to learn how to use Wal-Mart brand insulins, which act completely differently than the rapid acting insulins that I currently take. THIS WOULD HAVE BEEN FAR TOO DANGEROUS.

I did not have time to worry about how much I could afford to spend on insulin.

We don’t have time to argue over this issue. We need affordable insulin now. It’s a matter of life and death.

“Diabetes does not selectively affect individuals who can afford insulin and have health insurance; it affects people coming from all walks of life, regardless of socioeconomic status.“

Many people cannot relate to what it would be like to have your life depend on whether or not you can afford or access a medication. In all forms of type 1 diabetes and some forms of type 2 diabetes, you may be able to survive without insulin for as long as you can survive without water, which could be a few days or up to 1 week. Most people need a minimum of 3-4 vials of insulin per month. If we estimate that 1 vial of insulin can costs $300 without insurance, that would mean out of pocket insulin costs were $900-1200 each month for insulin.

What if a 1 month supply of water cost $900-$1200? Could you survive? For how long? What if you could only receive water once per month, and the amount depended on how much water your doctor thought you needed. What if the doctor didn’t estimate your water needs correctly?

What if there were restrictions on how much water you could receive in a given month by the company that supplies the water? Let’s say you ran out of water too soon and became extremely thirsty, but when you try to get more, you’re turned away because the water you were given last month should have lasted you longer. You will have to wait until next week to get your water. But can you survive until then?

What if the company you get your water from decided to verify that you REALLY need that much water, like insurance companies do with prior authorizations. They will contact your doctor to submit extra paperwork and if the larger supply of water is approved, you will know within 2-3 days. What do you do until then?

Diabetes does not selectively affect individuals who can afford insulin and have health insurance; it affects people coming from all walks of life, regardless of socioeconomic status. It affects our children, our parents and grandparents, our brothers and sisters, our friends and coworkers. No one who is in urgent need of insulin should be turned away from the pharmacy without insulin or the diabetes supplies that they need.

I Forgot About Fingerstick Checks

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It was just after 4:30 P.M. on a Thursday afternoon. I’d spent the last hour and a half at my work desk in my bedroom, checking email and dialing into a video conference call. I’d deliberately left my cell phone downstairs, wanting to resist the temptation to scroll idly through social media or check my blood sugar, which had been misbehaving most of the day.

At the conclusion of my virtual meeting, I lamented that my cell phone was downstairs. I wanted to know what my blood sugar was doing (especially if it was high so I could get some insulin pumping), but I didn’t want to walk that oh-so long distance down the stairs to retrieve it.

I sighed, resigning myself to the fact that I wouldn’t be able to check my blood sugar any time soon.

Then…I remembered.

I have a blood sugar meter mere feet away from me.

I could do a fingerstick check and actually know my blood sugar! I wouldn’t have to wait for my workday to end in order to check it, after all!

I still can’t believe that I momentarily forgot that I could check my blood sugar by pricking my finger…

As I ambled over to my nightstand where my blood sugar meter is always perched, I chuckled to myself, marveling over how I could forget that this was an option readily available to me.

Of course, I had the option to not be a lazy Susan and walk downstairs to get my phone, but that’s not the point! (Plus, I was trying to give myself a much-needed break from it!)

It just struck me as funny – I used blood sugar meters for two decades of my life. And bear in mind here, I haven’t even been alive for a full three decades yet, so blood sugar meters are just something I’ve grown up with. How could I forget about them? Have I really become so reliant on the 24/7 reporting from my Dexcom that I’ve shunted aside my only other device that can tell me what my blood sugars are?

I think that this incident indicates that I have. And that scares me a bit.

When I first became a Dexcom user in my late teenage years, I was told that my CGM wasn’t a replacement for fingerstick checks. So up until 3 years ago (when the Dexcom G6 came out), I tested my blood sugar with my meter at least 3-4 times per day, sometimes even more.

But then the Dexcom G6 came out, and the exciting news that the technology was so advanced that it meant that people with diabetes wouldn’t have to do fingerstick checks. Gone were the days of making diabetes treatment decisions only with confirmatory fingersticks or calibration. This was huge, but I was so untrusting of the technology for the first year or so that I continued on with regular fingerstick checks…

…Until one day I just kinda stopped. My multiple-times-per-day checks turned into maybe once or twice a day, then once or twice a week, and now…really, just once or twice a month. And now I’m facing the reality that I don’t exactly feel that this decision suits me because I am the type of person who craves as much data as possible so I can make the best-informed diabetes choices for myself.

So forgetting about fingerstick checks may just be my remembering again to do them. Because when I did check my level and saw that 140 mg/dL flash up on the screen, I felt reassured and thankful for this data point on my blood sugar graph. It was nice to see this number alone, without the reminder of the yucky numbers I experienced earlier in the day…

And best of all…I didn’t have to go downstairs in order to get this snippet of information.

4 Ways Diabetes Motivates Me

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Life with diabetes can be inconvenient, unpredictable, and downright frustrating. But it’s not all bad. In fact, after living with it for more than 23 years now, I’ve actually identified a few different ways in which it helps motivate me.

And what, exactly, are those ways? Well…

#1: It’s constantly challenging me to strive for the better: Better “control” over my blood sugar levels, better management of my diet and exercise regimen, and better care of my entire body, in general. While it involves a lot of work, it’s extremely motivating because I know that anything I do for the better of my diabetes and my body now will pay dividends in the future.

#2: Diabetes encourages me to ask questions. I think that my diabetes is the reason why I’ve learned to be curious. It pushes me to want to know the who, what, when, where, why, and how of various scenarios, both relating to and not relating to diabetes. It’s natural for human beings to be inquisitive, but they don’t always do something to pursue answers to questions. My diabetes pushes me to do that, with varying degrees of success, and that’s something I’m grateful for.

After having diabetes for more than 23 years, I’ve realized that it can be highly motivating.

#3: It pushes me to prove people wrong. There’s so much stigma surrounding diabetes…”You can’t eat that! You can’t do this! You can’t do that!” are exclamations that I’ve heard my entire life from different people. Rather than nodding and smiling politely at these poor, misinformed individuals, I strive to show them exactly why they’re wrong. Whether it’s explaining the facts or going out and doing the very thing they said I wouldn’t be able to do because of diabetes, it’s empowering for me to smash down diabetes misconceptions.

#4: Diabetes inspires me to seek more out of life. This goes hand-in-hand with point number 3, but it counts as a separate notion because this is all about how I view my life with diabetes. I didn’t fully accept my diabetes until I was a teenager. That acceptance represented a turning point for me during which I realized that just because I was dealt this card in life, it doesn’t mean that it should stop me from accomplishing my hopes and dreams. Over the years, my diabetes has made me want more: opportunities, experiences, relationships…you name it and I’m hungry for it.

Sure, diabetes can be my biggest headache…but it can also be my greatest motivator, and I think it’s important for me to embrace the beauty of that.

Luck O’ the Irish Diabetic

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Happy St. Patrick’s Day!!!

Last week, it occurred to me that in more than 3 years of running this blog, I’ve never written anything about St. Paddy’s Day here…so I sought out to rectify that immediately; hence, today’s blog post.

I love St. Patrick’s Day. Always have, always will. I celebrate it each year decking myself out in head-to-toe green. I eat a traditional Irish dinner – always prepared by my mother, until this year when I will attempt to cook the meal myself – that consists of corned beef, cabbage, potatoes, carrots, and Irish soda bread. We eat it while listening to Irish music and more often than not, we’ll have a Guinness or an Irish coffee along with the meal. My family’s attended St. Patrick’s Day parades in various locations in years past, though obviously, we didn’t go to any last year and we won’t this year, either. But we’re still proud of our Irish heritage and we made the most of it in 2020, as I know we’ll do today.

My parents’ dog, Clarence, and I certainly made the most of the day last year. I was dressed up like this for all of my work video conference calls, which made my colleagues laugh at a time when we all needed one.

So you know my plans for St. Patrick’s Day, but what does this have to do with my blog that’s about diabetes?

Let me explain.

The common denominator between this holidays, all the others, and my diabetes is…food.

Foods consumed on holidays are often special and laden with carbohydrates. Rather than deprive myself, I like to indulge on holidays, and worry a little less about my topsy-turvy blood sugar levels.

You might be thinking, “But the food you described isn’t even that carb-heavy!” and you’d be right, for the most part. Corned beef, cabbage, carrots…those are all easy to bolus for seeing as the carbohydrate content is negligible.

It’s the combo of potatoes – which normally, I can bolus for without any troubles – and Irish soda bread – hellooooo, carbs – that really screws me up.

You see, the problem is that Irish soda bread is too delicious. It’s a quick bread that has a buttery exterior and a tender, mouthwatering interior that’s densely packed with raisins. It doesn’t sound like much, but my mother’s recipe is sheer perfection and I can’t resist helping myself to a big ol’ slice (and a couple of mini, just-one-more-taste slices) of the stuff every year.

So more often than not, my St. Patrick’s Days end with high blood sugars (which I suppose is better than ending with a trip to the toilet due to excessive…ahem, celebrating).

The Irish soda bread is worth the high blood sugar alone, but this year, I’m hoping for a little luck when I tuck into this festive feast. I’m tired of simultaneously welcoming holidays and high blood sugars…it’s about time that I make more of an effort to have better levels when I’m eating special meals. I know the extra work will make the day and the food that much more enjoyable and special.

With a little luck o’ the Irish (and some aggressive bolusing), this diabetic will finally have a St. Patrick’s Day filled with lots o’ green, Guinness, and great blood sugar levels.

The Days that Diabetes Bothers Me

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The vast majority of the time, I’m relatively unbothered by my diabetes.

I accepted long ago that it’s not going away any time soon. While that acceptance has made it easier to live a full life in spite of diabetes, I definitely still experience the occasional day that diabetes bothers me more compared to other days.

The days that I’m unbothered by diabetes are enriched by the ones when it bothers me.

It’s the days that I’m trying to enjoy time spent with loved ones.

It’s the days that I want to eat whatever I want without any consequences.

Heck, it’s the days that I want to eat, period – I’ve had days in which diabetes has restricted me from eating much of anything at all.

It’s the days that I need a really solid night of sleep the night before, but don’t get it because diabetes interfered.

It’s the days that I’m feeling so burnt out from it all that I just want to be normal.

Obviously, I’ve learned how to power through these days that I’m truly bothered by diabetes. But the ones that I simply can’t find the strength to do so are the hardest, and that’s when diabetes really gets to me.

I think that after 23 years with it, I’m allowed to be bothered by my diabetes every now and then. I don’t have to radiate sunshine and positivity about life with diabetes 24/7.

However, I think it makes the times that I’m unbothered by my diabetes that much richer because that’s when I get to stick it to diabetes.

Take that.

My Thoughts on an Entire Year of Working from Home

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One year ago today was my first day working from home due to the pandemic.

I remember my final day in the office like it happened yesterday. There were hushed conversations in conference rooms, cubicles, and the office kitchen in which we all wondered how serious things were – and how serious they might become.

We had no idea what we were in store for.

One by one, as individuals who tended to work earlier in the day left for home, I said hopeful, “see you in a month” farewells, as we were all under the impression that we could come back to the office in a month. I remarked to one colleague, who is a close friend outside of work, that I had a feeling we’d all be grateful to come back and that we’d marvel in being able to be in close proximity to one another again.

I knew then that this was the start of something unlike anything most of the world had faced before, and I even documented the strangeness of it all by taking one last selfie at my cubicle (to be fair, I’d spent my lunch break at the hairdresser’s, so my hair was on point and IMHO warranted a selfie).

And here’s the aforementioned selfie, taken on March 12, 2020 at 5:38 P.M…during my last few minutes in the office.

That would be my final selfie, for certain, in that office. Because just five months later we’d all return to it one last time in small groups to pack up our desks, as our company decided to break the lease and save money on office space.

So I’ve worked from home for a year, and will continue to do so for the foreseeable future. I’ve got so many emotions tied to that: gratitude, sadness, loneliness, anger, resentment, wistfulness…

Let me go over the positives of working from home: I’m so grateful for my job and for how deftly my colleagues and I got used to full-time remote work. Several aspects of life are made easier by working from home, such as managing my diabetes (for example, if I ever experience a pod failure, I have every and any back-up supplies I could need at home as opposed to my desk drawers, which weren’t always stocked up all the way). I save time on a commute which allows me to fit in more tasks at the start and end of my day, and honestly, working from home full-time gave me the ability to get a puppy and feel confident knowing that I would be around to take care of her.

But there are some negatives; mainly, I miss the office camaraderie like crazy. I’m lucky enough to work with a group of people that I truly enjoy being around, so it’s been tough to maintain my connections with them virtually. And truthfully, I get lonely in my condo. Going into the office five days a week not only ensured I had contact with other humans, but it also guaranteed that I’d actually leave my home during the week. I’ve never felt so sheltered in my life, and it’s a weird feeling.

I guess that if I’ve learned anything in the last 365 days, it’s how to be adaptable. Honestly, not to connect it back to diabetes – okay but this is what my blog’s about so that’s to be expected – but it’s a lot like figuring out how to deal with change as it inevitably happens. Over the years, I’ve taught myself what to do when lows and highs happen, and how to manage certain situations if and when they occur in my diabetes life. And that’s what’s happened in this last year: a whole lot of learning how to handle life’s curveballs, in general, along with the ones that diabetes tosses my way.

Hello, Highs: Pooled Insulin Under my Pod Leads to Elevated BG

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Have you ever tried troubleshooting a problem so much that you start to feel insane, and then like magic, the solution to it becomes clear and you wonder why you hadn’t tried it earlier?

This was the case with me and the mysterious high blood sugars that plagued me for two and a half days.

Based on this image, can you tell what was causing my blood sugar to be stubbornly high?

Once I started noticing a pattern of high blood sugars that got worse every time I ate food, I started doing everything else except changing my pod. I tried taking insulin for double the amount of carbs that I was actually eating, I ran a 95% temp basal increase for 8 out of 24 hours in the day, I cut carbs altogether and ate only 0 carb foods, I skipped meals altogether, and I even tried marching around the house for 15-minute intervals to try to get my insulin pumping through my system faster.

And nothing worked. I was able to get my blood sugar no lower than 180, but for most of that 60-hour window of time, I spent a good chunk of it in the mid-to-upper 200s.

Finally, on the day that my pod was due for a change, I decided that it must be the culprit behind my high blood sugars. When I removed the old pod, I knew immediately that something was wrong because the smell of insulin was so strong; plus, there was a large, damp spot on the pod’s adhesive, indicating that perhaps my insulin was pooling under my pod instead of entering my body.

It took 5-6 hours after I removed the leaky pod, but I finally did start to come back down to my normal levels, and was totally back on track the next day. It was a frustrating experience to endure, but a stark reminder of something that I’ve known in the back of my mind for years: that when I’m in doubt, I should change my pod.

How Long Do AAA Batteries Last in an OmniPod PDM?

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How long do AAA batteries last in an OmniPod PDM?

The answer to this question has subtly haunted me for years.

My PDM is the only device in my diabetes management kit that actually runs on batteries. Everything else, such as my Dexcom receiver and my blood sugar meter, can be recharged, which is highly preferable over batteries. But until I make the transition to the OmniPod DASH system (which uses a rechargeable lithium battery in lieu of AAA batteries), I’m stuck with replacing the AAAs in my PDM whenever they drain.

But it was never overly clear to me…how do I actually know when the batteries are out of juice?

Just by looking at the battery display, you’d think that I’d need to swap out the AAAs A.S.A.P…but I discovered that isn’t the case.

There’s a battery icon on my PDM, of course, that shows roughly how much life my batteries have left in them. When new batteries are put into the PDM, it shows a fully charged battery. Some time after that, the battery icon is half full, and then after more time, it goes down to a tiny sliver to indicate the batteries are running low.

Ever since I became an OmniPod user, I always assumed that the batteries had to be replaced as soon as the display ran down to that itty bit of battery life. I just figured that was the signal. Plus, I didn’t want to run the risk of delivering a bolus or changing my pod only for my PDM to completely die halfway through, leaving me to figure out how much insulin I had left to deliver – or worse, with a pod not fully activated that I’d have to scrap.

For a long time, though, I’ve been wondering if I’ve been changing the batteries prematurely. Maybe they had more life past that little sliver. So I put my theory to the test: Last month, my PDM displayed the low battery icon. Instead of changing the batteries immediately, I decided to wait and see what would happen.

And I can report that my batteries did last much longer after that initial low battery icon appeared. In fact, they lasted an addition 7-8 pod changes (I lost track after the first handful). I was pleasantly surprised to discover that my PDM could make it almost an additional month past that first indication of a low battery! And even better, I learned that the system does give a warning that makes it crystal clear when the batteries should be changed: The battery icon goes from having a tiny bit of life left to a flashing display showing a completely empty battery. I forget what the exact message was on my PDM, but I also got a system notification telling me to change my batteries soon.

I wish I remembered exactly when I changed the batteries last, but if memory serves me correctly, then it was sometime in November. So the AAA batteries in my OmniPod PDM lasted roughly three months.

Not too shabby, and now I know exactly when I can expect to change my PDM batteries.

5 Things That Make My Blood Sugar Crash Quickly

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Have you ever noticed that certain activities have a swift and obvious impact on your blood sugar levels?

Well, if you aren’t a person with diabetes, then the answer to that is probably “no”…but I digress! Recently, I realized that there are five things that absolutely, definitely, without-a-doubt make my blood sugar plummet before long. Here’s my list – what’s on yours?

1 – Vacuuming. I live in a fairly small condo – less than 900 square feet total – but when it comes time to vacuuming the floor, it takes me a good chunk of time to do a thorough job. Maybe about 30 minutes total. So it shouldn’t be surprising that by the time I’m done, I’m normally a little sweaty and often in need of a snack because all that moving around has made my blood sugar drop.

Who else “celebrates” vacuuming their entire home by cracking open a fresh…juice box??

2 – Baking. This might be surprising because I’m the type of baker who must lick the spoon and sample the finished product as soon as it’s done, so you might assume that this activity makes my blood sugar go up. Not so. And this is because I am also what I call a “frantic baker”. I shuffle around the kitchen, rifle through cabinets, curse when I can’t find an ingredient and need to rush out to the store to get it…now you must get the idea. I’m always in motion when I’m baking, which pays off in the end. I need to try my baked goods in order to boost blood sugar that went low in the process of creating them. This is one of the many reasons why I love baking!

3 – Playing with my puppy. Little Miss Violet is four months old now and more rambunctious than ever. She loves fetching, running, chasing…and nine times out of ten, I’m fetching, running, and chasing right along with her. Before too long, Violet’s winded and on her way to dreamland while I’m on my way to the kitchen to grab something that will treat my low blood sugar.

4 – Cleaning the bathroom. A self-professed neat freak, I have a very specific process when I’m cleaning the 1.5 bathrooms in my condo. This process probably isn’t the most efficient because it involves a lot of walking up and down the stairs to gather various cleaning supplies, but it does do one thing well: lower my blood sugar, of course.

5 – Walking. This is pretty dang obvious because any sort of physical activity/exercise is bound to make my blood sugar drop, but not in the same way that walking does. I swear that 10-15 minutes of walking at a normal pace is enough to drop my blood sugar by about 100 points – that’s how effective it is for me. Walking is my sneaky little trick when my blood sugar is a tad too high: Instead of taking insulin to correct it, I just have to get a quick walk in and I’m falling fast in no time.

The Best Time for Me and My Diabetes to Exercise

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I am a phony morning person.

By that I mean that I pretend that I like getting up early in the mornings, but truth be told…I hate it. Oh how I long for the days that I could sleep in as late as I wanted and shun my very few responsibilities…

Even though I clearly don’t love waking up early, there is one benefit to it that truly lasts all day long. And that is getting my workouts done within the first hour or so of my day.

Listen, I’m not a fitness freak. I don’t have a ripped bod. More often than not, I’m working out so I can eat and drink the things that I like without feeling as terrible about it (only light sarcasm used in that previous sentence). But I do like exercising and try to do so every single day because, well, it’s good for me and definitely helps me to produce better blood sugars.

Exercising is a thousand times harder than it needs to be, though, when my blood sugar crashes halfway through a routine – which happened a lot more than I wanted it to when I was working out in the afternoons or evenings.

Fed up with the lows, I changed up my routine and that’s when I discovered the beauty of fasting morning workouts.

I am definitely not as flexible as this cartoon lady.

I learned that if I work out soon after I wake up in the morning and wait until after I’m done to eat breakfast, then lows almost never happen. It’s like magic. I’m able to get through my exercise routine (which is usually a half hour circuit of some sort) without having to modify my basal rates whatsoever. Since I don’t have any insulin on board (because I haven’t eaten any food yet), I’m only working out with my basal rate running in the background, so there’s a much lower chance that my blood sugar will really fluctuate when I’m exercising. Of course, mornings that I wake up with a low or a high blood sugar are a little more challenging, seeing as I either have to bring it back up to a good level for working out or get some insulin pumping in my system, but I wake up most mornings with my blood sugar in a range that makes me feel comfortable working out in.

All the diabetes business aside, I gotta say…my other favorite part of working out first thing is that it’s over with and done for the day. Ba-da bing, ba-da boom. It’s not looming over my head for the remainder of the day, and that’s a really nice feeling.

A.M. exercise is A-O.K. to my diabetes and me.