Tag: doc

An Ode to Log Books

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This was originally published on Hugging the Cactus on December 11, 2017. I’m sharing it again today because of all the outdated diabetes tools that I used to rely on, log books are something that I find myself wishing I still used, or at least kept to look back on, because they held me accountable. It’s funny how much that opinion contrasts with how I felt about them when I wrote this post! Read on for my full reflection…

Remember when log books were a THING that PWD used to track blood sugars?

Log books were pocket-size diaries (of a sort) designed for PWD to keep track of blood sugars, insulin and carb intake, mealtimes, etc. Basically, it was the old-fashioned way of recording blood sugars so that you could bring it with you to your endo appointments so your doctor could review the book for patterns.

I remember HATING having to write down my numbers. I felt like those little log books were contraptions put in place to judge me and my numbers. Imagine an eight year old who felt judged by something like that? It’s just wrong. But I get that they had a purpose to serve, and even when I was little, I knew it was important to write everything down even if I resented doing it.

That’s why I made it more fun by drawing doodles next to certain blood sugars – a frowning face would appear when I was high, and a mini burst of fireworks would find their way next to a blood sugar of 100 (which I now refer to as a unicorn bg, along with much of the rest of the DOC). I also distinctly remember using the log book to keep track of where I was injecting my insulin: “RL” would appear on the page if I was due to give a shot into my right leg, or “LA” for my left arm. These days, I’m really good about swapping sites, mainly because it’s easy to remember, thanks to my pods. But as a kid, it was more challenging, so writing it down helped.Thankful that my meter tracks my blood sugars for me now (also, that 230 mg/dL would’ve totally gotten a frown-y face back in the day).

Thank goodness for modern meters and insulin pumps that keep track of my blood sugars for me now. It’s so much easier to show up to an endo appointment and hand over my meter for the nurses to download. Plus, doing so means that my doctor and I get to review all sorts of colorful charts showing my blood sugars over a certain period of time, which is more telling and helpful than a doctor thumbing through my log book and murmuring, “I see,” every few moments.

Log books are such an archaic artifact of my diabetes history that I don’t even own any nowadays. I trashed them all, years ago, when I realized that my blood sugars from 2001 were sort of irrelevant to now. Do you still have any of your log books lying around?

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Backing Up to Basics

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When taking stock of my diabetes supplies, I realized there was something pretty important missing from my heaps of test strips, stacks of pods, and (seemingly) thousands upon thousands of lancets…

…syringes. I didn’t have any syringes in sight, save for the ones that come with pods and that are designed exclusively to be used for pod changes. (I only call that out because those syringes are made to hold 3 days’ worth of insulin and should not ever be used for self-injection.)

In fact, I’m not sure that I’ve ever even had syringes in my possession since moving out of my parents’ house.

Luckily, I’ve never really had a reason to need them – I’ve never had a desire to stop using my insulin pump since I went on it almost 10 years ago – but that doesn’t mean that it’s wise for me to not have a back-up supply on hand. So I decided to do something about it. I told my doctor that I’d like to have some in my reserves, just in case, and she wholeheartedly agreed. I picked them up at no cost and they’ve remained among my supply stash ever since.

Knowing that they’re there and available to me, should I need them, makes me feel that much more equipped to handle any possible diabetes scenario. It’s kind of funny to find comfort in having syringes, of all things, under my roof – but to me and to anyone else with diabetes, it just makes sense to have the most basic of back-ups around.

How I Handle my Diabetes Devices and TSA Scrutiny

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Traveling with diabetes is stressful enough. Add concerns over taking medical devices (not to mention insulin and other supplies) through TSA security and it can be a downright nightmare, especially when the TSA does something unexpected – as I wrote about here in my blog post describing my worst-ever TSA experience.

That single traumatic incident aside, my travel record consists of positive TSA encounters, most of which I attribute to me getting accustomed to what I should expect each time I’m at the airport. Here’s what’s worked well for me over the years, which I share with the caveat that this is me simply describing my own experience and what I’m most comfortable with – it will vary among people with diabetes:

  • I have TSA pre-check. Traveling with TSA pre-check means that I spend far less time waiting in line to get my bags and ID checked. Not only do I breeze through to the first security checkpoint, but I also skip the hassle of removing my shoes or my laptop/other possessions from my suitcase, making the whole airport screening process that much smoother and faster. I do believe that, as a person with diabetes, this has helped me deal with the TSA with minimal fuss and without fear of losing any of my diabetes supplies due to removing them from my bags in the hustle and bustle of the security line.
  • I always communicate with at least one TSA agent that I have diabetes and am wearing two medical devices. This may or may not be necessary, but I feel that it’s best to let the agents know what the bumps under my clothing are in case they notice them and demand that I remove them for inspection. More often than not, TSA agents are pretty understanding and more knowledgeable than I would’ve thought about diabetes devices, likely due to the fact that people with diabetes pass through on a daily basis. (Though there was one time that the TSA agent, who had an insulin pump herself, gave me a bit of a tough time about mine – to this day, I still don’t know if she was attempting to be funny with her snide comment about me asking for a pat-down instead of going through the scanners – see below for more).
  • I usually request a pat-down rather than walking through full-body scanners or metal detectors. Now, I know what you’re thinking – it’s safe to go through machines with diabetes devices. I agree with that and have definitely gone through them before. But I’ve found that requesting a pat-down is just easier because sometimes the TSA has not allowed me to go through the full-body scanners due to my medical devices. When I used to stay in line and go through scanners like the majority of people around me, TSA agents would almost always pull me aside afterwards and ask me to touch the devices (over my clothing) so they could swab my hands as part of their safety protocol. This was never a big deal to me as it only took an extra minute or two to conduct, but it also seemed to partly defeat the purpose of stepping through the scanners to begin with. Plus, I’ve always been a little paranoid about subjecting my CGM and pod to the technology in those machines – again, I have no real reason other than vague and infrequent word of mouth over the years about diabetes tech getting “screwed up” by the scanners – so I just stick to what I’ve become comfortable with by opting for a pat-down.

My typical TSA protocol may sound over-the-top or even a little ridiculous, but for a nervous traveler like me who relies on a routine in order to feel as prepared as possible when getting from point A to point B, these are the steps that I take that feel good and keep my head level – and hopefully, the kind of person that makes it easy for the TSA to do their job!

My Top 8 Tips for Traveling with Diabetes

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This blog post was originally published on Hugging the Cactus on June 22, 2022. I’m sharing it again today because I’ve got a trip coming up and definitely need a refresher on best practices that have worked well for me in the past when it comes to traveling with diabetes. Read on for my top tips.

Traveling plus diabetes can equal…a lot of chaos. At least, it does for me when I don’t take the time to properly prepare for a trip.

However, I’m happy to say that my most recent trip to New Orleans was remarkably mayhem-free, thanks to the steps I took in the couple of weeks leading up to the trip (all that covid nonsense aside). In fact, it went so smoothly for me that I decided now would be a great time to document what I did that helped me travel with minimal stress but maximum organization, before I forget everything I did! So here’s what worked for me:

  1. Making a list. Roughly two weeks prior to my trip, I physically wrote out a list of every single item – related and unrelated to my diabetes – that I’d need to pack for my trip. As I packed little by little in that span of time, I checked off items when I added them to my suitcase. It was satisfying to see the number of items dwindle so that by the morning of my trip, I only had a few things left to pack and I wasn’t worried about forgetting anything major.
  2. Having extra snacks on hand. A few days before my trip, I went to the grocery store and bought snacks. Like, a bunch of them. A few boxes of granola bars, some fruit snacks, things that were generally easy to transport and wouldn’t melt in any condition. This ensured that I would have food on hand at all times for any scenario, whether it be a low blood sugar or simply staving off hunger.
  3. Optimizing organization. One of my favorite “tricks” when it comes to packing is utilizing storage cubes! Some people might find them totally unnecessary, but for me, they equate instant organization. When they’re filled completely, they become little rectangles with handles attached to them, so packing my suitcase with the filled cubes is almost like planning a game of Tetris – except it’s even more satisfying because I know I’m doing myself a favor by sorting clothing items away from medical supplies, and keeping things like charging cables separate from my toiletries.
  4. Storing insulin properly. The last thing that I pack for any trip is my insulin. It’s literally the final thing I slip into my backpack before locking up my house. This is to help keep it cold for as long as possible, but then to also prolong the cold temperature of my insulin storage pouch. It does a pretty good job of keeping insulin cool, but on a longer travel day where I’m logging a couple hours of ground transportation, a couple hours of airport waiting, and a few more hours of actually air time, it does lose some of its effectiveness as the ice packs slowly melt. So I like doing what I can to keep the ice packs as cold as possible for as long as possible.
  5. Wandering the airport to keep blood sugar at bay. This might be the one element of my last trip that I would’ve liked to change, because I didn’t have as much time as I would’ve liked to pace around the airport before boarding my flights. I have used this strategy effectively in the past, though – my blood sugar and my restless body have both benefited from a few extra steps prior to a flight.
  6. Keeping all supplies within reach. Any diabetes supply, whether it was as sensitive as my insulin or as mundane as a back-up vial of test strips, stayed secure in my “personal item” – the bag that you can bring on a plane that doesn’t have to be stored in the overhead storage bin, it can actually go under the seat in front of you. For me, it’s not worth running the risk of needing any type of supply in the middle of a flight, only to be unable to reach it because it’s tucked away in storage (or worse, a checked bag that you can’t access at all). Knowing that I can get anything I might need, at any time, goes a long way in curbing my anxiety.
  7. Eating consistent meals. In my humble opinion, I actually think the options at airports are pretty decent these days and that makes it relatively easy to find an option that will work at any given mealtime. For example, I got a Starbucks breakfast sandwich the morning of my trip that helped my blood sugars stay steady, and on my trip back home I found a Caesar salad that was lighter on carbs to eat for lunch, which didn’t spike my already-slightly-high blood sugar further. I was tempted to skip those two particular meals because I was running short on time, but I’m glad I ultimately made eating a priority because I do think it made my numbers more stable.
  8. Staying hydrated. Last but certainly not least, I always have a bottle of water on hand when traveling. Always! I make it a mission to down at least one full bottle before going through security (that way I don’t have to waste it by chucking it), and then one of my first tasks post-security is to find either a water bottle refill station (most airports have these now and they’re awesome) or a store selling water bottles. It’s important to stay hydrated everyday, not just travel days, but there’s something about the stress of travel that makes me extra keen to keep drinking water. Plus, high blood sugars are already a nuisance to deal with – without water, they’d be even more insufferable and tricky to deal with when also trying to get from point A to point B!

So those are the things that I did to make this last round of travel go so well. What about you? Do you do anything special to prep for a trip that wasn’t featured on my list? Let me know in the comments!

It’s All Good

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I’m still not used to having an endocrinology appointment every 6 months.

For my first two decades with diabetes, I saw an endocrinologist (or diabetes nurse practitioner [NP]) every 3 months. In hindsight, this sounds like a slightly aggressive amount of visits, but it’s what worked for me for a long time. Those appointments often served as motivation for me to do better, as well as learn about new diabetes care options available to me. And I’m fairly certain that they were a good opportunity for my parents and healthcare team to put their heads together, at least when I was younger, and come up with ways to make life with diabetes easier for me.

But as I’ve grown older and become more independent in my diabetes journey, I’ve relied a little less on these four-times-per-year check-ins. I don’t know exactly when, but in the last few years, my diabetes appointments became more of a nuisance than a boon…and I think my provider at the time recognized that. She suggested reducing my appointment frequency to twice a year, and since making that change I’ve greatly benefited from it.

And it’s why, when I attended my first appointment of the year recently, it felt like a nice little status check of where I’m at with my diabetes. In fact, that’s exactly how my NP kicked off the appointment: She asked me, “how are you doing? Is there anything new going on that you’d like to discuss?”

It felt great to be able to tell her: It’s all good.

Nothing new, no major complaints. We did chat a bit about my “diabetes cure” fluke from last month, in which we came up with no definitive answers but I was encouraged to monitor my blood sugars around my cycle a bit more carefully to see if I could come up with any patterns. We also went over my bloodwork and she was pleased to report to me that everything looked good, which is always reassuring to hear. The appointment ended with a check of my feet and thyroid, as they always do, and then I was free to go.

Even though we didn’t make any changes to my diabetes management, it was still worthwhile and comforting to know that my care team agrees with me that everything is all good and to keep up what I’m doing. That, in its own unique way, is enough motivation for me to do the best possible job taking care of my diabetes between now and the next appointment. It really is all good, and I’m grateful for (and proud of) that.

An A1c Achievement

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Since transitioning to the Omnipod 5 roughly 8 months ago (and obtaining a deeper understanding of how the algorithm works), I strongly suspected that I would be pleased by the results of my next A1c reading. What I did not expect that it would be my best reading in four years – maybe even longer than that, if only I could see my results dating further back!

While I’m not going to share the exact number here, for reasons I’ve written about in this past blog post, I am writing about this little victory of mine because I needed to take a moment and reflect on how far I’ve come in my diabetes journey. For many, many years, I rejected the notion of diabetes technology. I was stubbornly resistant to exploring it whatsoever, likely out of fear that the change would have negative consequences on my health or standards of living. While I wish I could go back in time and encourage my younger self to give it a chance or explain how it would benefit me, I’m just grateful for the fact that I did eventually come around to trying it and realizing how much it changed my diabetes care and management for the better.

Don’t get me wrong, I’m still very much a proponent of time in range compared to A1c – and I’m thrilled to report that my time in range has also significantly improved since I switched to the 5. But for me, I can’t help but attach some extra value to my A1c, maybe because it was the standard measurement of diabetes “control” for most of my life with diabetes so far. So it feels really good and natural to celebrate my latest A1c achievement.

A Temporary Diabetes Cure

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I always envied people who experienced a diabetes “honeymoon” period. I used to think, how nice it must be to have some extra time to prepare for fulltime life with diabetes and not quite rely on insulin injections right off the bat! I also always assumed that, after 25 years living with diabetes, that the honeymoon phase had absolutely skipped over me, and I was positive I’d never get to experience it.

Turns out, my diabetes – that saucy little minx – likes to keep me on my toes as it recently surprised me with an abrupt 48-hour window of time in which it seemed like my diabetes was cured.

That’s the only way I can describe what transpired. It was the strangest thing. One day, I woke up, ate breakfast, and took insulin for it – just as I always do. Except instead of my blood sugar spiking or even leveling out after eating, it started to drop, which was strange because I ate a fairly typical meal that morning. At the time, I thought nothing of it and just ate some extra carbs before my blood sugar went too low.

No big deal, right? But this phenomenon happened again, following both my lunch and dinner. It was especially inconvenient in the evening, as I had a volleyball game and wanted my number to be up so I could play. I had some fruit snacks before the game to keep my levels up, but was surprised when even after that, I was dropping by the tail end of our third and final match. I remember being out on the court, trying to track the ball as my team bumped it back and forth over the net with the other team, knowing full well that my blood sugar was going low but feeling determined to stay in the game until it was over. The moment the final whistle blew, I ran to grab even more fruit snacks, and felt both annoyed and confused by the whole situation.

The following day, I decided I wasn’t going to mess around anymore. I wanted to cut my mealtime insulin doses in half to see if that helped me at all. It was a solid idea, but it didn’t prove to do much to help as I again dropped after breakfast and lunch. Okay, so clearly that course of action wasn’t enough. Maybe I could try switching from automated mode to manual on my Omnipod 5 PDM and put myself fully in control, rather than leaving it up to technology. I set a temp basal decrease to ensure I was getting very little basal insulin, and resolved to enjoy my pizza dinner that evening with friends.

Of course, pizza is notoriously difficult to bolus for, so I knew I’d have to do even more extra work in order to prevent my blood sugar from dipping. So not only did I take half the amount of insulin than normal, but I also did an extended bolus so that I wouldn’t get it all upfront. I ate two fairly large slices of pizza and also had a generous serving of chips that I technically didn’t include in my bolus calculations. So imagine my bewilderment when, 2-3 hours post-pizza, I was still going low. I poured myself a glass of regular soda, and it became my companion for the remainder of the evening. I’d take sips as I saw my graph report blood sugars that never went higher than 110, but fluctuated for the most part between 60 and 90.

It was wild, and I was actually getting pretty worried about the whole situation. I couldn’t make sense of it. I ran through all the variables that could’ve caused this to happen – was I wearing my pod in a strange site? Was it because of my period? Could it be due to my activity levels or changes in the weather? I weighed so many possibilities in my mind and came up with nothing definitive, so I went to my next best resource for input…the diabetes online community.

I asked around for input and was – as always – so grateful to the folks who reached out and served as thought partners with me. Based on what I learned, the most likely culprit is hormonal changes. In fact, perhaps it was a bit of a birthday gift from my diabetes as I ushered in a new age/phase in life. It’s still totally bizarre that it happened, but a friend reassured me of her own experiences with the same temporary phenomenon as she’s experienced menopausal shifts. So, maybe…just maybe this was the explanation I was looking for, and perhaps the whole thing happened to signify the start of my upcoming cycle.

I won’t ever know for certain if that was indeed the cause of my temporary reprieve from diabetes, but at least I can find a little comfort in knowing that I got through it (as my blood sugars and insulin needs bounced back with a vengeance the following day) and that I had the support and feedback from friends and strangers alike the whole time.

CGM or Security Blanket?

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So…remember all the times on this blog that I wrote about how important it is, as a person with diabetes, to be prepared at all times? And how it’s vital to have a back-up in case something unexpected happens with technology?

Well, apparently I don’t take my own advice. I mean, I usually do, but once in a blue moon, I am forgetful. Or negligent. In this particular scenario, I was both, because I simply didn’t pay attention to the fact that my CGM sensor was due for a change…and I was stuck at my workplace office, roughly 45 minutes from home, without my meter or a backup sensor in my bag. So when my CGM sensor expired at 1:48 in the afternoon, I realized that I wouldn’t have a means of checking my blood sugar until I returned home for the day. And I was a bit freaked out about that.

My biggest concern was that my blood sugar levels would run high and I wouldn’t know for certain or be able to do anything about it. I’d eaten more carbohydrates at lunchtime than usual, and had low confidence that I’d guessed the carb count accurately.

Instead of losing my cool or deciding to head home early, though, I impressed myself by choosing to ride it out. I felt sure that I’d be able to pick up my body’s signals if my blood sugar began to run low (which is definitely scarier than it running high for too long, anyways), and if it were high? Well, then, I’d just have to cut my losses and correct for it as soon as I got home. It’s never fun to have high blood sugar when it can be so easily fixed with an insulin dose, but given my options in this particular scenario I decided that I’d make peace with it, should that end up being my outcome.

It was a long 3ish hours, flying blind without my security blanket I mean, CGM, but I made it through and checked my blood sugar with my meter the moment I arrived home. And guess what? All that worrying about being high was for nothing because I was sitting pretty at 82 – a stellar blood sugar level in ordinary circumstances, but one that felt especially victorious after this less-than-ideal situation I got myself into.

The whole experience opened my eyes to the fact that my CGM is more than just a piece of diabetes technology to me, it’s a security blanket. It makes me feel that much more confident in making the majority of my diabetes-related decisions on a daily basis. And while it’s great that I have my CGM’s data available to me most of the time, it’s also an indication that maybe I could stand to be a little less reliant on it and trust myself and my own body a bit more. Maybe I could stand to check my graph 50% less than I do each day (believe me, I glance at it frequently, definitely more than I need to) to build a healthier boundary between me and my CGM. Or maybe I can do a better job at keeping tabs on my back-up supplies so I don’t run into this again.

Or…maybe I can totally do both of those things to do a better job of becoming my own source of security when it comes to my diabetes. I like the sound of that.

30

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Today I turn 30 years old!

What a strange sentence to write, since oftentimes I feel that I am simultaneously much younger and much older than 30. I’ve got a childish sense of humor and a penchant for video games and shirking responsibilities, but I also quite enjoy going to bed early and have my fair share of aches and pains that I complain about almost daily. But in reality, I’m merely entering my third decade of life, and taking my 25 years of diabetes (so far) along with me.

I’m also bringing the following mantra into my thirties: The best is yet to come. That’s because I have an unshaking faith in knowing that I’ll make many of my goals, hopes, and dreams turn into a reality in this decade – I will manifest them into existence, dammit, if that’s what it takes.

In addition to my excitement over this realization, it’s also beginning to dawn on me that this attitude can apply more specifically to my life with diabetes. I’ve seen for myself in the last 25 years just how far we’ve come, in terms of everything from standards of care to technology. How can I not have confidence, then, in the belief that the best is yet to come for myself and all other people living with diabetes? I can say with utmost certainty that the technology will only continue to get better, accessibility barriers will continue to be broken down, affordability will continue to improve, and my own diabetes care and treatment will continue to adapt and advance as time goes on.

So today, rather than mourning the end of my roaring 20s, I’m welcoming my 30s with open arms and the expectation (to riff on the movie 13 Going on 30, in which turning 30 means that one will be 30, flirty, and thriving) that they will be marked by a period of thriving with the knowledge that the best truly is yet to come.

The First Time I Self-Injected Insulin

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This blog post was originally published on February 9, 2019, on Hugging the Cactus. I’m sharing it again today because it’s a great reminder that trying new things (in terms of both diabetes and life in general) can be scary but definitely worth it. Oh, and that I have a really great dad. Read on for more…

The first time I self-injected insulin, I was absolutely terrified at the mere thought of it.

Since I’ve never really minded needles that much, you’d think that self-injecting would be a cinch for me. That couldn’t be further from the truth, at least for the first few times that I had to do it.

It goes back to one endocrinologist appointment when I was nine, maybe ten years old. My doctor and my parents were talking about how I was reaching an age where I should start to take on a little bit more responsibility in terms of my diabetes care. I don’t remember whether my endo or my parents suggested it, but one of the two parties said that a good starting place would be to start giving myself my own insulin.

Initially, I protested. I hated the idea. But I warmed up to it when my parents reassured me that they would check the syringe for me before I stuck it into my skin. At this point in time, I’d practiced drawing up my own insulin dosages. I’d pass the syringe along to my mother or father for the actual injection. So I had the first step in the process down pat, and it only made sense for me to put two and two together and do it all independently.

Since I was hemming and hawing over the prospect, though, my endo had the brilliant idea to practice on my father with a saline injection right then and there, given that he was willing for me to do it. As he rolled up his sleeve, I grinned wickedly (I was annoyed with him for some trivial reason that day) and waited while my doctor prepared the saline injection. As she brought it over, I panicked a little, and I must’ve asked two or three times whether it was actually safe for me to do this. Because even if I was irritated with him, for whatever stupid thing it was, I didn’t actually want to hurt him.

Once I was adequately assured that the injection would be harmless, I took the syringe into my hand, took a deep breath, and stuck it into my dad’s arm. I remember pushing down on the plunger slowly, and my dad sitting in the chair, totally composed and un-bothered by the sensation. When I took the needle out of his arm, I exhaled loudly, not realizing that I had been holding my breath the whole time. What can I say, it was a nerve-wracking feeling. It’s not every day that you learn how to inject yourself, or someone else for that matter, with a syringe.

Over the course of the next week or two, I practiced my new skill on oranges supplied to me courtesy of my parents. With each practice injection, my confidence grew and I realized that it wasn’t that scary. I would press the orange against my leg or my arm, pinch at its peel, and give it an injection of salt water – super quick, super easy.

In no time at all, I felt brave enough to give myself my first self-injection. Just like I did with my dad in the doctor’s office, I breathed deeply before plunging it into my leg, exhaling only when I was done. And I felt the satisfaction of having done it on my own, which was sweeter than I thought it would be.

Working up the courage to self-inject is just one example of many experiences I’ve had with diabetes and being afraid to try something new. Whether it was trying a CGM for the first time or transitioning to a pump, each new thing I introduced to my diabetes care and management routine scared the hell out of me at first. But just like I proved to myself that self-injecting was nothing to be afraid of, I’ve shown myself time and time again that new things for diabetes aren’t always so bad.