T1D and “What If?”

For me, my type 1 diabetes, anxiety, and the phrase “what if” go hand-in-hand. Or maybe in this case, it should be sweaty-nervous-palm in sweaty-nervous-palm.

In the past, I’ve written about how I believe there is a direct connection between the way my anxiety manifests itself and my diabetes. There’s no denying that the two are related. But another thing that ties the two together in a neat, worried package are these two simple words…”what” and “if”.

Of course, those two words are often followed by a series of other words that turns everything into a full question that is born from my anxiety. The questions all follow the same formula: What if X, Y, or Z happens? Questioning whether something will or will not happen will inevitably trigger me to convince myself that a less-than-desirable scenario will occur, leading me to slowly spiral as I ponder how I can possibly handle said less-than-desirable scenario.

Not following me here? I’ll give you an example. Take my incident last week when I mistakenly gave myself 10x more insulin than I intended to take (10 units versus 1 unit). When I was processing the gravity of that mistake, I asked myself, “What if I’d given myself 100 units? What if I’d been alone when all this happened?”, causing me to think about how much more dire that situation would’ve been and sending chills down my spine. It’s not fun to go down a path like that, yet for much of my life I’ve forced myself to face many “what if” scenarios that have never even happened because my anxiety lead me to that line of thinking.

After 24 years of T1D, though, and living all of my years with anxiety paralyzing me every now and then, I’m trying harder to challenge the “what ifs” and stop allowing them to rule my life, not just my perception of my diabetes.

“What if…”

I guess this is my public declaration, or vow, or affirmation, or whatever you’d like to call it that I want to be better about knocking those “what ifs” out of my way when I feel as though T1D or my anxiety are limiting me. I’m hoping to stop thinking about diabetes as a condition in which I’m held back by “what if” scenarios or one that aggravates my anxiety; instead, I want to have it be more autonomous and separate it from the negative thinking that all too often interferes with my everyday life. I’m just tired of thinking about diabetes with a “worst-case” mindset, so what if…what if I take back control of the “what if” and say “what if I have a really great diabetes day today? or “what if I know more about managing diabetes than I previously thought I did?”

Changing the overall tone of those what ifs sounds like hard work, but it also sounds like worthwhile work. So I’m challenging myself to do it, stick to it, and think…what if I could change how I feel about my diabetes and anxiety, and grow to love them for how they’ve made me stronger, more independent, and brave?

What if, indeed.

The Major Diabetes Mistake I Made

I recently experienced a diabetes first: I bolused myself for 10 units of insulin instead of the one, single unit that I had intended to give myself.

Whoops.

Major whoops.

This careless mistake occurred because I simply wasn’t paying attention when I was inputting numbers into my PDM. I thought I had entered “10” as the amount next to the number of carbs I was about to eat when in reality, I overrode my PDM’s suggestion from 1 to 10 in the total bolus calculator. And I didn’t even realize this until I heard my pod beep randomly several minutes after I’d fiddled around with my PDM. Thank goodness I did notice that beep; otherwise, I would’ve been alerted to my mistake about an hour later when my blood sugar would inevitably start to plummet.

Upon hearing that beep, I decided to check my PDM to see what was up – I assumed that maybe I had a temp basal running that I’d forgotten about, and my pod was just letting me know that it was finished. Obviously, this was not the case. When I saw that I’d bolused 10 units, a wave a panic crashed over me and I immediately started crying. My poor mother, who witnessed me making this discovery, started inquiring what was wrong and I explained to her what I’d done while I brushed angry, frustrated tears off my face. I was in disbelief that I’d done something so stupid. My mom, though, brought me back to reality and redirected my attention to the fact that I should prioritize finding food to eat that would ensure that my blood sugar wouldn’t crash any time soon. I remember taking a breath, then scanning the kitchen for something high-carb that would kick in sooner rather than later.

My eyes landed on cereal, which is notorious for causing blood sugar spikes but also incredibly easy to eat lots of…especially when you aren’t overly hungry but desperately need to eat in order to avoid a scary situation.

See my finger hovering over the digital touchscreen of my PDM? It’s pretty dang easy for said finger to slip and hit a number when I didn’t mean to do so.

So I poured myself a big bowl of Life cereal mixed with Cheerios – not my first choice when it comes to cereal, but that’s what was in my parents’ pantry and this beggar really couldn’t afford to be a chooser, given the circumstances. I sat there and stewed as I ate what was probably the least enjoyable bowl of cereal of my life because I was too busy cursing myself for making such a stupid mistake and wasting insulin that I didn’t really need. Why didn’t I check my inputs before starting my bolus? How could I have ignored my ticking pod as unit after unit of insulin pumped into my body? What kind of idiot does that to herself?

I can’t answer the first two questions, but I can take a stab at that last one – the kind of idiot who is a human who’s had diabetes for most of her life and errs from time to time, just like any other human being with or without diabetes.

Sure, I was furious with myself for screwing up like this, but all things considered…it was bound to happen eventually. We all make mistakes and it’s impossible to double-check every action taken in life. I’ve had some time and space to process this incident, and I’ve forgiven myself for this reason coupled with the fact that I’ve never done anything like this before in two dozen years of life with diabetes. That’s a significant amount of time to go without an incident like this!

Plus, with that forgiveness comes the value of an important lesson learned, which is to be more mindful when I’m taking a bolus. It’s so easy to mistype something on a computer keyboard or when texting someone and this scenario is no different from that. I need to be better about being my own autocorrect, but balance the weight of that responsibility with the knowledge that I’m a human who is managing diabetes 24/7, which is exhausting, and that perfection is a myth.

Major diabetes mistake made, lesson learned, and time to move onward and upward.

8 Things About Diabetes That Make Me Want to Rip My Hair Out

This post was originally published on Hugging the Cactus on June 5, 2020. I’m sharing it again today because I’ve had my fair share of moments lately in which I’ve genuinely felt like ripping out my hair (or punching the wall) over my diabetes! Read on and find out if you agree with this list – and leave a comment to let me know what you’d add!

Life with diabetes can be the opposite of a cakewalk. In fact, it can be so frustrating at times that I seriously consider ripping my hair out due to sheer agitation.

When thinking about the things that drive me nuts about diabetes, I came up with a list of 8 occasions in which I come this CLOSE to losing my freakin’ marbles:

1. When low blood sugars refuse to come up…

2. …And when high blood sugars refuse to come back down.

I’m considering these first two as separate list items because the scariness of a lingering low and the frustrating nature of a stubborn high can be two very different types of “GAAAAAAAAHHHH!” But both can be especially suck-y when you feel and know that you’ve been doing everything right to treat them without experiencing the expected results.

3. Pod and CGM sensor failures.

Oooh, any sort of device failure can be so exasperating any time of day. But they’re worse when they happen at inconvenient times, such as in the middle of the night or during an important conference call. All diabetes technology should work flawlessly at all times, but that’s not always the reality that we live in.

4. Inaccurate results.

I can’t stand when my blood sugar meter or my CGM report false readings. Sometimes, I’ll check my blood sugar two times in a row just to see how close both readings are to one another, and it makes me want to throw my meter across the room when I see that they’re off by 20+ points. Once, I had a reading that was off by more than 50 points! That makes a major difference in how much insulin I give myself in that moment in time, so inaccurate results can really derail my blood sugars for hours after.

When I first found this illustration, I could’ve sworn the lady was flipping the bird…which would also be an accurate depiction of what these 8 things make me feel like doing!

5. Folds in the adhesive.

Whenever I apply a fresh sensor or a pod, I try to be super careful and make sure that the adhesive sticks smoothly…but despite my best efforts, that doesn’t always happen. Folds in the adhesive are far from the worst thing in the world, but they do make it more difficult for my devices to stick on for the full length of time that I need to wear them, and I usually end up having to add tape around them to reinforce the hold. More tape = more folds = more irritation!!!

6. Unexplained blood sugars.

Anyone with diabetes has been there, done that. You could follow the exact same routine from one day to the next, even eating the same foods at the same times, and get totally different blood sugar results. Or maybe you thought that you bolused perfectly for a meal, only to find out hours later that you’re much higher or lower than you anticipated. Whatever the reason behind them may be, unexplained blood sugars are just obnoxious.

7. Screeching alarms.

Speaking of things that are obnoxious, let’s talk about wailing OmniPod or Dexcom alarms for a hot second. There’s nothing like a resounding BEEEEEEEEEEEEEEEEEEEP to ruin your day!

8. The INSANE costs of our supplies.

Undoubtedly, the thing that most makes me want to rip my hair out when it comes to diabetes is the cost of supplies. I’ve blogged more and more recently about the criminal cost of insulin – since the 1990s, the cost of insulin has increased over 1,200% (!!!) – and I’ll continue to do so until EVERYONE with diabetes can afford this life-saving medication. We never asked for diabetes to happen to us. But it did. And the fact that many people with diabetes have to make sacrifices in order to, well, survive, is simply not okay, and the most infuriating thing about living with this chronic illness.

The Diabetes Rule I Always Disobey

If there was a rulebook devoted to the do’s and don’ts of life with diabetes…it would be quite the tome. I imagine it to be as long as the fifth Harry Potter book, which had 766 pages and weighed just shy of 3 pounds, though it would certainly not be as engaging of a read.

As I started to visualize a diabetes rulebook, I started thinking about the actual rules it would list out. It would cover the basics, for sure, of life with diabetes, like “count carbs at every meal” and “remember to take your insulin”. But it would also get into the minutia – the things that aren’t so obvious, even to those who are fairly well-versed in diabetes. Things that I didn’t know until adulthood, like how glycemic index, alcohol, caffeine, dawn phenomenon, and so much more can affect blood sugar levels.

Yeah, it would definitely be a boring-ass read.

The diabetes rulebook would probably resemble this and look completely, utter unremarkable (otherwise known as BORING).

But as I was coming up with a seemingly endless mental list of diabetes rules, it stuck out to me that there’s one that I don’t follow. In fact, I’m not sure that I ever followed it. And that rule pertains to insulin.

The rule is about how if you open a vial of insulin, it’s best to use it within a 30-day (or maybe it’s 28-day) window. I think it’s because manufacturers claim it loses its potency after that timeframe passes, but to me, it’s a bunch of BS.

Maybe I do go through whole vials of insulin in a one-month period, or maybe I don’t. I have no clue, I don’t keep track of my supplies to that extent. But what I do know is that “expiration dates” and “best by” labels aren’t always based on exact science. I’ve totally eaten my fair share of “expired” foods (things like granola bars or cans of soup, definitely not wilted spinach leaves or moldy yogurt) because I use my common sense when making judgment calls about consuming those items. For me, it works kind of the same way with insulin. As long as an insulin vial has been properly stored since opening it (in a refrigerator’s butter compartment, because of course), then I feel safe using it beyond a 30-day period – again, within reason, using logic (I doubt that I’d use insulin dated YEARS ago).

I’ve even heard of folks using insulin that’s past it’s expiry date, and while I haven’t done that myself, I can’t say I blame anyone for trying to use up every last drop of the stuff when it’s in possession and it’s necessary to take. It’s too expensive to waste.

So if by breaking this “rule” makes me or other people rebels, I’ll don the title with pride…and smirk to myself as I think about other diabetes rules (ahem, pertaining to prolonging CGM sensor life, or using sites other than the abdomen for my Dexcom, or hardly ever remembering to change my lancets…) that I’ve broken over the years.

My 24th Diaversary

My 24th diaversary shall be known as…the one I almost forgot.

My diaversary, which falls on Christmas Eve, has never been something that I actually actively celebrate because I’m always too busy celebrating the holiday season with my family. And that’s exactly what happened this year: I was living in the gift of Christmas present (there’s a pun in there, I know) rather than reflecting on that fateful one 24 years ago.

My 24th year of living with diabetes…my, how time flies when you’ve got a broken pancreas and robot parts on the outside of your body.

It feels fitting, really, that I didn’t remember my diaversary until a couple weeks after it came and went, because this Christmas Eve was extra special in a different way. It was the first significant holiday since the pandemic hit that my entire family could be together. And I mean my entire family – I saw both my mothers’ side and my fathers’ side, and even my big brother was able to come home from Nashville for the week. So I was spending the holidays really rejoicing in the fact that we were all able to safely see one another for the first time since Christmas 2019, rather than dwelling on my diabetes diagnosis.

After all, it’s the people who surround me that make something like diabetes manageable. My supporters – family, friends, partner, dogs – are the ones who motivate me when I’m experiencing diabetes burnout. They’re the ones who let me cry on their shoulders when diabetes is too much. They’re the ones who high-five every diabetes triumph that I experience. They’re the ones who remind me that my life is not defined by diabetes (despite how much I talk about it). So with that in mind, I can get behind doing what I did this diaversary: celebrating them instead of my diabetes for every Christmas Eve to come.

When Diabetes Disrupts Dinnertime

I collapsed onto my dining room chair, grappling with a dinnertime dilemma as my hands shook from a swiftly dropping blood sugar:

Do I correct the low now with something sweet, and wait to eat my dinner awhile, or do I wolf down my meal and stay seated until my blood sugar stabilizes?

Both options come with their own set of pros and cons. In the first scenario, I’d be eating dessert before dinner – nothing totally groundbreaking, but not overly appealing and requiring me to account for the sweet’s extra carbs in my dinnertime bolus. But at least I wouldn’t deal with low symptoms all throughout my meal. In the second scenario, I wouldn’t be enjoying my food at all; instead, I’d hoover it down like a human vacuum and keep all my fingers and toes crossed that the complex carbohydrates would kick in as quickly as possible. On the bright side, I also wouldn’t have to eat or bolus for any extra/unwanted sweets if I went with the inhale-all-the-food choice.

But what both options have in common is that they also completely ruin the dinner experience for me by either delaying the timing of my meal or rushing me through it, neither of which is desirable.

Hey, diabetes…you weren’t invited to the dinner table.

That’s just life with diabetes, though – dealing with a series of undesirable scenarios. In this particular situation, I ended up eating my dinner as quickly as I could and my blood sugar came back up about 20 minutes after I was done with it. I was simultaneously annoyed and relieved. Sure, I didn’t get to enjoy dinner at the pace I wanted, but at least my blood sugar was back to normal. And I suppose it just makes me appreciate all the other meals that I get to eat that aren’t disrupted by diabetes, and those totally exceed the ones that do (thank goodness).

The Daily Drink that My Diabetes Dislikes

I remember my first-ever cup of coffee. I was around 10 years old. I had it at my grandparents’ house, where much of my family was gathered for some sort of holiday or other occasion. Coffee was being served with dessert, and I asked my mother if I could try some – I wanted to know why all the adults in the room were so enamored with the seemingly innocuous brown beverage.

I’d like to say it was love at first sip, but I think it was only after I poured in a hearty amount of cream and 2 or 3 Splenda packets that I felt any affection for coffee. But once I did that? I was a goner. Coffee became a staple for me. I’d get it from Dunkin’ Donuts at the mall whenever I went shopping with friends, pour a cup on the weekends to have at breakfast, and when I was feeling fancy, I’d go to Starbucks and get a couple of pumps of sugar-free syrup to jazz up an otherwise ordinary order.

But whenever I try to add anything like milk, real sugar, syrups, or whipped cream…coffee gets real dicey for me and my diabetes.

Coffee can get real confusing for a person with diabetes.

In other words? I’m at a loss as to how to bolus for things like lattes, mochas, or cappuccinos – let alone any of the crazy, carb-loaded concoctions that you can get at cafes or Starbucks.

As a result of my confusion around coffee drinks and, let’s be real here, my laziness (because I could look up carb counts, but the sugary spike that my blood sugar could experience after having one of these drinks make it not even worth it for me to do research), I tend to drink coffee black. And luckily, I like it that way. But that doesn’t mean that I’m not tempted from time to time – like when the local coffee shop that’s just a half-mile away from my home introduced a winter drink menu with things like an Irish cream latte, eggnog latte, and gingerbread latte on it. I seldom give into the impulse to try those kinds of drinks, but they sounded too good to skip out on.

So rather than have all 3 at once – because I’m not totally reckless like that – I did give the seemingly-lower-carb option a try (the Irish cream latte), while my boyfriend got the eggnog latte. I figured it was the best of both worlds because I could have a fancy drink to myself while also getting to try one of the more sugary options.

And guess what? My blood sugar didn’t spike after I drank it, not even a little bit. I think the secret to my success was being super active all morning long after I got the latte (I was busy running errands and tidying up my home for guests that were coming over later in the day). My insulin intake for the latte, coupled with lots of movement, seemed to prevent any disastrous blood sugars – and I think it also helped that I ordered almond milk in lieu of regular milk to go in the latte. Whatever the actual cause(s), I was just thrilled to learn from this little experiment that I can enjoy specialty coffee drinks after all – probably not all the time, but definitely as an occasional treat, which makes me a happy and well- caffeinated T1D.

Happy New Year from Hugging the Cactus!

2022 will be here in a few short days and the prospect makes my head spin. Where did 2021 go?!

Me, looking comfy as I casually ponder where the eff 2021 went.

As we approach the new year, I’m feeling several different emotions – the most prevalent one being gratitude.

Amid all the chaos of the past year that was filled with so many literal and figurative highs and lows, I can’t help but feel grateful for the many people and experiences that kept me calm in the storm. My family, my boyfriend, my friends, my dogs. The roof over my head. The opportunity to start a new job at a diabetes organization, which in turn reunited me with old friends and helped me make new ones. The chance to travel across the country and go on several weekend trips to closer-by destinations. And as often as I gripe about having so little time to myself, I’m also grateful to have such a jam-packed schedule that keeps my both my mind and body active and well.

With everything in the world feeling uncertain lately (oh, how unnervingly familiar it feels to merely say that), it’s helpful to remind myself of these things that make life so rich for me. I’m looking forward to carrying this reminder into 2022 with me and likewise, I can’t wait to continue connecting with the greater diabetes community in the coming year.

Happy New Year, Cactus Huggers – may you be healthy, well, and happy in 2022 and beyond!

3 Tips for T1Ds Transitioning to New Health Insurance Plans

This blog post was originally published on Hugging the Cactus on May 8, 2020. I’m sharing it again today because had I known these 3 tips when I first got my own health insurance plan, I would’ve saved myself from a whole lot of trouble – and headaches. Read on to learn more…

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

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

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

Carbs, Christmastime, and a Conundrum

I can’t believe Christmas is just a couple of days away!

It feels like the Christmas season just started, but really, I’ve had visions of sugar plums dancing in my head a whole lot longer than 23 days now.

Not just sugar plums, though. Christmas cookies. Homemade caramel sauce. Spiked hot chocolate. Reese’s trees (and bells, and nutcrackers, and any other shape Reese’s comes in)…

Conundrum: I love baking. I love Christmas cookies. I love tasting Christmas cookies that I’ve baked. As such, the above image of my Irish cream cookies is very tempting to me.

Needless to say, I feel like my sugar consumption is at an all-time high lately, no doubt due in part to the endless array of seasonal treats that seem to be readily available to me. This is partially my fault – I always have a stash of Reese’s in my home, and baking is one of my favorite hobbies (I feel obligated to try my creations before doling them out to friends and family, y’know, for quality assurance purposes). I should know better because I am very aware of the fact that I have little self-control, but said self-control is completely lacking lately.

So my conundrum is: Do I consume all the carbs this Christmastime and just have a “IDGAF” attitude about it? Or do I go ahead and enjoy all the delicious, carbohydrate-laden sweets of the season with minimal guilt?

I think the solution lies somewhere between those two extremes.

I won’t deprive myself of carbs, but I’ll be deliberate in how I go about eating them. I’ll pre-bolus so sugary spikes won’t appear as often in my Dexcom graphs. I’ll look up carb counts when I can. I’ll enjoy things in moderation, eating one treat at a time or sharing with others when I can so my carb intake gets automatically halved. And I won’t stop baking – it’s one of the things that brings me joy in life, so I know better than to cut out that entirely.

Besides, the Christmas season is so fleeting. I should indulge a little here and there and remind myself that it’s not just about the carbs and blood sugar spikes that cookies cause…it’s also about the holiday traditions associated with cookie baking and the memories made when eating them (and all the carbs). That fuzzy feeling makes me feel a whole lot better about my carb conundrum; coupled with my plan on how to approach carb consumption, I’m actually looking forward to eating many more Christmassy confections over the next few days.