YDMV - Your Diabetes May Vary. I love this phrase. I hate this phrase.
I love it because it's SO TRUE. What will work for one person won't work for another, and people that get that are my instant BFF's. There are people who understand that exercise may drop your sugars or raise them, people who get that correction boluses are not created equal. People who understand that just because it's generally accepted wisdom, it doesn't mean that it will work for you. Everybody's body is different. That's just the way the world is. Doctors and CDE's who get this are worth their weight in gold. (or worth their "wait", as it often is.) YDMV.
I hate this phrase for the same reason. It's SO TRUE. Diabetes would be so much easier if insulin and glucose and carbs and protein and exercise and sleep and sickness and stress would act the exact same way in everybody's body. If one unit of Humalog/Novolog would exactly cover 15 grams of carbs, no matter how much you weigh, how long you've had the disease, or how active, sick, or stressed you are. That way, when somebody asks "How do I counteract this high?" everybody would have the same answer, and it would WORK. The way it's SUPPOSED to. I wish all carbohydrates were created equal. I wish they wouldn't vary, based on how much fat and protein you consume with them, or how refined they are. I wish fruit came with nutrition labels.
But if wishes were fishes....
I think everybody with chronic illness feels this way. Wouldn't it be great if MS or Lupus responded exactly the same way to treatment and caused identical symptoms? Wouldn't life be better for those with chronic fatigue if going off gluten fixed everything, all the time? Wouldn't cancer patients have peace of mind knowing for certainly what the radiation/chemo will do? YDMV. Substitute "diabetes" for "disease" and it pretty much describes everything.
Except strep. I think that pretty much responds to antibiotics most (if not all) of the time. I could be wrong. After all, YDMV.
Friday, May 4, 2012
Thursday, April 19, 2012
I Don't Mean to Pry...
Scene. Me at the grocery store. Produce section. I live a very exciting and exotic life.
"Are you finding everything OK?"
"Yes, thank you."
"Ma'am, I don't mean to get in your business, but...
*eyebrow raise*
"What is that thing on your arm?"
"Oh, that. I have diabetes, and it's called a continuous glucose monitor. It checks my blood sugar every 5 minutes for me."
"No shi....throat clearing...No kidding!" (He did work there after all. I don't think his manager would appreciate his swearing at customers, even in astonishment at the wonder of our world.)
"What will they think of next!!"
I don't know. A cure? But it was kind of a fun little moment, showing this guy the advancements we've made, even though we have a long way to go.
(See how I use "we" as if I have had anything to do with it? Or maybe it's the "Royal We". I could have delusions of grandeur, you never know.)
It was the complete opposite of Kerri's story, which really does make me want to punch people in the throat. Maybe if I was in the candy aisle instead of the produce section I would have received similar treatment.
There's a comedian who goes around saying something to the effect of "Alcoholism is the only disease you get blamed for having." Well, I'm pretty sure there are a lot of PWD who would disagree with that. And people with AIDS. (Ever heard of condoms?) And even people with cancer (You shouldn't have used your cell phone so much! Didn't you ever hear of sunscreen?!) More and more we are getting blamed for what happens to be a hugely complicated mix of genetics, behavior, diet, environment, and plain old luck.
The focus on prevention, while very very good, (it really IS worth a pound of cure) has had the unfortunate side effect of people believing everything can be prevented and everything can be "blamed" on something.
To paraphrase Sondheim - So what matters is the blame? Somebody to blame? Fine, if that's the thing you enjoy, placing the blame, if that's the aim, give me the blame. Just give me the cure.
"Are you finding everything OK?"
"Yes, thank you."
"Ma'am, I don't mean to get in your business, but...
*eyebrow raise*
"What is that thing on your arm?"
"Oh, that. I have diabetes, and it's called a continuous glucose monitor. It checks my blood sugar every 5 minutes for me."
"No shi....throat clearing...No kidding!" (He did work there after all. I don't think his manager would appreciate his swearing at customers, even in astonishment at the wonder of our world.)
"What will they think of next!!"
I don't know. A cure? But it was kind of a fun little moment, showing this guy the advancements we've made, even though we have a long way to go.
(See how I use "we" as if I have had anything to do with it? Or maybe it's the "Royal We". I could have delusions of grandeur, you never know.)
It was the complete opposite of Kerri's story, which really does make me want to punch people in the throat. Maybe if I was in the candy aisle instead of the produce section I would have received similar treatment.
There's a comedian who goes around saying something to the effect of "Alcoholism is the only disease you get blamed for having." Well, I'm pretty sure there are a lot of PWD who would disagree with that. And people with AIDS. (Ever heard of condoms?) And even people with cancer (You shouldn't have used your cell phone so much! Didn't you ever hear of sunscreen?!) More and more we are getting blamed for what happens to be a hugely complicated mix of genetics, behavior, diet, environment, and plain old luck.
The focus on prevention, while very very good, (it really IS worth a pound of cure) has had the unfortunate side effect of people believing everything can be prevented and everything can be "blamed" on something.
To paraphrase Sondheim - So what matters is the blame? Somebody to blame? Fine, if that's the thing you enjoy, placing the blame, if that's the aim, give me the blame. Just give me the cure.
Monday, April 9, 2012
Sweet Irony
So, the physical I had to go into? The one they said I had to do or else they would drop me as a patient? The one they blamed my insurance company for?
Not covered by insurance.
It isn't "I haven't met my deductible" not covered. Not covered as in "Not covered." Apparently my insurance thinks I've been in to my PCP a little too often. (Once every 3 years is way too much.) My insurance company paid my doctor $1.25. As in, the cost of a bottled water.
HAHAHAHAHAHAHAHAHAHAHA
Of course, I'm laughing right now because my PCP hasn't charged ME to make up the 200+ dollars. Yet. If they do, I will laugh at them. It's their fault I went in, they basically forced me to make the appointment. If they had let me handle things the way I normally do, everything would be fine. Both for them and for me. They wouldn't have had to waste a doctor and his assistant's time just to make $1.25. Nope, they could have used that time to actually make money and see patients who need it.
I'll probably still have to pay it, though.
Not covered by insurance.
It isn't "I haven't met my deductible" not covered. Not covered as in "Not covered." Apparently my insurance thinks I've been in to my PCP a little too often. (Once every 3 years is way too much.) My insurance company paid my doctor $1.25. As in, the cost of a bottled water.
HAHAHAHAHAHAHAHAHAHAHA
Of course, I'm laughing right now because my PCP hasn't charged ME to make up the 200+ dollars. Yet. If they do, I will laugh at them. It's their fault I went in, they basically forced me to make the appointment. If they had let me handle things the way I normally do, everything would be fine. Both for them and for me. They wouldn't have had to waste a doctor and his assistant's time just to make $1.25. Nope, they could have used that time to actually make money and see patients who need it.
I'll probably still have to pay it, though.
Friday, March 16, 2012
A LOT of crap thrown out there at once.
So the other day, I bolused too much because I forgot what I ordered.
Today, I went to In-N-Out (do not judge my food choices) and realized I had forgotten my insulin altogether. My whole kit. No meter, no insulin, nothing. I couldn't test OR bolus.
Fabulous.
I called my husband to see if he could steal some insulin from his diabetic co-worker. No dice. They guy didn't have any extra needles for his pen.
I realized I was right by my endo's office, so I ran in and begged for a sample of Novolog. They gave me one, no problem-o. Whew.
Then I went to my Primary Care for a "physical" because I hadn't seen him in a while, and they were threatening to drop me as a patient. I complained about this. They blamed the insurance companies. They said "Oh yeah, you're here because insurance sent you a letter, right?" I said "No, I'm here because you said I couldn't come anymore unless I scheduled this."
So when my PCP walked in, he said "Hi, Heidi, I heard we strong-armed you into showing up." I laughed. And waited for the next question. Oh, yes, here it is:
"How's the diabetes?"
I always want to answer this question with "Killing me slowly, thanks, but I'm doing everything I can to make it SUPER slow." But I chicken out, and say "I'm controlling it as best I can."
And then the phsycial consisted of basically scrolling through the computer looking over all my labs from the past year or so. I wanted to be off the cholesterol meds.
"But they're working. And you need to lower it a little more. Your LDL is still high for a diabetic. As soon as Lipitor goes generic, you should switch to that."
"They have long term side effects. The cholesterol is genetic. (We won't discuss the In-N-Out). I have a family history of high cholesterol but no heart attacks. High cholesterol is a fake problem. Statins prevent second or third heart attacks, not first ones."
"The medical data would suggest otherwise. Although, yes, they are better at preventing subsequent heart attacks."
"They create long term memory issues."
"The benefits outweigh the risks. Especially for you. You're diabetic."
And that's always where the discussion ends. At "you're diabetic." Automatically high-risk for pretty much everything under the sun. At least he didn't try to throw BP meds or aspirin at me "just in case."
And he gave me a copy of my last labs that didn't get sent to me. I told him I always ask for a copy but sometimes they send one and sometimes they don't. He told me if the doctor doesn't make any notes like "discuss with patient" or "needs to change x" or even "looks good" than the lab work doesn't even go to the MA for her to send out. And thus the mystery of sporadic labwork was solved. And my last CRP (0.4 vs.1.1) was awesome, which boosted his "pro-statin" stance.
Whatever. I do take the meds, I just whine about it.
I showed him my Dexcom, which fascinated him to no end. He had never seen one. And whenever a doctor besides my endo sees it, they always say the same thing, and so I waited....waited...yep. Here it is:
"That's one step closer to an artificial pancreas. They've almost done it!"
Yes, yes they have. Next week I'll go pick it up. (Maybe if Phineas and Ferb worked on one...)
In other medical news, I did mention that I've been hoarse for about 6 weeks now. He gave me a nasal spray, told me to try that, if that doesn't work, try heart burn meds, and if that doesn't work, then I'll need to see an ENT.
In the meantime, the fact that I get paid to do voicing work is a problem. Especially since the voicing I do is for medical reminder calls. (If you get an automated medical reminder call, it might be me. It probably isn't, but the possibility is there. Just remember that.) Who wants a message that says "Your appointment is at 3 p.m." from somebody who sounds like they're horribly contagious? Nobody, that's who.
Well, if you made it to the end of this post, good for you. Truly.
Today, I went to In-N-Out (do not judge my food choices) and realized I had forgotten my insulin altogether. My whole kit. No meter, no insulin, nothing. I couldn't test OR bolus.
Fabulous.
I called my husband to see if he could steal some insulin from his diabetic co-worker. No dice. They guy didn't have any extra needles for his pen.
I realized I was right by my endo's office, so I ran in and begged for a sample of Novolog. They gave me one, no problem-o. Whew.
Then I went to my Primary Care for a "physical" because I hadn't seen him in a while, and they were threatening to drop me as a patient. I complained about this. They blamed the insurance companies. They said "Oh yeah, you're here because insurance sent you a letter, right?" I said "No, I'm here because you said I couldn't come anymore unless I scheduled this."
So when my PCP walked in, he said "Hi, Heidi, I heard we strong-armed you into showing up." I laughed. And waited for the next question. Oh, yes, here it is:
"How's the diabetes?"
I always want to answer this question with "Killing me slowly, thanks, but I'm doing everything I can to make it SUPER slow." But I chicken out, and say "I'm controlling it as best I can."
And then the phsycial consisted of basically scrolling through the computer looking over all my labs from the past year or so. I wanted to be off the cholesterol meds.
"But they're working. And you need to lower it a little more. Your LDL is still high for a diabetic. As soon as Lipitor goes generic, you should switch to that."
"They have long term side effects. The cholesterol is genetic. (We won't discuss the In-N-Out). I have a family history of high cholesterol but no heart attacks. High cholesterol is a fake problem. Statins prevent second or third heart attacks, not first ones."
"The medical data would suggest otherwise. Although, yes, they are better at preventing subsequent heart attacks."
"They create long term memory issues."
"The benefits outweigh the risks. Especially for you. You're diabetic."
And that's always where the discussion ends. At "you're diabetic." Automatically high-risk for pretty much everything under the sun. At least he didn't try to throw BP meds or aspirin at me "just in case."
And he gave me a copy of my last labs that didn't get sent to me. I told him I always ask for a copy but sometimes they send one and sometimes they don't. He told me if the doctor doesn't make any notes like "discuss with patient" or "needs to change x" or even "looks good" than the lab work doesn't even go to the MA for her to send out. And thus the mystery of sporadic labwork was solved. And my last CRP (0.4 vs.1.1) was awesome, which boosted his "pro-statin" stance.
Whatever. I do take the meds, I just whine about it.
I showed him my Dexcom, which fascinated him to no end. He had never seen one. And whenever a doctor besides my endo sees it, they always say the same thing, and so I waited....waited...yep. Here it is:
"That's one step closer to an artificial pancreas. They've almost done it!"
Yes, yes they have. Next week I'll go pick it up. (Maybe if Phineas and Ferb worked on one...)
In other medical news, I did mention that I've been hoarse for about 6 weeks now. He gave me a nasal spray, told me to try that, if that doesn't work, try heart burn meds, and if that doesn't work, then I'll need to see an ENT.
In the meantime, the fact that I get paid to do voicing work is a problem. Especially since the voicing I do is for medical reminder calls. (If you get an automated medical reminder call, it might be me. It probably isn't, but the possibility is there. Just remember that.) Who wants a message that says "Your appointment is at 3 p.m." from somebody who sounds like they're horribly contagious? Nobody, that's who.
Well, if you made it to the end of this post, good for you. Truly.
Wednesday, March 14, 2012
Today, I Was A Moron.
Today I went out to lunch at a place that serves yummy sandwiches and salads. I often order the same thing every time I go.
I ordered. I sat down. As I waited for my order, I bolused for the tasty sandwich with thick 12-grain bread coming my way.
About 5 minutes later the server shows up with my cobb salad. Which is what I had ordered. It's also something I would consider not bolusing for, or maybe doing a minimal bolus to cover the carrots and whatever they might put in the dressing. How hard is it to remember what you ordered? Apparently, that is a tricky situation.
Hmmm...okay then. Much insulin about to be coursing through the system. Lunch not offering the carbs to offset the insulin. Fortunately, they give you a cookie with every order, whether you want it or not. And so, I ate my cookie, stole my daughter's cookie, and half of my husband's.
They did not get dessert.
Because today, I was a moron.
I ordered. I sat down. As I waited for my order, I bolused for the tasty sandwich with thick 12-grain bread coming my way.
About 5 minutes later the server shows up with my cobb salad. Which is what I had ordered. It's also something I would consider not bolusing for, or maybe doing a minimal bolus to cover the carrots and whatever they might put in the dressing. How hard is it to remember what you ordered? Apparently, that is a tricky situation.
Hmmm...okay then. Much insulin about to be coursing through the system. Lunch not offering the carbs to offset the insulin. Fortunately, they give you a cookie with every order, whether you want it or not. And so, I ate my cookie, stole my daughter's cookie, and half of my husband's.
They did not get dessert.
Because today, I was a moron.
Friday, February 17, 2012
High as a Kite. And Not in a Good Way.
So, last night I saw a blood sugar reading of over 300.
I haven't been that high since I was diagnosed, and I realized it was kind of a 'mental barrier' for me. I guess there was a deep inner dialogue that said "you may be close to 240, but at least you're nowhere near 300. Your pancreas won't ever let you get that high." Apparently, my pancreas will let me soar right up there with Cheech and Chong.
Speaking of the personification of organs, I always picture my pancreas as really really sad that it isn't working. I know others have it sipping pina coladas, or mocking everyone while it collects unemployment, but I always see it as trying really hard, and it keeps getting smacked down. Kind of like Charlie Brown with the football.
(Lucy is my immune system. Too bratty for her own good. Charlie Brown is my pancreas. A hard worker that just can't seem to get it right. Someday, he'll kick that football, which is full of islet cells. You just wait and see. Or, more likely, someone will kick it for him while he stands by and cheers as Lucy is thwarted.)
I have way too much time to think about this.
At least I know what caused the 317, which isn't always the case with highs. I was going low right before yoga class, and I seriously overtreated, thinking what with the exercise, and the tastiness of this particular carby treat, what with the bananas AND the brownies...yeah.
I also learned that 10 days might be too long for the Dex to handle. After yoga, it said 122, so I was congratulating myself on the dealing well with the massive dessert. Oh, but the meter read 252. OK, time to change the sensor. But since I had no idea if that was 252 and *rising*, or if I was coming *down* from an even higher number, I figured I would check again in a half hour before I corrected. And then, well, I forgot, what with the Tivo'd shows to watch, until Dex buzzed that it needed 2 start up bg's, which, of course, was 2 hours later. Whoops. My bad. Well, the bad belongs to Diabetes, but still, I seriously could have handled that better. It also showed me how dependent I've become on the Dex in such a short time.
Again, live and learn. And You're a Good Man, Charlie Brown Pancreas.
I haven't been that high since I was diagnosed, and I realized it was kind of a 'mental barrier' for me. I guess there was a deep inner dialogue that said "you may be close to 240, but at least you're nowhere near 300. Your pancreas won't ever let you get that high." Apparently, my pancreas will let me soar right up there with Cheech and Chong.
Speaking of the personification of organs, I always picture my pancreas as really really sad that it isn't working. I know others have it sipping pina coladas, or mocking everyone while it collects unemployment, but I always see it as trying really hard, and it keeps getting smacked down. Kind of like Charlie Brown with the football.
(Lucy is my immune system. Too bratty for her own good. Charlie Brown is my pancreas. A hard worker that just can't seem to get it right. Someday, he'll kick that football, which is full of islet cells. You just wait and see. Or, more likely, someone will kick it for him while he stands by and cheers as Lucy is thwarted.)
I have way too much time to think about this.
At least I know what caused the 317, which isn't always the case with highs. I was going low right before yoga class, and I seriously overtreated, thinking what with the exercise, and the tastiness of this particular carby treat, what with the bananas AND the brownies...yeah.
I also learned that 10 days might be too long for the Dex to handle. After yoga, it said 122, so I was congratulating myself on the dealing well with the massive dessert. Oh, but the meter read 252. OK, time to change the sensor. But since I had no idea if that was 252 and *rising*, or if I was coming *down* from an even higher number, I figured I would check again in a half hour before I corrected. And then, well, I forgot, what with the Tivo'd shows to watch, until Dex buzzed that it needed 2 start up bg's, which, of course, was 2 hours later. Whoops. My bad. Well, the bad belongs to Diabetes, but still, I seriously could have handled that better. It also showed me how dependent I've become on the Dex in such a short time.
Again, live and learn. And You're a Good Man, Charlie Brown Pancreas.
Monday, February 6, 2012
High? As it turns out, not really.
4:30 a.m. BUZZ!! I grab the Dex groggily. High. Over 200. Mmmmkay. Since I'm awake anyway, I stumble to the toilet, turn the light on in there, and give myself a shot to bring the sugars down.
As I climb back into bed, my husband asks me if I am low. I tell him no, it's high this time, and settle down. Then it occurs to me. 'This is a new sensor. I should double check that high with my meter.'
119. I just administered enough insulin to drop me 100 points and I'm at 119???? Well, that can't be good. In fact, it could be really, really bad.
So I do what I need to, I eat some carbs. (Doesn't everybody bolus at 4:30 in the morning for a little snack?) I recalibrate the Dex. I remind my husband where the glucagon is in my nightstand, just in case. I settle back in bed, but I know the rest of the night is pretty much shot when it comes to any actual sleeping. My husband tells me "I'm awake with you" and I love him for it.
My friends, it's moments like these that make the FDA balk at the artificial pancreas. My Dex is accurate most of the time. I would guess that it's close to 90%. I mean, there was the time when it said 276 and I was in the 120's, but I knew that one was screwy - it had ??? right before, and while I don't always 'feel high' (insert random drug reference here) I would have noticed a 276. And it's not always accurate on exactly HOW low I am, but it's definitely a warning that I didn't have before, and one that I love. Plus, the fact that I can remember these anomalies shows me how rare they are. If I was saying 'every day this sucker messes up constantly' things would be different.
I've only had it for a month. I reserve the right to change my tune. Your diabetes may vary, of course.
But if an artificial pancreas thought you were at 276 and started dosing enough insulin to drop you over 140 points when you aren't even at 140, the lawsuits are going to pile up like a lazy person's laundry. (Not that I would know anything about those piles.)
So, the question is, is it worth it? How accurate does it have to be before it becomes available? When do the benefits outweigh the risks? Everyone has to answer that for themselves. Again, I reserve the right to change my mind, but at the moment I say, YES it's worth it. Bring it on. Severe lows and highs are ALWAYS a risk for diabetics. We know it. We hate it, but we know it. And while my precious Dex messes with me sometimes, the thought of going back to random finger pricks to manage makes me want to vomit. Increasing our quality of life and our ability to manage is always a good thing. (Of course, if the artificial pancreas kills me, I might feel differently.)(But I would be dead, so I probably wouldn't care.) (My family would, though.)
Plus, I don't see the option of shots or pumps going away. I think the AP would just be another option for patients who want it. Some will be too scared to take it. Others will jump on it. Others will wait and see. Others might go back and forth. We're good that way.
So there you have it. I survived the Dex misreading something, and it got me thinking. I now know why they tell you to double check before you treat. I mean, I knew that before, and I typically do check, but it's very difficult to be responsible for my actions at 4:30 a.m. Live and learn.
As I climb back into bed, my husband asks me if I am low. I tell him no, it's high this time, and settle down. Then it occurs to me. 'This is a new sensor. I should double check that high with my meter.'
119. I just administered enough insulin to drop me 100 points and I'm at 119???? Well, that can't be good. In fact, it could be really, really bad.
So I do what I need to, I eat some carbs. (Doesn't everybody bolus at 4:30 in the morning for a little snack?) I recalibrate the Dex. I remind my husband where the glucagon is in my nightstand, just in case. I settle back in bed, but I know the rest of the night is pretty much shot when it comes to any actual sleeping. My husband tells me "I'm awake with you" and I love him for it.
My friends, it's moments like these that make the FDA balk at the artificial pancreas. My Dex is accurate most of the time. I would guess that it's close to 90%. I mean, there was the time when it said 276 and I was in the 120's, but I knew that one was screwy - it had ??? right before, and while I don't always 'feel high' (insert random drug reference here) I would have noticed a 276. And it's not always accurate on exactly HOW low I am, but it's definitely a warning that I didn't have before, and one that I love. Plus, the fact that I can remember these anomalies shows me how rare they are. If I was saying 'every day this sucker messes up constantly' things would be different.
I've only had it for a month. I reserve the right to change my tune. Your diabetes may vary, of course.
But if an artificial pancreas thought you were at 276 and started dosing enough insulin to drop you over 140 points when you aren't even at 140, the lawsuits are going to pile up like a lazy person's laundry. (Not that I would know anything about those piles.)
So, the question is, is it worth it? How accurate does it have to be before it becomes available? When do the benefits outweigh the risks? Everyone has to answer that for themselves. Again, I reserve the right to change my mind, but at the moment I say, YES it's worth it. Bring it on. Severe lows and highs are ALWAYS a risk for diabetics. We know it. We hate it, but we know it. And while my precious Dex messes with me sometimes, the thought of going back to random finger pricks to manage makes me want to vomit. Increasing our quality of life and our ability to manage is always a good thing. (Of course, if the artificial pancreas kills me, I might feel differently.)(But I would be dead, so I probably wouldn't care.) (My family would, though.)
Plus, I don't see the option of shots or pumps going away. I think the AP would just be another option for patients who want it. Some will be too scared to take it. Others will jump on it. Others will wait and see. Others might go back and forth. We're good that way.
So there you have it. I survived the Dex misreading something, and it got me thinking. I now know why they tell you to double check before you treat. I mean, I knew that before, and I typically do check, but it's very difficult to be responsible for my actions at 4:30 a.m. Live and learn.
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