Thursday, March 31, 2011

Thoughts from the First Week

1. Adult bowel incontinence smells 10x worse then an infant's.(goal for this week: do not gag/vomit on patient.I'm sorry, but it does take some getting used to)

2. Paperwork is already the bane of my existence.

3. White shows everything. And I can't use it to "blot" anything, without looking like Frankenstein Nurse.

4. I wish we had lockers.But students are not really wanted, they are just tolerated,and as such, there is a long list of ridiculous rules of things that are not permitted in the facilities...among them, any type of med. Because, as you might have guessed,there was an unfortunate incident involving a resident rifling/OD'ng on a student's meds. So my insulin gets to chill in my car.(it's not freezing,and it's not hot,but still it's highly inconvenient to not have that with me)

5. I have no appetite in the nursing home, but as soon as I get out of it I'm ready to go to the nearest fast food place (or home) and down 1500 calories. I think it's the smells.

6. Looking for information in a chart is like looking for a needle in a haystack.(sorry for the cliche, but it is) I think I could literally spend all day filling out that comprehensive assessment form,it isn't organized,and it's full of conflicting info.

7. I don't know anything.Please don't leave me alone with a patient.(not to worry...the instructor knows this,& first semester we don't breathe on the patient unless said instructor is nearby.)

8. The elderly can be so sweet, and interactive. If I had to live in a nursing home I can't say I would be that way.If I was lucid, I would try and escape every chance I got.

9. Mealtimes and insulin peaks never match up,which is why every time I get a chance to eat I'm in the low 200's.(in another hour, I'd be in the 100's,but lunch is NOW)Not that I'm hungry...but I have to eat something to stop my stomach from growling. Never been close to low but I still get the occasional "are you ok" glance from the instructor.

10. BYO glucose tabs, juice,and food is absolutely imparitive. There are no vending machines/staff (kitchen/cafe) privileges (nor any access to any nearby stores)so you've got to plan for a disaster scenario and bring enough food to treat low blood sugars all day. Otherwise,you're probably in deep water. (I wanted to ask what they do if a resident has severe low blood sugars but since many of them have difficulty swallowing, I'm guessing 911 would be called. Not what I'd want done for me but I'm pretty sure I don't get to go walking around with a huge hulking glucagon kit in my pocket)

Friday, March 25, 2011

Peak & Trough: A Lesson From Nursing School

Disclaimer: I'm not a doctor, a nurse, or even play one on tv. So don't take any of this as medical fact..YDMV,consult with your own Health Care Guru.

You can go ahead & say it. How does this not look like the action of fast acting insulin(only more of the "peak" part)

And because much of my thinking is colored by diabetes,immeadiatly my mind starts drawing parallels in the D-World.

What you're actually looking at is the action of a medication. There's the time it "starts working" (T1) the time it's peaking (T2,etc) and the time it tapers off.(T3) A "peak" is the time when it's most effective but there is this not so small matter of ensuring that that peak stays inside the minimum effective concentration and the minimum toxic concentration lines as well. And let me tell you something,trying to keep the drug onset,side effects,peak times, minimum toxic concentrations straight (x 20 or so meds per pt) is not exactly easy. Drugs also like to clash with other drugs & are absorbed differently. Anyway,insulin is the easiest example of this because generally there is only one side effect (hypoglycemia) and that's like the minimum toxic concentration. Bad,bad, BAD to have enough insulin in your bloodstream to cause that.(although it's not that difficult to get into that situation)

A "Trough" is a blood level drawn right before the next medication dose. It tells you if you are at the minimum effective dose and if not,that you need to do something about it.(I do troughs with my mag levels too only I don't take the dose until I get the's like a "fasting" result) People with diabetes do alot of troughs only there is always some insulin involved and one can never be quite sure that the dose you are taking is too much/just right/not enough because we can't see how our bgs will respond. But in my observations,blood sugars(postmeal) do not go as high when there is a certain amount of mealtime insulin still floating around, 3-4 hours later.(this also applies to snacks) Maybe because my basal is so low(I have to have insulin above & beyond that,where food is involved). Prebolusing also helps.But with diabetes,the line between keeping a little extra IOB and spiraling down into hypoglycemic horror is a very thin one. (am I an expert on this,nope, but understanding how Apidra works in my body is a step toward more consistent bgs)
And of course there are a hundred other factors involved(exercise,etc) which makes D a constant science experiment. Nursing school is not entirely detrimental to one's health. (it's rekindled the "gotta sync this right" flame)

- Posted using BlogPress from my iPhone

Monday, March 21, 2011

Freestyle Failure

It's been a very (long)& relaxing weekend, but unfortuently, there have been several bumps in it. Most noticeably, I begun using the new butterfly strips with the "Freestyle Freedom" blood glucose meter & am getting readings all over the spectrum.I brought two meters on this road trip,& I can't really tell what's the problem-meter,or strips,because I don't have any control solution) It's really disconcerting when you can't even trust your meter/strips & it's not the sort of situation that you want to strive for "tight"(80-110'sh) control in. I thought if I had my Dexcom on,it would at least give some guidance as to which hundreds I'm actually in(100,200,300,400,etc.)but that's been giving me question marks so at this point, I'll take the lowest meter reading & go with that. Tomorrow,we'll head back home & I do have a One Touch meter(& leftover strips) that I consider to be the "Old Faithful" glucometer...99% of the time it's right. I hopefully have strip solution for the freestyle meter so I can do comparison's & figure out just what is wrong here.

Lesson of Story: never bring something "new" on a trip,without first testing it out first. Technology is a great thing but if it malfunctions it changes diabetes care from control to survival mode.

- Posted using BlogPress from my iPad

Friday, March 18, 2011


(the following is a deep,dark rant,and if you can't handle unfortunate realities I encourage you to stop reading now.I think most PWD feel like this,at some point.)

Sometimes being the only person with diabetes sucks.

Sometimes I don't bolus for that piece of Triple Decker Death-By-Chocolate caramelized goodness.(on purpose,and I shortly rue the day..not a good idea even you are tired of diabetes)

Sometimes I forget my meter,forget lancing device,forget
strips,forget glucose,forget back up insulin,forget pump supplies,or forget money. And sometimes I forget all of those.

Sometimes I want to give up.(dark thoughts,don't go down that road)

Sometimes a blog comment really makes my day!(ok,most blog comments really make my day)

Sometimes I want to hit the Diabetes Police very,very hard.

Sometimes I can throw 100 carbs at a low & not break 120,other times I can eat 15 & voila, I'm 220.

Sometimes I wonder if a middle of the night low will be how I go.

Sometimes I wonder if there will ever be a cure.

Sometimes spontaneous combustion of tears is the sole symptom of a low blood sugar.(classy,not)

Sometimes I wonder if any of my classmates will be caring for me(in a nursing home) in 30+ years.

Sometimes the combination of Diet Coke & Spearmint gum tastes like rotten socks.

Sometimes having diabetes isn't as bad,when everyone else out there "gets it" too.

Sometimes I wonder why I'm so lucky,despite it all,when others haven't been.

Sometimes I think I'd like to beat the insurance company executives over the head & make them see that supply restrictions is not the way to contain costs,they'll simply pay for the complications later.

Sometimes I'll spot a fellow pumper in the wild.

Sometimes I'll eat twice as much of whatever I'm told not to eat,just to spite whoever said I couldn't.

Sometimes I wake up and have no idea how many carbs were actually consumed during that 3 AM low.

Sometimes I will eat sugar-free candy,and not gag.(if the situation is non-resolvable)

Sometimes I wish I had a personal Endo 24/7 who would take care of the diabetes crap while I just lived my life.

- Posted using BlogPress from my iPhone

Thursday, March 17, 2011

Luck O'The (Non) Irish

I did it.

I really just passed my head-to-toe assessment,missing only such minor details as skin turgor, the true position of the Right Lower Lobe/Left Lower Lobe (on the lateral sides) & something else. When that was over,my instructor asked me cheerfully if I felt better about it now.(the answer was no,the anxiety hadn't time to dissipate) & then it was on to the Skills portion. I drew the two easiest skills there were(putting on gown/mask/gloves(& taking off) & drawing up and administering an insulin injection). For one brief moment,my heart stopped as I remembered(too late) that N70/30 is supposed to be rolled prior to draw up but I verbalized it & it was ok.

And then I (so I thought) felt better. About everything.

And then she asked "Can I ask you something?" and I knew precisely where the conversation was going.I can smell invasive personal questioning a mile away.

"Do you wear an insulin pump?" ( yes) "How many years?" (10) etc.etc.

I guess either the accommodations paperwork found it's way to her or she checked up on it because at no point had I given any indication that I was D,(checked bg,or had a pump in view) unless she really did see me checking my bg in the depths of my purse(& discreetly treat the low) during that first roundtable discussion. (it's not possible to tell someone is D just from how they give an insulin injection) I was going to bring it up the week of clinicals (so she wouldn't have time to forget it) but I guess now was as good as time as any. She was really nice about it,& if I need to test/treat/eat it's fine with her.And if I keel over,well,it's good to know what from.( I assured her that that wasn't likely to happen I don't have many severe lows but it's always a possibility) And it's not like I'm a 2 year old and can't take care of myself but it is incredibly comforting when someone (competent) knows,it takes off some of the burden of trying to handle diabetes & school perfectly.There is wiggle room,in both parallel universes.

And then I felt truly better-and more then ready to chill out for the next week.
(Spring Break starts NOW,woohoo!)

- Posted using BlogPress from my iPad

Friday, March 11, 2011

Apple to Apple(s)

Thursday,March 10, was another great moment in the history of Apple.It was the day this debuted....

and I happily gave up my unlimited data plan(well,not happily,but accessibility trumps having so much data that you don't use much anyway.)

Personal Hotspot(created by my iPhone) accommodates 3-5 Wifi enabled electronics on that network. We don't have Wifi at home,& attempts to create one have been unsuccessful(my husband has forgotten/claims to have never created a certain core password & it hasn't really been worth the headache or $$$$'s to get a professional opinion.)Now I can run my iPad (or upload camera, or anything) off it.(instead of having to go to school/someplace with Wifi). It's much easier to blog from an iPad then an iPhone. (5x screen? and I can use my Bluetooth enabled keyboard,which is still in the box from my birthday package!) There is a data cap of 4(GB) which I will probably exceed & have to pay the overage charges,but perhaps not.(I never came anywhere close on just my iPhone usage) When I called to activate it,the phone tech in the iPad dept. had no idea what I was talking about & insisted it couldn't be done.(it's like she hadn't gotten the memo that Hotspot was debuting that day) I gave up,hung up,and rebooted the iPad and voila,it worked.I can also use my iPad to review lectures from the comfort of bed(I don't care what the instructors say,bed is an excellent place to study) which I couldn't do before.

Best Apple update EV-ER.(barring the giving up my gold star unlimited service,but being AT&T,of course they were going to pull something like that. If Verizon ever gets to the point of similar options (& my contract runs out) I would consider switching.)

- Posted using BlogPress from my iPad

Wednesday, March 09, 2011

The Middle

In three weeks,there is a plan. That plan involves 80 new white-jacketed,scrubs & gear clad nursing students to be unleashed among 7 healthcare facilities for the long-awaited "clinical" setting.

Frightening, I know. But before we get there,we have 2 classroom tests, 2 "oral competency head to toe assessments" another math test,an online test,and a week of Spring Break to survive. Quite frankly it feels like a lifetime away because if you fail at any step in between you can't go to clinicals and flunk ze course. The oral competencies must be completely memorized (you're doing an actual physical exam in front of the instructor) and the whole situation is a step beyond test anxiety.(multiple choice tests just don't compare) If you go blank,you're good and screwed.

But if you survive,you're awarded with a 1.3 week long "Spring Break" (some of which will be spent studying,still,it will be nice).And when you come back,get involved in real live patient's just a hop and a skip away till May,& you'll get a break for good.(for a few months)One Semester will be done...3 more to go.

I can do this.

- Posted using BlogPress from my iPhone

Friday, March 04, 2011

The Not-So- Magical Express

Somewhere between the intersections of Ketone Valley and DKA Junction, the grand 'ole Diabetes Express made an unscheduled "pit stop" at 3 am last night. It could have been the fluids situation(getting extraordinarily low) or something else. All I know is,it sure felt like all of that. I was hoping the parchment-like thirst wasn't anything critical but the line on my Dexcom revealed a 3 hour spread in the 300+ range & there would be no "ignoring it." Fingerstick revealed a 355 mg/dl.Out came the emergency syringe(I do not mess around with bolusing in such situations). Something had obviously failed big time,but I was too brain dead to fix that something. My blood cells were bathed in glucose,& my "super system" circulatory system felt as sluggish as the Washington Beltway on a Friday afternoon.My kidneys were having their heyday,as my lungs also worked overtime to get rid of the poisonous CO2 accumulating,compliments of the ketones. I felt like a giant prune,& going to sleep never felt so easy but in that moment,there was still a chance to turn The Diabetes Express back to the sunnier (& cheerier) land of Euroglycemia. Chugged two cups of water to chase the ketones,& crawled back in bed.

(down to 201, & non-existent ketones)
Today is another day.(& one that fortuently doesn't require going to school.Youngest brother is getting married today.) Being hit by the Diabetes Express takes a day or so to really recover.(it's amazing how fast you can get into trouble & how long it takes to feel human again)

- Posted using BlogPress from my iPhone

Tuesday, March 01, 2011

Diabetes on Demand (Disclosure)

"Who here has diabetes?"

Those were not words that I EVER imagined coming from any instructor's lips, let alone the department (semi) head. But flow they did, in response to another student's inquiry on a diabetes-related topic.

"Oh, I do, I do, I do!I got it when I was 16.5, which isn't as sucky as some ages to be diagnosed because you can take full responsibility for your disease,and can wield a needle like a pro, but still,the only good age to get diabetes is age 86(or whenever you're in your final illness) when you don't really care that much because you're nearly dead..."

(Wait a second. What am I about to DO? I'm about to tell a group of people (of which, 50% will probably turn out to be food Nazi's and hound me relentlessly for the next 1.5 years (till graduation) about how I should manage "my" diabetes. They don't need to know. This is a teachable moment,but it is not "my" teachable moment. There are 30+ people in this room & my not saying anything,will not forever influence/ruin their careers.) And so my hand(burning with the urge to go UP) stayed down.

"Some of my student's in past semesters have diabetes,and have better perspectives on that (various diagnosis ages) then I do."

I thought about that, and while it's certainly up to the individual in question whether they want to share that I don't think it's something an instructor should be asking the class. That's an extremely personal question. I have diabetes,and at this point only the disability office knows it because they're the only ones who need to know. It still feels a tad weird though (the amount of candy that flows through this class is like being in kindergarten)like you should say something (about why you're not chowing it down like the best of 'em). Nothing against the candy in question, it's usually my blood sugars that I don't want to chase for the next 6 hours. Regarding different diagnosis ages,things are very different when you're dx'd at 6,16,26, or 60. But at every age, the patient can be involved in SOME way. (6 year olds are very smart & can get concepts before adults do) Being dx'd at 17, my childhood was D-free and candy was candy.(not something to be fought over, or something that would kill me.) I didn't have major food issues because I was diagnosed in the age of carb counting(and we always ate pretty healthy, so no changes there either)Getting diabetes is so much more then "anxiety over insulin injections" such as the examples in class are portrayed. It's more like anxiety over hypo/hyperglycemia/blindness/stroke/heartattack/kidneyfailure/amputations/neuropathy/foodbattles/dating/marriage/childbirth/job/healthinsurance/bloodsugarswings/earlydeath etc.etc.etc. I guess they choose that (as something that the nurse can actually "do" something about.)You can't dive forehead deep into something, you've got to take it by degrees.

On the plus side,I've survived three tests,a math test,a presentation,and a paper (with mostly A's) so I'm not just surviving,I'm doing pretty darn good. Switching to disability accommodations in the testing center was a really good idea.(less stress,lower bgs,and the slightly extra time have really improved my test scores)I should have done this a long time ago.