A Day in the Life of an Physician

The Story of an Ivy League Doctor
AKA...
(academia disenchantment from the patient perspective)

When I was 18, I went to Yale

Praying the whole time that I wouldn’t fail

For my father is a surgeon, and my mother into psych

I’ve been programmed from the very start what I was gonna like.

Well, I worked very hard and I kept my nose clean

Kept busy in anatomy with hearts and eyes and spleens.

I knew that I could I do it- I knew most everything

And I graduated Mag.Cum Laude to get my classes’ ring.

On graduation day, my very first stop

Was a very exclusive clothing shop

They monogrammed my jackets, and pressed my silk screened tie

And off I promptly went to (3 letter medical school acronym) to apply.

My first official night on call, it truly was a blast

Wracked up twenty-two admissions and an old friend from my past

My resident smokes pot, and I really gotta go

There’s just too much to this doctoring I doubt I’ll ever know.

I kept my eyes open, and I kept my mouth shut

As I learn all the hospital scuttlebutt

I learned who has got the hots for whom

And the nurses hate the techies in the Operating Room.

Derm was pretty gross, saw a Basal Carcinoma

To me, it was anything BUT a Fascinoma

Is it Lyme, or Leprosy, its quite hard to tell

One thing is very certain, though- the patient is not well.

Now its off to Endocrine, the type 2's in denial

Are making it quite difficult to keep my pasted smile

The type 1's need new kidneys- theirs are fully shot

Cuz each was diagnosed with D, a diaper-wearing tot.

Let’s go to Ob-gyn, see some cute, small preemies

Is that a sudden gush of blood that’s making me feel squeemy?

Birth is very wonderful, but sick kids sure do holler

I think I’ll find some other way to make my daily dollar.

Cardio was fun, but as I walked through the door

Old ladies had M. I.’s- man, they all hit the floor

The CCU was full, the chiefs said go away

I lasted one full hour on that sunny day in May.

So where’s my special niche- maybe its in psyche

As I’ve been saying all long, as just a little tyke

My mother gave me therapy, I’ll feel your deepest pains

There isn’t anything, in front of me, for you to be ashamed.

But I think I’ll be a cancer doc- play hard life and death

As the patients look in fear to me, when they can’t catch their breath

I’ll supervise the interns, and attend the M and M’s,

All the time while acting that I CARE about them!

Now I have a fancy office on the very first floor

And the patients come from all around, because they need to hear more

The world, it does my bidding, not the other way around

Those nights spent sobbing in the bathroom seem such a distant sound.

( But there’s more to this sad tale

Then my pen can ever tell

Cuz when you’ve passed, and come up top

And really think that you’ve arrived- 360 to the stop

All of life comes down to this- we all must make the choices

But I am here to tell you, that bigger bucks, and razor red Rolls Royces

Will not stop the clock from slamming down your own blunt coffin nail.)

So be sensitive to your patient's needs.

All Work and No Play....

Gluco-Burst (Artic Cherry)gel is good stuff. Layed in a goodly supply(Krogers had a half off sale), along with various other D supplies. I also purchased 10 candy bars, which no doubt looked pretty weird to the cashier-but hey, its my money.

The blood sugars are doing much better (disaster averted). Still, I've had 4 numbers (this week) below 140, and one of them was a 36. Not a very number-friendly week.

And tomarrow? Tomarrow, I take my logbook to get my diabetes control anylized to the nth degree (by the CDE) Control is not remotely possible, neither is an a1c under 7. Not without a miracle (or continous glucose moniter). I have great hopes that they'll be available soon- one way or the other.(Either I convince the insurance company, or pay out of pocket for it myself) Its more of a war zone out there- and I'm glad some days just to have survived. Every day lived successfully with diabetes, no wonder WHAT actually transpired, is a cause for celebration. Kicked it in the rear once again. My SIL (as a cardiac nurse) sees many young PWD's up on her floor.(making the connection that they took rotten care of themselves) 30 years later, though, if you get cardiac complications who can really say its because of that? D-care has changed so much over the years, and I think I'd be very glad to see my 47th birthday,even if I had cardiac problems. Other things, (like genetics and smoking) count very strongly too. How many of those young PWD's also smoke? (quite a few, probably) Its not just diabetes thats a serious risk factor,but its always the biggie.(one that people look at)

Some bright individual hacked into my Ebay account+ listed a fraudulent item, putting their original email address in the auction listing so people would contact them directly. My regular email was immeadiently flooded with Me-Me-Me (Sell to me) offers for this high-priced Super Deal.
I promptly changed every concievable password, alerted Ebay, and closed down the listing, taking steps to secure my account. And then I emailed the would-be seller(in the hopes that I could get his reg.address + track him down). He didn't spring for the idea, informing me that he could only accept bank-to-bank transfers. I'm kind of dissapointed that he didn't take the bait, I'd like this guy to spend the next 15 years in jail. I'll think of something. I'm not stupid, and he obviously isn't either... I had the strong urge to tell him precisely what I thought of him, but that would be the last I'd see of him.

Thank goodness for a LONG weekend, I'm so glad this week is over. I intend to pamper myself to the gills, my initiary includes:
Friday- CDE appt, lunch at Golden Corral(buffet), shopping trip(Old Navy, Rite Aid, Bath and Body, wherever else), library, reg. doc appointment.
Sat.- Free meal at Chick-Fil-A,(breakfast) see Baltimore (Orioles'?) baseball game with b-friend...do some more clothes shopping on trip back. This weekend is 20% OFF weekend for all TJX employees, so I should be able to get some great clothing deals.
Sunday- Sleep.
Monday-Sleep.
Tuesday-Who knows, who cares-I'm lovin' it.
Wednesday-Back to work.

One Sunday Morning

Its 1:14 AM, my blood sugar is in the upper stratisphere(200-400) and it WON'T COME DOWN. I can't sleep (as the ketones bounce along with the bg, turning my stomach to mush + my throat into a second Sahara). I want to puke(but can't, it takes more then DKA to make me puke).
This has been going on approximently 13.5 hours. I've taken 4 extra shots of Novolog, to get the blood sugar +ketones down + I am now 205, small ketones.
The reason for this "bad D trip"? Extreme stupidity (on my part), I should have never gotten
a naval piercing. (May my mother NEVER read this blog) Funny how many sets I've gone through and never had one, now this. Suffice to say, it doesn't take a rocket scientist to connect the dots(infection=high blood sugars)
It might be true, D's are more prone to infections of this sort, but I didn't exactly take stellar care of the piercing. Regardless, I've changed my mind about having one- I want it out and healed up, navals can take up to a year to completely heal. The next time I decide to get a piercing, I'll just get a second set in the ears...(safer territory)
Next step=doubl(ing) of basal. I should probably call the intern on call, as thrilled as that will make him/her. I need an antibiotic + to clear up this situation but I'd rather wait till Monday to see the doc, if at all possible. Not possible, if the ketone situation doesn't get any better.
Stupid diabetes. (highs make me cranky as heck, in case its not immeadiently obvious)

Reflections upon Diabetes(andJulia's Meme)

Sometimes it all gets overwhelming (this generally isn't because of a bad D-day).
Coworker: "So, Heidi, what DO you spend your money on? You must be loaded-you don't have a family,mortage, OR other things of that nature..."
What do I spend my money on? Copayments for meds, copayments for dr. appointments, a sizeable weekly paycheck cut for that medical insurance, low blood sugar treatments, assorted herbal remedies to assist with managing the D- and all the other monetary struggles of the single working person. Diabetes dictates one's career path, its the primary reason I haven't finished my BD by now.
They say diabetes makes you a stronger, better person. I think, the only (positive) thing diabetes ever did for me was to make me more compassionate towards the health struggles of others. To see the person-not the failures that got them into that situation. Isn't that the heart of true medicine- helping the patient? not blaming them for their disease..
Quote for the Day:
From Disease, I have learned much that Life could not have taught me any other way.
- Goethe
I think I would be a much better person without the diabetes...
(any good effects that may have come from D I could still learn somewhere along life's path)
Thyroid results came back low.

Endo wants me to start taking Synthroid, once again. I was on it once, after the diabetes diagnosis (for about a year). Then (in my infinant teenage wisdom) I decided to stop, remarkably, my yearly tests have been normal. Except this last time. I had the thyroid antibodies at diagnosis, so I suppose it was only a matter of time before I needed it permanantly.
"You'll feel much less tired...and if you decide to get pregnant, its important to have normal levels.."
That's all fine with me- but I don't remember if it affects basal requirements?

Julia's Meme

1. Pretend you're stranded on a desert island. You already have shelter, water, batteries, an abundant food supply that doesn't revolve around coconuts and even a cabana boy/girl to minster to your, erm, needs. However, you need some intellectual entertainment. Give me your top five desert island:
Books
1. I want to go home! -Gordon Korman. (a kid book, but adults like 'em too. They're too funny)
2. Foxtrot(comics)
3. Zits! (comics)
4. Anne Rice books
5. My novel(when I get it published)

Movies
1.Flight of the Navigator
2. Complete dvd box set of ER(seasons 1-12)
3. Ladder 49
4. The Sound of Music
5. The Fugative


Albums (NOT compilations of your own making)
and tell me why these make the cut.
-Just give me a radio..


2. Now, pretend you won the lottery. It's a huge amount, although not sickeningly huge. After you've given away your chunk to charity, paid off all your bills, set up savings/trust funds for kids and self and given money to deserving family and friends, you're left with $5 million, which you must use to build a house. Where would it be? What would it look like? Tell me how you'd furnish it and then describe your first party there.

I'd build it in Switzerland, it'd be a chateau with all the basics of life(private movie theator, spa,pool, etc.) located close to a ski resort. Basically, big. I'd host a weekend diabetes conferance, but it'd all in be in English.(I don't speak French or German...) Everyone is invited, but you'd have to buy your own plane ticket (don't think I'd have much of the 5 million left over).


3. If you could have dinner with five people from history, living or dead, who would they be? What about five fictional characters? What would you serve at each dinner?
Abraham Lincoln
Neal Boortz
Nicole J. Baker
Ronald Reagon (pre Altzimers!)
Winston Churchill

Legolas-he's extroidinarily cute.(Went through a bleach-the-hair phase, when LOTR came out)
Garfield


I'm going to only serve ONE dinner, I hate cooking. Either that, or we'll just eat leftovers the other 4x!
Virginia Ham(Fried)
Corn on the Cob
Baked Potatoes
Chocolate Meringue Pie
Mint tea
4. Describe your least favourite and best characteristics. (are we talking about physical characteristics here?)
Least Favorite- I'm too short.REALLY too short. My 6'4 brother uses the top of my head as a elbow rest.
Best Characteristic- People automatically subtract 10-12 years off my actual age, so I get by with alot of stuff grown-up folks usually can't..lol.(And I'll be carded till I'm 50) I've been told its a wonderful thing to look young, maybe in 10 years I'll totally buy that.

5. And finally, answer James Lipton's Ten Questions:

What is your favorite word? Chocolate
What is your least favorite word? diabetes
What turns you on? Any guy in a silk,striped tie.
What turns you off? Old guys with goatees + ponytails.
What is your favorite curse word? don't curse.
What sound or noise do you love? the wind blowing over a body of water.
What sound or noise do you hate? belching/burping
What profession other than your own would you like to attempt? Journalism
What profession would you not like to do? undertaker!
If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates?
"Well done, good and faithful servant."
(I do believe in Heaven, obviously)

D-blurb(s) of the Week

We take a break from the normal, humdrum, painfully dull, diabetes self- recordings to bring you the latest and best D-Bits from 'round the world. (Yes Julia, I am working on those questions-but they require some major thinking, and it'll take me a few days...)

From the Czech Republic:
Got Islets? Get monitored!

Comments: Kind of interesting, but if the iron just decomposes anyway in the body...no way to moniter the existance of the islets. (Defeating the entire purpose)

The History of Diabetes Forecast:

From this: (November, 1948)















(In the early years, "Forecast" had a blue cover(this made everyone happy + cheery about reading it, as blue urine test=excellent control). Later, they switched to other colors as blue got pretty boring, and eventually, to pics on the front...)

To this: (December, 1998)
















Lastly this:! (June 2006)
















I wonder what it'll look like in 2048, if there still isn't a cure.

Need a Cat? Someone in the UK needs to adopt this sweetie.
I've considered getting a cat (it might turn out to be a great hypo-alert animal), but I don't have the time to properly care for it. (As selfish as that sounds-its true, and if you can't properly provide(food/shelter/medical care) for any animal, you have no business owning one)

CWD's Whats New lists are TRULY exciting reading. Especially the journal articles (exotic research studies), that generally have one of three effects:
A. Sigh, roll eyes, backclick. You knew all that stuff anyway. (it's nothing new)
B. Email a knowledgable friend for an interrpretation- you haven't managed to get past the first two words...
C. Gasp and stare in wide-eyed horror as you learn yet ANOTHER potential D-problem that nobody ever told you about.
I prefer the newspaper articles that tell of PWD's living happy, sucessful lives.

They've changed the rules on Lantus:
So now one could probably safely mix L+fast-acting. If I were on Lantus, I still wouldn't do it. It feels so WRONG, like one of those set-in-stone unbreakable diabetic laws (it has been around since 2001, so its practically that)

Surfin’ DCCT

(With apologies to the Beach Boys and Ray Stevens!)

We’ve a case of the ‘beates, it’s a ‘98
Its got a meter and a pump and its doing just great
We’re loyal to the party, and the party line
But us ‘betics (or PWD's) got to have a little fun sometimes.

We were having us a party, getting nice and drunk
When the leader of the type 1's (a green haired punk)
Keeled over like an anchor, he was trying to show
Half a keg of the best, would not get HIM low.

Now here we be
Surfin’ DCCT
(Surfin’, Surfin’, DCCT)
Hello CCU
As I’m turning blue
Yeah, we’re getting kinda drunk, getting totally layed
C’mon Honey Sugar, tonight we’ve got it made
We don’t wanna start no Endocrine Fight
We just want to smoke and drink and party tonight!

You thought the company exotic when you “did the Dew”
Till you met the charming nurses up in ICU
One prick of the finger, and we all flipped
There’s been a mutiny on board Denial’s Ship.

Let’s you and me
Keep the DCCT
(Keep it, Keeppp the DCCT)
My Hba1c
Is now 5 point three.
Yeah, now I’ll be real good, cuz I don’t plan to go
Up to my endo’s- to watch him blow.
It won’t be all bad, my friend, you just wait and see
A better lot you’ll have when you keep the DCCT.

Weekend Bargains

I'm a bargain hunter-I'll shop for anything. And in this rural community, some of the biggest events of the summer are the town yard sales. There are two of them that everyone (and their cousins) comes to, one was held last weekend, and the next will be held the 2nd weekend in June. I am fortuanate enough to live (now) right smack dab on what will be the busiest street in town, come June 9.
Bicycles, trucks, cars, vans, rollarblades, wagons, buggies, and go-carts will converge on this little piece of nowhere. Hispanics, Russians, Old Order Mennonites, West Va Hillbillies- the air will abuzz with a hundred clashing dialects not soon revisited on any other part of this country.(to my knowledge)
Borrowed a large slab of wood from my folks, that will be one of my main set-up tables. Still need to get some smaller card tables. My mom and I will take turns manning it( one shops for more junk, the other watches).
I got alot of deals on Saturday...
2 NIP zip disks
3 new Home Interior candles
decent pair of steel toed working boots
NIP shoelaces
dry erase (calander)
a Lego building table( which I'll either resell on Ebay, or give as a gift)
cute frog desk organizer
craft stuff
set of 4 quilted placemats
a Pegasus t-shirt
several cassettes
jar of homemade jelly
Part of the fun of extreme yard-sale-ing is figuring out what effect 6 hours of walking will have on your blood sugar. I decided I didn't want to deal with lows, I'd take my pump off and just shoot up for whatever I ate.
7 AM- 150. Ate breakfast, bolused, took pump off.
9 AM- My car being parked over a mile away, I knew I didn't have much choice about discreteness in diabetes care . I needed to test, I might need to shoot up, and I couldn't help it if half the world had to watch.
So, I found a corner, crouched down, and pulled out my little black kit.
A lady stared (trying to look like she WASN'T staring). From that look, I knew she knew I had diabetes + she was worried that I'd keel over at any second. Either that-or I am a drug addict, getting my fix!Her fears were confirmed by a syringe-in-the-abdomen 30 seconds later. Wide eyed horror flashed across her face.(Like "Why is she doing that HERE?!?")Finishing up my business, I quickly exited that yard sale before anyone else could observe this private ritual. (or call the cops) I don't like to make people uncomfortable, but I also don't like being made to feel like a drug addict or worse..
10 AM- I need a snack, so I buy a BBQ sandwich and Diet coke.
10:30 AM- Low.Drain juice, stagger along side of road, thinking about the cruel irony of getting low JUST when the food should be working! Daydream about CGMS's, and catching 99.9% of these things before they happen!
11:30 AM-226. Conservatively shoot 1U.
12:30 AM-156. Finish up yard sales, go home. Eat lunch, take nap. Wake up 210, feeling more like 500, drink 2 liter bottle of Diet Coke.(and half a gallon of water) Must have got slightly deydrated from the exercise.
It was fun though, I just need to better figure out my basal needs in these circumstances.

One Batch Novolog

Ingrediants: (x 10)
100 units Insulin Aspart
16 mg glycerin
1.50 mg phenol
1.72 mg metacresol
19.6 ug zinc
1.25 mg disodium hydrogen phosphate dihydrate
0.58 mg sodium chloride

Mix throughly, do whatever weird funky chemical reactions necessary. Bottle in 10 mL vials.
Sell to unsuspecting PWD's, $85+/vial.

Makes: 1 happy PWD, lasts 10 days-1 month.
Discard remainder.

I've gotta say, there's some pretty weird sounding stuff in there. No matter how safe it may be,its a little bit freaky to think its all being pumped into my blood stream. Especially the disodium hydrogen phosphate dihydrate!
I guess that's why it's so darn expensive...

Up and Down

This hasn't been a good week.
Yesterday, my check bounced the bank, I had to take out a cash advance(on my rent), and the endo's office called me to reschedule a much-needed appointment. My landlady informed me that I'm "breaking" the lease(by not mowing every week) and I'd better shore things up (or July will be Moving Month). I dropped my pump on the concrete floor(at work), its amazing it didn't crack/chip/blow up. And I had another exotic low at work, caught it though. I do not like these new low symptoms. (weakness in legs) I have a mountain of dirty laundry, but haven't had time to visit the laudrymat(along with everything else). And there is nothing to eat in the refridgerator, as I burned the pot of goulash(i.e., a little bit of everything) yesterday evening.
Butttt....
the blood glucoses are really, really stable. That's one good thing. Have only had 1-2 numbers over 200, and two lows since Sunday. Which, for me, is amazing. Usually, when I'm stressed to the skies, bgs follow suit.
More amazing numbers to follow, as I slave over my lawn tonight! My brother has loaned me his mower, but I don't have a weedeater(so I'll either have to pull them out, or use scissors).

I AM: ME! (Meme)

I am: ME! (PWD, Republitarian, writer, musician, insulin-pumper, EMT, nursing student, retailer,etc.)
I want: a happy, healthy family. (hopefully without my lousy genetics)
I wish: for a continuous glucose moniter
I hate: cooking. I'd rather clean..
I miss: spontainialty, to just hop in the car without the customary stash of medical supplies/food.
I fear: middle of the night hypos, that I'll never finish my (nursing) degree.
I hear: The neighbor kids, splashing in the pool, enjoying a sunny April afternoon.
I wonder: when there will be a cure.
I regret: Never telling the pediatric CDE she was a wonderful person. Never seeing past the end of my own woes, to see anothers. Funerals are too late for too many things.
I am not: organized.
I dance: to many types of music.
I sing: and I don't care that I sound bad!
I cry: over the sappiest novels/movies, and when I am exausted.
I am not always: a dedicated worker.
I make with my hands: crossstitch, gardens, a sparkling-waxed Nugget, and an interesting blog.
I write: because it is "art" to me
I confuse: words that sound the same
I need: more money...
I should: get a life.
I start: many things
I finish: Finish? What's that?
I tag: You!

Famous PWD's

Me....

With the old Cozmo Case:















With the new Cozmo case: (that just came in the mail)















I can't decide which I like better- differance(s) between the cases include:

Old
-Flap cover over screens(accidental bolus protection)
-Doesn't look completely "medical"
-Slightly smaller
New
-No plastic covering menu screen/ buttons (Ease of bolusing)
- Sturdier black clip, pump not so likely to "fall off" waistband
-Stiff, needs breaking in(obviously)

There's a new D-life video on Jason Johnson:


Elliott Yamin- Still in the running for American Idol!I've car-chalked my back windshield, to show my total support (until he wins...or gets kicked off) We're rootin' for you,Elliott! ( I would post a pic, but the rest of my car needs a good wash(it's not very photogenic)

Drama in the Workplace

Had one of those truly mortifying lows yesterday, about 45 minutes before the end of work. 30 minutes before, had tested 133, put a temp basal till the end of work.(1.5 hrs) Started to get lightheaded, figured I was probably low, ate/consumed candy-but it wasn't enough. Then my knees buckled, and I was kneeling on the floor. I couldn't get up, after a couple of minutes of trying, I gave up and just sat back down on the floor, leaned against the side of the lane.
"You ok, Heidi?" a coworker in the next lane over asks.
"Fine," I lie, as I drain a bottle of juice. "I just need to sit here awhile, I'm having a low."
"Go right ahead- you look terrible!"
5 minutes pass. Word of the drama in lane #3 has reached the ears of two other coworkers, who pro-offer mini-Butterfingers, Kisses, and hard candies. This is a really weird low, I'm not dizzy now,my legs just won't support my body.
20 minutes later, I'm feeling slightly better. Stand up, and finish the order I'm working on(takes less then five minutes). Clean up work area.
3:30 pm-Quitting bell rings. Phone rings.
I answer.
"Why on earth didn't you let me know you were having problems?What happened?"
The voice of my supivisor jars me back into the realities of the working world.
" I'm fine, just got dizzy and I had to sit down. They gave me candy, I was having a low blood sugar."
"That's good, but if it ever happens again, I need to know about it. Are you ok now?"
"Yes."
It's called Saving-the-Company's Gluteus Maximus- if I would've injured myself on my journey to the floor, the company would be liable for medical costs/employment compensation. This isn't the first time I've had a low blood sugar there, but the last bad one was 4 years ago, I can generally treat/work through my lows. (nobody even knows I'm having them) If I took off for every low I'd ever had, I wouldn't get anything done! (and my supivisor wouldn't either)

I went home, fell into an exausted sleep for 3 hours, and rechecked my blood sugar.

120. (this was 4 hours after I took my pump off)

Now, to figure out what had caused this rapid low. Thought it was a new infusion set prob, on the wise advice of people who know me just a bit too well, (I tend to keep my infusion sets in to long) but an hour post-supper my abdoman began rebelling against my Healthy Choice lunch, now I'm thinking none of it absorbed, hence the rapid drop in bg.
Healthy Choice- the next great way to lose weight, one way or the other. Called in sick today, as its still wracking its way through my system.

The DC Expo was great, despite getting there rather late (1:30 p.m.). I underestimated how long it would take me to get there on the Metro, but fortuantly the Convention Center was right on the Metro line. And there were plenty of helpful folks directing people towards the Expo(on the upper floor) Downstairs, the American Dental Association was having its thing (quite appropriate, actually, I wouldn't have minded listening in on some of those speeches).
I registered, and begun making the rounds.

2 hours later, figured it was time for a blood sugar check. (And why waste a strip...when there was a station set up to do it for free?) So I filled out a couple of permissary forms, got it checked (475, yay) got an a1c done, asked an endo a burning question I had, and completed the rounds.

It was definatly free pedometer day- everyone from NovoNordisk to Blue Cross/Blue Shield was passing them out. I got 5 differant pedometers. (I doubt it will inspire me to exercise more,though) Saw a Cleo sample, (very, very cool-I want some) partook of the various sugar-free-but-still-loaded-carbohydrate samples, and acquired too much stuff.(as usual)

Supper at Union Station, watched Ice Age 2, and back on the Metro.

Then the real fun began. It was raining hard, and I took a wrong turn coming out of the parking garage. Ended up circling Baltimore via the Beltway, for the next 2 hours. Eventually, I made so many wrong turns that I made my way back to DC, saw my "exit" that would put me back on the road I needed to be on, and was fine from there. Got home at 3 AM, extremily glad I don't have to deal with that madness every day.

Gas was $3.07 for a gallon of regular, that night. (vs the $2.87 around here) This isn't a political blog, but the whole situation is getting more +more ridiculous. Its not price gouging, when the supplies of crude oil/refined gasoline are gradually getting used up. And if we're not going to drill for more oil, we can expect those prices to keep going up. We need more efficient cars, and another source of fuel. (sooner or later, we are going to run completely out of gasoline and have to deal with these issues!)
I don't even get mad anymore(over the prices of gasoline), it could be much worse. (and I'm sure it will get much worse!)

Adventures in Bolusing

I don't like Coke, Cherry Coke, Vanilla Cherry Coke, or any other carbonated, highly sugared, beverage.


But pretty much anything Diet, I'll drink- be it Coke, Pepsi, or Brand X. It isn't the sugar angle(that has me discomforted), it just tastes WEIRD. I never treat my lows with soda, unless its the absolute only thing available. I'd sooner eat glucose paste( another totally yucky thing, in my humble opinion) then drink coke. Apparently, some PWD's don't feel this way- they'll actually drink regular, and bolus for it. There is nothing whatsoever wrong with this. (heck, I will happily bolus for a mixed drink) So it must be the sugar-carbonation combo ( take either one seperatly, and my taste buds have no problem with it) that throws my taste buds in a whirl.

So what could induce me to voluntarily drink a 20 oz bottle of Cherry Coke?
Coke's newest promo.

In every Coke-Pepsi-Mt.Dew promo, the coded caps come out first on the regular drinks. (As that's good marketing sense, most people drink regular) Several weeks later, the diet drinks get them. (Except the Diet Pepsi movie ticket promo-that's exclusively Diet)
But the updated Diet Coke products are at least a week away, from making their grand appearance. And I wanted to start saving points NOW.

So I bought a Cherry Coke, did a split combo(1/2 then, 1/2 over course of 2 hours, I drank it over 2.5 hrs) and checked my blood sugar every hour. I am not used to bolusing for soda, since I rarely drink it.
1 hr later- 209
2 hours later- 213
3 hours later- 210
Very consistant, at least. I did a corrective bolus, (as my stomach rapidly churned up acid) sucked on hard candies/bolused for hard candies, and swore I'd never do that again. Not even for a bottle cap. Not worth it.

There's been some changes with the BGAT study, I've got to do some more follow-up paperwork soon(instead of in a year). I'm really not that fond of paperwork... but they sent me another E-gift Certificate, ($50) so its ok.

Five Years on Sunday

I'd better just post this now...because I don't know if I'll be back (or awake enough) to post Sunday. The ADA Expo is Sat, and I may turn it into a weekend deal.

7.5 years with diabetes. Five, on the pump. Five year (increments) anniversaries always feel like big ones.

There's the "1" year (diabetes for one year, pumping for one year) anniversary- you think you know everything.

5 years- You bemoan the fact that there STILL isn't a cure, or a decent continuous glucose monitering system.

10 years- I expect to feel old, but I hope diabetes technology will have GREATLY improved. Always knowing what your bg is, would be so wonderful.

15 years- By then, a cure. Period. End of discussion.

But back to that day...

Monday, April 23, 2001 dawned clean and clear. I was more then ready- I'd been waiting months for this day.

6 A.M. (knock on parents' door)
"Dad, can we leave now?"
"NO-it's 6 AM. We don't have to be there till 9:30. Go back to bed."

7 AM (knock on parents' door)
"Can we leave NOW?"
"No, we're leaving at 8- we're not getting there really early!"

8 AM (knock on parents' door)
"Can we puh-lease leave now?"
"Ok. (sigh) Got all your stuff?"
"Daddd, of COURSE." (teenage indignation)

9:30 A.M.- Sitting in the CDE's office, impateintly waiting for the other trainee to show up. My dad, after talking to the CDE, leaves. (I'm a big girl, I'll pretend to be fine for the next 30 hrs.)

10:15 A.M. - Still no other trainee. I've bounced around, triple-checked my new pump + supplies, visited the restroom and read the the too numerous journal articles lining the walls of the room. Things need to start, before I go nuts.

10:30 A.M.- 12 year old trainee shows up, with her mom. It's re-training for her, she's already on a Disetronic.

Carb Counting. Basals/Boluses. Infusion sets. A brand new world.

And a brand new meter- the One Touch Ultra has hit the market. Pediatric CDE gives us both one, along with strips/lancets/ Minimed sets.

Blood Sugar Check- its time to put the training in action. 5,4,3, 2,1- I'm never going back to the 45 second Accucheck. This meter is so unbelievable.

236.

My fellow trainee smirks from across the table. "Ha ha, I'm 186."

Brief irratation at this immature juvenile. "Big deal, that's not a great number either."

Mom isn't watching. "Andi (CDE)- can I get you to look at her stomach sites? I'm really concerned about them."

CDE looks at them, studies them, analyzes them to the nth degree. Leaves room.
"She's got a rash- better stop using the stomach for awhile, put lotion on them. Talk to Dr. (X)
if they don't clear up."

CDE is busy quizzing me on what to do next. "How much insulin would you take for a corrective bolus?"
3 units, ok. Knew I'd be high anyway, I'd skipped the prior evening's Lente. (as per instructions)
12 year old is punching in her bolus like a pro. Well, she has been pumping 7 months. I try not to gape. Someday I'll be doing that.

Stuff all my new stuff into my supply box, self-consciously adjust the pump onto my jeans waistband, and prepare to move on out.
Next Step: Admission.

"Here, I can take that." My CDE relieves me of the supply box, I've only got my duffel bag and backpack to take care of now.
Past the Medical School Auditorium. Down the elevator. Down more hallways.
I see a sign for the Morgue.
"Are we near the morgue?!?"
"Yes, this is the basement."
I wish I hadn't asked. Probably lots of people who didn't take to pumping, ended up down here.
Up another elevator. Around to the cafeteria.
"Hon, I can take your stuff up. You can eat lunch with (the dietician), and she'll bring you up when you're done."
I hand over the rest of my stuff. "OK, thanks."

We have a very healthy lunch- which the dietician payed for. I couldn't eat anything sweet, until boluses were figured out, but I wasn't hungry anyway. Dieticians can be nice people- despite the intial awkwardness. She made sure I bolused appropriatly, for every bite.

Lunch being over, we headed up to the pediatric ward, where the nurse/intern on duty were waiting.
First, its the nurse's turn. Tons of paperwork. A blood sugar check, revealing a number deep into the 400's.
She freaks, and goes to tell the intern.

The intern shuffles in. Tall, skinny, shaved head. Facial complexion a chalkish white-green. Either an Ex-Member of the Grateful Dead, or having some serious medical issues himself.
"What're you in for?"
Brief confusion- aren't they supposed to already know this stuff?
"Starting an insulin pump."
"Ok. What's that?"
"Ummmmm, its a pager type thing, and it goes through a tube to my skin," I reply, wishing I could explain it better.
"Ok." Nothing on his face reveals whether he gets what I'm talking about. Suddenly, I wish very strongly that my own endocrinologist would show up + prevent an ensuing disaster. I don't feel confident that this guy knows squat about type 1 diabetes.
"Ok. Let's talk about your current medical history."
Yes/No/Yes/No.
Diagnosis: Perfectly healthy in every regard, except the D.
He reads the nurse's note. "Checked ketones?"
"Yeah, I'm moderate."
"Ok. Let me check on something." Leaves room. Comes back in. "Take 8 units."
I remember how to bolus, and I do so. Take nap, drink fluids, feel rather nauseus.
6 pm- Supper arrives, on the dot. I eat half of it, bolus for the whole thing.(still feel high)
8:30- 121.
Hourly blood sugar checks, all night. Study for final exam, watch movies, fall asleep.
7:30 AM- Ped. Endo checks in.
"Your overnight basals are great...you were between 110-121 ALL NIGHT. Still have to adjust the daytime. Couple of hours, we can discharge you."
8:30 AM- I eat breakfast, bolus, and promptly skyrocket to the mid 300's. Not so simple, this pumping thing.
9 AM- Intern pops back in, medical student in tow. "Wanna show my student your pump?"
I do so(while the intern scribbles in the chart). Medical student is duly impressed.
9:30 AM- Ped CDE pops in again, reviews various things. I still feel incredibly dumb, but figure eventually I'll know it all.
12 PM- Lunch time. Unfortuantly, I'm still mid 300's, and I have got ketones (yet again). Ketones= no discharge, and I'm in panic mode (thinking I won't get discharged in time to make my final exam, and if I don't make it to that class, I flunk). Of course, the more I worry about it, the higher my bg goes. I bolus well, skip lunch, and pray to get discharged quickly.
2:30 pm- Mid 300's, but ketone free.
"Ok, we can discharge you."
I'm packed, and ready to go in a matter of minutes. I call my parents, and my mom starts out to come get me.
3 pm- Still waiting on discharge paperwork. I may have to start walking, if these people don't hurry up. Can't be late for class!
3:15 pm- Admit to the other side of the room. Chat briefly with the mom, think how lucky I am that I just have diabetes.
3:30 pm- Nurse arrives with discharge paperwork. I sign, grab belongings, and make a beeline for the elevator.
3:35 pm- Mom arrives, picks me up.
5:30 pm- Deliver speech on childhood diabetes, (final exam) get an "A."
6:00 pm- Classmate gives speech on kids with diabetes/insulin pumps, looks in my general direction, and tells me I might want to consider getting one. I am too incensed/embarressed to merit an intelligent reply, I hunker down in my seat and glower darkly.(A. It was a really bad speech, and B. I'd wanted the topic) And I see her Disetronic, for the first time that semester. Never knew she even had diabetes, thought she just knew someone with it.
I mutter something to the effect of "Maybe" and long for class to end. (Never told her I'd just gotten a pump)
Every "Pumpversery", I go out to eat (pump anniversaries are much more fun then dx anniversaries!) Don't know where yet- as I still may be in DC.

A Bunny a Day...

Keeps the glucose hoppin'!
















I was fully intending to eat this 1-lb chunk of heaven on earth, before my youngest brother showed up, bearing gifts:















A complete 31 inch tv, dvd , and vhs system with an impressive sound system. It took some rearranging of my (already cramped) living room to get it all in.
Nice.
Of course, there's a reason he is getting rid of it- end of summer, he's going to Naval boot camp (so he's getting rid of stuff now)
Then, he cleaned out my refridgerator (what he didn't eat, he threw away), discovered the chocolate bunny, and the rest is history. Oh well- there's always Post-Easter specials. (I'll find another one)

And then my sweetie sent this over:






Flowers for Easter!:-)









My insurance company has denied coverage for infusion sets, period. (and they are still holding to their 400 strip/3 month policy)
I am so frustrated- and confused. Who on earth do I appeal to? I can't appeal to my insurance company, they don't do prescription services anymore. Can't appeal to the prescription supplier- because they don't make the policies, they follow them.
So I called up Corporate Headquarters HR yesterday. They told me I had to file appeals with my local HR manager.
Hmmm, this is amazingly difficult. (even for an insurance fiasco)

Have a wonderful Easter, all.

The Great Cake-Off (and other matters)

126, 321, 221, 298, 213, 245.

Basically, my attempts at "Playing Pancreas" suck. I'd rather have my old one back.(functioning at full capacity)

Its springtime- the birds are singing, the flowers blooming, and the grass/weeds growing. (like mad) My landlady kindly reminded me of that fact, she stopped by at 9:30 pm last night, scared the living dickens out of me. (thought it was a robber) I assured her that the lawn WOULD get mowed this week,(putting her mind at rest) and she happily drove off. Now all I need, is a mower. (I'll borrow one from someone) Got my work cut out for me, this weekend!

The Great Cake-Off is in 19 days. Its not a very diabetes friendly event, but I don't believe in letting diabetes dictate every action of my life.
Contestants bake two cakes- one for the judging, one for the auction. (proceeds from auction go to a worthy cause) As for the judging...well, after the judges get done with it, its open season for anyone to taste.
Tons of cakes- carb count all unknown- even with a pump, it sounds like a formidable bolusing challenge.
I'm don't expect to win, but it sounds like a worthy cause to contribute to. Maybe someone would actually eat something that I baked...(without keeling over dead) I'm not a great cook.

Went to a doctors appointment, waited 2.5 hrs on the doc. Seemed like he was getting paged every 20 minutes, in between his scheduledees. It is not the longest I've ever waited in a doc's office, but it definatly felt more like the ER then a doc's office! By the time he came in, it was 4:45, almost quitting time so he didn't go through the usual "how's your sugar" 30 minute lecture. (one good thing) Poked around my stomach/back, checked a urine sample, and dashed off a quick scrip for an antibiotic. I like this doc, he does a through job of things but sometimes I think he prescribes antibiotics for everything, just because I have diabetes. Just because I have diabetes, doesn't mean my immune system doesn't function fine. (most of the time) I hate being different.

By then, it was 5:30 pm and the regular pharmacy had closed. Drove down the road to a Walmart,
where they transferred my info(from another store) and filled the prescription. Unfortuantly, they didn't have an updated prescription card, so it was either pay out of pocket or come back.
I comprimised, bought enough pills for a couple of days, and decided to come back later, (w/card and rest of copay) for the rest.

Saw a One Touch Ultra 2, (while waiting at the pharmacy). It's Lifescan's newest attempt at combining Ultrasmart features(graphs, etc) into an Ultra. It looks a little bigger then an Ultra- but it has the same shape. Looked interesting, I may get one (if it's smaller then an Ultrasmart). Before the Ultrasmart research studies begun, I was a Ultra fan(and I will go back to them, at the end of the studies, if nothing better comes along)

Family Ties

Age, environment, viruses, genetics. All important triggers, in type 1 diabetes.

Still, if you don't have a family history of it, you wonder. What REALLY pushed things over the edge?
I was raised on the healthiest of diets. Farm girl- went to the doc extremily rarely, blah blah blah. When I got diabetes, I knew I couldn’t have gotten it from eating too much sugar ( that was eaten extremily rarely, anyway).
Sitting in the ICU room (at diagnosis) they asked if there was any family history of diabetes. I had no clue, I looked at my mom, and she said yes.
Two cousins, one diagnosed at 11, one at 17. None of them too keen on the concept of pumping, apparently. Another cousin passed away of DKA, in 1963. (At age 11)
And then there’s my cousin’s wife. Every complication in the book. Shortly after diagnosis, my mom took me to see her( to put the urge for good control in my heart) in the hospital. It hardly worked, I was as uncomfortable as anything (and just wanted to get out of there). Now, I hope I am more approachable(then I was then), I know it wasn’t all “her fault” for all the complications she sustained. I feel bad for her.
Nothing on my dad’s side. (other then one or two type 2's) Type 1, seems to be the maternal "touch" in our family tree. Every single case seems to have been inherited from the maternal side.
My one cousin(married, no kids) is in unbelievably great control. If ever there was a “poster child” for a perfect D pregnancy, she is it. (I haven’t seen her in years, she lives in CA) Sometimes I wonder- are my chances of having a kid with diabetes considerably higher then 4%? I wish my cousin would have some healthy kids, it would make me feel better about my (future-kids will still be a longggggg time off) chances. Having diabetes yourself is easier then your child having it. (My hats off to you moms and dads, I would be a nutcase) I’d have to rewire my thinking- start being very responsible about diabetes care!
But maybe T.C. (aka Thomas Crapper- the guy who got rich off the water toilet) had a premonition that one day, one of his relations would get diabetes and need one. Yes, on my dad’s side I am related to him. T.C. had no kids, thus no descendants. It goes to show- you can’t pick your relatives!(Especially those of such notorious, embarressing fame) I just wonder how many other type 1's were in the family tree, and died from diabetes.
I am glad to have diabetes in the 21st century (vs the 19th-20th) - and have the tools necessary to treat/live with it.

Daylight Savings Time

Without exception, I always wake up low, when the time changes.
Doesn't have anything to do with extra basal/whatever. Its just a particular Heidi quirk.
Anyway, Sunday 8 am my Low Alarm went off. I was awake just enough to disconnect from my infusion set, and resume sleeping.
At 9:30, I was 124. (so it worked)
Saturday,hit the road by 8 am....

Add 45 minutes on the Metro.

Destination- Smithsonian!

Boyfriend and I had a quick lunch(hotdogs, drinks) before visiting:


Washington Monument:



Jefferson Memorial:


WW2 Memorial:


Holocaust Museum. Unfortuantly, taking photographs wasn't allowed (inside), and the main

show was sold out for the day...but it was still

interesting.










Supper was a tres multi-culteral learning experience (cafe near the museum)- I had something,

I don't recall the name of, but it was quite good. Like a cheese bread( outside) and a mashed

potato-brocculi filling.
My rating- 7 stars out of ten. It'd have been better with chicken in it.

Boyfriend stuck with a tuna fish sandwich and fruit smoothie. (there is safety, in familiarity)

A quick visit to the Gift Shop....

The Tulip Library: (yeah, its really called that. Pretty funky name, if you ask me)


And back to the metro. (it was INSANE) Everyone was going home, or at least it appeared that way. To a country girl, its always a tad overwhelming (being crushed in a pile of folks just waiting to enter the Metro Station!) Standing room only (on Metro), until outside the DC limits. By then, I thought I was going to collapse from exaustion. Slightly nauseus. Sat down, checked blood sugar. (157)
It was a great day, anyway. Had alot of fun.

Monday was very uneventful at work. We had all these cases(same brand sold by Fifty-50) and it made me want to get some...
Then it was off to the dentist for some fillings.
Pre-dentist: 157
Post-dentist: 407
I was shocked to see that 400 number- I've never gone up like that before. Maybe they gave me some ephinephrine with that novocaine!

Walk the Line

Positive news on the glucose front- the "Streak" is over. Beautiful numbers. Life back to normal, in Diabetesville.
And then I woke up Thursday morning.
Apparently, last weekends' Eat-A-Thon had unforeseen effects. (beyond the instant lowering of my a1c, whooo hooo) This became immeadiedly apparent, during the mad rush to prepare for work.
None of my pants fit.
I briefly considered taking a "Fat Day", before remembering that my employment doesn't offer such benefits. In fact, if I tried it, I'd probably be forever immortilized in the Dumbest Excuse Ever Heard Hall of Fame, + get laughed at by security every time I walked through the door. Best not risk it.
Sucking it up, in, and under, I found the least offensive pair, selected an extra baggy sweater, packed my ultra healthy lunch, and waddled off to work.
Unfortuantly, the yogurt I'd packed for breakfast had gone spoiled, so I was "forced" to eat my back-up chocolate bar. I do much better if I eat something early in the morning, it doesn't have much to do with blood sugar levels. I just need that food in my stomach.
Lunch, was a Grilled Chicken Salad with a 85 blood sugar. Something finally going right...
At 2:30 pm, the floor manager held a meeting.
"Ok people, listen up. Everyone here?Are you SURE? We just got word that we've recieved another bomb threat (late last year we got one) and management has decided that we're going to let the authorities check this place out tonight. If they find anything, work is a no-go tomarrow. I want a complete update of everyone's phone numbers- let your supivisors know.
If you don't hear from us, work is still on. Now you're all adults- and capable of making your own decisions, I'm not going to tell you to not come tomarrow. You make that call. But if you don't, you'll be working Sat."
Suddenly, that morning's clothing woes seemed woefully insignificant.
Pandemonium ensued.
Last year, when we had the first bomb threat, they shut down for the weekend. 11 am, Friday morning they held the meeting- in five minutes, that place was emptier then the day before Christmas.
I made up my mind I'd come in today, if they didn't find anything. No way was I coming in Sat.
Approximently 1/2 my collegues didn't feel that way, however- the parking lot was pretty empty this morning! There was absolutely no problems, nothing blew up, and no trucks driving in. I was nervous, just like everyone else..but beyond that, the day was ok. I wore my medic alert today, if there was a problem, I needed the assurement of some sort of indentification on my body. Call it weird, but I needed it.(for peace of mind)
WEEKEND IN DC(Apple Blossom Festival)!!!!!!!!!!!:-) (maybe I'll find some shorts that fit..I need to do some serious exercising!)

Feeding time at the Zoo

Some days, it feels like feeding time at the zoo. You aren't hungry. You never want to see a bloody juice box again. But you have too, the insulin demands it.
And it goes on and on and on and on...
Many things can spark this off, extra activity, illness, various meds. But in my case, I'm fortuatate to know- once you know, you can adjust things, right?
Wrong.

Friday, March 24

12 pm- wake up, 65. Drink juice.
5:30 pm- 135.
7:30 AM- 72. Cut breakfast bolus in half.
8:30 AM- 224. Cut basal to 0.0 for next 3 hours.
11:30 AM- 90.
12:15 PM- 60.
This is the beginning of hypoglycemia extroidenaire (for the next week). I will average 5-7 lows per day, nothing will prevent them. My insulin needs will drop from an average 30 U/day, to under 10. (it has to do with hormones, and it happens several times a year)
Its a mini honeymoon, of sorts. During the daytime, I need no basal. At meals, my insulin/carb ratio quadruples, (1/40, vs.1/10) a "dangerous bolus" is anything over 2 U.
Every time it happens, I have no clue what I'm doing.

2:25 pm- 135 Cut basal to 0.0, for next 5 hours.
5:30- 150
7:30- 180
9:30-90
10:30- 55
Bedtime snack.
Saturday, March 24
4:30- 320. Bolus 4.5 units.
7:30- 62. Nothing like waking up low, on a Saturday morning.
Juice, fruit bar, granola. No holds barred. If I'm going to be constantly low, I'm going to make it a more pleasurable experience. (New rule- Anything I want, I eat) I will go to the most carb-ish restaurunt in town, and eat my way into an early grave. (just kidding)
Depending on how today goes, I also have glucagon on the stand by. I've never injected mini doses before, but I hear it can be helpful when dealing with prolonged hypoglycemia. Haven't had a glucagon shot in eons, (6 years?) I'm not sure how my body will react to that either but what the hey, I'm testing frequently anyway...(and I need to use 'em up before they expire!)
If that doesn't work, I'll call the endo. (probably will mean a trip to the ER)

ADA Expos

I've been to one ADA expo. (2004) Didn't make it to last years.
As I recall,
-Chris Smith
wooed everyone with his extra low carb-fat-sodium-everything chocolate-strawberry dessert.
Surprisingly, it was edible. Surprisingly, it was even good. But I still wasn't going to pay $20 for his book.
- Fortuantly, I missed all the type 2 speeches. (they looked incredibly boring) It wasn't planned- I was two hours trying to find the place. Don't get me wrong- it was an incredible bonding experience( I agree with ya, Kerri) but I wasn't going to sit through varying levels of Diabetes 101 (Can I eat sugar? Do I have to take a shot?) if I could possibly NOT. That would be torture.
- Christopher Saudek,MD
was also a speaker. The Future of Diabetes (Type 1 cure) kinda speech. It was interesting, but he talked for over an hour(the convention was closing up shop, by the time he finished)
- The ADA was giving out free books. (any book from their catalog) I chose A Field Guide to Type 1 diabetes, got it a couple months later.
- The Ask the Endo and Ask the CDE booths were especially popular. (there were others- Ask the Podiatrist, Ask the Pharmacist, Ask the Dietician, Ask the Shrink) I got in line. 20 minutes on the CDE one, 45 on the endo. The endo sent his kid to get lunch, he was too busy to get it. There's dedication. I asked the endo if I would go into DKA less quickly then other people, given
I've got this kidney thing(DKA= acidosis. Kidney Thing= Alkolosis) that nicely balances things out. He said nope, I'd probably just get a "mixed-state" acidosis-alkolosis combo. Didn't recommend testing out that theory. As of last August I've learned, that it doesn't slow down DKA one iota, so there are absolutely no benifits to having weird, exotic diseases that clash with diabetes.
I wish they'd have the Expo when the cherry blossoms are in bloom-
I could get more bang for the buck. (DC experience)
I've never been to the Cherry Blossom Festival- I would love to go, this year. (even if I do have to make two trips (in April) to Washington DC)