Tag Archives: diabetes

What’s in your pigeonhole?

There’s always been a kind of up and down about my diabetes. Not just when it comes to blood glucose levels, but with everything. Work has been one of those things. Sorry that this is so long. Hope you’re still there at the end.

When I was first diagnosed, all the way through my first 15 years or so with diabetes, I didn’t really experience any clashes between my diabetes and my jobs. Later on, I had a few uncomfortable moments here and there, and for the last few years everything has been absolutely great. There are certainly reasons for all of this, and the reasons are probably not everything you would think of right away.

I should also mention that my A1cs were coming in pretty high during these years, when I was actually seeing doctors. I rarely tested my BGs. And I was on MDI (multiple daily injections); I didn’t start pumping until much later. So as long as I wasn’t running to the restroom every five seconds, there weren’t many outward signs of my diabetes at all.

Then I started the job I have today. That was around 16½ years ago. My A1cs were still in the 9s, but shortly after I started seeing a new endocrinologist who started me on Lantus. Now, my knowledge of diabetes was still practically nothing at this point, so I injected as prescribed, which was once per day. That’s it. The lantus did its thing, which was okay for a while. But my A1cs were still in the 8-9 range. And then, the lows started coming. Terrible lows. Lows that gave a new definition to hypoglycemia for me. Including a couple of bad ones at work.

After a couple of those events, I had to deal with internal conversations with my bosses. I have a hard time describing this, and after all this time I’m still not sure I can do a good job of it. I was called in, behind closed doors in one instance, and was asked “What are we going to do to make sure this doesn’t happen again?”. How do you answer that? Especially when your knowledge of your own diabetes is practically zero, but you think it’s not. Another conversation included a directive that because these lows seemed to be happening just prior to my normal lunchtime (not true, but they weren’t always aware of the other times), I was going to be required to go to lunch 45 minutes earlier than I had normally been going to lunch. Great… Let’s take the lunchtime issue out of the equation and add 45 minutes to the time I eat between lunch and dinner; I might go low right after work, but no one there will know about it because I won’t be there. Problem out of sight, out of mind. This was something no one else in my organization was required to do, and I was pretty unhappy about it, but what could I do? I had a really good job and people who depended on me. Plus, I was working with (and for) people who otherwise were very good, very nice people. I felt like I was running out of options, but didn’t know where to turn.

I muddled through a little longer. Okay, a few more years longer, before things began to change, and I think my co-workers started to see diabetes in a different way. Part of that involved a hypoglycemic event involving a co-worker who, until then, I was unaware had been living with diabetes. My boss came to me asking how I could help this person at that moment, while they were still trying to come out of it. I’m pretty sure they shouldn’t have shared the diabetes thing with me, but since they did, I shared what I felt during those times. I just started talking.

I told her about how hypoglycemia is a near-death experience, and how you can get this violent mental and physical swing between just wanting to survive, then feeling horrified that you’ve been such a bother to people who up to that point don’t know your diabetes and can’t hope to understand it on such a level, then wanting to prove how strong you are by going right back to work and performing like a superstar, all while feeling so physically weak that you just want to curl up in the corner and sleep for the rest of the day. This was the reward for coming back from the brink of extinction. And, oh, by the way, it might happen again tomorrow. You never know for sure.

I think that helped changed the perspective of how people at work viewed hypoglycemia, at least. My outward attitude started to change too. I started caring more about my personal survival and less about whether someone thought diabetes was a mark of personal weakness, or weirdness, for that matter.

Five years ago, I began to see a new endocrinologist, who for the first time, started to explain carb counts and blousing and updating basal rates based on exercise and eating habits. I started to check my BGs at regular intervals each day. I got off of the Lantus and started on Novolog. I started on an insulin pump, and my A1c started to come down.

Still, I felt pretty alone with my diabetes. Then my wife heard an interview on local public radio with someone who talked about an “artificial pancreas” and made me listen to it. I said, “Great, what do you want me to do about it?”. She said, “Find out about it. Someone online should be blogging about diabetes. Why don’t you do a Google search?”.

I did, and for the first time, I had that “Holy crap, I’m not alone… Holy crap, me too” moment. I began to learn even more, and talking to people living with and not living with diabetes. I remember having conversations with people at work and finding out that almost all of them were touched by chronic illnesses in one way or another. I had a conversation with one of my bosses where I was able to explain, and have understood, I think for the first time, that diabetes isn’t as easy as take a set amount of insulin, eat a set amount of food, exercise a set amount, and everything will be perfect. You can do everything the same every day for a month and have 30 different days’ worth of results. I learned how to say that from the diabetes online community.

I’m not sure what the moral of this story is. Sometimes I just need to write things to get them out of my head, you know? If there is a moral for me, it’s maybe that people act differently given different circumstances, and those circumstances are often influenced by things we’re unaware of at the time. I know I can’t influence every situation the way I want to. But I know that knowledge helps me deal with situations better, and I know that acting with empathy for all and perseverance through the difficult times can help me hold my head high even when the going is tough.

I read something recently about a workshop where a speaker was talking about acting with integrity in everything you do, and he mentioned that everyone gets pigeonholed at one point or another. His advice was, when you do, make sure your pigeonhole isn’t full of shit. The workshop was for new National Football League coaches and executives. Maybe the workshop should have been for existing coaches and executives. I don’t know. My question to you is:

What’s in your pigeonhole?
 
 
 

A few D and non-D thoughts.

Because this is my blog, here are a few random diabetes and non-diabetes ramblings, in no particular order:

– Ever notice a difference in how your diabetes works with different insulins? Don’t answer that. I don’t want to know… yet. The fact is, they all work. It makes sense if they don’t all work the same. The trick is in finding what works best for you, and then not using what you’re using as an excuse for results that don’t make you happy.

– Additional note: Don’t tell me they all work the same, then tell me I have to pay three fucking times more for one than I have to pay for another. There’s a point where copyrights of manufacturers and the rights of so-called insurers need to be tempered by the needs of patients who need said insulins to survive. Three fucking times more means the balance is skewed too far toward the manufacturer and/or the insurer, and not enough toward the patient.

– I’m very excited to be speaking later on today with the brother-sister team of Hayley and Ethan Maurice, who earlier this year climbed Mount Whitney, tallest peak in the contiguous United States, raising thousands for JDRF. I’m eager to find out how things have been going since their backpacking adventure, and get a little inside scoop on how things were during their climb too.

– Part of the reason why I’m speaking with the Maurices today, and not before their trip, is because my life has been scheduled beyond belief for the past several months. I mean, I’ve had something scheduled every single Saturday morning going back to mid-May. That’s the last time I’ve slept past 7 a.m. on any morning. Sorry to complain about it so much, but every time I whine about how busy I am, it kind of lets off a little of the pressure I’m feeling, plus it helps me to focus on what is really meaningful, which is the fact that I’m amazingly lucky to be so busy. And this Saturday morning: I’m helping a friend on the other side of town at 7 o’clock. Then I’m meeting a rep from a pump maker. See what I mean?

– I get the fact that people are feeling a little jealous about the ALS ice bucket challenge. I’ve seen enthusiastic ice bucket challenge videos from people who have never donated to any of the diabetes-related things I’ve advocated for. Hell yes, I’m jealous. But I don’t begrudge them one ounce of their fun nor one dollar of their fundraising. I don’t wish Lou Gehrig’s disease on anyone any more than I wish diabetes on anyone. They are both horrific things to have to live with, and the sooner they’re both eradicated from the earth the better. I’m sad that we in the diabetes world get a lot more attention for complaining about an article in the New York Times than we get for helping to save the lives of children who don’t have access to insulin or the means to pay for it. But as I’ve noted before… when I compete, I don’t feel good, even when I win. When I help, I feel good, even if no one notices. So let’s keep our eyes open for opportunities to help, and if we keep helping, I think an opportunity will present itself and grow like this one did for ALS. If: We are all working together. Supporting each other.

– Speaking of other things I (probably) have no business weighing in on: Is it okay now to call this whole Ray Rice thing a fiasco? Maureen probably had the best take on it yesterday when I asked her whether she thought the NFL had knowledge of the elevator video prior to yesterday. She said: “Sure they knew the video existed. They just didn’t want to pay for it like TMZ did. Good for the NFL for not paying for it; shame on the NFL for not doing the right thing in the first place, video or not.” My take: No one should get a free pass on this issue. Including the fans of my favorite football team. The statistics show that no one is untouched by abuse. I’d be really happy if we could say that no one is untouched by protection from abuse. No one. Ever.

Now I’m off to search for those Medicine X videos from last week. I’m jealous of everyone who was there, but in the most supportive of ways. I can’t wait to hear everything I’ve only heard up to now via Twitter and blog posts. Be safe, be well, and remember: I support you… no conditions.
 
 
 

Start of the Snap.

Before I begin today, please allow me to say Happy Anniversary to my wife of 21 years. No baseball games tonight Maureen… let’s celebrate!

Part of my day Wednesday was spent getting training and getting started on my four week trial of the Asante Snap insulin pump.

Asante is confident enough in their product to offer a free four week trial of the Snap pump to prospective customers, complete with a voucher to help pay for the Humalog cartridges required for the pump’s use (side note: Asante, you have no idea how much I appreciate the help). In the end, it’s not much different from Medtronic, who, after I would submit insurance paperwork and a prescription, would help me through the process of purchasing the 530g system, then allow me to return it within 30 days if I wasn’t satisfied. The biggest difference between the two (I had to submit the same type of paperwork for my Snap trial) is that for Asante, this is a trial, with the opportunity to go through the purchase process once it’s complete. If I decide not to keep the pump, I already have a postage-paid envelope to drop the pump into to send it back.

After just a couple of days, I can’t speak with much authority on the Snap. So I’ll just give some first impressions.

Maybe I’m a seasoned veteran after 4 ½ years of pumping (I doubt it), but training seemed a pretty easy thing with this pump. My local rep was knowledgeable and able to describe everything about every menu item on this device. Training was simple and straightforward, and the thing that took the longest was probably just inserting the cannula. Part of trying out a new pump also involves trying out a new infusion set. The one I’m using has extra long tubing, which can be a little tough at times. But the extra length really comes in handy when you have to put on a dress shirt for work.

I like that this pump has a volume setting. I cranked that sucker up, and I can actually hear beeps from my pump! I can also turn the volume way down for those times when I’m at a play or at the movies.

Programming a bolus is simple too, though I have one question of anyone using the Snap: After programming a bolus, have you accidentally hit the button to cancel that bolus when returning the pump to your pocket or belt clip? I haven’t done that yet, but it seems like it would be easy to do.

The display is nothing to write home about. Kind of like the Medtronic display (though brighter), I think of it as an MS-DOS screen, if you’re old enough to know what that means.

Taking the display a bit further, I should tell you that Asante is in the process of updating their screens to a color display, which should start happening in late November. Along with that, users will also have the opportunity to choose from a wide variety of pump color combinations. So my question was: If I purchased the pump now, would I be allowed to upgrade in November? The answer is… Yes. Anyone purchasing the Snap pump between now and November 15 will not only be able to upgrade their pump to a new color combo and a color display, they will also be allowed to keep their original version too. For someone new to pumping, this could be an easy way to get a backup pump for nothing extra.

I’m not a big fan of the belt clip. But honestly… Can you say you’re a fan of any of the belt clips from any manufacturer? I can’t think of a way to improve belt clips without invoking the phrase “putting lipstick on a pig”.

When my trial is finished, I’ll try to get a little more in depth with the Snap. In the meantime, if you have any questions, feel free to ask. If I don’t know the answer, I’ll try to reach out to my rep for the solution. Also, if you have experience with the Asante Snap pump, I’d love to hear some of your insights!

Disclosure: I’m beginning a standard four week trial of the Asante Snap insulin pump. This is the same trial that is available to all users who are considering starting on insulin pump therapy, or are considering a pump change. I was not given anything by Asante, and I was not asked to write about my experiences. In fact, I did not tell them I’m a writer at all. All opinions, as always, are my own.
 
 
 

Wordless Wednesday: Birds.

I am so busy right now, I don’t have time to write much at all. So today, I’ll share a few photos from last week, when The Great Spousal Unit and I traveled with her dad and his wife (and her brother) to Blackwater National Wildlife Refuge. Blackwater is home to one of the largest groups of nesting bald eagles on the east coast. We saw a few bald eagles, but I couldn’t really get a good photo of one, though there is one of an eagle off in the distance drying his wings after diving into the water for a fish. It was a great day, and we enjoyed seeing all of the wildlife. Here’s a look:

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Here's your eagle.  Sorry I couldn't get anything closer.

Here’s your eagle. Sorry I couldn’t get anything closer.

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Happy Wednesday!
 
 
 

Three reasons why I don’t see a CDE.

I’ve enjoyed reading about the recent American Association of Diabetes Educators meeting in Orlando. Wil Dubois at Diabetes Mine has written thorough recaps of many facets of the conference, and thoughtful viewpoints of the conference and of Certified Diabetes Educators in general have either been posted or will be posted at ThePerfectD and Diabetesaliciousness, as well as on blog posts I haven’t seen yet (If you’ve seen a good one, feel free to link to them in a comment below). There’s no doubt Certified Diabetes Educators do an amazing job of providing education, encouragement, and ongoing information for people living with diabetes. Metaphorically placed end to end, their numerous success stories could stretch from here to the moon and back, and probably back again. They are an important and vital part of the diabetes community.

So why haven’t I seen a CDE since my diagnosis 23 years ago?

The reasons are many. I’ll give you three right now. I’m not saying these are good reasons; in fact, they might be downright ridiculous. I’m not saying you shouldn’t see a CDE. If it will benefit you, you should. But why haven’t I seen a CDE in 23 years? It’s more than just a simple “I don’t wanna see a CDE”. Here we go:

A doctor has never asked me to see a Diabetes Educator.
This is true. I saw a Diabetes Educator in the hospital after my diagnosis. She taught me how to inject insulin, gave me the lowdown about the exchange diet (it was 1991), and she even warned me about certain parts of my anatomy not functioning properly if I didn’t take care of my diabetes (creepy, but true). Since then, not only have my GPs and endocrinologists not suggested that I see a CDE, they haven’t even mentioned it at all. Ever. I never thought about it either, until reading online about how much people love their CDEs. Since then, I’ve thought about discussing it with my endo. But as you probably know, time with our primary healthcare professionals is precious and short, so I never got around to it. But this whole paragraph makes me think: Are doctors not recommending CDEs to their patients enough? Are they only recommending them where there aren’t enough doctors or nurses in the first place? I don’t know the answers to those questions. I’m just asking.

It’s one more person to make an appointment with. And pay.
I already need to visit my endocrinologist every 90 days (no complaints about that… it just is). Then there’s my GP, whom I don’t see often, but still. I also have to keep regular appointments with the eye doctor and the podiatrist. I have to see a dermatologist every now and then. Now I need to schedule time with a CDE too? I’m already forking out over three grand per year in out-of-pocket expenses for my diabetes. Like it or love it, it’s one more appointment and one more expense.

On the other hand: If a CDE could help me get to a better state of diabetes management, they would be worth their weight in gold. Just sayin’.

Side note: I can see where people on an insurance plan that still requires referrals would just say no to this outright. Why pay an out-of-pocket expense to get a referral from the primary or endo, then pay another out-of-pocket to go see the CDE? This is why many plans have done away with the idea of referrals for everything—it’s too expensive for them too. In fact, some plans are probably saying that they won’t cover visits to a Diabetes Educator at all, though I don’t know how prevalent that is. Again, my view on that is: If it helps, it’s more than worth the cost.

It’s one more person to answer to.
This is probably the dumbest reason, and yet the easiest to write out. Why do I feel this way? Because I like my endo. I trust my endo. I want my results to make my endo happy every 90 days. If my results are less than stellar, I feel a little like I’ve let her down. I do not want that responsibility every 90 days with an additional person. To change this would probably require rewiring my brain, so I see a CDE as an additional member of my team, there to help me rather than be another person telling me what to do. But right now, while things are going okay, I’m worried that an additional person added to the mix might make me less likely to want to listen to their advice, no matter how helpful it may be.

Now… go ahead, leave a comment and give me the 1000 reasons why I’m wrong about all of this. I know I deserve it. But please be respectful. I might deserve criticism, but not hatred. Thanks.

Disclaimer: As I said above, these are NOT reasons why you should not see a CDE. Everyone has a right to seek the best help they can find.