Tag Archives: Type 1 diabetes

Diabetes vs. Cortisone

This has not been a good week for me and Dear Diabetes.

In the last five days I have had 55-60 total units of insulin shooting through my body. Of that, 30 units is continuos basal.

That’s a lot.

To put it into perspective, normally I average 17-21 total daily units of which 12 is basal.

Right now, I am triple dosing.

Yet, my blood sugars are high.

Abnormally, dangerously high, unable to crack below 13 mmol most of those days.

Generally, I am rarely above 10.0 mmol.

The resistance is strong.

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This photo was compiled late Friday afternoon. By end of day, my total daily dose was at 57 units.

The culprit: a cortisone injection in my right hip joint that was administered Thursday morning to counter the effects of a labrel tear.

Apparently it is well known in the medical field that cortisone (and other steroids for that matter) can often wreak havoc on diabetes management. Yet, I was never made aware.

Not from the surgeon who booked the appointment.

Not from the nurse who prepped me for the cortisone.

Not from the doctor who administered the injection.

They all knew I had Type-1 diabetes and that I was on an insulin pump.

When I met with the surgeon, our initial conversation was about surgery, and I flat out asked how surgery would affect my diabetes. He told me, minimally. When it was decided a cortisone shot would be the best course of action, I did not ask about my diabetes. Maybe that was my fault, but given that I had asked about it for the surgery side of things, you would think, if it was an issue, the surgeon would have notified me.

He did not.

Prior to getting the cortisone, when sitting in the radiology waiting room, the nurse had me fill out a form that asked if I had diabetes. I checked yes, and added that I had type-1 diabetes and am on insulin pump therapy. (A similar form had been filled out at the surgeon’s office as well.)

In the exam room, I asked the nurse if I should remove my insulin pump. She said no.

She did not tell me the insulin would essentially be like water going through me following the injection.

When the physician came in and informed me of the procedure and the effect the cortisone may have on my joint, and the small chance of infection, he said not a word of my diabetes. He had every opportunity. I had to move my insulin pump out of the way. When the procedure was done, I got tangled in my insulin pump wiring and he helped untangle me.

No one said a word.

Thursday night my blood sugars had crept up to 13.7 mmol. after dinner. It was a burger dinner, and I thought maybe the ketchup or bun had an effect. By the morning, they were at 16.4 mmol. I thought my infusion was faulty, maybe there was an air bubble in the line, or the canula had bent. I switched it out. Two hours later, they were at 16.9 mmol.

I was beyond frustrated.

I do not do high blood sugars. I rarely have them. I do not know what to do.

I raged bolus. I increased my basal by 100%. I ran the insulin through the line, checking that it was actually going through. I questioned every dose I had administered. I re-reviewed everything I had eaten. I switched out the old insulin, for a new, in-the-fridge bottle.

None of it worked.

Nothing made sense.

By dinner, I was near tears. I had no idea what was going on with me.

I was scared.

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12:30 a.m. Friday: scared.

I was worried about ketones. I was worried about the incessant itching of my legs, so bad I drew blood. I was worried about my perfect hemoglobin A1c.

Big Ring asked if the cortisone could have had an effect.

Light bulb.

My fingers swiftly tapped over the Google keys and sure enough it was there.

Cortisone is a beast for diabetes.

Are you effing kidding me? Why did know one, not one of those doctors, inform me? Why?

I posted on Facebook asking all my T-1 peeps for advice on how to deal. So many suggestions. So many expressions of shock that I was not notified ahead of time.

It’s still not perfect.

My basal has been set at a continuous +200%, which is the maximum basal dose for Animas pumps, for days; if it could go higher, it would. I’ve been testing my blood sugars every two hours, and at nearly every test, I’m doing bolus corrections. Since getting the cortisone, I have dosed, both by pump and syringes, 235 total units. I go hours without eating. I fear food, and the effect it will have on my blood sugars. I’ve cracked the extreme highs for the most part, now sitting between 8.0 and 10.0 mmols, but that’s still with the crazy increase in insulin. I feel sick inside. I feel lethargic, winded. Even talking is an effort.

I don’t know when it will come down.

I don’t know when I will feel better.

But I do know, every step of the way, I was failed by the medical system.

That is not acceptable.

 

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The unthinkable

The unthinkable happened.

Seven years ago I had feared the worst. My first marathon, it was pouring rain. The marathon had yet to start, and I was in the porta-potty for the umpteenth time when I heard a loud, stomach-dropping splash in the grossness below. I thought it was my pump. It was not. Thank freaking every god in the world! It was one of my electrolytes bottles.

From that day forward I have been beyond careful. I am, unequivocally, the slowest person when it comes to washrooms. About a month ago I was in a long washroom line with a friend. We were the next up for the two available stalls. She told the girls behind us not to worry, she was quick. I gave them an apologetic look: I’m not.

You see, I don’t hide my insulin pump. It is almost always clipped to my belt loop, or when I’m not wearing a belt, the waistband of my pants or skirts or shorts. That means nearly every time I go to the washroom, I am not only pulling down my pants, but I’m also either unclipping my pump and holding on to it, or trying to ensure the weight of it doesn’t cause my belt to unloop and drop to the seriously unsanitary grounds below.

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The other day, I was not wearing a belt. I was wearing high-waisted jeans. My brain was in a post finals fog; I had only just finished minutes prior. I peed. I grabbed some toilet paper. I heard a clang.

The clip on the back of my insulin pump had wriggled free of my jeans. The infusion was in my stomach. It was the 43 inch tubing attached instead of the 23. Had it been the 23, it might have been saved. But no…

It was in the toilet bowl – the pee-filled toilet bowl.

Oh. My. Freaking. Ewwwww!

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Sure, I’ve heard that urine is “supposedly” sanitary. I learned from one of my lovely campers back when I was a camp counsellor in Maine years ago that pee is the cure for athlete’s foot. Still, that knowledge did not give me comfort. This thing is vital to my life; it should not be covered in pee.

And the worst thing, it actually proved waterproof. That means, no new pump for me.

Ewwww!

Sometimes…

Sometimes I don’t want to stop.

Sometimes I’m in the thick of a really great book, and I don’t want to stop.

Sometimes I’m in the middle of writing a killer sentence, and I don’t want to stop.

Sometimes I’m climbing down the Eiffel Tower in the twilight hours, and I don’t want to stop

Sometimes I’m in the depths of a needed sleep, and I don’t want to stop.

Sometimes I’m at 8.5 km of a strong 10 km run, and I don’t want to stop.

Sometimes I’m hurting with joy, giggling so hard with my boy, and I don’t want to stop.

I can see the words on the screen go blurry.

I can feel the letters in my book as they punch me in the face with every bounce across the page they make.

I can sense the happy flutters in my belly being strangled into sickening worry.

I try to control the shakes.

I try to ignore my heated cheeks.

I squint at the screen.

I cover one eye, hoping it will empower the other.

All for just a few more minutes.

A few minutes without Dear Diabetes.

But then, the full-body sweats come. Reality sets in. I cannot ignore Dear Diabetes. I cannot shove him off to the corner, not even for a few seconds. He is there. He will always be there. He won’t ever let me forget it.

The other day my blood sugars dropped to 3.0; I felt as though they were 2.0.

I didn’t want to stop.

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Dreaming for the glory of glasses

Alright eyes, we got this. Don’t let me down, eyes. This year is our year. Got it. Alright, let’s DO this.

That was the pep talk my lovely, grey eyes got yesterday morning all through breakfast, all through transit, all through the rainy walk, and every step up the five flights of stairs to my opthalmologist’s office.

Yesterday was my annual eye appointment.

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This appointment I dream of for 365 days, hoping, praying, begging for my eyes to finally falter in the presence of my opthalmologist.

I am obsessed with glasses, been so ever since one of my elementary school besties showed up to class in an oversized pair of pink specs. I loved them! I had to have them!

When I was diagnosed with Dear Diabetes shortly after and told my diabetic eyes could be a thing of concern, I swear to you that was one of the happiest days of my life. My parents were near tears and I’m practically jumping for joy. (I was nine, what can I say, glass half full girl!)

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Friends know if they wear glasses, I’ll be trying them. I mean seriously, how could this face NOT be granted the glory of glasses???

But noooooo, year after year, blinding appointment after blinding appointment, they keep regaling the perfection of my eyes, exclaiming they’re getting better with age, no diabetic spots, and that once, majorly noticeable wandering eye, it’s majorly dissipated.

They wait for me to smile, but instead get a grimace.

I. Want. Glasses.

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These eyes NEED glasses!

So yesterday, I’m sitting in the office noticing every seat filled with someone in glasses. Could this be my year, I thought. Surely, everyone in glasses is a sign, I thought. I am getting older, after all. Eyes fail with age, right? Right???

My eyes are dilated. The room starts to blur. One word fills my head over and over: Please. Please. Please. Please. Pleeeeeeeeeeease.

I’m in the office. I see an information placard on age-related macular degeneration. Symptoms include yellow-white deposits that mess with photoreceptors causing impaired vision.

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Hmm…

I’ve been experiencing major eye irritation for months. Lots of thin eye goop that causes a burning sensation. I thought it was the circulating dust, or allergies, but maybe it’s AMD.

Squinting my eyes, I put my face right close to the sign, practically nose touching it, and read further.

Oh crud.

This is NOT good.

Abnormal blood vessels growing in my macula!

Leaking blood and other fluids!

Complete vision loss!

Oh crud! Oh crud! Oh crud!

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Found this pic on How the Light Gets In blog. The whole post had me giggling…I could totally relate!

I want glasses. I don’t want diseased eyes.

My specialist walks in, sticks a blinding light through my dead eyes. Looking good, she says.

Erm, I stutter.

Yes??? she waits.

Erm, you don’t see leaking blood?

Noooo??? she queries.

I start talking a mile a minute, telling her about the burning sensation in my eyes, how they get real itchy, and painful, how I’m sticking my fingers in there trying to get what’s causing the pain out practically every minute, and that I think it might be age-related macular degeneration, and that my eyes are gonna fall out, all the while my stomach fluttering with opposing excitement and fear. Hoorah to glasses. Eek to dead eyes.

She pauses. I swear to stop from bursting out laughing. (Note: she knows my great desire for glasses). You have dry eyes, she said. That’s all. They’re not dying. They’re atypical diabetic eyes. She hands me a sample of gel drops.

No glasses for you!

Once again spurned by damn perfect eyesight.

Sigh.

Home is the Mountains

I didn’t want to call him.

Big Ring was expecting it; I know he was. He didn’t say he was, but the implication was there. This is the way you need to go,” he said, his eyes boring into mine. These are the roads you want to be on,” he emphasized, sloooowly. “Do you know where you’re going? Do you know where you’re going to turn around? Do you know your landmarks,” he asked, the volume of his voice increasing with every new question. And finally, “I’ll be around for an hour or so if you need me,” he called out as I was shutting the door behind me.

Big Ring isn’t usually this over-protective. I have a history of getting lost; no matter how detailed the directions, 98 per cent of the time, I somehow get completely twisted around on the road, and in the mind. I’ve done it countless times both driving and running, so much so it’s a given I’ll be calling him to help unlose me. But this time I wasn’t driving or walking, I was cycling. It was to be my first solo ride to the city, and I don’t know why I wanted to go against my nature, but I was determined to not get lost, to not need outside assistance, to not call on Big Ring.

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Holly GoQuickly: It’s just you and me baby!

Years ago, when I first started riding again, I was riding solo all the time, but that was when I was still living in the valley, where I grew up; if I got lost there, it didn’t take much brainpower to figure out how to reroute myself back to an area I was familiar with.

City cycling is a whole other can of worms.

In the city, I’ve only ever ridden with Big Ring and a friend of ours, never alone. And I’ve only ridden to the city a handful of times; the other times, I’d drive and meet up with Big Ring on the bike before starting. It never once crossed my mind to go it alone. I ran alone in the city all the time, but cycling, that was a Big Ring and I thing to do.

But then we had Little Ring…

Riding together was becoming harder to achieve.

And then I couldn’t run….

I needed to learn to go it my own.

And so, I waved a worrying Big Ring goodbye and set out on my solo adventure. And at first, it was going well. I was following the B.C. Parkway, which essentially no one (except for maybe me) can get lost on as it follows the Skytrain the entire way into the city. As long as I could see the Skytrain tracks above me or to the right, I was good.

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Central Park: Wahoo! Made it to Burnaby without getting lost!!!

I veered off at Central Park, away from the Skytrain line, and was to follow the Ridgeway path into the city; as long as I saw the green signs that said Ridgeway, I was good. There was one, mini hiccup where the sign was posted just past the street I was to turn on, so I kept going straight thinking I was to turn on the next street, only to realize seconds later I should have already turned, and then when I turned around, I turned left, which I quickly realized I should have turned right. Oops. No biggie.

I was only planning on a two-hour ride as we were heading out of town the next day and I had some packing to do. I thought 20 km out would be a good place to turn around, but when I saw a turnaround road that Big Ring had mentioned, I was only at 18 km, so I kept going figuring I could hook up with the next turnaround road at Heather.

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At this point, I was feeling pretty proud of myself.

Minutes in to the turn, something didn’t feel right. Big Ring and I had ridden on Heather coming out of the city the other day, but we were going the opposite way that I was currently going. Hmm… I kept going, I kept following the little green signs, because surely the green signs would guide me in the right direction. Nope. A few more turns and a couple more kilometres and I knew something was most definitely not right.

Frick.

Don’t call him. Don’t call him. Don’t call him.

A commuter cyclist headed towards me. Pointing directly in front of me, I asked him if this was the way to the city. There was a look of laughter in his eyes, or was it pity? Nope, that’s the way to Richmond, he said, and then pointed behind me saying that was the way to the city. Neither of which were the direction I needed to go.

Soooo, which way to New Westminster? Which way to home?

Home is to the mountains, he said. North, he said. Go north. Go to the mountains.

Phew, no phone call to Big Ring!!!

I got back on the route I came in on figuring I best not be too adventurous in trying new routes given my two hours had already passed and I needed to get my sorely padded butt home. Things somewhat fell off the rails when my blood sugars went drastically low. I try to test every hour on the bike, but getting lost distracted me; wanting to get home lickety split distracted me; and the diabetes was forgotten. Had I kept to that testing regime, I likely would have caught the low before it dipped below 3.0. Argh..

Waited out the low, found the B.C. Parkway, and off I went.

I came to a crossroad. The little green sign told me to go straight, but the path off to my left looked exactly like the path we’d ridden a few rides earlier, and given the so-called trusty green sign had already gotten me into an earlier pickle, I went with my memory.

Big mistake.

Oh bloody fricken hell, why do I not follow signs. Yes, it was the same path we’d ridden, and good on me for recognizing it, but I failed to recognize the turn I was to take to get back home, and suddenly here I was about to merge on to a crazy assed busy street. What the freaking hell? I had nothing left in me. My butt was sore. My head felt like a volcano had erupted. I was hungry. I was tired. I just wanted to be home.

And the phone came out. His number was punched in. Big Ring was called.

After all, it wouldn’t be a proper PoP adventure without getting lost at least once, right!

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Not even the chicken scratch directions on my arm helped.

RIDE-DIABETES-RIDE:
8:20 a.m. BG pre-fuel: 6.9 – PB&J sandwich (39g)
9 a.m. BG pre-ride: 7.8
Temp. basal: -70%
Time: 2:53:29
Distance: 44.86 km
Average speed: 15.5 km/h 😦
Ride BG: @60 min. 4.1 (applesauce + temp. basal -100%) @130 min. 3.1 (dried apricots) @200 min. 8.9
2:30 p.m. BG post-ride: 10.4
Temp. basal: +70% 2 hours

Cycling and Diabetes: Third Time Lucky

Third Time Lucky.

It took three rides on the bike before I managed near blood sugar perfection.

All the rides began around the same time, a few hours after breakfast, but varied in distance and length. The first ride back, I was chasing lows the entire time, even before we began, my blood sugars were dropping. Ugh.

About 30 minutes before the ride, I inhaled half a peanut butter and jam sandwich on whole grain bread, around 25g carbs, no insulin. My blood sugars were 7.6 before the sandwich, and 20 minutes later were down to 6.1. I dropped my continuous basal insulin down 70 per cent. An hour into the ride, my blood sugars were at 4.5. I ate a savoury salted sweet potato Clif gel, which was all sorts of disgusting, had 2 dried apricots, and turned my basal off completely. At lunch, an hour later, they were 4.2. I had a bowl of smoked salmon soup and a hunk of foccasia bread, no insulin. An hour and a half later, they were 5.1 – more dried apricots. The ride ended at 6.4 to which I increased my basal by 70 per cent over 2 hours, in the hopes of warding off post-ride highs, but instead resulted in a blood sugar crash an hour later.

Well that was a fail.

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Pterodactyl’s got to get his pre-flight PB&J fuel on too!

Next ride two days later, I upped the sandwich intake and had a full-sized peanut butter and jam sandwich, approximately 42g carbs, no insulin. My pre-sandwich blood sugars were 6.4, and post-sandwich were 10.1. I dropped my basal 70 per cent. One hour in things looked promising; my blood sugars were holding at 6.7. But this is an iffy area for me. If I kept riding without eating, they could continue to drop. Or if I ate without taking insulin, they could surge up. Or if I ate and took insulin, they could bottom out. What to do? What to do? What to do? I opted for a packet of apple sauce, no insulin. One hour later, they were up to 9.7, and by the time the ride was done they were at 12.1. Argh.

Well that was a fail.

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This was much tastier than that salted sweet potato blech!

The next ride, I didn’t do too much different for the pre-ride prep. I ate a full sandwich an hour before the ride, no insulin. The pre-sandwich blood sugars were 6.4 and the post sandwich were 10.7. I dropped my basal down 50 per cent. One hour in, my blood sugars were 6.3. I had half of a cashew-date-ohmygawdthisissodisgusting bar. An hour later, they were 6.1 to which I plugged my nose and swallowed the other half of that bar. By ride’s end, they were 5.9. I increased my basal by 50 per cent over the next two hours. No lows. No highs.

Oh happy girl!!!

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But was it fourth time lucky? Only time will tell…

Medtronic Global Heroes Part 2: Science!!!

About 15 years ago I met a couple of gals, who I kid you not spent an entire summer trying to convince me that science was the coolest thing on the planet. I was a hard sell; after a lack lustre experience with it in high school, and an eye for the words, I never imagined science to be anything more than something I had to do. (Little did I know then that it would turn into my life journey.) Had those gals had the Medtronic Headquarters at their fingertips, they may have had a bit more success of shooting science love into my heart!

On day two of being a Global Hero, my new besties and I toured the Medtronic facility. Holy freaking hell!!! This place was like serious nerdville for us diabetics (and all the other technology enhanced peeps as well). We got to see medical devices in the making; check out the behind-the-scene intricacies of a study that is working to make infusion insertion less painful on us wee pin cushions; and talk to the very scientists whose brains are working every day at making our lives better to live.

Medtronic headquarter.

The Medtronic logo: sick to healthy.

And that’s where Tom comes in. This man, wow! I don’t think I will ever forget his voice; the light in his eyes; the passion in his words. For years, pretty much since I got the pump, I have been lamenting its size. It is the thickness of a ‘90s style pager, and the size of a deck of cards. That is TOO big. When I wear it on my belt, my shirts ride up all the time because of it. Tight-fitting jeans are a challenge because of it. And dresses, I look like a bloody hunchback when wearing a cardigan because, unless I want to sport the look of square boobs, it ain’t fitting in my bra! So naturally, my question to Tom was:

“Are they ever going to get smaller?”

Before I could speak another word, before I could tell him my issues, he looked me straight in the eyes and the words just shot out of his mouth faster than a cannonball, arms waving every which way. He fully admitted the technology wasn’t good enough. He wants it smaller, thinner – the thickness of an iPhone. You’re not satisfied, he said, I’m not satisfied!

Sure, I could have been sold a bill of goods, but if you’d seen those eyes, I think you’d agree, this man is going to do everything he can to get insulin pumps to the point where I will be satisfied, where the 100s of 1000s of other insulin pump users will be satisfied. I’m not gonna lie, I kinda, totally fell in love with this man!

Insulin pump technology: "Not good enough!"

Insulin pump technology: “Not good enough!”

Walking through headquarters, Big Ring kept pontificating the benefits for the employees – they had to have had a fantastic onsite daycare; they must have a state-of-the-art gym; a basketball court likely… maybe even a napping room! Not only the passion of the employees, but the grounds – it was like a university campus in of itself. But me, I wasn’t thinking of any of that. As soon as I saw the electron microscopes in action (which I had only just discovered in my microbiology text the week prior) I was in serious lala land – coolest things EVER!!!

My girlfriends of 15 years ago would be so proud – Science!!!

Ahh, but the tour wasn’t all sunshine and rainbows. The moment I walked through those doors, I felt somewhat like a Scooby Doo intruder about to be unmasked. You see, I was wearing a super cute dress, and as mentioned the pump doesn’t hide well, at all, in dresses. Normally that’s not an issue; I’ve used this sucker as a fashion accessory for six years now. But the thing is, my pump, ahem, isn’t a Medtronic Pump!!!

INTRUDER ALERT! INTRUDER ALERT!

Okay, so it’s not like it was a secret, Medtronic knew my pump wasn’t theirs. They don’t discriminate against other companies when selecting Global Heroes. But still, I was touring the Medtronic facility, I was meeting the Medtronic scientists and engineers, and would be a handshake distance from one of the top big wigs of the whole company! I could have at least disguised my pump as a Medtronic one. That is all.

Stephen Oesterle, Senior VP for Medicine and Technology.

Stephen Oesterle, Senior VP for Medicine and Technology.

Leaving Medtronic, my head was spinning with information and details and things I wanted to do, things I needed to do. But it was a precious little boy’s face who filled the majority of my brain capacity. Lightening Bolt, my four year old nephew who was diagnosed in June with type-1 – he is going to be the beneficiary of Tom’s, and all the other Medtronic employees, passion! Thank you.

The future of T-1.

The future of T-1.