Saturday, October 24, 2015

A Rendevous With the Artificial Pancreas

Last weekend, my dreams came true. Well, kind of.It was a joyous thing, to get off from class and coast off into parts unknown, the weekend entirely free from school and kid and spouse and life and blahdeblah...a kind of weekend getaway, as it were. I'd gotten a random "hey, we think you could be a good fit for this study" email from UVA several weeks prior, and after some serious analyzing of my schedule determined I could do it Friday Oct 16-Sunday October 18. Since UVA is a nice little 3-5 hour drive away, (depending on the Beltway traffic) timing was absolutely everything. I have certain days that absolutely do not work (Tuesday, Thursday, and Friday) so I didn't think initially I'd be able to do it. I was able to get my LabCorp screening bloodwork done on Monday of that week,(remotely-since LabCorp is a national chain)but I still had to come in to meet with the study physician and get an EKG. Wasn't too happy about that, but we had an "off" Thursday (which basically only happens twice this semester) so I used that day to go down and back. Because of traffic, it took 5.5 hours to get down there and 6 to get back. (I'm not going to lie, that sucked, but one of the RN's there took me out to lunch because she felt sorry for me that I had to travel all that way. It really should have only taken 3 hours, in a non-traffic-less world but good luck with that one).

(Virginia is for people who love the AP.)
Anyway, everything was looking good with my bloodwork and EKG so the timing was on for Friday afternoon at 4 pm. I was hoping to sneak out of class early, but opportunity did not present itself (they've got this system where at the beginning of skills lab, they take attendance and at the end of skills lab, you have to turn in a form) without getting Critical Units, which is how you fail the program. Nah. (I'd just have to get there slightly late) I'd made sure I was ready to hit the road the instant it let out.(snacks, drinks, address in GPS, bladder empty) It did let out, and in two minutes I was in my SUV and on the road, feeling that joyous October breeze as I sped down 495 at 70 mph. 95, 495, 66, the miles sped by and I was making good time. On 29S there were some major road snafus but I still got to Charlottesville around 4 pm. I called the coordinator to leave a message, because I was having difficulty locating the "research house" (drove by it 3x before I got the idea that said "footpath" was actually a road, and I needed to drive up that road.) Parked behind the house, drug in my bag and backpack and announced my presence. The coordinator was just calling me, because by that point I was about 30 minutes late.(I would have been much later if the traffic hadn't been so good)

(The research house. It dates back to 1800,as part of an old plantation. Miraculously,it was not razed during Sheridan's Civil War burnings of 1863-4(?). It is quite picturesque,and cozy, if you don't count the fact that the baseboards creak at night and when you are the sole research participant it gets a little creepy in the dead of night. Yes, I always had a nurse and tech with me and University Police was a few minutes away but I couldn't help thinking worst thoughts in the dead of night.)

The first order of business was to prove a state of non-pregnancy, so a urine collection cup was unceremoniously handed to me for a stat dipstick. That was negative (like it was going to be otherwise between the lab order and the urine collection,(4 days) but I digress) so the study coordinator told me I was cleared to participate.

Took a deep breath, and they showed me around the house and I picked out a room to stay in. (there is one patient bedroom downstairs and multiple rooms upstairs) I was the only participant that weekend, because the other individual failed the bloodwork. (for this study, the a1c has to be 7.0-10.0. Courtesy of nursing school, and a 0.8 jump in my a1c since August, I was in that range).

The main hub of all the action was the dining room. About 4-6 people were hanging out in there, waiting for me, to get things started. I put on the study Dexcom transmitter and began the 2 hour warm up period. The first nurse then introduced me to the study glucometer..and had me check a blood sugar.

At that point, it was about 5 pm. I wasn't allowed to eat until I entered bgs into the Study Dexcom,and until the study doctor had placed the study pump on me. So I wandered into the living room(just off the dining room) and watched tv(they had multiple subscription services, but I only have Hulu Plus so the data analyst helped me set that up) and I just lay on the couch and chilled till about 6:30, when my G5 (phone) started telling me that I was trending down into the lower 70's. So I went back to the dining room, they checked me (83), and fed me two glucose tabs. 30 minutes later..checked again, 95. Fed two more glucose tabs. Calibrated study Dexcom. One of the study physicians had arrived (he is the medical director), and he set up the study pump (a Tslim) and synced the pump and cgm with the Artificial Pancreas. (run off an android phone) He put in the infusion set,(in my abdomen) because it was a straight metal needle and I'm not really comfortable with those sets.

This is what my abdomen looked like at that point.

(lovely, nu?) Normally, I don't put sensors or sets in my abdomen because of scar tissue..but they were insistent. My G5 transmitter was on my outer thigh,well out of the way of all this get up.)

I then removed my old pump so I wouldn't be getting 2x the amount of insulin needed, and they gave me the official Fanny Pack of these Artificial Pancreas games.

It was quite roomy, which was good because I had to keep the Android phone, study cgm, and insulin pump in there at all times. Inevitably my personal phone and glasses also lived in there because I still needed to be able to view my cgm data,(the study physician and multiple people had told me this was fine) since the study cgm was blinded,and not doing me a whole lot of good with the personal diabetes management.

Upon further inspection of the pump,it was revealed to me that it was a prototype punp and only had those two screens. And the study cgm was a special prototype as well, the data was blinded from my view. It was a lovely "pumpkin spice" fall color..not your regular blue/black/pink receiver.

It was amazing, holding the AP phone in my hand.(much like holding a newborn for the first time) I got this rush of "Hello, future!" and maybe even a little teary-eyed as I cradled that piece of technology in my hand for the very first time. The study doctor repeatedly told me how very appreciative they were of me (etc.)and not that it was needed, because I would have jumped at the chance regardless but it was nice to hear. (this particular trial arm had just been approved so I was #1 and a great deal of protocol-reviewing went on) On the table, there was a document for the protocol of blood sugars/ketones/seizures/what have you that had every possible scenario. Under 80 and over 300 there were much more in-depth,involved checking/treatment. Any seizure, nausea/vomitting, blood level of ketones on HIGH or two blood sugars under 50 put you out of the trial. The side table was stocked with 4 glucagon kits, testing stuff, Dexcom stuff, 8 glucose liquids, 4 large jars of glucose tabs and other random diabetes supplies.(I brought my own insulin)

 (Ready for anything!!!)
It was then time for supper- a microwave dinner of some chicken/pasta type thing and a couple strawberries. I guessed the carb amount, and entered it into the Artificial Pancreas screen along with my blood sugar. The AP gave me a suggestion (based on my entered insulin: carb ratio) and I confirmed that suggestion. I ate dinner, while everyone stared at me.(or rather, talked. Talked a lot.) The study doctor left, the tech guru left, the data analyst left, the other RN left, the study coordinator left, and the clinical coordinator left...leaving the overnight RN and the monitoring technician. (my cgm data went to the "remote monitoring" computer that they have (aka laptop), so that they could see my data whatever I was doing.) I was very tired so I went to bed, before the recommended 11 pm time. At 11:20, the RN woke me up to check a blood sugar because remote monitoring was showing me over 300.(which is their "confirm with blood sugar and correct" point.) Since this is the control admission, I was the one inputting the data and determining the dose to take. After that, the signal between the cgm and the AP went off the grid so the tech and the nurse were both trying to figure it out (involving a call to the study doctor to let her know my blood sugar, since it was 300, and actions taken.) Blood ketones were checked again(2nd time) and it was 0.2. I entered everything into the pump, took the corrective dose, and eventually fell asleep. 

(Breakfast. Some omelette thing,2 strawberries,and my Diet Coke Zero.)

That dose worked, and by morning I was around 150. I had to eat breakfast between 8-9 am (protocol), so I wandered out to the dining room to check a blood sugar, guess the amount of carbs in the breakfast, and bolus through the AP. Most everyone from the night before had shown up again so I figured this was the core data analyzing team. (names were not sticking though. Ever meet 10 new people in 12 hours?)
Exercise was scheduled for 10:30 am, so there were a lot of things that had to take place before then. Two new RN's showed up and the night RN left. The study MD talked to me about the politics of research studies,the FDA, and of the many "agreements" that had to take place between various companies to make said technology shareable between pumps/cgm systems. Another research study (Medtronic) was going on, and had essentially taken up their regulars (wine and dine baby, I confess to getting a little jealous when I heard that Medtronic is paying $1100 for their research study AND PUTTING THEM UP IN A SWANKY HOTEL AND GOING TO NICE RESTAURUNTS), which is why they are calling the out of town people (aka me) because you can't be in two research studies at once.(I'm the back up plan.) Don't get me wrong, any AP research study is better then none but eating crappy microwave dinners and being reimbursed slightly more then the cost of your gas pales in comparison to the above. Regarding the food, apparently the chef was on vacation that weekend but the microwave dinners just kept getting worse. So much so, that by Sunday afternoon I just wanted to leave and never eat food again. The data analyst (also a type 1, who had been involved in the Medtronic AP studies) told me to get involved in the Medtronic studies..because they are that swanky. (That's going to be my life goal, when I exit this one.) Most of the people there were either RN's, going to RN school, or type 1's themselves. (there were two type 1's) So even though there were no other patients there that weekend, we had some pretty great
"exchanging of war stories" (which is wont to happen when you get PWD together.) It was a very friendly, jovial environment. (Everyone is on a first
name basis, even the MD's. Patients are referred to by their first names, because of HIPPAA, and anything you choose to disclose to other patients is up to you but you do sign a waiver stating you accept any loss of privacy (aka there's lots of loss of privacy when you've got people swarming over you day and night.) Killed time for a couple of hours,and I then changed to exercise clothes and they put a heart rate monitor under my ribcage which effectively cut off all meaningful breathing.(too tight) A cab (van) showed up and we then all got into it and went to the UVA gym.

(the bag o' Diabetes Crap that RN #2 carried out)
At this point, another MD (I know this MD from past studies, I met her in 2003) showed up and we went into one of the gym's rooms (with a lot of exercise bikes) The heart monitor stopped working, and no amount of tweaking things was getting it working again. The sole other occupant of that room stared at me and my entourage. (probably thinking, what the what?) Checked a blood sugar, decided to eat a snack bar/drink water/and not bolus.

I confirmed with the MD that I wasn't bolusing for the snack I was going to eat.

Got on the bike. Pedaled for 15 minutes: goal heart rate 140. Heart Monitor and Fitbit went in and out of not working, so one of the two RN's that was monitoring the bike situation placed her fingers on my wrist to check it manually. When 15 minutes were done, they helped me off the bike and onto a chair. Checked my blood sugar. Gave me water. Let me rest for 5 minutes. Checked my blood sugar again. Got back on the bike-pedaled for 15 more minutes (goal heart rate 140). Helped me off the bike, blood sugar, hydrate, five minutes, blood sugar. Got back on the bike-15 more minutes, goal heart rate 140. Back off. Blood sugar. Hydrate. Rest.

Blood Sugar Progression:

7:16 AM: 240 (correction given)
8:15 AM: 183 (breakfast bolus given, based on suggested dose)
11:14 AM: 176 (start of exercise. Ate a 15 carb snack bar.)
11:32 AM: 160
11:37 AM: 166
11:54 AM: 153
11:59 AM: 158
12:15 AM: 143 (end of exercise)
12:43 AM: 166. (Lunch blood sugar)

By that point, I was more then done and really tired. (I'm not a spring chicken anymore) I could see why they do an EKG before starting the study, because heart rates of 140 are no joke if you aren't used to them. The seat was also exceedingly uncomfortable, so between the seat and the creaking of my knees I felt like I was 90 years old. Everyone was pretty supportive though (even if they didn't have to reach a HR like that when they pedaled on the bikes),laughing and keeping me otherwise amused. (except for the whole not breathing thing) It felt really great to take that horrible constricting HR monitor off. Boarded back up in the cab, back to the research house.

Lunch was extremily horrible. It was a giant burrito, and it was extremely dry and tough. I literally had to force it down my throat but at some point I just couldn't do it anymore and told them that. (No butter or sauces were permitted, because that would alter the caloric count) You are supposed to finish all your food but it just wasn't happening. I told them that it was going to come back up if I did that, and the RN disposed of it in the trash can.

By supper, my appetite still hadn't returned. I forget what was served but it was along the lines of pasta/chicken/soooo dry stuff and I put off eating till the last possible time that protocol allowed, because my appetite had officially died. The RN tried to make it appetizing(sprinkling the Parmesan cheese on it, putting it on an attractive dinner plate) and that helped slightly but it was a struggle. Post lunch, at 3:30 PM I was 254, I requested a correction and my blood sugar was 293 at 4:10 pm. Eventually, it went down to 155 at 6:42 pm. I "estimated" the supper carbs extremily high, because I was getting sick and tired of the highs and reaching the "I want to rage bolus this down" stage. That seemed not to matter one iota, blood sugars at 9:37 pm (185) and 11:01 pm(183). Corrected for the 183, which the night nurse wasn't too thrilled about because I supposedly still had insulin on board but I did it anyway. The night nurse was also a Labor and Delivery nursing instructor and she asked me about how pregnancy had gone. It felt truly weird to be complimented on an "excellent job" for having a normal weight baby,when so much of that just felt like dumb luck. Oh,I did work hard(12-15x a day checks were the norm) but it still felt like luck,that there were no serious complications. Sure she "got it" on some level but I'm not sure I deserve to be complimented for luck. It was slightly weird,because it puts you on a pedestal you don't belong on.

 At 4:56 am, I woke up feeling high as a kite(G5 had me at over 300) so I wandered out to the dining room and requested a check. This didn't suit too well with the technician because remote monitoring was showing me at under 300, and they thought I was supposed to wait till I reached over 300. So they had to call one of the study doctors, who told them to let me correct. I blood tested (275), took the suggested dose of insulin through the AP, and by 8:25 AM was 163. I didn't try to go back to sleep because it was pointless, I was good and high and awake. Breakfast. Protocal that day said that exercise was to be about 1 hour after breakfast, but because the cab company ran late it was 10:08 before we all got to the gym and began the exercise.

(heart rate readout device)

(Exercise bikes)

10:08 AM: 247
10:25 AM: 216
10:46 AM: 193
11:07 AM: 174

This time, they just checked once after each of the 15 minute exercise bouts.(and obviously, I did not eat a snack before hand, because I was high) The heart rate monitor worked just fine and I could see my HR as I pedaled.

Dance party! (these are the best people. seriously. they experienced my pain right along with me. And the music helped to get my HR up there.)
Back to the research house, where my pre-lunch(12:29 pm) checked in at 193. Post-lunch: 236. (3:59 pm) At that point, it was officially the end of the study and the tech person gave me instructions about setting up my account on Diasend. (to send pump, blinded cgm, and meter) I am also supposed to sync the Fitbit to the app once a week, to send that data. Another study doctor showed up and removed the pump, and I put my old pump back on. Gave me a packet with pertinent log-in info, and telephone numbers to everyone. The study coordinator then gave me cgm sensors, the study meter, 300 strips,3 cables(to download data), the Fitbit, and the blinded CGM receiver. Loaded me up on snacks for the road and I then drove home. In approximently one month, I return for the closed loop admission-and will see how well the AP controls my bg. It's going to be slightly nerve wracking for me because I'm trusting a machine, but at least the protocol is in place to be watching me 24/7 to make sure I don't go to far in either direction.

Team Artificial Pancreas,forever.( I will probably save this can forever..I find it interesting that all their Coke Zero cans said this.) Until we meet again.

Friday, September 18, 2015

A New Diagnosis

On Monday, I awoke,took my child to the baby sitter(as schools were closed for the Jewish New Year) and came back to a voicemail on my phone.

"call us immeadietly." (Signed, Genetics Dept.of University)

I called. I knew in my gut they were going to tell ME I was the reason for my child's genetic condition because that is how it is,my husband is the largely healthy one.

"we got the results back...


And you also have the 17Q12 deletion."

Well, joy. And does this mean I have MODY as well?"

"yes,but we need to communicate with 
Dr.S (adult geneticist-it was J's genetic counselor who called me) to formulate a plan of action that will also involve your endocrinologist."

I didn't cry this time,because frankly it makes perfect sense that the weird health stuff that has happened all my life beginning at babyhood when no one could figure out why my head was so large and I only wanted to sleep,not eat.(many tests later) was in fact related to a genetic condition. Or why my spine is not straight,or the tinnitus that began when I was 12 years old. Or why I've gotten chicken pox, Shingles,and Lyme disease in my first 20 years of life. Or why the diabetes came on over 6 months and the magnesium issues as well.

New Diagnosis: 17q12 micro deletion. Magnesium issues from that. Not Bartters Syndrome. Probably not type 1, because it specifically encodes for MODY 
5 diabetes. Like,basically impossible to have type 1.

Basically the news feels like I'm a freak of nature,because this happens at the very basest of levels. I don't know if this effects lifespan (I'd like to think it doesn't but who knows) and the MODY 5 puts at risk for liver and kidney dysfunction. I guess the good news is that I have above average IQ, it hasn't effected that but can it? Also the chances of passing it on to offspring are 50/50.(hence the reason J has it,& it affects people different ways so that some people cannot live independently.) I'm already being monitored by a kidney doc,but there will be a whole new care plan with aspects of what I might be likely to get.(Different from J's plan,as they don't know what his level of functioning will be as for now he has none of the physical problems.) My Endo will also collaborate with the geneticist as it may be possible for me to take some oral medication with insulin,to lower the amount of insulin I take.

And that's where that's at. I'm still kind of stuck in the disbelief stage. (With all of this) And dealing with the knowledge that this was no random error that caused me to give it to my son.
Diabetes still sucks & these waters are uncharted.(read: mini identity crises if I no longer fit in the type 1 world)

Sunday, August 16, 2015

Wondering "if"

 My head knows it's impossible..but on days like today and yesterday,my heart whispers "what if? What if you weren't type 1? What if pills were a possibility? What if everything you ever thought you knew about diabetes control is just another option?"

I ate 200 carbs yesterday. 150 today. My sensitivity is through the roof.(Mostly that is because I was doing a grueling flea market prep,actual 7 hrs at flea market,& then carting the remainder home.) Hot weather,& exercise have serous effects on my bg. 14 units as a TDD is hardly a cure,but it is 10 fewer units then I'd normally need for such a day. It's not the first time I've needed much less insulin,I have these times when it's actually under 10 units. I think that if I tried something like Invokana,I'd be even more sensitive to insulin.(I'd consider that as a good thing..the more sensitive you are,the less you need,& the less you have to worry about extreme hypoglycemia.) As someone who had one such unpleasant event last month,and who barely avoided the ER I am a fan of the less IOB,the better. 6 units on board when you are as sensitive as I am is not a good scenario.(Never "double correct" for a 340. It was scary,as I couldn't eat enough to stop the drop.) I really want to discuss starting Invokana with my Endo.(Along with glucagon scenario plans. Mini Dosing in adults doesn't do enough. )

Bottom line is,I want my D to become more easily's not that I consider insulin to be evil. It isn't.(you need what you need) Low carb does that but I love my carbs,and would have no energy on such a diet. Yeah,I do eat low carb some meals but I balance it out with the others.
Bottom line is..your diabetes may vary. And you need to find the best option for you.

Wednesday, August 05, 2015

One Thousand Tomorrows

I use to think
That 1,000 tomorrows would make up
For 52 bad yesterday's.

Ah,hope springs young,& eternal
Years pass
A thousand tomorrows will soon be today
And turn into yesterdays.

Normal numbers don't save me
From the darkness of the place I'm in.
I don't see the light.
I don't see the hope.
I don't see the promise of tomorrow.
There is only today,& living the pain.
(And the further spiral of the numbers.)
Yesterday probably even wasn't that bad,because yesterday I was at least breathing.
And my yesterdays with diabetes now match those without.(16.5 + 16.5)

This also I know
That a bad today
Keeps you from feeling the promise of tomorrow
And that it doesn't have to be permanent thing.

(But like diabetes,depression just kind of sneaks up on you,smacks you on the head,and delivers a boatload of other difficulties to keep you in that place. And I'm tired,& probably my thyroid levels are completely whacko and I'm fully aware I need to go to my pcp and get back on something. I know. I'll get sorted out.)

One step at a time.
One today at a time.
Turning into tomorrows.

Thursday, July 16, 2015

FFL: Complicated

Ten years ago, I got on a plane and went to Florida to hang out with a bunch of diabetes people. I was getting to know (IRL) the people that had previously lived 
only in my computer.(aka the Children With Diabetes Chatrooms) There was no Adults With Diabetes support. I volunteered to be a chaperone at the Teen Dance,which amounted to me standing outside the door and making sure no parents snuck in.(That was how I met Joe S.)

2015. My ninth FFL. I am kind like the shy little sister that hangs around and that everyone kinda knows of,but not really knows,because I am a shy introvert and public speaking doesn't happen much. The thing about introverts,they have just as much insight into things as the extroverts but nobody gets to hear it much. I will say that I have become more outgoing but still most people don't remember that they "met me" the year before. (I also must be a sucky conversationalist.) The regional (2004)CWD conference in DC,the very first one I went to, I didn't say a word I was so shy.(I think I have improved from that.) 

2.5 weeks ago I had a laparoscopy,& spent 8 days recovering from that. On Tuesday,(the 7th) the hubby kid and I flew down to Florida, getting to the hotel about 2 pm. Spent some time at Hollywood Studios but by 8:30 pm we were all pretty tired & went back to the hotel to crash.

Wednesday was amazing..the one Masterlab session that I went to was like a "play" of diabetes,emotions,and how it related to our lives. And we read out loud what we had written. It was incredible and there wasn't a dry eye in the room. After that I had to go to a Focus Group with my friend(for Omnipod) which was a chance to tell them what they needed to incorporate,AND pick up some Disney Dollars for participation. The afternoon was spent crashing(nap.) And at 6 pm,the exhibit hall opened and a buffet was served. It's always mass pandemonium in the exhibit hall,but still fun.

On Thursday, after dropping J at childcare my friend and I did the Celiac screening,& then went to the retinal screenings. They had a lot of trouble with their equipment on me,& had to do everything about 20 times.(because of my fake lenses) And someone before us was receiving some very bad news so Dr. Ben had a lot to handle with that family(& making arrangements for treatment). It was a couple hours later,& we had moved into the last "consultation room," and the medical student was telling me she wanted Dr Ben to take a look at a couple of things and my brain was going straight to "I'm screwed" while trying not to have a panic attack waiting for Dr Ben. Dr Ben came over to the computer,went through the tests,& said he had to run one more something looked swollen.(come back in 20 minutes) I went and gulped down some lunch from the buffet and was back in 20 minutes.(hubby had picked up J,eaten lunch,& gone back to the room) Dr Ben took me back to the primary testing room,took several more photos,& then showed me the photograph of my left eye. Said photograph looked like an aerial photo of Mars..with one large black,crater looking area.

"You've had a bleed. Here is your macula,if the bleed is in your macula it can permantly affect your vision. It's not in your macula,comparatively speaking the bleed and the macula is like the distance from New York to Chicago. It's not an active bleed-you see the little yellow things around it? Those are exudates and it means that the body is trying to heal itself. It can heal itself in a few months. Better control will help."

"Is it purely diabetes related?"

"Yes,500's did this. 300's do not."

One 500 can do this..

(& I'm not perfect. I've had a few 500's in the past few months. But I've lowered my a1c by 0.8 in the past 1.5 months. I am getting where I want it to be.)

I don't believe what I am seeing,yet the evidence is there. I've had no eye issues,no hint of a problem between last years exam with my opthamogist and today.

"I didn't know it could happen that fast."

"Yes it does."

Tears take over at that point,and I ask for a hug before stumbling out the door to seek a bathroom to unload my grief in private. My first real complication,here to stay. I don't feel like doing much of anything that day,like the black crater on my eyeball just took over my heart as well. Things go on though.(with a banquet that night)

The next day,there's a session on complications that my friend literally drags me to,upon threat of everyone coming to the hotel room to bring the session to ME. That was what I needed to hear though. So many brave stories were shared,and though I'm not sure I really know how to convince myself it's not my fault it helped to hear that no matter how many complications we may get,it doesn't mean our lives were without purpose.(plus,we are managing an unrelentless disease 24/7/365) Remainder of the conference, I cried on a few more shoulders and had a few more heart to heart conversations and spent two days doing theme parks full throttle before going back on Monday.

Tuesday: surgery stitches out.

And Wednesday came. I was there,bright and early for my opthamologist appt. They moved pretty quickly,with the standard medical questionnaire, eye pressures, charts and drops and about ten minutes later getting to see the doc.(I had J with me as the babysitter is on vacation this week) My Optho took his standard 15 seconds per eye,everything is fine see you next year..

Wait a second. Stop everything.

"Are you sure? Because I had a screening at a diabetes conference,& they said there's a spot of something in my left eye."

"I don't see anything. Who did this "screening", anyway?" (The condescension in his voice was oozing from every pore.)

"Children with Diabetes conference and I think it was a NJ school of medicine with the eye screens?"

"What did they tell you?What kind of screening was it?"

"That its a bleed and it needs to be monitored and it should go away. And I should see my opthamologist for it."

He takes another look then,with mirrors and bright lights and look up/down/sideways. 

"Your retina looks fine. I am seeing a small bit of blood,a speck really. I think it is neovascularization. I think a retina specialist should take a look at it though."

"Is that NPDR?"

"Yes. Normal,really, for those who have diabetes. I don't know if this is diabetes because it looks very stable and usually it is in more then one area so I want them to take a look at it."

Impression: Oh great,it could be years old and you are just now catching it. Incompetant much?

"This "diabetes conference"...have you gone several years?"

"Yes." (I can see where this is going,he's now feeling insecure about missing this and is trying to figure out if I am second guessing his skills.)

"Well,we will see you next year. And by the way..tell me next time someone sees something in your eyes,hmmmm?" Side friendly pat on the shoulder.


Yep, I'm done with this guy. Arrogant condescending incompetent charmer. I may just see what retina guy has to say and either just go to him,or find a new Optho.

It's been an exhausting few weeks. I now have a whole lot of respect for Dr Ben and zero for my ex-opthamologist,I feel belittled,confused,and more then a little T-d off at what my Optho had to say. No respect for anyone else(who hello,caught your mistake you idiot) and no respect for the dr-patient relationship. He did manage to completely erase any residual "should I switch" doubts. I'm still processing the sadness from this diagnosis but it helps to have heard that NPDR is not a "done deal" toward blindness,the majority of T1's do get this.

Sunday, June 21, 2015

Surfing the Sugah Wave

The best part of Endo appointments is after they are over..and the next three weeks are squeaky clean,filled with promise and hope and resolve..a diabetes clean slate.

That day has come and gone for me.(almost a month into my current "journey.") In the meanwhile,all the promises I made (email CDE! Prebolus! Eat more green things! Do not stuff Twinkies into mouth at midnight and "forget" to bolus!) are a distant memory, I really suck at diabetes improv projects. But then I dropped a pump,& another threw 5 consecutive cartridge error alarms and had to be replaced and my blood sugars were a grand and unmitigated disaster and I needed a breath of fresh air so I dug out my Omnipod pdm,traded supplies for some pods,and gave it another go.

And these have largely been my blood sugars ever since. That's 24 hours where I might briefly go above the high line,versus a daily journey of 100-360 blood sugars. For the most part prebolusing isn't even necessary.(except breakfast) Every thing I do works. (Which is super weird) I think some of it might be 
from pod placement..using my arms because the other places have scar tissue from so much use and it's been good to have that fresh territory.

In the meantime,I had a repeat a1c done this week(diff doctor) and my a1c has dropped (!)0.6 points so it looks like it might be possible to make significant changes by next appointment.(in August)
I have enough pods to ride this wave to summers end and if I break the 7.0 barrier, I am going to talk to my Endo about another RX. I never thought I'd be doing this but right now,this is exactly what my body needs..a break from the rollar coaster. It's also helped immensely that I got the "Sugar Surfing"book and have tried to implement some of those suggestions.

I'm lovin' it. (Well,as much as that's possible.)

Friday, June 05, 2015

Project: Genetics

I've come to the conclusion that I have "Left-side-of-the-body-itis",having had to have had 2 cataract surgeries,1 L.arm ulnar nerve surgery,1 tonsillectomy, 1 C-section, 1 L.eye muscle surgery for double vision,& I'm not entirely sure where the pancreas really is in me but I'm guessing it's toward the left. Also 1 messed up Lumbar Disk affecting strength and motility on the Left Leg although that has much improved,& I'm now in matenence phase (chiropractic) for that. However,I now have a messed up ligament in my left shoulder and it hurts to do anything with it. I told my chiropractor today that I wanted to get it evaluated and what followed was an exam,an adjustment,& a torture device known as traction.(basically a head vice) I was supposed to stay in it for ten minutes(at 10 pressure) but after five I started dry heaving,getting dizzy,and having a pounding headache and no more of that could I stand. He asked me to do three sets of things to make sure I wasn't stroking out(it can happen when you are manipulating the carotid artery),which I wasn't,but it took about ten minutes to recover enough to go home. I then had a headache from heck for the next two hours and horrid nausea. And it didn't help my shoulder pain either. I think this is going to be a slow process,& a headachy/nausea/dizzy one at that as we try to get a pressure I can stand. He told me to roll up a towel to put under my head to help release the pressure,& a specific lifting technique to use. I might have a pinched neck disc as well,if things don't improve we will get an x-Ray. And bonus props for calling me later to make sure I was still alive. I like my chiropractor,the techniques really do help & he knows what he's doing. Would far rather go through this then spine surgery. I'm just wondering how many other left sided things can fail though.

In other news,my Endo does think I have MODY 5 but it will be awhile before I can get specifically tested for it...I am negative for 17Q12 chromosome haplotype deletion but that doesn't completely rule it out,& it's much more expensive and has to be tested through a genetics division.(next appt.: August 28) It is what it is,no rush.