Friday, January 28, 2011

How Diabetes Makes Me Feel (In Pictures)

I was on CafePress yesterday browsing their Diabetes awareness t-shirts and other products, and I have to say that I was quite amused by all of their designs.  Whether serious or humorous, they are all just so...true.  Some are strictly awareness-based, while only someone with diabetes could appreciate the wit in others.  They range from self-depreciating to downright angry, and manage to hit on everything in between.  In other words, they cover the wide array of emotions a person with diabetes has on a day-to-day basis regarding their disease and all it takes to manage it.
So, for today's post, I decided to chronicle my feelings about diabetes in CafePress designs.  It goes without saying that all of the images are from their website and are their intellectual property, so please respect that!

My D-Life in Pictures

When I was first diagnosed (August 23, 2010), I learned as much as I could about diabetes.  Then came American Diabetes Month in November, and it gave me the chance to participate directly in raising diabetes awareness through my blog:

I soon learned how often you encounter all of the myths and misconceptions surrounding diabetes while talking to people about your disease.  Some are simply curious, but others want to impress their "knowledge" (and miracle cures) upon you.  I learned to take these opportunities to educate people rather than being defensive.

However, sometimes it's hard not to be defensive, especially when you encounter the always-lurking "Diabetes Police"...These are the people who, upon finding out you have diabetes, make it their personal mission to watch everything you do and put into your mouth.  They question whether or not you should be doing/eating things, and it's never hard to read the judgment on their faces.  They're usually of the old-school way of thinking:  DIABETICS (because we're not just normal people to them) should never eat sugar or carbs, and that you have the disease simply because you ate too much sugar or didn't exercise enough.  White foods are all bad, and if you work hard enough, you can "cure" yourself of the disease...Because after all, their aunt/friend of a friend/preacher did.  Psh.  I don't even have to tell you what I feel about that.

There are days (usually when things are going well and my BG stays within my target range) that I feel like this:

Then, there are times when nothing I do seems to work and all of the effort I put into managing my diabetes is for nothing...When I think I'm doing everything right, and my BG numbers are still high, I feel like this:

Or, when I get completely overwhelmed at all I have to do to keep this disease from taking over my life, and at the fact that it's NEVER GOING AWAY, I can't help but feel that:

...And neither can I.

Then when I'm at my lowest, I realize that God doesn't give us anything we can't handle, and that He is always with us during all the struggles we have to go through.

Which gives me the courage to believe:

And remember what it is I'm doing all of this for...That one day, I'll be able to put a onsie on my healthy little baby that says:

When I think about my goals, and that the end result will definitely be worth all of this pain and effort, I feel better about this disease and am able to keep it in perspective.

And when things are in perspective, it's easier to have a sense of humor about your situation:

The chemical formula for glucose =)
And because a little humor never killed anybody:

Then, once you feel (kind of) okay about your disease, you can feel more confident in yourself:

Being able to use an insulin pump has given me an extra advantage over my disease.  I got started with it on Wednesday, and it's already made my D-life less complicated and a little easier to manage.  I'm still trying to think of a name for my pump, but right now I just call it my diabetes superhero.

And finally, insulin (whether from the pump or through injections) keeps me a live, literally.  But it isn't a cure.  It's a band-aid solution to a major operation kind of problem, and the number of people affected increases every day.  We need a cure!

And, just in case:

Diabetes isn't a fun disease to deal with, but it's better than the alternative...Complications only occur when the disease goes uncontrolled and unmanaged.  Knowledge is power, and the sooner you're diagnosed, the better!  With proper control and effort, you can live a long, happy life with diabetes.

Thursday, January 27, 2011

And Pump Makes Three...

I have some great news...Yesterday I not only ended up getting my pump in the mail, but I also got to go for pump training that same afternoon!  My CDE called yesterday morning and said she had the afternoon free if I wanted to come (keep in mind, she's two hours away), but I wasn't sure at that point if the UPS man was going to bring my packages before lunch, when we would have to leave.  I spent the whole morning watching out the window for him like a kid waiting for Santa on Christmas Eve, but he didn't show up.  I had written it off as a disappointment, but I decided to drive through town (which only takes a couple of minutes in a town of 2,500!) in a last-ditch effort to find him.  I drove past the barbeque place (where he eats fairly often), but no UPS man.  I was about to turn around and come back when I spotted him coming from the opposite direction, so I followed him to his stop and asked him for my packages.  I explained the situation, and he was happy to find them for me.  I should probably add that we've had the same UPS man for the 10 years we've lived here, so we know him pretty well...and I'm pretty sure he gets stalked fairly often. =)  So, off we went--my dad had an appointment up there that afternoon, so it worked out great.  He dropped me (and my two big boxes) off at my CDE's office and went on to his appointment.

Pump training went great.  We went over the basics (safety, pump functions & setup, etc.), and most of it was common sense stuff.  I was relieved when she told me we wouldn't be messing with the CGM until a couple of weeks from now, when I've had the chance to get used to using the pump first.  Many of you already know that was the part that I was most nervous about, so I have to admit I wasn't that disappointed to have to wait.  It will give me a chance to get used to inserting the infusion sets before I have to do the same with that big, honking needle!

Anyway, after going over all of the need-to-knows, she had me go ahead and insert my infusion set (the Quick-set) myself.  She walked me through the whole process, but I kind of jumped the gun on the needle removal part...She told me to grab the blue part to pull the needle out, so I did--before she could tell me to hold the infusion set down with my other hand in the process.  We were afraid that I may have pulled out the set by doing that, but it all appeared to be fine.  She told me to keep an eye on it and if it got red or my BG went up, it was probably sitting on my skin surface instead of beneath it like it should be.

We went and ate supper right after that, and I got to try out the bolus wizard for the first time...We would have actually practiced doing that in my CDE's office, but she said I was the only person who'd ever come in for pump training that had a BG within the target range during the visit--so no bolus/correction for me!  She just walked me through the steps instead.  Since we ate Mexican food, I decided to do a square wave bolus so that my insulin would spread out over a couple of hours to match the slower absorption of higher-fat food.  It was wonderful to not have to get up and go to the bathroom to give myself a shot, or worry about giving two shots for the square wave effect as I had to do before.  Not only that, but it's pretty awesome that you can watch it happen--I'd bolused 4.7u over two hours, and I was able to see it give the final 0.1u over the last couple of minutes.

We set three different basal rates: 0.7 for 12:00AM to 3:00AM; 0.85 for 3:00AM to 8:00AM, and 0.4 for 8:00AM to 12:00AM.  I knew that this setup would probably not be the right one for me, and I had this confirmed when I woke up at 6:00 this morning with a BG of 60.  I was stable from 12:00AM to 3:00AM, but that next increase was just too much for me.  I'm pretty sure it's because unlike most people, I don't experience the Dawn Phenomenon very often...My fasting  BGs are usually normal, below 100.  On the other hand, I have a feeling that the 0.4 basal rate for daytime won't be enough, because I tend to run highest in the evening after supper.  I guess we'll just have to see what happens!  I'm supposed to call my CDE today and let her know how it's going so we can make some changes if needed (which we will, obviously!).

All in all, it hasn't been a very big adjustment for me.  The hardest part thus far was having to figure out what to do with it at night, because I toss and turn a lot.  I ended up clipping it onto my pj bottoms and undies, just so it would stay in place better.  I tucked the tubing in there as well, and everything seemed to have stayed in its place overnight.  I'm planning on making some pump bands to go around my thigh for the nights that I wear gowns instead of regular pjs, and for when I'm wearing dresses or skirts.  I started to order some online, but for what I would have spent, I figured I might as well just buy some stretchy fabric and make my own since I know my way around the sewing machine pretty well!

Other than that, I'm just glad to have the opportunity to use such an amazing piece of technology.  It's already simplified my D-lfie, and I look forward to using it to help me achieve my goals.  Since my new 24/7 companion and I will be spending a lot of time together, I figure it's only appropriate to give it a name...I just haven't come up with one yet.  I'll keep you posted on that one, and suggestions are always welcome =)

Tuesday, January 25, 2011

Diabetes Blogging: The Good, The Amazing, and The Reality

Yesterday I posted about the anxiety I've been feeling in regards to using my Medtronic CGM once it comes in due to the horrific reports of blood and pain I came across in the diabetes web community. 

Exhibit A:
"The only thing about the Medtronic CGM that absolutely crushes my soul is that hollow spear you insert it with, the thing Medtronic calls a "needle". A needle is what is on the end of my Symlin pen or perhaps my infusion set. They should describe it accurately, like this:
'A large, hollow, very sharp nail that enters with the grace of an angry bee's stinger and provides an additional 5 to 10 seconds of throbbing, intense pain.'" 
--Jason, tudiabetes forum member
Exhibit B:
Another tudiabetes forum member suggested that Medtronic redesign their transmitter and sensors to not be so awkward and bulky, and to not have a needle "with its own zip code". 
And another poster compared it to being shot.  Yay.

But then I came across Too Sweet, a blog written by the mother of a beautiful little girl with Type 1 diabetes, and saw that she had good things to say about the MM CGM.  As far as the pain factor, her post "Well, at least she'll never know the difference." shows that it's just part of the countless uncomfortable (and many times painful) things we do to keep our diabetes under control.  After reading several of Amy's posts, I realized how lucky I am to have the luxury of dealing with this as an adult.  I can't imagine how difficult it must be to have to deal with diabetes in childhood, both for the child and the parent.  While I'm not looking forward to blasting that monster of a needle into my body, I now see that it's doable.  After all, if a brave little five-year-old girl can handle it, surely I can!

One thing I've learned in the past five months since my diagnosis is that the diabetes community is wonderful.  They stick together, offer encouragement and support, help each other through the inevitable storms of this disease, and praise one another's successes.  It reminds me of the definition of love in 1 Corinthians 13, 4-8:
 4 Love is patient, love is kind. It does not envy, it does not boast, it is not proud. 5 It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. 6 Love does not delight in evil but rejoices with the truth. 7 It always protects, always trusts, always hopes, always perseveres.
 8 Love never fails.
The diabetes community is a loving one if there ever was one.  It's a club that no one wants to belong to (I don't know about you, but I sure didn't sign up for this!), but once you find yourself a member, you see that it's one that won't let you down.  Diabetes bloggers provide an endless source of information for newbies like me, and are truly an inspiration for all of us.  They are proof that this disease is a manageable (albeit annoying, uncomfortable, and inconvenient) one, and that it is possible to live well with it.  Anytime I have a question related to diabetes, whether it's related to medical advice or everyday living with the disease, I know that I can find what I need online.  Yes, at times it's scary, but sometimes reality is too.  At the end of the day, all we can do is our best and hope that it's enough.
So, in conclusion, I want to thank the amazing d-bloggers I've looked to for information, support, and endless wisdom over the past five months, whether they know it or not.  Their knowledge, kindness, and sense of humor have gotten me through many days of doubt and feeling alone with this disease, and for that I am incredibly grateful.
--Kerri @ sixuntilme
--Lyrehca @ Managing the Sweetness Within
--Lisa @ Lisa From Scratch
--Amy (& Emma) @ Too Sweet
--Everyone on tudiabetes

Monday, January 24, 2011

Pumpin' It Up...And the Horror Stories of Using a CGM

This weekend, my husband and I had our one year wedding anniversary (yay!), and I got a coat of paint on my bathroom walls (which I've been meaning to do forever).  In D-news, I thought I was going to make it through the weekend without a reading over 200, but no such luck.  When I checked before bed last night, I was at 212...Bummer.  I'm sure it had something to do with the fact that I threw my usual dietary caution to the wind in celebration of our anniversary--I had chocolate-filled croissants and fruit for breakfast, a Dairy Queen grilled chicken sandwich & tater tots for lunch, popcorn w/chocolate-covered almonds at the movies, and fajitas for supper.  Then, after we got home, I had a couple of glasses of Banfi Rosa Regale.  I thought I'd correctly bolused for all of it, and was doing fairly well until that sparkling wine...which, I have to admit, was pretty sweet, and I think may have been the cause of my elevated BG.  Nevertheless, I couldn't do much about it at that point, so I went to bed and woke up normal (or as normal as I can be) this morning.

This afternoon, upon arriving back to work from lunch, I got a call from my Medtronic rep informing me that they would be shipping my pump and equipment today and that I should receive it by Wednesday.  I'm super excited to get my pump and start using it, but that excitement was curtailed somewhat when I started reading about the Medtronic CGM...Blood, scar tissue, pain?!  OMG.  Pain, I can deal with...To an extent.  Hello, I give myself 4+ insulin injections per day on top of stabbing my finger 8+ times.  But a 1/2 inch probe (which means a 1/2 inch needle for insertion) being propelled towards my fragile body with an insertion device?  Oh boy.  I've seen the sensors in person, but never thought much about them (past "Wow, that's a long needle..."); however, reading all of these forums and blogs is making me anxious.  I've had tiny bruises and bumps and even a little blood with my injections, but nothing compared to the torture described on the diabetes web communities.

When I decided to get the CGM in addition to my pump, I was only thinking about the advantages it would give me in monitoring my BG levels, and that this would be incredibly helpful in bringing my A1C down to the proper pre-pregnancy range.  That needle didn't scare me then because I figured I would just "deal with it" as I have with everything else in the past five months.  Sticking my finger x times/day?  No problem.  MDI (Multiple Daily Injections) insulin therapy?  I'm your girl.  But as the reality of using the CGM and inserting the sensor is finally hitting me, I'm scared.  The bloody pain and discomfort described by other users has me holding my breath in the way I do when I'm anxious about impending doom.  It has me questioning whether or not I made the right decision in going with the Medtronic CGM, and if I'll be able to get past my fears to actually use it as it's intended.

The conclusion I've come to is that I'm going to have to just not think about it, put my big girl panties on, and deal with it.  Because at the end of the day, all of this pain, discomfort, and general annoyance is worth it.  As long as I can reach normal (or as near-normal as possible) BG and A1C numbers, which will give me the best possible chance of having a healthy pregnancy and baby, I'm in it for the long haul.  Hopefully, the horror stories of the Medtronic CGM will just reflect human tendency to complain about bad experiences, but not bother sharing good ones.  And to be fair, they haven't all  been bad...Amy of Too Sweet, a mother of a beautiful little princess with Type 1, sings its praises and emphasizes what a wonderful tool it is in managing such an unpredictable disease.  Many users point out that realistically, you do have to be committed to wearing the device and acknowledging its limitations to fully appreciate what it can (and can't) do for your diabetes management.  And, let's face it, most things related to managing this disease aren't the most comfortable things in the world to do.  I suppose all we can do is take it one day at a time and make the most of what we're given.  I'm very thankful that I have the opportunity to use this tool, and despite my reservations, I'm hoping and praying that it will exceed my expectations and give me an extra edge over my D-life.

Friday, January 21, 2011

The Definition of "Diabetic"...and Why I'm Not One

Thank you,!  You are my new favorite definition engine (although it's not like we didn't have a great relationship before) =)
World English Dictionary
diabetic  (ˌdaɪəˈbɛtɪk) 

— adj  
1.  of, relating to, or having diabetes 
2.  for the use of diabetics: diabetic chocolate  

— n  
3.  a person who has diabetes 

Usage:  Rather than talking about a diabetic  or diabetics , it is better to talk about a person with diabetes , people with diabetes 

Word Origin & History

diabetic  1799 (adj.), 1840 (n.), from diabetes.

It's refreshing to see an everyday source like take the initiative to be politically correct in the case of describing people with diabetes.  I've written about this subject before (See my post from the 30 Days of Blogging in November for American Diabetes Month, FAQ), but I'm calling attention to it again because it's something that affects almost everyone with this disease at some point or another, and that really needs to be nipped in the bud.

The thing is, just about anyone who has any disease doesn't want to be defined by it, and people with diabetes (PWD) are no exception.  Yes, this disease does take up a significant portion of our time and energy throughout the day, but we try to not let it take over our lives.  We are so much more than this disease, and only ask to be treated as such.  

It's a phenomenon that can be traced back to older generations, when the word "diabetic" was the go-to word used to refer to someone with diabetes.  Even today, when I Googled "Being referred to as a diabetic," this is what came up:

    You wouldn't describe someone with cancer as "cancerous", after all...So why diabetes?  The most frustrating thing is not so much when someone uses the descriptive (i.e., "She found out she's diabetic"), although that irritates me plenty; it's when they use the noun ("I didn't know you were a diabetic").  I like to call this being referred to as "'Diabetic' with a capital 'D'".  Most often used by the Diabetes Police (you know the ones...they sit disapprovingly and watch you eat, then make the comment "I didn't think Diabetics were supposed to eat
[fill in the blank]", either to your face or behind your back), it's a word thrown around without concern or compassion for those on the receiving end of it.

I don't think that these people are ill-intentioned most of the time, but it hurts nonetheless.  As I pointed out in my FAQ post, I didn't sign up for this disease, and I don't like to be defined by it.  It's hard enough to deal with sometimes (physically and emotionally) without being constantly reminded of it or having to feel like you have to defend yourself because of it.

I think "diabetic" is simply an antiquated term that should be eliminated from popular usage.  Back in the day (actually, until 1980, when the first home blood glucose monitor came about), diabetes was a disease that tended to control people's lives.  The technology simply wasn't where it is today, and diabetes was a disease that was incredibly hard to manage and often lead to horrible complications and even death as a direct result of poor management.  Today, however, diabetes is still a chronic illness, but a manageable one.  You can get BG meters for less than $20 or often for free from your doctor or pharmacist.  There are countless pharmaceutical drugs that are well-documented in lowering BG levels, and recent insulin analogs more closely mimic the natural function of the pancreas.  Insulin pumps allow those of us who depend on insulin some freedom to lead a more normal life.  (Or so I've heard...Mine won't be here until next week, then I'll let you know!)

The reason I make this point is to show that diabetes management has changed drastically in the past two decades, and I believe that the way it is conceptualized in the media, popular culture, and daily life needs to change as well.  Myths and misconceptions surrounding diabetes are rampant, which makes it difficult for those of us dealing with the disease.  People tend to view diabetes as a "fat/lazy person's disease" that can be controlled if only the people with it would try/work hard enough, whether they would admit it or not.  I will be the first to confess that before I was diagnosed, I had a lot of misperceptions about diabetes.  I've learned a lot since then, and now I know the reason I didn't have much accurate information on the disease is because there's not enough awareness about it.  What attention it does get in the media is often negative, and further contributes to the bad reputation it has.  Not only that, but celebrities who have diabetes often reinforce the myths instead of using their position to educate the public.  In those cases, it would be better if they simply didn't mention it at all, because it is already hard enough to combat the negativity and fallacies without their "help".

The bottom line?  Yes, I have diabetes.  Yes, it does require a lot of effort and daily (and sometimes hourly) attention to manage.  Yes, it means that I've had to make some lifestyle changes and allow for interruptions in my routine because of it.  It means that I'll have to watch what I eat, use insulin, and check my blood sugar for the rest of my life.  BUT, although it is a part of me, it isn't who I am.  Sometimes I would like to forget about this disease for a while, and not have to explain myself.  (See sixuntilme's posts "A Pump Vacation" for more on this and "Disco Boobs" for a hilarious and entertaining story on how diabetes sometimes complicates everday life)  Diabetes doesn't define me, and it's not my first name.  So please don't refer to me as "A Diabetic".  Just Ashley (or even "Hey you!") is fine. =)

Thursday, January 20, 2011

Heated Debate: Does Diabetes Ever "Go Away"?

I subscribe to feeds/email updates on several blogs that I regularly follow.  On Tuesday, I received one from "Keeper of the Home, Naturally Inspired Living for the Christian Homemaker" with a post from a guest blogger entitled "What is 'Real' Health?"  Although the basic tenants of the author's message were good (eating and living healthier to achieve better health), I took issue with her including diabetes on her "Signs of Not So Good Health" in the article.  It was not the fact that she was suggesting that a better lifestyle would make you healthier that angered me (in fact, I agree 100% on that one); rather, it was her argument that losing weight and improving diet & exercise habits would make Type 2 diabetes go away. 

Here is my response:
I have Type 1 Diabetes. It is not because I'm "unhealthy"; I'm not overweight, I eat right, and I take care of myself. Type 1 Diabetes is an autoimmune disease caused by a genetic predisposition paired with an environmental trigger...Not bad health. Unless by bad health you mean an entirely unpreventable genetic predisposition coupled with a similarly inexorable environmental factor. To suggest otherwise is to further reinforce the notion that these diseases are the person’s fault and that a change in diet is going to make them go away. Becoming and staying as healthy as possible isn't going to make Diabetes of any kind "go away". It may become more controllable and something that doesn't require as much daily disruption, but once you’re diagnosed with it, it's always going to be a serious health concern that requires attention. To suggest otherwise is simply irresponsible. There are already too many people that ignore their Diabetes to the further detriment of their health; too many “miracle cures” that encourage people to stray away from the proper management of their disease.
Therefore, to include Diabetes on your "Signs of Not So Good Health" is to misinform the general public and further reinforce the common misconception that all Diabetes is caused by poor health habits, such as eating too many sweets. This gives some people without diabetes a superiority complex that causes them to make people with Diabetes feel like it is THEIR FAULT they developed the disease. It’s so important to point out that you have to have the gene to get Diabetes--you could be 500 lbs and not leave the couch all day, but if you don’t have the gene, you’ll never develop the disease. Yes, the incidence of Type 2 Diabetes is on the rise, and some cases are preventable, especially in those who are overweight or obese. Being diagnosed with Prediabetes in particular allows the person an opportunity to become healthy and prevent the development of Type 2 Diabetes.
Don’t get me wrong, I’m all for being/becoming as healthy as possible; since being diagnosed with Type 1 Diabetes, I’ve become the healthiest I’ve ever been. Being diagnosed with a chronic illness is a major motivation to take care of yourself as well as possible. HOWEVER, as I’ve already stated, it’s horribly detrimental to misinform both the people affected by these diseases and those who are not because it makes life harder for those of us who have to deal with the day to day challenges that these diseases entail. It’s not something you can “overcome;” it’s only something you can manage as a part of living well. I don't doubt your intentions are good, and the overall message is great, but in the future, please, please, PLEASE review the current medical literature before making claims of this nature, especially since there are many who will take your word as scientific fact.
I received this reply from the "Keeper of the Home" site admin/main blogger:
@Ashley, I think that Kate was probably referring more to Type 2 diabetes, which develops later in life. Type 1 diabetes is certainly a serious illness that needs to be properly treated. I do think it's important to mention that it can be managed in many cases through dietary and lifestyle changes, as it sounds like you yourself have done. :)
To which I responded:, I agree that she is most likely referring to Type 2 rather than Type 1 Diabetes. However, it would have been helpful for her to mention this, as the two Types are very different in their causes and treatment!
I have been making dietary and lifestyle changes, but this only helps to some extent--eventually, most people with Diabetes (of either type) will need insulin to properly control their BG numbers (according to my CDE and the classes I've taken), which in turn prevents complications. And after all, isn't that the most important thing?
I elected to make this switch early on, while I'm still in the "honeymoon" phase of Type 1 (when your body still makes some insulin and numbers are easier to control). I started with diet & exercise, then moved on to Janumet (sitagliptin/metformin) when my numbers were inexplicably high. This was around the time we found that I had slow-onset Type 1 rather than Type 2 Diabetes. My numbers kept rising, so I chose to start insulin therapy recently. I think the end result (lower BG numbers and less risk of complications) is much more important than the form of treatment, be it diet & exercise, oral meds, or insulin. It's also important to point out that the failure of any of these treatments (not including insulin, of course) does not mean the patient is being noncompliant or not making healthy lifestyle choices; sometimes, the current treatment simply isn't enough to properly control the disease. This may seem like a minor distinction, but trust me, when you already feel like it's somehow your "fault" you developed this disease, it means the world to know that some things are truly beyond your control and sometimes will not respond to the changes you're making, however positive.
Again, I agree that dietary and lifestyle changes are very important not only to disease management, but to overall health...But again, this disease usually requires much more than that to be properly managed! =)

From the post's writer:
@Ashley, Yes, I was talking about Type 2. And it's critical to understand that MANY of these cases CAN be completely managed or eliminated. There are plenty of people I've talked to who have! Drew Carey would be the most famous and recent example....
The thing is, in type 2, it's primarily about insulin resistance, often due to obesity. If you can lose weight and get your adrenal glands on track, and your hormones working properly, your body will not be resistant to insulin any longer. This is not true in type 1; but it is true in type 2. Many, many people CAN make changes to be healthier! And many have.
I am also not intending to "blame" anyone for their health; in most cases, diseases developed because there was a lot we did not know. Most people believe they are doing their best because they only have so much information. Doctors often don't tell people the right stuff. Such as, eat lots of grains, fake sugars, and not too much fat! That's a recipe to get sick, but it's what doctors tell you. So it is not anyone's FAULT, I am just saying that regardless of where you are, you can feel good again, you can have hope.

And finally, my reply to that piece of information:, Managed, yes. Eliminated, no. Even if, as you suggest, insulin resistance is decreased through weight loss, it doesn’t change the fact that you have diabetes. Your pancreas produces less insulin over time, so even if weight loss fixes the problem in the present, your blood glucose numbers will likely rise again in the future and require attention again. Insulin resistance does not “disappear” in these cases; it is simply much more manageable as your body more efficiently uses the insulin it makes. But what about the cases of Type 2 in which the body doesn’t produce enough insulin in the first place? In these cases, it’s not insulin resistance that is the problem, but insulin deficiency. Many Type 2 patients have some features of both of these problems. Again, as pancreatic function decreases and produces less insulin over time, the symptoms of diabetes will return down the road for many of the patients who are initially able to eliminate them through diet & exercise/weight loss.
I should add that although my sister and I have Type 1 Diabetes, my dad has Type 2. He was able to manage his through diet and exercise alone, which led to a 30 lb weight loss. He no longer has to check his BG several times a day or even several times a week, but he is still careful to watch what he eats and exercise as he should. His endocrinologist, whom he still sees every six months, still considers this Type 2 Diabetes, albeit well controlled. Any diabetes expert will tell you this…Diabetes is a lifelong disease, and although it can definitely be well managed through the lifestyle changes you’re suggesting, it never goes away, and to suggest this is simply dangerous. I’ve read literally a dozen books on the subject over the past five months since my diagnosis, and I keep up with the latest news and research related to it on a daily basis. The best response I can give you is an excerpt from the ADA’s Complete Guide to Diabetes (4th Ed., 2005, pg. 48):
“Despite what you might read in the newspaper or be told by friends or relatives, there really is no such thing as a ‘touch’ of diabetes. What people may be talking about is type 2 diabetes, which often responds well to healthy eating and regular exercise and may not have yet shown any signs of damaging body parts. Or they may be describing gestational diabetes, impaired glucose tolerance, or pre-diabetes.
The reality is that diabetes is a serious, life-long disease. Describing someone as having a touch of diabetes is like saying a woman is ‘a little bit pregnant’—it just isn’t true because both are ‘yes or no’ conditions.
Once diagnosed, diabetes doesn’t go away, although there may be times in your life when it’s easier to manage. If this happens, you may be tempted to think your diabetes is cured, but don’t forget that there will also be frustrating periods when nothing you do seems to help keep blood glucose levels where you want them. Aging, weight gain, an injury that makes it harder to get regular exercise, or a gradual slowdown of insulin production all make diabetes harder to manage. When these things happen, you’ll need to adjust your diabetes therapy to match your body’s new needs.”
Again, managed. Not eliminated. This may seem like a minor distinction, but I think it's important to differentiate between being asymptomatic and being cured. Yes, weight reduction often does decrease the symptoms of diabetes and can make it more manageable, even leading to a decrease or elimination of treatment in some cases, but the disease is still there. If that person goes back to their unhealthy habits or gains the weight back, the symptoms of the disease will return, as the will in many cases simply due to aging and a decline in insulin production. To suggest that diabetes is "cured" in these cases is irresponsible because it causes those who should be monitoring their disease (even if they are symptom free at the time) to not give it the proper attention, which could lead to complications. If they didn't realize that they needed to begin treatment again and their blood glucose levels are rising (which in many cases doesn’t lead to obvious symptoms), it is doing damage to their organs in the meanwhile.
I am also well aware of the example of Drew Carey "curing" himself of Type 2 Diabetes with weight loss, but as you can see from the online diabetes community, his statements have angered many of us who have to live with this disease. He had the opportunity to educate the public on diabetes, and instead contributed further to misinformation. Please read this blog post written by sixuntilme, a well-known and respected diabetes blogger and person with diabetes. She explains the whole "weight loss/diet & exercise as a cure for Type 2 diabetes" thing wonderfully.
It's your choice if you would rather believe anecdotal "evidence" or hearsay over scientific fact and medical expertise, but please take care when you express these opinions as fact in the public arena...As sixuntilme points out, it really does make life harder for those of us dealing with this disease because it minimizes its seriousness and further contributes to the wide array of misinformation and myths surrounding it.

I hope I wasn't too harsh in my responses, but it truly does irritate me when people who know very little about diabetes try to impress their "knowledge" upon me.  Not only that, but as I said in my replies, portraying personal opinions (which in this case, are simply myths and anecdotal evidence) as scientific fact not only has the potential to harm those who need to closely monitor their disease, it also reinforces the misconceptions about diabetes that those of us who deal with it on a daily basis fight to correct. 

It's like the time that a lady told my mom that her preacher used lemon juice to lower his blood sugars, and that my sister and I should keep a bottle of it nearby in case we have highs.  It's in those cases that usually I shake my head and say "okay," while in reality I'm thinking, "Seriously, lady?  My pancreas doesn't work.  It doesn't produce insulin any longer.  Lemon juice will not do diddly squat to reduce my numbers..."

The reason this "advice," though I'm sure well-meaning, angers people with diabetes is because it minimizes the effort it takes to truly control the disease.  Those who don't have to deal with the several times a day (or sometimes hourly) finger sticks; oral meds with not-so-fun side effects (I'm talking about you, metformin!); injecting insulin into our abdomen, thighs, arms, or butt; constant worrying about where your blood glucose numbers are at, whether they'll lead to long-term complications, and hoping your insurance will cover all the numerous doctors visits, testing supplies, medications, and medical devices it entails, simply can't understand what it takes to make sure that this disease stays well-controlled and simultaneously trying to not let it take over your life.  I know I didn't until I was diagnosed.  Not until you've walked a mile in my shoes...

Furthermore, as sixuntilme pointed out in her similar blog post (which I highly recommend reading if you're interested in the subject, the argument that weight loss is a "cure" for diabetes simply perpetuates the myth and the thinking that those of us who have the disease simply aren't working hard enough to keep it in check.  This thinking is not only dangerous, since there are already so many people with diabetes who ignore their disease, but it also diminishes its importance to the point where it may affect funding for research.  We need a real cure, and what we're getting instead is a bunch of bologna from people who have no idea what they're talking about.  I'm no medical expert, but as soon as I was diagnosed I made it my personal mission to learn as much as I can about the disease so that not only can I properly manage my diabetes life, I can advocate and educate people on it. 

This type of media coverage (along with the celebrities' stories on "curing themselves" or "switching from Type 1 to Type 2 by 'weaning themselves off insulin'" [hello, Ms. Halle Berry]) isn't the kind we need.  It's people like Kevin Kline and Brett Michaels (who are both careful to keep their public statements on diabetes in line with scientific fact) who are true examples for the diabetes world and ambassadors to the general public.  And not to mention my fellow D-life bloggers, Lyrehca, sixuntilme, lisafromscratch, and the TuDiabetes Community, to name a few.  They help those of us dealing with diabetes feel like we're not alone (as it often seems) with this disease.  Because let's face it, sometimes it feels like it's us against the non-diabetes world and it helps to know there's someone out there, even if they're halfway across the country, who is going through the same things we are.

Wednesday, January 19, 2011

Adventures in Insulin

As many of you know, I went last Friday to do insulin training with my CDE.  It went great (as I expected it would), and I learned a lot.  I am currently on Lantus for my long-acting insulin (once/day, at bedtime) and NovoLog for the short-acting (before meals & for corrections @ meals).  So far, my experience has been a positive one.  Even though I've still had some weird highs as I get my dosage fine-tuned, my overall average has already come down quite a bit.  I also had the worst low since my diagnosis--43 two hours after breakfast on my first full day on insulin--but it wasn't too bad.  I just treated it with fast-acting glucose (16 g), and was back up to 92 15 minutes later.  No biggie.  The highs, as always, have annoyed me more than anything.  It's so frustrating to think you're doing everything right, and then still have high numbers.  I increased my Lantus from 10u to 12u last night in hopes that it will help give me better control during the day, specifically after meals.

In other news, I faxed my forms to Medtronic in order to begin the process of getting an insulin pump.  I finally decided on Medtronic because I think I'll benefit from the CGM (Continuous Glucose Monitor) on it more than I would the remote bolus feature on the Animas Ping.  It was a tough decision, especially because I'll be stuck with it for four years!  My sister has the Ping and loves it; I just decided that the CGM would serve my purposes for the pump more.  As I've mentioned in previous posts, one of my main goals in pump therapy is to have a healthy pregnancy and baby, and I believe the CGM will help me achieve that by giving me an opportunity for better control and fine-tuning than even the pump alone gives. 

Although I'm excited and ready as I am to begin the journey into pump therapy, all of this has brought out a lot of emotions related to my diabetes.  I've read many different places that some people compare going on the pump to being diagnosed all over again, and although I'm just in the beginning stages of obtaining a pump, I've already learned that this is very true.  For some reason, even though the decision to begin insulin therapy and go on the pump was entirely mine, it's brought to the surface some ambivalent feelings I still have about having diabetes.  I've handled it all fairly well over the past five months, but I still have some "why me" moments at times.  It's starting to really sink in (even more) that this isn't something that's going to go away, and even though I'm glad to have started insulin because it's going to give me better control, it's hit me that I'll probably never be able to survive without it in the near future.  In some ways, having slow-onset Type 1 is good because the changes aren't so dramatic, but in other ways, it's like knowing the other shoe is eventually going to drop and not knowing when it's going to happen.

As I posted on Facebook the other day, five months ago, when I was initially diagnosed, I would have been devastated to find out I had Type 1 Diabetes.  After all, Type 2 can usually be managed with diet and exercise, or oral meds if it comes to it, while Type 1 means insulin to stay alive, forever.  Now, though, I really am as okay with it as someone in my situation can be; I know God has a plan for me, and although it's sometimes hard to see how this could be part of it, I'm trying to stay positive and see the good in everything. 

So, I think now is a good time to reflect on the positive aspects of my disease, in no particular order:
  1. Even though I have a chronic illness, it's a manageable one
  2. It could always be worse, and there are millions of people who have much more pressing things going on in their lives right now
  3. It's led me to become the healthiest I've been in years...Well really, ever.
  4. It's led to some great conversations and opportunities to help others who are in the same shoes
  5. My sister and I, who are very different otherwise, have something in common.  It's not the greatest commonality in the world and I wouldn't wish it on anyone, but I think it makes it easier for both of us knowing we're not alone through all of this.
  6. I know more about my body now than I ever did before...Not only have I read tons of books on diabetes, I also have a dozen or more on pregnancy.  One of the first things I was worried about upon being diagnosed was whether or not I'd be able to have kids, and now I know that with the proper planning and management, I have the same chance as anyone in the general population to have a healthy pregnancy.  Not only that, but the human body is amazing and fascinating!
  7. My husband and I have already had to deal with a very real and immediate crisis together, and we've become closer and stronger as a couple in the process.  Our one year anniversary is on the 23rd, and I was diagnosed on August 23rd...I like to think that was God's way of showing me I wasn't going to have to go through this alone.
  8. It's made me appreciate my family and friends all the more.  They are a great, wonderful, amazing, supportive, and encouraging rock for me.
  9. I've had to reevaluate what is important in life...And appreciate the little things in a way I never did before.
  10. One of my biggest fears (losing my health/having to deal with a chronic disease) has become a reality, and I'm still alive.  Not only that, but I'm doing pretty great with it all!  I now know I have it in me to overcome huge challenges and come out of them a stronger person.

Wednesday, January 12, 2011

Quitting (and I'm Not Talking About Smoking)

I have had a lot on my mind over the past week, mainly stuff dealing with diabetes and all it involves.  Anyone who has this disease understands the sometimes overwhelming impact it has on your life.  All of the finger pricks, carb counting, and remembering to take your meds takes up a lot of brain capacity, to say the least...And that's without counting the thought space devoted to worrying where your BG is at at any given time, and how the things you're doing are affecting it-one way or the other.

I talked yesterday about how anxious I get when it comes to my numbers; how stressed I am when they're high and how ambivalent I get when they're actually within my normal range.  The lows don't concern me so much except for when they're actually happening--then, the shakiness and everything else that comes along with it sucks, but I always carry glucose tablets with me, so it's usually not that big of a deal.  The numbers game that is my BG is always floating around in the back of my mind, although I have gotten a lot better in terms of the level of attention I give it. 

One thing I've learned, though, is that it's something I'll probably always have to deal with.  This disease is not going to quit, so I can't either.  I suppose it's all a matter of balance--not ignoring your diabetes (bad), but not letting it take over your life either (also bad).  I often think, as I'm sure many of you do, about how good people without diabetes have it.  They can eat 10 carbs at any given meal, and *poof*...their pancreas makes up for it, with them being none the wiser.  I know, I used to be one of "them"; however, that's another thing that strikes me as unfair...aside from my childhood, when I was overweight, I've always eaten fairly healthy.  I've always been the one who buys the low-fat dairy products, lean meat, and low sodium versions of most everything...I was always known as the one who ate healthily.  I look at other people who are overweight, never move far from the couch, and eat whatever they want, and I think that it sucks that I'm the one who got this disease instead of them.  I know, I know, life is not fair.  And trust me, I try to keep a positive attitude most of the time...But I am human.  I have moments of "it's not fair."

It's not fair that other people can just decide to have a baby, and that's it.  All they have to do is try until it happens.  Yes, I know, it doesn't happen quite so easily (or sometimes at all) for everyone, but most people don't have to give thought to the effect that pregnancy will have on their body, or vice versa.  They don't have to worry about getting their BG under control for three to six months before conception, or else risk miscarriage; or if the baby is full term, macrosomia (an abnormally large baby).  They get a free pass for nine months to eat whatever they want, whenever the want; they don't have to worry, as I will, about how everything they put into their mouths will affect their BG, and in turn, their baby.  They don't have to give a thought to the fears of being on insulin and having a severe low while being alone and somehow damaging their unborn baby or themselves.  Theirs are not automatically labeled "high risk" pregnancies, even if they are healthy as can be.  They measure their pregnancy in trimesters, not A1Cs. 

Again, I know.  There are other people who have it much worse than I do, and trust me, I am grateful that although I have a chronic illness, it's a manageable one.  But until you've walked a mile in my foot-friendly shoes, please don't judge me.  As I said, I'm only human.  The purpose of my blog is to share my journey through my diabetes life with you, and I promise to always be honest and candid...But it isn't always going to be pretty.

Probably the biggest, most overwhelming thing about this disease for me is that it isn't going to go away.  You may be saying "duh" right about now, but think about it...It's never going to go away.  There is no cure for diabetes, despite what so-and-so's Uncle Tito did that magically made his disappear.  For me, that means that this is something that I'm going to have to deal with day in and day out for the rest of my (hopefully long and fulfilling) life.  It's not going to quit, so I can't either.  I could quit my job (though I don't want to), I could quit my marriage (definitely ditto on that one!); I have the option of quitting a lot of things, but diabetes unfortunately isn't one of them.  Sure, I could do as many PWD (People/Person With Diabetes) do and completely ignore it, let it (and themselves) go; however, I'm not that irrational.  I want to live.  Not only that, I want to live well.  So I guess I'm stuck wishing I could quit, but knowing there's no way in hell I will.

Tuesday, January 11, 2011

Changes...And My Fear of Them

After a couple months of the same blog design, I decided to finally change it; however, I inadvertently saved it without first noting the location of my old design, so it may be lost forever...

Nevertheless, the last couple of days have been better than preceding weeks, at least in regards to my BG control.  I think I was probably right in my thinking that some part of my high numbers was due to stress, and since I've relaxed after my appointment last Wednesday, my numbers have been better.  My postprandial following lunch yesterday was 125 after a solid four carbs (the amount my dietitian recommended, but that I've hesitated to take in due to highs), and was 98 last night after my three carbs at supper (+ a glass of Chianti)...I should have had one more carb with that meal, but the way things have been going--it was 180 after yesterday's breakfast and 220 following lunch on Sunday--I've been keeping my carb intake on the conservative side.

I don't care how many times I've had to check my BG over the past four and a half months (488 times, plus however many I've had this week, to be exact), every time is like waiting for major test results for me.  Those five seconds before the "beep" and the reading are torturous...I tend to hold my breath and hope, hope, hope that my numbers are within range, even as futile a venture as hoping could be in this situation.  If fervently hoping could control BG, my numbers would be perfectly within normal range 24/7!

On that note, how horrible is it that I can't just enjoy my good numbers when they happen?!  Just now, my postprandial was 110 after three carbs @ lunch, and I anxiously awaited a pig to fly by the window.  In all seriousness, though, when I do have good numbers consistently over a short amount of time, I get unduly suspicious of my good luck, my BG meter, what's to come, or all of the above.  I can't just bask in the goodness of normalcy because I'm so afraid that it won't last if I actually acknowledge it.  I guess that's part of learning how to live with this disease on a day to day (or hour to hour) basis.

As many of you know, I'm going for insulin training this Friday, and I'm genuinely excited...And, of course, just a little nervous.  I suppose I'm not like most people in that I asked my doctor to switch me to insulin, whereas many PWD (People/Person With Diabetes), especially those with Type 2, fear the needle to the point where they'd rather stay on oral meds even when insulin would be more effective in controlling their disease.  As I said, I'm not like most people.  I'm the type of person who likes to know everything about anything that is going to have a significant impact on my life; i.e., diabetes.  I can't just ignore it or blindly trust in the medical system to be looking out for my best interests.  I don't doubt the expertise or good intentions of my wonderful endocrinologist, but I also like to know what's going on when it comes to my body.  After all, I'm the one who has to live in it, and it's the only one I've got!  Therefore, I have countless books on the subject (most of which I've already read or at least thoroughly skimmed) and would like to consider myself well informed on many aspects of the disease. 

One thing I don't know much about yet, however, is insulin.  Hence, I ordered two books on the subject yesterday:

  • Using Insulin, Everything You Need for Success with Insulin

  • Think Like a Pancreas: A User's Guide to Managing Diabetes with Insulin

  • I hope that they come in soon so I can at least glean some knowledge on insulin use before my appointment on Friday.  I already downloaded  A Practical Guide to Insulin Pump Therapy for Pregnancy by James Bernasko, MD, on my Barnes & Noble nook yesterday, and I'm partway through it.  Maybe I'm jumping the gun a little by reading up on pump therapy during pregnancy when (a) I haven't even started insulin shots yet, yet alone the pump; and (b) it's still going to be a while before my husband and I are ready for a baby.  Oh well...Just part of my Type A personality, I suppose.  Knowledge makes me feel more comfortable with things (like diabetes) that I have little to no control over...And I say that meaning that I can't change the fact that I have diabetes, just the way that I manage it.  And I happen to deal with things by learning as much as I can about them waaay in advance, so that when the time comes, I know (sort of) what to expect.  And in this case, I'm planning on going on the pump ASAP because (a) our insurance year switches over on March 1st; and (b) I have no idea when we'll be ready to start a family, so (no surprise here) I want to be prepared...As my husband says, he may be ready today or five years from now!

    On that subject, I'm also knee-deep in books on pregnancy, much to my husband's suspicion.  I've already had to reiterate several times my need for knowledge, but he's convinced I'm cooking up a plan of some sort to force him into having a baby--despite the fact that I would never, ever do something of the sort.  I just truly feel more prepared when I at least know the basics of things that might happen or will happen in the future, no matter how distant.

    Friday, January 7, 2011

    Finally, Answers(ish)...

    In my last post, I told you about the challenges and triumphs I've had since I was diagnosed with diabetes.  My numbers had been high again despite being on oral medication and counting my carbs, so I was anxious to see my endocrinologist to gain some insight and get some answers.

    Wednesday, I (finally) had my appointment, and it turns out that I'm much harder on myself than my doctor is.  I suppose he sees very high numbers every day, but I still would like for mine to be within the normal range of a person without diabetes...or at least, that's what I'm aiming for.  My husband and I have started to discuss when we think we'll be ready to have a baby, so it's super important to me for my diabetes to be well controlled. 

    The lab results from my last visit indicated that I may have slow-onset Type 1 diabetes rather than the initial diagnosis of Type surprise there, because that was exactly what I'd been expecting.  My doctor was going to continue treatment as we had been (Janumet, a combination of Januvia (sitagliptin) & Metformin, 50 mg, 2x daily); however, I told him that I wanted to go ahead and start insulin therapy since we might want to start a family in the near future.  I want to be able to get comfortable with using insulin before pregnancy, and since our insurance begins its new year on March 1st, I want to get started with the pump very soon as well.

    I wasn't sure how my doctor would react to my request, but he pulled out a referral form right then and wrote the orders for me to get insulin and pump training.  He told my mom, who had been sitting in the waiting room, that I was "very motivated."  I guess he probably doesn't get many patients who actually want to go on insulin!  I called that afternoon to make the appointment, so I go next Friday to the same CDE I saw for my consultation prior to the diabetes education class I took to get started on insulin.  She's also a pump trainer, so I'm hoping it will be a one shot deal (no pun intended =) ) Either way, I really like her and respect her knowledge, so I'm definitely looking forward to learning from her.

    It seems like my body is responding better since my appointment due to the simple fact that I'm less stressed than I was prior to it.  My lymph nodes on my neck were swollen to the point that they were painful, and now they're back to normal.  My BG numbers have even been slightly better.  It never ceases to amaze me how much stress affects your body!

    At this point, I guess I'm just waiting for next Friday (one week!), and trying to figure out which pump would suit me best.  I think I'm still leaning towards the Animas Ping, but who knows what will happen between now and then!

    Monday, January 3, 2011

    New Year, (Hopefully) New Me...

    As we all know, 2010 came to a close a couple of days ago and 2011 is now here in full swing!  New Year's is usually just a blip on the radar for me, an homage to the whole "this year, I'll finally lose weight/exercise more/drink more water" thing we all do, but this year it has quite a bit of significance for me: 2011 is the first year I've started with diabetes.  I was diagnosed on August 23, 2010 (my seven month wedding "anniversary", no less), so I've dealt with the disease for just over four months now. 

    The past four months have been a series of ups and downs, both emotionally and literally, as I've come to learn what it means to live with diabetes.  Many of you followed my journey through the American Diabetes Association's "Blog 30 Days of Diabetes in November - and Beyond!" and are familiar with some of the challenges and breakthroughs I've had over the past few months.  I've learned A LOT about the disease, dealt with its inevitable highs (and lows), and been through the emotional roller coaster of being diagnosed with a chronic illness.  Through it all, I can honestly say I've come to know myself better and am on the road to being the healthiest I've ever been thanks to the urgency and importance of healthy living to managing this disease.

    For the first couple of months, I was able to use diet and exercise as my only means of diabetes management.  However, at the beginning of November, I started having some unexplained highs.  I would eat two carbs, and my blood glucose would go up over 100 mg/dl, and I was seeing numbers higher than I'd experienced thus far (in the upper 300's).  I called my endocrinologist, and he wrote me a prescription for Janumet, a combination of Januvia (sitagliptin) and metformin.  My BG quickly improved after that, and I was back within my target range most of the time.

    That level of control only lasted about a month, though, because in the past few weeks I've been dealing with abnormally high postprandials (after meal BG) and higher-than-normal fasting readings again.  I forgot to mention that I was initially diagnosed as Type 2, but all of the professionals in the field that I've talked to (dietitians, CDEs, insulin pump representatives & nurses) have all been skeptical of that piece of information.  You see, I'm 22 years old, of normal weight, and relatively healthy otherwise...Not your typical Type 2 patient.  The first time I saw my CDE, she thought my mom (who was with me for the appointment) was the patient, and when we told her I was the one there to be seen, she had me pegged as Type 1 and was in disbelief when I told her otherwise.

    I don't doubt my endocrinologist's expertise, and all of my labs have been consistent with a Type 2 diagnosis; however, as one book pointed out, sometimes you have to treat the patient and not the labs.  I've come to the conclusion that we may not know for sure which type I am (though I'm leaning towards Type 1 or LADA) until things go down(or up?)hill...i.e., I'm in the "honeymoon" phase at this point, and just caught it early on.  I'm going back to the endo for a three month checkup on Wednesday the 5th, and I'm anxious to see where I'm at A1C and lab-wise.  I'm also going to push for starting on insulin because I think it would give me tighter control over my BG and will put me on the right track to preparing for pregnancy.  My insurance switches to a new year on March 1st, so I'm wanting to get on the road towards getting an insulin pump as well.

    I've been going over the materials I was given over the Medtronic and Animas pumps, so I'm in the midst of contemplating which one would be better suited to my needs.  I like the CGM (Continuous Glucose Monitor) feature on the Medtronic, but from what I've heard, don't know if the sensors that go with it would be reasonable cost-wise since I'm not certain my insurance would pay for them.  My sister has the Animas Ping and really likes it, and the feature I like the most is that it can be remotely controlled instead of having to bolus at the pump itself...which I can see being helpful when you don't want to expose yourself when you're in public--i.e., the majority of the time.

    THEREFORE, I have a lot of things going on right now, and not only diabetes-related.  My husband just started a new job and is in the process of finding a work truck, and we're both trying to decide if we're ready to start a family anytime soon.  Right now, the verdict is that I'm going to do what I have to in order to get healthy and prepared for pregnancy, and we'll go from there!