What I've Learned in Six Months

The day before yesterday marked six months since I was diagnosed with diabetes.  In a way, I can't believe it's already been six months; on the other hand, I've learned a lot in that short amount of time.  One thing is for sure: it's been six months of disbelief, anger, and heartache; reflection, self-assessment, and hard work.  I would be remiss to say that I haven't had any d-related joy or happiness, though, because it's a wonderful feeling to know you're getting your numbers (and, therefore, your health) on track.  The day-to-day victories over your blood glucose are hard-won and fulfilling, and the knowledge that you're leading a healthier life is the bright spot at the end of the tunnel.  To sum it up in 420 characters or less, here is my Facebook post from February 23rd:

Today marks six months since I was diagnosed...I can't believe it's been that long already & how much I've learned since then. My life has changed so much, but it's given me the chance to become the healthiest I've ever been, & I'm thankful for that. I'm also thankful for such an amazing husband, family, & friends...You have all been such an amazing support through it all, & I love you guys! ♥

I've learned a lot in the past six months, both about diabetes and about life in general.

1)  I'm a lot stronger than I thought I was.  When one of your biggest fears becomes reality, you learn a lot about what you can really handle...and for me, it was more than I expected.  I came across a quote that says, "You never know how strong you are until being strong is the only choice you have." and it's so true.  Diabetes doesn't give you a break--it's a 24/7, 365 & 366 on leap years kind of responsibility.  Sometimes I don't want to be strong...I'd rather just be normal!  But unfortunately, I don't have that option.  I just have to do the best I can to try and stay positive and motivated, and not let this disease take over my life.

2)  It isn't as bad as I initially thought it would be.  When I was first diagnosed, I thought finding out I had Type 1 instead of Type 2 would be the end of the world...but it wasn't!  The first month or two, I wore my incorrect Type 2 diagnosis as a badge of honor, telling anyone who asked that I was "just managing it with diet and exercise" (thank you very much).  Then my numbers kept creeping up, and I started on oral meds (Janumet).  I did feel the sting of failure then, because I couldn't claim the "diet and exercise only" treatment medal of honor anymore.  Fast-forward to a month later, and I chose to begin insulin therapy to gain better control of my still upward-trending numbers.  Not even two weeks after starting on insulin I got my pump, and the rest is history!  The pump has made my life so much easier, and a little more normal (whatever that is), which is huge for a PWD.   

3)  Life (and diabetes) is a rollercoaster, and sometimes we're just along for the ride.  Any PWD will tell you that this disease is unpredictable even in the best and most stable of conditions.  You could eat and do the exact same things two days (or even meals) in a row and get completely different results.  This can be difficult and very frustrating at times, because just when you think you have things under control, diabetes rears its ugly head again and you're in the 300s.  The days when you start low are often the most challenging because you find yourself chasing highs and lows for the rest of the day. 

Today is a prime example of this phenomenon for me.  I woke up at 68, corrected, and was at a respectable 106 before breakfast.  I bolused for my meal, then two hours later ended up at 209.  Breakfast was, admittedly, an unusual one for me since I normally only eat something light--this morning, my mom and I went out for breakfast and shared an omelet and some biscuits and gravy.  I ate a reasonable portion and set part of my bolus to be delivered over 30 minutes to cover the fat content of the meal, so I thought I would be in my normal range afterwards. I'm not sure if it was a rebound high, or if I underestimated the carb content of my meal, or if it was just because I'm not used to eating those types of foods for breakfast...or a combination of those factors that led to my post-meal high.  Either way, I did a partial correction since I still had insulin active in my system, and was at 176 before lunch.  I decided to eat a chef salad with a few crackers and some dressing since my BG was higher than normal, and bolused on the generous side for my meal.  Two hours later, I feel the familiar symptoms of a low, and sure enough, I'm at 68 again.  I ate a slice of strawberry cream cheese pound cake (20g of carbs, first ingredient: sugar), and 30 minutes later I'm sitting at 84 and hoping I'll stay there for a while.

I haven't started using my CGM (Continuous Glucose Monitor) yet, but I'm pretty sure today's BGs would look something like this:

4)  Blood glucose numbers should be just that: numbers.  As anyone who knows me personally or follows this blog knows, I'm a perfectionist through and through.  I had one "B" in high school, and graduated with a 4.0 from Texas Tech in August '09.  Some call it a type A personality; others, a control freak.  Call it what you may, that's who I am.  I don't like situations that I don't have some level of control over; I loathe last-minute plans.  So you give me a blood glucose meter and tell me what my range should be, and I'm all over it like white on rice.  The biggest challenge of my first few months with diabetes was trying to see those numbers as information for treatment rather than a grade.  No matter what I knew logically, those numbers were a measure of my self-worth.  If I had a "good" BG day, I owned my diabetes.  If I had a "bad" BG day, however, diabetes controlled my life.  I've had to work long and hard to change my way of thinking, because I knew it was flawed.  I would like to think that I now have a much healthier, more balanced way of managing my diabetes, but I know there's always room for improvement (and there's my perfectionist side coming out again!).  I found this sign the other day, and sooo wanted to buy it...But I didn't know where I'd put it:

Ahh, how great it will be when I truly start believing it, rather than just trying to move in that general direction!

5)  I'm not alone through all of this.  Even though my Dad has Type 2 and my sister is a fellow Type 1, I felt completely alone when I was first diagnosed.  It seemed like no one in the world around me had a clue what I was going through, so nothing anyone said really sunk in...after all, who were they (all normal and healthy) to tell me I would be fine?  It didn't seem fair that everyone else got to go along eating whatever they wanted, not giving a second thought to a food's carb content while I analyzed everything that went into my mouth.  I went through the "it's not fair" thing so much in the beginning that I could smell the corn dogs and funnel cake.  "How come I (the one who always ate healthy and tried to stay a healthy weight) ended up with diabetes when there were clearly so many people around me who lived much unhealthier lives than I did?"  "Why does everyone else get to have babies and not worry about how their body is going to affect their baby's health and wellbeing while I have to go through months of hard work just to get to a point where I can safely become pregnant?"  "Why do my friends get to stay home with their kids while I'll have to keep a full time job the rest of my life just so I'll have insurance to afford my medical care?"  It's not fair, not fair, NOT FAIR.  Then (as my perspective returned) I realized that while I had a chronic illness that wasn't going to go away, there were plenty of other people who were dealing with much worse things.  One of our friends just went through their little one having open heart surgery to correct a congenital abnormality, and another has a baby who has gone through lots of kidney issues.  All of it makes me see that each of us has something to deal with; a cross to bear, if you will; and in the end, it's all about how we deal with what we're given.  Life isn't perfect, we're not perfect, so why should we expect everything to be that way?

My husband, mom, family, and friends have all been an incredible support system during the past six months, and I am incredibly grateful for all the kind words, encouragement, and reality checks they've given me.  I try to do a lot on my own, but once I realized that's not always the best way, I've come to really appreciate and welcome help from others, even those without diabetes who have "no idea what I'm going through." =)

6) Diabetes doesn't have to control your life.  This was another tough one for me.  Being the perfectionist I am, things are often "all or nothing" in my mind.  With diabetes, I soon learned that it's all a balancing game, and that you can stay somewhere between obsession and neglect most of the time.  At first, my life revolved around managing my disease.  I was constantly thinking about it.  Now, especially after getting my insulin pump, I'm able to forget about it until it needs attention (which we all know is frequent enough).  Diabetes is still a huge part of my life, but it doesn't define who I am.  I'm more relaxed about the higher readings I get every now and then because I know that overall, I'm doing a good job.  One big lesson I've learned is that when I'm not so worried about my numbers, they're a lot better.  Go figure.  Since I've been on the pump and not stressed about my numbers so much, I've brought my overall average down to somewhere around 116-120.  Now if I can just continue that trend, I'll make my goal A1C (6% or less) in May...and hopefully get the go-ahead for pregnancy!

As with all chronic illnesses, diabetes is tough.  It's not only a physical disease, but an emotional and psychological one as well.  If you're not careful, it takes over your life one way or the other.  But with enough balance, humor, and support, I've learned that it is possible to not only live, but live well with diabetes.  As with most things in life, perspective is incredibly important when dealing with this disease.  Yes, it is a chronic illness, but thankfully it's now a treatable one.  And hopefully in the future, it will be a curable disease.  In the meanwhile, I'm going to just try to live the best I can with it.

Sites and Fashion and Puppy Dogs

I had a free second, so I thought I'd post an update on how everything is going with my pump.  First of all, my average is down to 116 since I started the pump, which corresponds to an estimated A1C of about 5.7%.  My goal is 6.0% or under, so hopefully I can keep the current trend going!

I've also had fairly good luck with the actual wearing of the pump.  I've only had one bad site, and it was entirely my fault.  I had it in my upper thigh and pulled the tubing enough to disturb the site while pulling my pants down to use the bathroom...Great, I know.  I've never been the most coordinated person to begin with, so two feet of tubing is more than enough for me to get tangled up in!  I went to a friend's house after that, but had to return home and change my site because of the pain I was having.  I moved it to the back of my hip again, but I had some pain there too...I'm assuming it was because it was positioned more to my side than I'd previously had it.  After a couple of days of that, I relocated it to my abdomen once again.  I do have some pain when it's there, but it's mainly if you hit it...Or sometimes, if I hug my husband.  Boo.  Nevertheless, I know that site location is just something every first-time pump user has to figure out for themselves, and I'm trying to give each location a fair shot.

Worst part of being on the pump?  Honestly, for me it's not being able to wear dresses with as much freedom as before.  I love wearing dresses, but I've worn skirts the past couple of Sundays since they're easier to clip the pump onto.  This past Saturday I ran the tubing under my dress and clipped the pump onto the neckline, which seemed to work alright.  I've used my trusty sewing machine to make a couple of pump bands to put around my thigh, but I've only used them while sleeping for now--I figured I better test-drive the design before I go out in public with it, only to have it end up around my ankle and leaving my pump dangling!

[Side note: the pump does not, in fact, come detached from your site or body if you drop it.  I'd heard that the sites were strong enough to hold, but experienced it for myself a couple of days ago while changing clothes.  It did freak me out, but my husband was standing right there and retrieved my dangling pump while I composed myself...And realized nothing happened!]

Best part of pump therapy? Having so much better control over my diabetes.  Since I've been on the pump, it seems like I've achieved a better balance between effective management and worrying too much about my disease.  It seems counterintuitive, but being on the pump allows me to forget about my diabetes more often (in a good, healthy way of course...meaning it doesn't dominate my thinking 24/7 like it did before).  It's so effective at helping me manage my disease that as long as I do my part in remembering to check my BG and bolus correctly, it does its part in keeping my BG under control.  If I'm traveling, I don't have to worry about the inevitable BG increase that comes with simply being in the car and not being able to do anything about it...I just set a temporary basal increase and go on about my merry way.  Ditto if we have a special occassion coming up.  I just set my basal rate, then bolus a little more than usual for whatever we eat.  It's taking some trial and error, but I'm starting to get the hang of how much I need to bolus for what foods.  I told my CDE that was the biggest challenge of being on insulin in general...It would be so easy if all I ate was packaged foods, but that's obviously not the case.  As with everything else, I suppose I just have to do the best I can and hope it's enough =)

On another side note, I was amazed that our dog (that is actually still a puppy technically speaking) didn't blink twice at my pump.  He's such a hyper thing that he does tend to bump it while he's jumping up and down, but so far he hasn't payed it any attention.  I figured having the sensitive nose that he does, he'd go nuts over the smell of my insulin (after all, I can smell it and I sure don't have the nose he does), but it isn't the case.  This is definitely a good thing, though, as my previous wireless laptop mouse can attest...He tends to chew up anything and everything he can get his little paws on.  My nook was lucky I was only out of the office for a minute or two when he got ahold of it.  There are tooth marks permanently embedded in the page-turning buttons and a couple of marks on the screen, but that's a trivial result compared to what he's capable of!

Anyway, I guess that's all I have to say about that.  I hope you are all having a wonderful week, and if not...Well, it's half-way over!

Hard Work Leads to Success...Sometimes

This morning I received the email edition of my "Page-A-Day" Calendar (Keep Calm and Carry On: 365 Quotes, Slogans, and Mottos for 2011).  The quote for today was

“The only place where success comes before work is a dictionary.”   —VIDAL SASSOON

Everyone knows this theoretically, but it's so hard to put into everyday practice.  Through college, I always worked hard to get the grades I wanted, and ended up graduating Summa Cum Laude with a 4.0 GPA.  It took a lot of hard work, studying, and late-night paper writing to get there, and it definitely wasn't easy.  At the end of the day, hard work equalled success.

Similarly, I was very overweight as a preteen.  I did Weight Watchers in 7th grade and lost around 40 pounds, taking me from a size 16 to a 10-12.  Again, it was certainly not easy to lose the weight, especially at an age where most kids eat whatever they want, whenever they want without a care in the world.  Despite the challenges I faced, I succeeded because I worked hard.

Applying this principle to diabetes management is a very different animal, however.  Sometimes no matter how hard you try or how much effort you put into it, you still may not see the results you want.  Anyone who has had this disease for any period of time will tell you that you can eat/do virtually the exact same thing at the same time of day two days in a row and you'll undoubtedly end up with a different result.  Diabetes is complicated and unpredictable.

This realization leads some PWD to not try as hard, give up, or even to have a bout of complete D-burnout.  After all, why even bother when you can't control the results anyway?  What some people fail to realize, though, is that this way of thinking, albeit very natural, is skewed.  You see, even though you may not be seeing the numbers you expect or hope for, you're still monitoring your disease in the process.  As any good endocrinologist or CDE will tell you, your BGs are simply information; there are no "good" or "bad" numbers, and they are a way to gauge how effective your treatment is.  In addition, everyone will have the occasional high or low numbers; it's part of the disease.  Obviously if you're having consistently high or low numbers, your doctor may want to review and possibly change your treatment, but the general consensus is to not sweat the spikes that are bound to happen every now and then.

Now it's time to tell you that it's very hard for me to practice what I preach.  Whenever I see an out-of-range number on my meter, I have one of those "dang it" moments...especially when I've done everything I can to make sure I hit my targets.  Believe me, I know that nothing is more frustrating than to think you've eaten fairly well, only to hit 340 two hours after your meal.  I know because I've been there.  It's super hard for me to not see the numbers as grades, because I'm very much a Type A perfectionist...Good when you're trying to get a 4.0 GPA, but not so great when it comes to a balanced diabetes self-care plan.

I struggle a lot with balancing my diabetes care and my emotional well-being.  More specifically, I have a very hard time not letting the attention I give to my disease take over my entire life.  Part of it is that I want to take care of myself and be as healthy as possible.  As many of you know, my number one motivation for controlling my diabetes is that I want to have a healthy pregnancy and baby in the near future.  I know I have to get my A1C under 6.0% before we decide to conceive, so I've been working hard to keep my BGs within that range.  My next A1C test is in May, so I still have a few months to get the hang of the pump and keep the tight control needed to reach my goal. 

The problem therein is that keeping tight control requires an immense amount of energy and attention on my part, often to the point that it feels like a second job.  My husband is constantly reminding me that I probably don't have to give my disease quite so much attention, but keeping that balance is very hard for me.  Being the perfectionist that I am, it's often either all or nothing in my way of thinking.  If I'm not 100% on top of it, I feel like I might as well not care at all.  I know logically that this way of thinking is harmful, but I'm only being honest...this is the way I feel and think about my disease, no matter how flawed it is. 

I've done better since talking with my CDE and realizing that my numbers weren't as out of wack as I thought they were.  I emailed her Sunday evening, completely frustrated with my high numbers.  When she called me back Monday, she told me that although she understood my frustration, my numbers were actually not that bad.  In fact, she said she was surprised at how well I was doing.  Her perspective helped me immensely in realizing that my efforts are paying off, and that I shouldn't sweat those out-of-range numbers so bad.  I suppose it's another case of being harder on myself than the professionals are on me. 

My CDE has been a great resource through all of this.  I email her my BG numbers pretty frequently to get her feedback, and I talked to her once a day while we were trying to get my basal rates on the pump regulated in the beginning.  She is honest and straightforward with me, but encouraging and supportive as well.  When I think about all she's helped me with, she's really my best D-friend.  Since she has two sons with diabetes, she knows what the reality of this disease looks like...And what a monster it can be to live with.  As a woman, she understands my motivation for keeping my diabetes well-controlled, and she has the knowledge to help me get there.

All in all, when I'm being introspective, I can see that despite my frustrations, despite the higher-than-I'd-like numbers and perfectionist-related frustrations, my hard work is paying off.  The hard work is definitely worth it, even if it doesn't always lead to success by my stringent definition.  My overall average in the past 16 days that I've been on the pump is 119--well within my target range.  I'm still always trying to hit lower numbers, but if I can at least keep this up, I'll definitely hit my target A1C in May.  I know it's not going to be easy, but I also know deep down that I have the motivation and drive to get me there.  Because more than anything, success for me means having a healthy baby in the future, and what better motivation can you get than that?

The Diabetes Rollercoaster

It's been a week and two days since I got my pump, and I already love it.  It's made my life a little more normal, and as any PWD knows, that's no small thing.  We (my wonderful CDE and I) finally got my basal rate on the right track (yay for no more morning lows!), and I've done two site changes on my own with no issues.  Now the goal is to tighten my control even more and get rid of the higher numbers I've been having postprandial (after meals). 

Speaking of highs after eating, my husband and I ate at Texas Roadhouse last night, and although it was wonderful, I ended up at 341 afterward.  It freaked me out because I had turned up my basal rate (because we would be heading home afterwards, and the two hour car ride raises my BG) and bolused according to the nutrition information I found online...Therefore, there was no reason for it to be that high.  My first thought was that I had a kink in my infusion set or something of that nature, but everything appeared to be working correctly.  It took me until the end of the night just before bed to realize that my mealtime bolus was waaay off, and that was what had caused my high.  I should have used my portion estimation and carb counting techniques rather than relying on the dubious information I found online.  Lesson learned...The hard way.

Then at 11:30PM, I was back down to 113...And I had one of those "oh crap" moments because I had just given myself another 0.5u correction based on my BG before I took my bath (213).  By my calculations, there was a possibility (albeit a very slight one) that I could have a virtually nonexistent BG in the middle of the night, so I ate a snack that reliably raises my BG to match my active insulin and went to bed.  At 3:00AM, I was at 154 (just as I figured), and by morning I was back to normal again (96).  I suppose yesterday was just one of those days on the diabetes rollercoaster of highs and lows.

Diabetes seems to be full of "should(n't) haves"...I should have exercised more, I shouldn't have eaten that extra serving of (fill in the blank), I should have payed more attention to what I was eating, I should have bolused differently...Should have, should have, should have.  Unfortunately, all of those "should haves" don't get us very far, unless we can see their intrinsic value in learning from the mistakes we make.  All we can do is do our best, and if that isn't good enough, try harder next time.  It's taken me just about the whole five months since my diagnosis to become comfortable with seeing BG numbers as a tool for treatment rather than a grade for how well I'm doing.  Any Diabetes Educator, Doctor, or book will tell you that "there are no such thing as bad BG numbers," that they're "only information"...But that doesn't mean that seeing 340 on your meter doesn't suck.

Even though I still don't like the higher numbers I've had (and I'm talking the 140's-180's, not the super highs from last night), I can already see the difference the pump has made in my BG control.  Even with all of those highs thrown in, my average is 119, which should mean a 6.0% or under A1C if I keep it up.  Now that we've got the lows taken care of, we can start to focus on gaining even tighter control, and that's something I'm looking forward to.  I've always been a perfectionist, so that type of goal is definitely appealing to me!

Hopefully by May I'll have an A1C that reflects all of my hard work...I'm shooting for under 6.0% (an average of 126) so that if we're ready by then, my husband and I can start a family.  Getting on the pump is just the first step in achieving this goal, and I'm so thankful I have such a wonderful tool to help get me there.  I know it's not going to be easy, but all of the challenges (and inevitable failures) aside, it's a journey I'm so ready for.  What better motivation for having excellent control of your diabetes than another life depending on yours?  I will do whatever it takes to get where I need to be before we conceive, and to nurture and protect that life once it happens.  I feel more comfortable with this responsibility knowing that I have my pump to help me along the way, because it gives me an edge over a disease that never takes a vacation...well, besides the honeymoon phase, if you have one =)