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.

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.

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 2...no 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!

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! 

Diabetes in the News

I was trying to think of something to write about next, and I finally got my answer while surfing the web yesterday.  On MSN.com's home page, one of the headlines was "6 Misconceptions & Myths About Diabetes", with other diabetes-related articles below.  I was excited to see that diabetes was getting some face time, but I was slightly disappointed by the content of the articles after reading them.

6 Common Myths and Misconceptions About Diabetes
http://health.msn.com/health-topics/diabetes/articlepage.aspx?cp-documentid=100266985&gt1=31010

In this article, Sue McLaughlin, former president of healthcare and education at the American Diabetes Association, expounds on the most common myths about the disease.  Most of her advice is spot-on, but I had a small problem with #5:

"A diabetes diagnosis means you automatically need insulin. That's the case with type 1 diabetes but not with type 2 diabetes. In some cases, proper diet, exercise, and oral medications, if needed, can keep type 2 diabetes under control for some time before insulin becomes necessary, McLaughlin says. The key is to make a lifestyle change. That means no smoking, more healthful eating habits, and regular exercise."

Don't get me wrong; it's nothing but the truth.  However, I think that her statement about insulin may further discourage those with Type 2 from taking insulin when often it could be a great option for treatment.  Research is showing that by starting insulin right away (instead of as a last resort after medications and diet have failed to be effective), the pancreas' beta cells (the ones responsible for insulin production that are damaged by diabetes) may be preserved from further destruction.  I am all for making that lifestyle change she talks about, but I'm also a big proponent of finding the absolute best treatment for your particular case, and that very well might include insulin.

Aside from that one minor complaint, I found this article to be informative, especially for those who may not be familiar with the disease and might stumble upon it as I did.  Mainstream media is a GREAT way to raise awareness, so I'm happy when diabetes makes the top headlines.

4 Easy Steps to Lower Your Diabetes Risk
http://health.msn.com/health-topics/diabetes/articlepage.aspx?cp-documentid=100267080&gt1=31010

When I first read the title of this article, I was intrigued.  You often see articles on prevention of other diseases, but rarely do you come across one in the headlines on the prevention of diabetes.  Dr. Judith Fradkin of the National Institutes of Health's "4 Easy Steps..." are just that--short and easy.  However, I don't see how they really apply to the prevention of diabetes specifically.  Yes, they are essential steps for achieving good overall health and preventing obesity or losing weight, which are both key to preventing Type 2 Diabetes. 

However, I don't like the correlation she makes between eating sugar and the prevention of diabetes...After all, the first article clears up the myth that eating too much sugar causes diabetes, so why lead people to believe that it's true?  Again, I know that eating less sugar is a great idea, but it's not going to prevent someone who has the genes and other environmental factors from getting diabetes, according to my understanding. 

Losing weight, exercising, eating whole grains, and getting better sleep are all good things for anyone to do, and very well may help prevent someone with the predisposition from developing Type 2 Diabetes.  What the author didn't mention, however, was that there are no guarantees when it comes to disease prevention.  In my case specifically, I was relatively healthy, and I still ended up getting diabetes.

Finally, right under the links for those articles, there was a link to Bing search for "Find delicious recipes for diabetic diets"...Right after the myths & misconceptions article specifically noted that there is no "diabetic diet".  I'm not convinced I'm the only one who notices these things...

Maybe I'm being too picky, but the way I see it, if they're going to put these articles front and center, I wish that they would ensure that the information in them is current with today's medical knowledge about diabetes.  Otherwise, they may just be contributing to the very misinformation they're trying to clear up.

A Lesson in Diabetes Etiquette

I hope everyone is doing well!  It seemes like everyone I know has been sick in one way or another lately...My husband, as well as my friends' husbands and kids, were all down this week with a stomach bug.  Luckily, it passed me by.  I don't know if I'm quite ready to deal with illness and diabetes at the same time just yet!

I had a big lesson in foot care on Thursday.  We had driven a couple of hours to see my aunt for her 50th birthday and to run some errands while we were there.  I wore some flats that I've had since I was in high school (I graduated five years ago this May), thinking that they would be comfy...But I was wrong!  In hindsight, I should have known; however, in my defense, who would have thought?  After running around town all day, I had painful blisters on both of my little toes from the pointy toe on those shoes.  My aunt gave me a bandaid to put over them, but they were still extremely painful the rest of the night...I even  had trouble walking! 

Normally, I wouldn't think much of it; but now that I have diabetes, I'm more conscious of how I treat my feet.  I've been babying them the last couple of days to help them heal as quickly as possible, and now I know that I shouldn't wear shoes I haven't worn in a long time when there's going to be lots of walking involved.  Before, I would have dealt with the pain in the name of fashion, but now I can't do that.  Lesson learned!

Speaking of lessons, I would like to share this handout that I got at the Diabetes Health Fair with you.  It's a great, straightforward way of giving those who don't have the disease some advice on how to treat those of us who deal with it on a daily basis.  The tips might surprise some of you, but anyone with diabetes will tell you that they're all correct!  You don't realize until you are having to deal with this disease firsthand the impact that others' comments have on your spirit.  These are all little things, but trust me, they will be greatly appreciated by anyone who has diabetes.

Courtesy of the Behavioral Diabetes Institute:
(Click to enlarge)



What's Next?

Bonus Days!
Wednesday, December 1

What’s next? – Even though American Diabetes Month is over, diabetes continues to be a 24/7/365 disease. What will you do to keep America’s focus on diabetes?

This month has given me a chance to reflect on my experience with diabetes in a way that will hopefully inspire someone else to learn more about the disease, take care of themselves better, or get involved in diabetes awareness and advocacy.  I also want to take the opportunity to say "thank you" to the people and organizations that are fighting every day to make life better for those of us with diabetes.  I have faith that someday, a cure will be possible because of their dedication and passion.

Even though the "Blog 30 Days of Diabetes in November - And Beyond!" is finished, I plan on continuing my blog posts on my experience.  I hope to include some diabetes book reviews, interesting articles and news on the disease, and of course, the ups and downs of living with diabetes.  I hope that you'll continue following my blog, and please let me know if you ever have any post suggestions or comments!