Health care is a basic human right, not a privilege. For some reason, we’ve allowed ourselves as Americans to be fooled into accepting that one must be blessed with “means” to actuate appropriate health care. As a nation we have failed to realize that our health care system is a barometer of our society’s value for human life.


Tuesday, August 29, 2006

Excuse me, did I leave my memory with you?

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This week has just been NUTS! when it comes to me losing my mind...! In one way, this week should be exciting, as it marks the last week that my son, my lovely six year old Sandis, is in day care. Starting next Tuesday he begins his lifelong, well seemingly lifelong, journey in education. In preparation for this, Ive had quite a few changes of my own in the works just so we can work around all that comes with public eductaion. First of all, Ive had to change my work schedule. I used to work a lovely 7am to 3:30 pm. At times it felt ridiculously early as I drug my bum out of bed at 5 am, but on the same token, it felt deliciously early leaving work when most everyone else has at least an hour left on the clock. It gave me the perfect time to go and run, while the kids are still covered by day care. Well this week comes the switch to normal life, and along with a normal life comes normal hours: 8am - 4:30pm. So with that in mind, I am now a 5:30am runner.....

Today was my first day out pounding the streets at five something am...I really can't run very far yet with my injured knee ( i have a medial meniscal tear in my right knee) but I managed to eke out a mile and a half, the second time in 3 days, and come home to further eke out some tae bo with these ghastly band things. I can't speak for anyone other than myself, but blood sugars while running and working out in the morning are just so much more cooperative than they are in the afternoon and evening. I found as I was training for my half marathons that I just could not do my long runs (read > 10 miles) in the afternoons, beacuse inevitably came the low that just wouldn't come back up. On mornings though, with approximately 1/8th of the carb replacement required for afternoons, and one hour less of basal reduction, Im running steady with no dips whatsoever. It was a trick I was grateful to learn, and Im sure as I become accustomed to running outside in the dark with no music and fabulous cool winds, I will value this more and more!

Back on track to the initial subject at hand, (how Im losing my mind, that is), it seems that with the new schedule, I am COMPLETELY out of sorts. For the past two days I have forgotten my syringes and symlin AND backup test strips! Where is my mind? How do I forget what Ive been doing for so long! It is because my routine is all screwed up. Shower in the morning, running and working out in the morning, heck kids eating breakfast in the morning! There is just too much going on!

To avoid this in the future though, I put my symlin and syringes in my purse after dinner......I better go stock the test strips too while I am at it!

Monday, August 28, 2006

The Newest Rumour on the Block - CGMS and Insurance

So the rumour I've heard is that there has been a few, perhaps few and far between, yet still a few insurance companies that have in selected circumstances, actually covered CGMS systems.....And today this has me completely freaking out, because I swear, by all that is holy, mighty, and all that junk, that I WANT one of those CGMS systems. I mean, I'd prefer one of the minimed variety, solely for the fact that I've always had minimed pumps and I know and trust the company, but I would take the dexcom in a heartbeat if I could convince my insurance companyto help cover it!

I actually spoke with my current endocrinologist last visit about getting a CGMS system come the beginning of next year as I'll have some money put away and I was thinking of doing it out of pocket. She, however, was not quite as excited as me and was not even close to signing off a prescription for a device that I fancy has the ability to CHANGE MY LIFE! She is of the variety that feels that perhaps the CGMS will do more harm than good for an aggressively treated type 1 as they will have TOO MUCH data to work with....I can see her point, but she's crazy....I can never have too much data. I poke my fingers upwards of 20 times a day. Ive designed complex logs to track everything you can humanly imagine tracking, well outside of glycemic index, although, that IS an idea.......

So her less than exuberant reaction to my desire to have one of these systems, combined with a few other problems Ive had with her office, has me thinking, that perhaps, more thank likely, it may be time to travel on up to the big bad twin cities to seek out a doctor who doesn't think that the best treatment for high variability,coupled with a TON of lows (and reduced ability to even feel those lows) is aiming to have my blood sugars between 130 and 170 at all times.....I want someone who isn't afraid to be aggressive, is willing to try new things (like using Regular insulin at dinner time rather than a square bolus to try and cut out some nasty lows I have been having...just an idea, may not work, but it MIGHT work, and if it does, isn't it WORTH IT?)and agrees 100 percent with me that CGMS is my ANSWER in helping to reduce low blood sugars and to address my reduced hypoglycemic awareness before it REALLY becomes a problem.

Ive had a few other problems with this office that have also got me thinking about leaving the clinic, doctor, team there. First of all, this is the ONLY endocrine clinic in Saint Cloud. And if you try to get a good appointment time, good luck, these doctors don't like to work before 9 am or after 4pm.....I guess that is true of most doctors though....I also fax in my sugars to the clinic weekly. Each time I fax in my sugars, I send them to one L's attention. I send them specifically to her because my doctor instructed me to send them to her because she is "most qualified" in her opinion to deal with pump/symlin patients. Well the lady never calls me back! A diabetes educator DOES call me back, but it is NEVER her and it is a different person every week! I have no continuity of care! How can you know what to change if you have no idea what we changed the week before, or what my goals are? or that the reason my blood sugars are 160-170 every day between 3 and 4pm is because I want them there for pre-exercise or pre-run? (I don't want them lower!) This malcontent list goes on and on and on....

My fear of lows can at times be pretty overwhelming, and the lows I have can be pretty frightening, feeding my fear of them. They are not frightening because of what happens when I am low, they are frightening because of how darn chipper I feel with a blood sugar of 35.

Ive considered getting a dog that is trained in sensing hypos, but a small 2 bedroom apartment is not an ideal situation for a dog + me + 2 crazy kids. Ive applied for the University of Minnesota Islet Transplant program, and have progressed to the point where I am to send in a thousand medical records and letters from my doctors, but have put that process on pause, at least for now, trying to see what else I can figure out before I go there more seriously than I already have. What I really really want is that low alarm. I want to sleep through the night, if only for one night.

Well, on that note, and with all the thought and excitement I have been putting into this the past few months, hearing that some insurance companies, albeit rarely, are actually covering these systems, Im ready to go for it. I am ready to appeal, appeal, appeal if need be, but I need a team that believes this is right for me to do it. So Im switching doctors. Ive decided, for now, on Lisa Fish at the International Diabetes Center in the twin cities. She wrote in her bio that she is very interested in helping to aggressively treat diabetes with insulin pump therapy. That sounds right up my alley and Im hoping she is the type of progressive doctor that is willing to take chances. Not dangerous chances, but Im the first one to step forward and do this type of chances....I mean, it is only my life, and I only get to do this ONCE, and I want a doctor and team that wants this life of mine to have quality and be outside of excessive restrictions and fears.....

So, I guess, wish me luck! Im sending in my self referral tomorrow and hopefully this week I'll know when my first appointment with her is....I'm nervous, but Im ready....

Sunday, August 27, 2006

Why my sugars are never "good" at night

It is, well, it is because I eat. I go to bed at 10, and then I wake up at 11pm, half asleep but with a knot in my gut, inwardly afraid of a low that probably is NOT going to happen, and I eat something, usually without bolussing for it. If I do bolus, I UNDER bolus. Then, again, I wake up at 2am, and do the exact same thing.....Ive thought about this so often, every morning in fact, and Ive tried several things to try and break this habit. It is so frustrating! I have to figure in a 2 am snack in my daily total calories if i even DREAM about ever losing weight, and you can bet that that 2am snack is not broccoli or cucumbers.....

I think it all began when I was 16 or 17, heck maybe even age 15....Back to NPH days......I used to wake up every night low. Not normal low but DESPERATELY LOW, in my teen, twenties and high in my thirties kind of low. I would tumble ot of bed, crawl through the downstairs and up the stairs, and collapse next to the ginger ale cabinet and gulp at least a can, then once conscious enough, I would ravage anything I could get my hands on and then mope on back to bed. There were nights that I remembered these nighttime adventures, and there were nights that I "awoke" at the kitchen table, and there were nights where I had no idea I had made the trek until the next morning when I am confronted with the wreckage of pop cans and empty cereal bowls in the kitchen still bleary eyed from sleep. We moved on to Lente after NPH, then Ultralente and FINALLY the pump, which has effectively eradicated the night time lows, but not the night time voyage to the kitchen.....AAACCCKKK! does ANYONE else have the problem of the nighttime eating attacks?

The worst part is, try telling your doctor you "sleepwalk" and "EAT IN YOUR SLEEP" and that is why your morning blood glucoses just won't fall into place.....They look at you like perhaps you truly belong in the psych ward rather than the endocrine clinic.

Anyhow, in the past year, Ive worked out some things that seem to help, but don't eliminate the problem. I keep my glucometer by my bed. The point being that if I wake up, and I do wake up at least 3 times a night, I check my blood sugar and can alleviate any fears I might have about a low, when It comes back normal or slightly elevated. The problem being, that if Im not over 130, Im too nervous to sleep and have to have a snack to calm my fears......This fear of mine runs deep.

I also take symlin and one side effect Ive had with symlin, or something that has come with the better blood sugars Ive had with symlin, is reduced hypoglycemic awareness. Ive been 25 and felt just peachy, which scared the CRAP out of me, becaues it was 11:30 at night, and I checked my blood sugar only because I was having some trouble drifting back off to sleep. I fear, that being a single mom, one night I just won't wake back up. How do you teach a six year old to deal with the possibility that I might not wake up and what you need to do if for some reason I don't? I mean, we have the phone numbers up and he knows who to call, but really, how do you do that and KNOW that it is going to work?

There is so much so deeply rooted in this night time blood glucose problems and eating escapades, that I KNOW that i really don't want the kind of tight control that would tie my gut in knots if ONE thing caused a low that for whatever reason that ONE time I didn't wake up with. I have confidence in my basal rates, and my carb ratios, but I don't have confidence in the forever what ifs of this disease and insulin therapy....

Saturday, August 26, 2006

And So It Begins......

After reading some of my favorite D-blogs on the OC I wonder if what I have to offer can ever compare! But after being on this diabetes road at it alone for a long time now maybe it is time to let a few others in? You know, others as in people who don't think that diabetes means you can't eat sugar?
I'll begin with just a little history on myself, then I will close with a rant I have about the ineducated public in regards to diabetes. I have been a diabetic for closing in on 15 years (year 15 is reached at some point in September but I really don't know my dx date). I am a pumper (currently using medtronic minimed paradigm) for 11 years and I also take symlin (for 8 months now). I have had differing levels of success with my diabetes through the years. Pre-pump my a1c was a whopping 13! (you may sit down if you need to breathe...) Post pump it promptly settled at an 8 and over the past year Ive varied from 6.2 to 7.2(current a1c).

I come from a family of diabetics. My mother is a type 1 diabetic for 43 years now (you can applaud now if you like) and she is also on a pump. She also has no diabetic complications other than spilling protein in her urine, which has been controlled by one of the -iprol medications for the past 11 years (It is probably lisiniprol, but I don't remember the class of drugs it is). I grew up watching her give injections and yes checking her pee. I remember when she got her FIRST glucometer and how HUGE of a deal it was! I also remember that she ALWAYS did what she wanted to do. If she wanted a piece of cake, she had a piece of cake. She also woke up five mornings a week at 5 am and ran. She never let her diabetes take away her life! I saw this and understood this before I was diagnosed. I was diagnosed at age 13, and aside from the fear of having to give myself injections ( I mean really, who WANTS to do that?) I really wasn't very upset about it. I had witnessed my mother living a full life from my birth, and I knew that I could do that too. And, I guess I HAVE been doing that!

Now on to my rant.....where to start first? There is a woman I work with, lets call her Poo. Poo always makes an issue of how diabetics aren't supposed to eat sugar, that is why they call it sugar diabetes (where do people get this crap?). She even goes so far as to bring it up in conversation with all my coworkers at lunch, or break, to single out my personal dietary habits. Now, I really don't eat terribly, but I don't focus on cutting out sugar. I actually use very little artificial sweeteners (all that artificial crap makes me wonder what's really going on there) and focus on using natural sweeteners like raw sugar, honey and maple syrup. Im a huge sweets fan, and I also have a little more freedom with allowing myself a sweet with the symlin ( more about that at another time) so I don't have the crazy spikes. I do attempt to straighten her out by explaining the difference between type 1 and type 2 diabetics (we have similar dietary constraints, but if we are not trying to avoid being on insulin, and can control our sugars effectively with insulin, there is NO reason to NOT have sugar) but the thing is, people just can't or won't understand this as well as I will. They either just don' tcare enough (it doesn't personally affect their life, which is understandable) or they CAN'T understand it. Anyhow, I let it roll off of me as best as possible but makes my blood boil!

Anyhow, my son is throwing a fit as he is having trouble putting the bottom fitted sheet on...I don't remember ever having this much trouble learning to make my bed, but perhaps Ive just shuttered it away somewhere in my mind and filed it as a traumatic experience......I believe it may be time to be my son's personal cheerleader and fill his soul with an "ICANDOIT" attitude, because, this crying shit is driving me BATTY.....

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