Tuesday
Jun192012

ugh. what a week. 

I have been nursing a yucky feeling for a few days now. My blood sugars are just this side of normal and I am less than pleased about that.  Did you know that illness, along with that time of the month, can raise your blood sugar? If yes, a gold star for you. Just another bonus of T1D.  

Life has been been hectic and crazy and depressing and wonderful and stressful and all kinds of busy in just the last week alone. With that in mind, this is just going to be a quick update and later I'll write in more detail on some fronts.  I'm in the midst of deciding how much I want this blog to drift into realms of my life not directly related to T1D. Although I guess the argument could be made that no such part of my life is non-affected by this condition...

Yesterday I had not one but two doctors appointments sandwiching my workday.  I started off bright and early with an appointment with an actual podiatrist rather than a off-kilter LCSW with projection issues.  She was delightful and quite funny which made the visit much better than expected. Now it's my turn for a gold star. After all my freaking out over my cold foot, I got a complete and thorough look-see and according to my DPM, my feet are not diabetic aka low risk for issue. Which is really the best I can get diagnosis wise as everyone is essentially low-risk.  You (that's right, you) could step on a nail tomorrow or break your toe or get some awesome gnarly gash that get's nasty infected. That's right, I said it.  Low-risk is the best anyone can expect. 

She did say that I should make a habit of always wearing shoes (not socks. something with a sole) even when just walking around the house as a precautionary measure. I can't say I'm thrilled about this but as with everything - if I have to wear 'em - they are going to look good.  And thanks to a simple question on Facebook, I have quite a few brands to explore. I tell you - you ask ladies about footwear and you get ANSWERS ;) And thank you Zappos VIP - my new shoes come tomorrow!

The doc also made a crack about how she'd be out of a job if they went around cutting people's feet off whenever someone had an infection.  After reciprocating with a joke about job security, she went on to reassure me that even if I notice something out of the ordinary that doesn't mean the worse. I just need to be diligent and proactive. Once again - this is really something everyone should do when it comes to their health - foot care or otherwise. 

I ended my day with a visit to my amazing PCP. We were essentially just checking in to see how I've been dealing with everything since the diagnosis. I brought my numbers to show her (and let's face - brag a bit. I might as well take some pride in my control, right?).  She was kind and said she had been keeping an eye on my charts and she too is excited to see my A1C next week.  Despite my crew over at the endocrinology building, I think it's going to help to stay in contact with my PCP as I have known her much longer and am very comfortable with her, plus it will no doubt help my care for her to be more intimately in the loop.

Remind me to write later about a great recipe I got to try out this past week at a couple of potlucks - Fresh Mediterranean Salad - only 6 carbs for a cup's worth.  Until then... 

Thursday
Jun072012

The straw and the camel are not pleased with one another.

AKA - today I freaked out. 

It all started with my second and last appointment (as far as I'm concerned) with the LCSW I was asked to see to check on my sanity.  Nathan came with me as he's been making a point to get to know my care team and we all agreed it would be good to talk about 'feelings' together.  

So to be fair. I do think the first visit with the LCSW was a good thing. It was helpful to talk to someone other than family and for all the information she gave that I took with a grain of salt, she did have some surprisingly astute insights on things I didn't think she had even caught.  The second visit though... well I think it's fair to say, she went off the rails.  

Started off reasonably enough, then, instead of asking Nate to retire to the waiting room or something of that nature she instead began reciting medical advice and information to us about diabetes. Most of it was already known, but the point, most importantly, is that she shouldn't have said any of it in the first place. And she went on and on and ultimately I was feeling really uncomfortable. This isn't even noting the fact that she was making references to her own medical conditions. I think it's fair to say she was 'projecting' to use some nice and applicable clinical speak. Particularly as she went off for some time about diabetic footcare and the horrible consequences of not taking care of one's feet. Also a lot of stuff that my dietitian and endo hadn't felt the need to cover which made me skeptical and scared all at once. To some extent it felt like she was trying to give me problems to have. She kept saying stuff about how 'in the future, you might feel like [INSERT UNCOMFORTABLE, SCARY, NOT GOING TO HAPPEN EVENTUALITY UNLESS OF COURSE I TOTALLY DECIDE TO THROW THIS WHOLE MANAGEMENT THING OUT THE WINDOW]." 

In some ways, I'm glad Nathan was there as he can vouch for the above and probably add some thoughts of his own on the whole thing.  After he and I debriefed about the session, I decided to cancel my upcoming appointment with her as it would undoubtedly do more harm than good.  

Unfortunately she planted the seed. Post camping hike, I came home with some bug bites and a couple of blisters. It was a very long hike after all. Nothing is scary about them, standard water blisters. Since I know quite of bit of my friends/family are in the medical field, let me note that I'm keeping them clean, and am under orders to report if anything looks red, irritated or abnormal. They mostly had reabsorbed when I decided to go with a friend and Nate on a 4 mile run. They still looked fine post run but I did reach out to my endo and RD/CDE to just check in and let them know about them and see if they had any special instruction. They did not, just told me to keep my blood sugars in check and watch 'em heal. 

All sounds good.  But then I notice that I can't seem to get my feet warm, foot actually, my right foot. This is Wednesday and I'm wearing sandals at work and have a small space heater, so I tried that for a while, no luck. Plus I feel a little off, maybe I'm getting sick I think. I left early and totally crashed when I got home, but alas, two hours later I woke up and that one foot, still cold. Nathan, being the adorable man he is, filled a bucket with warm water for me to soak my foot, then after a quick massage, wrapped them up in wool camping socks and my moccasins.  Still the sensation of cold persisted.  

By now I had consulted the internet.  Not a wise move I acknowledge. I convinced myself that I'm having circulation problems and am terrified about my feet. I think I would have been concerned with these symptoms regardless of this disease, however, as a result of the LCSW's diatribe, I started to really get worried. This morning, Thursday, I made an appointment to see my endo for peace of mind more than anything.  I was pretty sure that everything was in my head, a little bit of hypochondria undoubtedly, but just the same, I was scared and I'm pretty sure the anxiety wasn't helping my blood sugars. 

I spilled my guts to my endo. That the LCSW had really freaked me out and that it was probably all in my head, told her that I was scared. I didn't/don't want to loose my feet. She was wonderful. She thanked me for saying something, that she was going to talk to the LCSW, that it wasn't appropriate and it wasn't accurate.  I had just been diagnosed and foot complications like that don't just come on. It's more often in Type 2s and then those that have extenuating circumstances such as high blood pressure and cholesterol that are then compounded by the diabetes.  She tested my circulation, checking my pulse and the response time for blood flow in my toes. The temperature didn't feel any different between my two feet. Everything is great. Beyond that she got to see my most recent set of numbers, my average is 122 for the past 5 weeks - WOOT!  

So ultimately a bit of a crazy high stress morning and, most importantly, I learned a lesson. Keep some Xanax in your purse.  

Thursday
Jun072012

Keeping cool

So the question was raised as to how I kept the temperature of my insulin under control while on our camping adventure and thus I thought it a perfect time for another installment of kitted out: diabetes medical gear explored.  

As you may or may not know insulin is a finicky beast. If it gets too hot it will spoil, if it gets too cold it will freeze and then clump when you thaw it (who wants to inject that!), not to mention that you only have about 28 days from opening of a new insulin pen (in my case) before it starts to loose its potency and you have to replace whether or not it's finished. The safe temperature for in-use insulin is considered to be room temperature (or no higher than 86 degrees Fahrenheit), while unopened insulin should be kept in the fridge. That's right, I have a stock pile of fast and long acting insulin just kicking in the back of the refrigerator with the baking soda.  

Aside from this past weekend of camping, I also have a much needed and much anticipated girls weekend coming up in August which will require transit and thus temperature control of my insulin.  It should be noted that our girls' weekend will take place in glorious Scottsdale (we got a Groupon!) and I hear it's hot there, particularly in late August.

Thus I began my Amazon.com hunt for a suitable solution that both worked effectively, looked good, and ideally had free super saver shipping.  I ended up with the Frio Duo Cooling Wallet.  The Frio line of cooling products covers the gamut, but the version I specifically got of their "insulin cooling" product is meant for insulin pens.  As the duo suggests, it holds two so I can have both my fast and long acting insulin with me and protected from the elements. 

Essentially the concept is that of evaporative cooling. The product is two pieces, and outer shell and then an inside piece that has gel crystals that are water activated. When soaked in ice cold water for about 5 minutes, the whole thing swells up and can keep insulin cool for up to 45 hours at a time. The great part is you can refresh it by just repeating the process. Which was great as after hiking, it had definitely started to warm up so I just soaked it again in the ice water that collected at the bottom of the cooler and I was set the rest of the trip.  

Back in the days of my youth when my sister, mom and I used to hit up the yearly air show at Miramar, we had a similar type of product to keep cool, much resembling this number here.  Although ours were the oh-so 90s red bandana pattern. Super classy.  

Monday
Jun042012

Camping Luedtke-style

Camping! The new (old) frontier! Nathan and I went on a 2-day adventure for his 30th birthday to the far reaches of Santa Clara County to the largest state park in California - Henry Coe State Park. Aside from the jerks in the camping spot next to us (note - if you are a douche, don't hold your bachelor party at a state park - kids and generally decent people, really don't want to hear about your sexual conquests, that, let's face it, are probably lies), we had a great time. The views were really spectacular and it was pretty amazing to explore such a variety of environments all within the scope of one day hike. We explored live oak forests, canyon streams, chaparral ridges and there were even some pine trees and a few redwoods for good measure. Not to mention a lot of wildlife. On the drive up we saw a young buck, at the campsite there was a very curious raccoon, and quite a few hawks and quail along the way.

The challenge of managing my diabetes during the course of a day-long hike in a variety of terrain and high temperatures was a large one. Especially considering that I am still getting the swing of things and figuring out the particulars of how my body responds to exercise, and this was going to be a special circumstance as it was not a 30 minutes jog but a 6.5 hour hike. The map below shows our route (the yellow was our day walk - around 13 miles, and the pink was our evening hike - about 2.5 miles).

The plan was that I would not take any fast-acting insulin but rather combine the exercise with a steady, reasonable intake of carbs, protein and fats throughout the hike to keep my blood glucose in a healthy range. We started out around 9:30am with a hearty protein laden breakfast of a salmon burger with scrambled eggs, gluten-free bun, and avocado. About every hour to hour and a half, I took my BG and adjusted as needed.

Well enough suspense already, here are my numbers from our half marathon of a birthday hike: 

  • 7:43AM (Wake-up) - 96 mg/dl

  • 9:38AM (Start of the hike) - 131 mg/dl

  • 11:04AM - 107 mg/dl

  • 11:49AM - 108 mg/dl

  • 1:27PM - 96 mg/dl

  • 2:48PM - 89 mg/dl

  • 3:40PM - 130 mg/dl (so there's bit of an increase here, as our water stores had run out so I slowly drank a juice box over the course of a half hour to avoid dehydration)

  • 4:24PM - 144 mg/dl

If anything, I got sick of eating constantly to keep my sugars up. I just wanted to walk and not munch away on some almond butter or a lara bar. Lucky for me, my husband enjoys a snack or two, and was very good about not only getting me to test but also making sure we didn't go longer than 30 minutes without at least a bite of dried meat or some trail mix. To some extent, it became a bit of game, and it was really rewarding to see how well we were able to manage my numbers with consistent monitoring both of the actual numbers and how I felt as we climbed. 

Tuesday
May292012

Ode to a Marshmallow

Turns out that marshmallows, well, they are mostly sugar.  I knew this. But as we have begun preparing for Nathan's birthday camping trip this weekend, I had to face the reality of this.  Let me roll back however to first describe my deep and unabiding love of the marshmallow. I love them. I recognize they hold no nutritional value however there is something about that powdery coating that then melts away into ooey-gooey stickiness that just calls to me.  

Let's be clear I am referring to jumbo sized, roasting on a spit, s'more making marshmallows and not the mini version that might as well be used as museum putty.  I love roasted marshmallows so much that I've been know to make them happen over a gas, or hell, even an electric stovetop.  Of course over an open fire is preferred. And then I don't just roast those babies once, I take a twice as nice approach. First I do a quick burn so that the outer layer of the marshmellow takes on a dark amber color and the sugars crystalize to form a bubbly crispy shell. Then that layer is gently removed when it has cooled just to the touch, and again, into the flame the interior cotton ball of marshmallow goes for a slow roast till golden brown and delicious.  

Now it's important to note that I can and I just might have a marshmallow in the future - be it this weekend or some other time - let's however take a look at the numbers and what that means for Ms. Diabetic over here. A single lonely marshmallow is 6 grams of carbohydrates.  But let's be honest with each other - who eats just one, right?  A serving size of marshmallow is 4, so now we are up to 24 grams of carbs.  Now for just the one I could maybe get away with not taking any insulin but odds are good I would see a sharp blood sugar rise as marshmallows aren't exactly complex carbs so they would pretty much hit my blood stream straight away. So when the math is said and done, I would have to take 2 units worth of my fast acting insulin prior to consuming just the marshmallows.

What about s'mores, Michelle?  Well let me tell you that would push us up to about 3-4 units of insulin depending on how good of chocolate is used and assuming a 10 carb graham cracker.  To give some perspective, I've been averaging 4 units of insulin for full meals. This would be 4 units for a single desert. 

With all this in mind, I found myself in Whole Foods this weekend (a dangerous game, let me tell you).  I think in my head I thought that perhaps they would have an ridiculously expensive albeit alternative marshmallow that would somehow miraculously be low carb.  Unfortunately this was not the case. Like a fool I found myself tearing up with the bag of marshmallows in hand. Seriously, I got weepy. 

I think the hang up is not that I can't eat this marshmallow or any other, essentially sugar packed product, but more that I have to think about everything that goes in my mouth. And not from the perspective of "don't be a fatty, Michelle." But rather from the perspective of - will this cause significant BG rise which despite offsetting with insulin will proably still result in a sharp sugar spike that will then cause all the associated symptoms of yuckiness and feeling awful?  Everything in this disease is constant.  Worse part - I'm only 29 days in.