Thursday, August 18, 2005

The Breast Exam and Fragmentation of the Patient

Today I went for my annual mammogram. It is probably the only non-diabetes related medical procedure I experience.

I find mammograms interesting because they say a lot about medicine. The breast, as the object of examination, is manipulated as if it were an independent part of the woman's body. This fragmentation is accentuated by the fact that the surface where the breast is placed is usually cold. The woman is placed in a position relative to the x-ray machine which is tantamount to contortion, as the breast, the focus of the procedure, is pulled away from the body and placed rather aggressively on the cold, hard surface. Finally, the breast is compressed between two plates up to the point of discomfort, which the technician asks about in an effort to get the most squish up to the point of the victim's tolerance.

Thus, the breast almost behaves as an independent entity during the test. The woman is separated from the breast. That is what fragmentation is in medicine. Another example is a Pap Smear, in which the focus becomes the uterus. In this vaginal exam, the woman is even shielded from that part of her body when a drape is laid over her knees. I had a gynecologist once who seemed to recognize me, finally, when he got down in front of my uterus, as though my cervix had my name on it. Once, as I was getting ready to leave, he quipped, "She stands up. She wears clothes." A patient not laying on a table with feet up in stirrups was something remarkable to him.

There is an obvious effort to make the mammography procedure more comfortable. At my "Breast Clinic," the waiting room is decorated with homey brightly colored furniture, almost cushy. There is a valence across the top of the window which faces the hall. In one corner (much to my delight) is a real desk with a computer on it, with Microsoft Explorer up and ready to go. A couple of times in the past, there has been a stuffed dog laying on the cold surface where the breast is compressed, in an attempt to warm it up. I have since learned that there is a market for mammogram warmers -- an attempt to make the experience more comfortable.

Perhaps these measures are meant to encourage women to have their breasts examined every year. It sure beats a cold waiting room, but the comfy waiting room environment ends when the woman enters the examining room. There, everything is functional, and there is no doubt that the breast at the "Breast Clinic" is an entity unto itself. "It stands up. It wears clothes."

Wednesday, August 17, 2005

Continuous Improvement in Diabetes Care

It seems that hospitals and HMOs can improve outcomes for diabetics by focusing on improvement of care.

An article about my health care provider, ThedaCare, give results of a continuous improvement program in diabetes care. The following are some of the results for diabetes care:

...through a combination of strategies aimed at improving care for patients with diabetes, ThedaCare has:

Increased the number of diabetic patients receiving a yearly eye exam from 65 percent to 85 percent

Increased the number of diabetic patients with HemoglobinA1c (HbA1c) levels below 8.0 from 43 percent to 60 percent

Reduced the average HemoglobinA1c (HbA1c) level among its diabetic patients from 8.7 to 7.6

It isn't surprising to me that there has been a focus on diabetes at ThedaCare, since the head of ThedaCare is Dr. John Toussaint, an endocrinologist who was my first diabetes doctor in the area.

Tuesday, August 16, 2005

I am in control!

I have been in control for two days now! I have been testing several times a day, and only once had a value over 200. I am counting carbohydrates and taking only the amount of insulin needed to cover those carbs. It feels great!

Sunday, August 14, 2005

I ate a Sees Chocolate...

I just ate a Sees chocolate. Daniel brought them home. I try not to eat them unless I have hypoglycemia. I don't have hypoglycemia. Okay, so how much damage did I do?

There is an insert in the Sees boxes listing the nutritional facts, as they call them. I have a box of assorted chocolates. There are six charts in the little insert. Find the right one! A serving size for the assorted chocolates is two pieces, calories 160, fat 9 g, carbohydrates 20 g. Those chocolates are expensive luxuries in a diet, with all that fat and carbs! Okay, so I only ate one. One little chocolate -- 10 g of carbohydrate, 4.5 g of fat. Very expensive in the diet.

A cure for hypoglycemia is only the two chocolate serving. If it weren't for my kids, those chocolates would be around for a while!

Tuesday, August 09, 2005

Am I being studied? Nobody asked ME!

I am feeling annoyed today. I went to see the dietitian and diabetes educator, and although things went great with them, I have been wondering about something written at the bottom of my forms. There is a line on the bottom of the form that says "Special Status," and next to that, "Publish." I have seen this before, and in the past it has said, "Study." I have asked what this is about, and I get no answers. It seems nobody knows -- or else I am being put off.

As a social scientist, and a person accustomed to collecting data, it sounds to me as if I were in a study, or being studied, and that the results are going to be published. In anthropology we have a tradition. It's called, "full disclosure." It means that the people who are being studied consent to being studied, that I have told them what the true goals of my research are, and that I protect their identities. I have not consented to being studied nor published. Nothing has been disclosed to me.

UPDATE: I sent an email to my PCP's office, and received back some emails from the nurse (not the person I sent the emails to) giving me the run-around again. At first she didn't understand what I was talking about, and now she is telling me it's probably nothing and not to worry about it. I wrote back and told her to ask and find out. I am not going to accept "don't worry about it." If it's in my file, it's my business.

ANOTHER UPDATE (August 17): I again contacted the nurse at my PCP's office. I told her I was not yet satisfied. She responded that their "MyThedaCare expert" (MyThedaCare is the patient access website) couldn't reproduce the results. She said I need to bring in the form showing the word "Publish" at the bottom. I don't have the form because the diabetes educator took it. I have now sent the diabetes educator an email (also through MyThedaCare) asking her if I could have a copy of the form.

Sunday, August 07, 2005

My Syringes

I know the Blogathon is over, but I had to add one more picture: my syringes. These are ultra fine syringes made by BD. They are subcutaneous. I use 1/3 cc and 1/2 cc. The needles are so skinny and small that you can hardly see them unless you're up close. For anyone who is afraid of needles, the truth is, these don't hurt. You don't even feel them.

The Boys Say Thanks!!!

Much thanks also from Ace and Henry, who were underfoot much of the time during the Blogathon, and especially Ace, who demanded constantly I play with his toy. I wish I could have gotten a picture of them both with a ball in their mouths -- a usually pose.

The Venus of Willendorf takes the last shot...

Okay, I promised one more picture of me shooting up. Here I am taking morning dose of Lantus, rounding out where I started my first shot yesterday morning. I do look like the Venus of Willendorf!!! Oh geesh, to lose that weight...

Luv Ya for all the support during the Blogathon!!!!

To Lei, Patty, Sennoma, Terrilynn, Sheana, and everyone else who followed my blog during the Blogathon! Thank you so much for the support for my efforts and for the Juvenile Diabetes Research Foundation! Thanks to the two friends who donated to my campaign and my mom, whose arm I had to twist but who finally came through.

No thanks to the rest of my relatives, those executives and doctors and lawyers and engineers, who did not come through with a dollar. Not even a penny.

I just want to tell everyone how much I got out of this Blogathon for myself. I never realized how all-consuming my life with diabetes is. To have it all down in words and pictures is pretty amazing. I really learned something from this experience. Plus, I had fun!

And it was great getting to know all of you! Let's stay in touch! xoxoxoxo



Here I am eating blackberries, and the Blogathon is almost over. I should post myself taking insulin one more time. Shouldn't I?

I'm Awake! I Swear!

It's my medication, I know it is. If I just weren't taking so much medication, I wouldn't fall asleep! It's that bipolar disorder. I have an excuse!

I feel as fat as...

...the Venus of Willendorf. I suppose it's one of those female self-image things, but since I quit smoking and gained weight, I feel pretty rotten about the way I look. I bet she had Type 2 diabets.


It's now 2:16 am. I didn't take my pills last night. I have a stack of them for my "head." They call it "polypharmacy." I guess the moral here is that if you have one affliction (say, diabetes) it doesn't mean you aren't going to get another one (say, bipolar disorder). One of my friends once commented, after she was diagnosed with ovarian cancer, that she had been thinking that this was her "big disease." Then she added, "You can think something is your big disease, but then it might not be." Interesting.

Off to take the meds.

Saturday, August 06, 2005

Diabetes and the "Art" of Healing

I am a big fan of the NYU Medical Humanities, Literature, Art, and Medicine Database. This wonderful resource indexes medically-related film, poems, works of art and literature by topic, disease, affliction -- whatever topic you might want to find related to medicine.

There are several medically-related topics I enjoy looking up in this database, but of course diabetes is relevant here. The list for diabetes isn't that long, and oddly, "Steel Magnolias" is not listed under film. There is also no diabetes art listed -- but is there any? Hard to know (maybe I will invent some, ala Judy Chicago...I've got some ideas!).

Still, there are 17 works listed under literature that I haven't read. I am especially attracted to the W.H. Auden poem, "The Art of Healing." I know I must have read this recently. Yes I have read it. Here is a quote:

From "The Art of Healing"
by W.H. Auden

Most patients believe
Dying is something they do.
Not their physician,
That white-coated sage,
Never to be imagined
Naked or married.
Begotten by one,
I should know better. “Healing,”
Papa would tell me,
“is not a science,
but the intuitive art
of wooing Nature.”

Uh oh!

Uh oh! I crashed out there for a little while. Maybe I can use my diabetes as an excuse? Uh...I had low blood, I had high blood sugar...

Thank God, I'm still here!

"Steel Magnolias" and My Pregnancy

I'm starting to struggle with staying awake. I nearly fell asleep thinking about the movie, Steel Magnolias, in which Shelby, played by Julia Roberts, dies of complications of diabetes brought on by pregnancy. Shelby gets pregnant against her doctor's advice and goes on kidney dialysis after the birth of a healthy baby boy.

This film was released in 1989. Camille was born in 1991. I was haunted by the film during my pregnancy, because people (especially my mother) thought my pregancy would harm me like Shelby's harmed her. I hated having to explain that I had consulted with doctors before becomming pregnant, and had been given the go-ahead. I like that movie, but it made me crazy at the time.

BB King and the One-Touch Ultra

BB King is the spokesperson for One-Touch Ultra, which is the meter I have. Apparently he likes being able to get blood for his tests from his arm, so he won't have to prick his fingers which he needs for playing. I haven't really understood the relationship between the brand of meter and where you can get blood. It would seem that multiple sites would have been available all along. If less blood is necessary for testing (if that is indeed the argument One-Touch is making) you would think all the new meters would provide the same benefits. The logic of the argument just doesn't follow. I guess some people buy it, and that's why One-Touch uses that commercial.

I've Blogged 12 Hours of My Diabetes Routine So Far

It's almost 12 hours since the Blogathon began. I have gone through an entire day of sharing my routine. When I started this, I wasn't sure what I was going to blog about. I had ideas. For example, I thought I would talk about going to Africa with diabetes, or how I was diagnosed. But something slightly different happened naturally; I wrote about my day-to-day, hour-to-hour triumphs and trials with my diabetes. I wrote about the basics. I took pictures. I shared what it is like being an insulin-dependent diabetic.

Now that we are coming up on the second half of the Blogathon, I again have little idea where my writing will take me. I am not worried, though. There is still plenty to say about diabetes and how it has affected my life. Now on to the next 12 hours!

Dinner -- The Same Routine, AGAIN

Here is my dinner. A piece of steak and some corn on the cob, no butter or margarine. Total: 25 grams of carbohydrate, 29 grams of fat (3/4 of my fat allowance for the day).

My blood sugar was 286 when I tested it before dinner. It should have been between 80 and 120. Here is how I calculate how much insulin to take: 1 units per 15 grams of carbohydrate from dinner, plus 1 unit for each 50 points above 120. Total insulin: 5 units. I inject myself ONE MORE TIME.

I'm Diabetic, and This is My Meter

I haven't gone through the finger pricking and blood sugar testing on here yet. Well, this is my meter, a One-Touch Ultra. It's half the size of my cell phone and gives results in five seconds. It also stores (I think) 100 blood sugar values.
The meter uses a small drop of blood on a test strip. To get the blood, you need a finger pricker. I really don't understand what all the fuss is about on TV, with people talking about finger pricking hurting. I never found it painful, but I think you have to adjust the pricker to the right depth. Besides, you prick your finger so many times calouses develop. It really is no big deal.
Final picture: the tiny drop of blood to put on the test strip. With the new meters, you need less and less blood, so that is an improvement. I'm sure it helps a lot of people, especially children. It has just never bothered me to prick my finger.

Nearest Distant Shore

Terri-Lynn, who has a 6 year old with diabetes, is one of my sponsors. She has a very nice blog called Nearest Distant Shore. There are some lovely photographs, and a whole lot of music! Visit it.

What they said about my blog

This is what Sennoma said about my blog on the front page of Blogathon this evening:

Candice is blogging for Juvenile Diabetes Research Foundation; she has had Type I diabetes for 19 years. It’s quite an eye-opener to see what she goes through every single day — in fact, every time she eats. Sponsor Candice here.

Very cool! Thank you Sennoma.

"One" Magazine and Crock Pot Recipes

I received a magazine in the mail today from Penzeys Spices. It is the first issue of a magazine called "one." It is an absolutely beautiful magazine filled with incredible recipes -- from regular folks, but totally slicked-out in large magazine format. Unfortunately, there is no dietary information. One would need to sit and figure it out.

One of my favorite cooking websites, Southern Us Cuisine has hundreds of crock pot recipes. I've cooked some great Hungarian goulash from one of the recipes here. I also had to go to Penzeys and buy the sweet Hungarian paprica first. Thus, my crock pot led to receiving the magazine, "one." Funny, huh?


This diabetes joke and many others are from the Defeat Diabetes: Islets of Humor website.

I was bad again...

Oh dear. This time I binged on cookies, and topped it off with two slices of bakery French bread loaded with margarine. I have yet to figure out what this cost me in terms of units of insulin. I think I need to take nine units.

I have had trouble controlling my appetite since I quit smoking a few months ago. I just need to cover everything with insulin. My A1cs have been really bad.

In case you don't know, an A1c is a measure of blood glucose control over the past three months. A good A1c is between 4.8 and 7.0. A1cs at this level reduce or prevent complications. My A1c this last time was 8.9. Scary. This is the reason the doctor thinks I should go on a pump. It seems that my diabetes has become harder to control, even covering for the food. I am doing my best.

These factors are exactly the reason I started Diabetes Buddies. I thought, that with some support, I could conquer some of my demons. Namely, the food demon.

It is so hard to maintain control.

Going Through the Routine AGAIN

Okay, this time I needed to take two units of Humalog insulin, after eating the yogurt and berries. The first pictures is drawing up two units (see how little that is?).

The second picture is me injecting AGAIN.

I'm sure you're getting the point by now. "Tight control" means taking multiple injections of insulin every day. You are watching my routine.

My Lunch -- I do it right

This is my lunch of plain low-fat yogurt and blueberries. It is about a cup of yogurt and half a cup of berries. It has 3.5 grams of fat and about 30 grams of carbohydrate. A very safe choice. Plus, it tastes good. Tastes like ice cream to me. I do like it better with blackberries or raspberries though. I need to take 2 units of insulin to cover it. (Back to the insulin.)

Have I made up for the two cinnabuns yet?

Servings Sizes as Sports Equipment?

I found this on the American Diabetes Association website. It's a guide to portion sizes using, of all things, sports and game metaphors. Makes me want to eat a cup of pasta.

A serving of… Measures… And is about as big as….
Cheese - 1 ounce - Four dice.
Rice - ½ cup - Half a baseball.
Bagel - 4 ounces - A hockey puck.
Meat - 3 ounces - A deck of cards.
Peanut butter - 2 Tablespoons - A ping-pong ball.
Pasta - 1 cup - A tennis ball.

Dogs and Cats with Diabetes

When Daniel and I were living in our first house, a little condo in Irvine, California, the lady upstairs had a cat that took insulin. She faithfully injected it with insulin subcutaneously every day, lifting up its skin. She also had to leave food around for it because a cat can't tell you when it has hypoglycemia and needs to eat.

This was the first time I heard of a cat with diabetes. Since then, I've heard of it a lot. Apparently up to 1% of dogs and cats get diabetes. That's a lot of pets on insulin, and a lot of obsessive pet owners. There are also a lot of websites about diabetes in pets, both about individual animals and about dog and cat diabetes in general. That tells you how common it is.

My friend Chrissy told me just this morning about a lady she knew who had a cat with diabetes. The cat was about 20 years old and the lady had it on an insulin pump. An insulin pump costs about $5,000 nowadays. I wonder how the lady justified that. I guess some people leave their estates to their animals too.

Diabetes Monitor, a e-magazine, has an entire web page of links for diabetes in dogs and cats. It's the best resource I've seen on the subject, although a google of cat diabetes or dog diabetes will bring up all sorts of links.

While we're talking about types of insulin, I should point out that there is special insulin for dogs and cats called Caninsulin. It is a pork insulin.

I don't think I could stand injecting an animal with insulin. I think it would irritate me having to spend my time doing that. It is enough of a hassle injecting yourself with insulin

Insulin for the Cinnabuns

This is my shot to cover the cinnamon buns. The FitDay data says 60 grams of carbohydrate for two medium buns. That would have been four units, but I didn't believe it and took six. I will have to check my blood sugar in a little while. Something else to post!

Eating Bad Stuff -- Again

Check out my FitDay record for today. I have already gone off my diet today. I had two cinnamon rolls with that sugar icing. Daniel made them. I just couldn't resist. I have no will power at all when the food is sitting there on the stove, hot and sticky and ready to be eaten.

Interesting, when I went looking for pictures of Cinnabuns, I found lots of pictures of rabbits. I guess a lot of rabbits are named Cinnabun.

Now to go take some more insulin to cover the cinnamon rolls.

Lantus Insulin and other Insulins

This is Lantus insulin, which is also known as insulin glargine. Who knows what that means. It is recombinant DNA human insulin -- synthetic insulin. Not everyone likes human insulin, by the way. Some argue that it causes hypoglycemia and prefer animal insulins such as pork or beef. Unfortunately for these people, Eli Lilly doesn't make animal insulins any more. I am happy with my Lantus, although I never took animal insulins. Eli Lilly has half the insulin market.

There is a nice webpage comparing insulin types at Drug Digest. I am also including a picture here of the difference between NPH insulin and Lantus insulin. Before there was Lantus, there was always some slope in the way the insulin affected blood sugar. That's the sharp peak. Now that we have Lantus insulin, we have an insulin that provides a steady background dose and the result is less fluctuation in blood sugars. The Lantus is the straight line. Lantus insulin is as much like a pump as possible without being on a pump.

The Genetics of Type 1 Diabetes, by Hsien Hsien Lei

Lei has kindly written this article for the blogathon. She has also written a post on her blog about me, my diabetes related activities and my struggle with diabetes. Lei's blogs include her Genetics and Public Health Blog (where the posts about diabetes are) and her Cotton Pickin' Days personal blog. If you go by her Genetics blog, be sure to check out the article on how humans are genetically similar to pigs!

The Genetics of Type 1 Diabetes
by Hsien Hsein Lei

Type 1 diabetes occurs when the insulin-producing cells of the pancreas are destroyed by the body's own immune system. About 18 regions of the genome, labeled IDDM1 to IDDM18, have been associated with an increase in type 1 diabetes risk.

  • IDDM1 - HLA genes that encode immune response proteins

  • IDDM2 - insulin gene

  • IDDM4 - genes for ZFM1 (zinc finger protein 162), FADD (Fas-associated death protein), and LRP5

  • IDDM5 - SOD2 gene

  • IDDM6 - gene associated with colorectal cancer (DCC), gene that encodes a zinc finger DNA binding domain (ZNF236), and a molecule that opposes apoptosis (bcl-2)

  • IDDM7 - genes for NEUROD1, IGRP

  • IDDM10 - GAD2 gene

  • IDDM11 - genes for ENSA and SEL1L

  • IDDM16 - gene that encodes for immunoglobulin heavy chain

  • IDDM18 - ILB12 gene

  • CTLA4 gene - regulates immune system

  • CD28 gene

  • ICOS gene

Despite these and other candidate genes that have been associated with increased risk of type 1 diabetes, no gene therapy or gene-targeted drugs have been developed thus far. As more genes are discovered and their functions better understood, it will become possible to figure out exactly why some people have type 1 diabetes and to provide them a cure, as well as prevent others from developing it in the first place.

For more detailed information, see The Genetic Landscape of Diabetes, NCBI

Now to "Inject" a Little Humor!

Four Europeans go hiking together, and get frightfully lost. First they run out of food, then they run out of water.

“I’m so thirsty,” says the Englishman. “I must have tea.”

“I’m so thirsty, says the Frenchman. “I must have wine.”

“I’m so thirsty,” says the German. “I must have beer.”

“I’m so thirsty,” says the Jew. “I must have diabetes.”

Will I survive the Blogathon Quiz???

40 %

There's a 40 % chance that I'll survive the 'thon.
Will you survive the Blogathon?

Oh Geesh. It looks like I'm in trouble.

Shootin' Up

Okay I took this picture myself and I sorta missed. I meant to get the syringe in there. What I got was my hand, my belly and a couple of bruises. The bruises are from needles. I don't get a lot of those, but when I do, they stick around for a while. I will have to catch a better picture the next time around.

Drawing up the Syringe

I took this one a little while ago drawing up my dose of Lantus. I take my Lantus in the morning, but that's a different story and another post. In case you don't know, Lantus is a long-acting insulin, supposedly 24 hours, and is a kind of background dose. Anyway, here I am drawing up my Lantus. I took the picture myself, so my other hand is missing, but I think you get the idea.

The Injecting Stuff

This is my current injecting equipment. I've had that pounch with that cooling insert for about 15 years I think. It's filthy. I need to get a new one, or at least wash this one. But maybe I won't need it much longer. I am supposed to get a pump, whenever the diabetes educator decides that I am "ready." As far as I am concerned, I am ready NOW!

The Blogathon Begins!

It's 8:00 am. I am up and raring to go. Gotta go downstairs and take my insulin though. Maybe I'll take a picture and post it!

Monday, August 01, 2005

A1c Testing at Home?

Brystol-Myers Squibb has a machine that allows you to test your homoglobin A1c levels at home. The device is called Choice DM A1c Home Test. The test is disposable and the results come in about 8 minutes. I found it online for about $19.00. Click here for a news release dated December 2004. It appears this little device has only been on the market for seven months.

I don't need a home A1c because I get it tested regularly at my doctor's office. It might be great for people who can't afford to go to the doctor or don't have insurance. Would have been a great thing to have taken to Africa too, hmmm!

Link Between Diabetes and Alzheimer's?

There have been some studies of the relationship between Diabetes and Alzheimer's disease. The latest study, coming out of Kyushu University, Japan, found that diabetics were 3.1 times more likely to develop Alzeimer's disease than non-diabetics.

This number far exceeds the proportion found in studies in the US. One US study of more than 2,500 people found the ratio to be 1.8 times. A study in the Netherlands of more than 6,000 people found that diabetics were 1.9 times more likely to develop Alzheimer's.

Hiroshi Kiyohara, who leads the Kyushu University team, said, "Prevention of diabetes and proper control of blood-sugar levels will become an important issue for society as it continues to age."

These findings are scary for me, because there is a history of Alzheimer's in my family. As far as I know, I am the only one with type 1 diabetes. My uncle, who is not related to me by blood, had diabetes for years before he was diagnosed recently with Alzheimer's. My grandfather was type 2 diabetes when he developed a form of dementia at age 80. We don't really know whether this this was Alzheimer's. It was 1966.