Rats keeping fit -- without diabetes!

From the Islets of Humor website (islets -- like islets of langerhans on the pancreas -- get it?  get it?)

Great Endocrinologist in Seattle/Bellevue

I found a great endocrinologist in the area.  His name is Gary Enzmann and in a two week period he was able to adjust my pump so that I no longer had extreme highs and lows.  Interestingly, he adjusted it so I take LESS insulin.  He said that I was having lows, my liver would kick sugar into my system in a desperate attempt to keep me alive, and then my blood sugars would go to high.  A slight adjustment, and now I am always around 100 plus or minus a bit.  I still have some lows and highs, but I am much, much more stable.

I just received a bill from his office, though, and it looks like my insurance doesn't cover him.  Odd, he was on the list.  I am hoping it's just an interim bill that will show the payment down the line.  If not, I'm going to owe $533.80 for the first visit, and I don't know how much for the second.  And I need to go back in December (plus get a flu shot in the meantime).  I am in the process of trying to get new medical insurance.  I am sure it's going to cost me big bucks, but I've got to do something.  I've had crappy insurance ever since I left Missouri, and even there it was pretty crappy.  It's that stuff that takes over your Medicare coverage.  It is the suckiest insurance in the world.

UPDATE October 15, 2010:  The doctor's office is going to resubmit the bill under a different code.  Hope that works.  Dishonest blankety-blank insurance company!!!!

It's been almost 5 years

It's been almost five years since I posted here.  I started this blog for the Blogathon in 2005.  I was blogging for the Juvenile Diabetes Research Foundation.  Apparently there was no Blogathon in 2010 -- they took a year off -- but there will be in 2011 and I think I'll do it again.  In the meantime, I'm going to pick up this blog on type 1 diabetes and continue it.  I think it provides some useful information.

The interesting thing is that the last time I posted, I had just gotten my insulin pump.  My endocrinologist here in Seattle/Bellevue (he has two offices) asked me if my pump is out of warranty.  I think the warranty was five years (I'll have to check) so that means I have two and a half months before my pump is five years old and out of warranty.  The question is -- if my pump breaks, how will I get a new one?  This one was $5000, and right now I have crappy insurance.  I don't now how Medicare-based insurance (the ones the health insurance companies take over from Medicare) handle medical equipment like an insulin pump.  I'll have to check.

I get my insulin pump!

This is my new insulin pump. It's an Animas, and it arrived the day before Christmas, in a big box full of all sorts of paraphrenalia. I just got it hooked up on Friday. Right now it is pumping saline so I can learn how to use it without any risk -- a trial run, I suppose. Tomorrow, Tuesday, January 17, will be the day I start with insulin.

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."

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.

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!

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!

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.

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

Candice

Berries

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.

Polypharmacy

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.

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 sugar...no, 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?

A1c?

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.