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Thursday, March 31, 2011

So I have this idea . . .

Ever since I came up with the term no-hitter in regards to going 24 hours without an alarm on a CGM, I've had a bunch of hits on that post.  I've seen the term show up in a lot of places, and it's made me proud to see that.  And since the term refers to baseball (and it's opening day), I've decided to create the No-Hitter Hall of Fame

The idea is pretty simple:  let's post our no-hitters in one place as a place of encouragement and honor.  Include your name, date of your no-hitter, your personal high/low thresholds, and what you were doing on the day of your no-hitter (like "eating salad all day and doing nothing" or "ate pizza then ran a 5K").  Very rarely do we get medals for "winning" at diabetes (unless you've been living with it more than 50 years, and I've got very long to go before that), and what better way to feel like a winner than to be part of a hall of fame?!

You can email me your no-hitter at arnoldandme at gmail dot com.  So far I've added mine and Stacey's no-hitter, and I would love to get more! 

Wednesday, March 30, 2011

Hello, is This Thing On?

I think Dexcom might be on to me.  *looks over shoulder*  You see, I was able to extend a lot of my sensors beyond their 7-day standard life to 10 days up to 19 days.  This delayed me ordering another shipment for almost 2 months.  So I think they secretly programmed all of my new sensors to die exactly on day 7 so that doesn't happen again. 

I'm almost done with the first of 4 boxes of my latest Dexcom shipment, and each of those sensors have lasted 7-8 days and no more.  My last sensor got the pink slip after it failed to alert me to a 35 mg/dL low and my current sensor started giving me "Sensor Failed" after I restarted it after its first 7 days. 

My diligence to try to extend my sensors has only led frustration and lack of valid data for 10 of the past 24 hours.  After 2 hours of "???" post-dinner, I was about to change out the sensor before bed.  But it came back to life for 30 minutes.  When I gave it my bedtime BG test, it responded with "Sensor Error #1", which standard protocol calls to wait one hour and try recalibrating.  Not willing to stay up for another hour, I simply turned off the receiver with intentions to try to recalibrate it the next morning. 

I turned the receiver back on and gave it my morning BG reading, and again I got "Sensor Error #1".  "Fine!  Die on me on Day 8!  See if I care!"  So I pulled the sensor out and put a new on post-shower (so it was half a free shower day).  Two and a half hours later, it prompted me for my 2 BG readings. 

Frustration. 

I really don't like when I don't have a CGM overnight, but luckily my BG behaved.  I know I shouldn't get upset about my sensors doing exactly what they're supposed to do--lasting 7 days.  But the frugal side of me still wants to make these things last as long as possible. 

Monday, March 28, 2011

Hardware Department

I've had my trusty insulin pump Arnold for about 3.5 years now. But about 3 years ago, I noticed that changing the AAA battery out became quite a physical feat. You see, the general directions state that you can use a nickel or a quarter to open the battery cap. However, that little booger would not budge no matter how hard I pushed with George Washington's little head.

So I eventually had to use a flat-head screwdriver to open my battery cap. This works pretty well, except my battery cap gets more stripped each time I change my battery. I keep wondering if I'm ever going to get to a point where I will never be able to open the battery cap and will have to order a new pump, but I always get it open somehow.

Until recently.

This past Saturday, after a rainy day spent indoors cleaning the house, I was applying some lotion after drying out my hands with cleaning solution. When all of a sudden, "BOOP-BEEP-BOOP!" "Huh?! I should have plenty of insulin," I thought. I look down at Arnold and saw the empty batter symbol and "Low Battery" lit up by a green backlight. "Fantastic!" Nothing like trying to open a stubborn battery cap with a screwdriver with lotiony hands. It's like trying to put a cat covered in butter into a bath. Impossible!

After several attempts to open the battery cap, nothing was budging. Of course, my mind immediately goes to, "OMG, I can't get it open! I am going to die! Or at least have to give myself a shot every 2 hours until Monday because I don't have a prescription for Lantus!" I was freaking out . . . a little.

I run out to the garage where Trey was working on one of our cars with black, oil-stained hands. "HELP!" I said, holding my pump in one hand and the screwdriver in the other. "My hands aren't clean," he said. "I don't care. I can't get it open because I have lotion on my hands and I'm freaking out . . . a little." So he takes my pump and unscrews my battery cap while I held the new battery in my hand. He puts the new battery in, screws the lid down, and the screen comes back to life. "Thanks," I said, sighing at the same time. He smirks at me, knowing I was freaking out over something so simple, or to him at least.

Day 85 by Arnold_and_Me
Screwy insulin pump.

I do this every time it takes more than 2 attempts to change my battery. I am easily convinced that my life will end because I can never open it. I just need to keep in mind that I have the ultimate Hardware Department just a "Honey . . . " call away. Or maybe I'll just forgo the lotion next time.

Thursday, March 24, 2011

Not Suppose to Happen

Ever since I've had Constance, I haven't had a lot of lows below 50 mg/dL thanks to its handy alarm that goes off when I go below 55 mg/dL.  And she's great about alerting me before then if I go below 70 mg/dL (my preset "Low" alarm).  Needless to say, I was getting pretty good at feeling my lows and not letting them sneak up on me (hello, hypoglycemic unawareness).  That is, until this past weekend . . .

This past weekend we were hosting my parents and nephews during their Spring Break (My nephews' Spring Break, not my parents.  Retired people don't have Spring Breaks, do they?).  So we spent most of the time trying to find activities that would keep a 9- and 11-year-old boy busy, active, and happy.  We went bowling, played pool, played on the Wii, and chased our 2 dogs around in the yard.  The combination of being a full-time aunt and hostess made for little diabetes management.  One day I only tested my blood sugar 3 times the whole day!  (Preview of motherhood?)

So I pretty much relied on Constance to keep me alert to any out-of-range happenings in my blood sugar.  I know that's not her purpose, but I felt confident in her keeping me on track.  And one afternoon, after a series of movies and Wii time, I felt a little "off".  Nothing crazy, just a little shaky and feeling fuzzy in the head.  Constance said I was holding steady in the low 80s, so I didn't worry when I tested expecting a reading between 70-90 mg/dL.  However, a gleaming 35 mg/dL welcomed me on my screen!  I didn't want to alert or scare anyone, so I stealthily grabbed a glass of juice and filled it to the brim.  I sucked it down and grabbed an ice scream bar from the freezer (which we don't normally have, but we were spoiling our nephews . . . and ourselves).

I walked out to the garage where Trey was working on something, and sat down beside where he was working.  Even though my parents and nephews know I'm diabetic, I didn't want to make a scene.  But I needed to let someone know how low I was in case things got worse.  "I'm 35."  "Whoa, really?!" Trey exclaimed.  "Yeah, I didn't feel that one coming."  I just sat there for 30 minutes, eating my ice cream bar while Trey continued working.  "This sucks," I said, finally gaining enough composure to speak.  "How am I going to be able to keep up with our kids when a weekend with our nephews wipes me out?"  Trey jokingly said, "Maybe having kids can be your cure?"  I smiled, and went back inside to test, 110 mg/dL.  I knew I was coming up fast and over-corrected, but a 35 mg/dL scares the crap out of me too much to be conservative. 

This incident only confirms the fact that I shouldn't rely on my CGM in place of finger stick tests.  Had I not tested because Constance thought I was in the low 80s, there's no telling how low I would have gotten!  At the same time, I expect her to alert me well before a 35 mg/dL when I'm low.  That sensor was fired and changed out on its 8th day, because I do not consider a 50 points difference a passing grade.  The current sensor is working like a champ the way I expect it to.  Regardless, incidents like these shouldn't happen.

Thursday, March 17, 2011

"Please, sir, I want some more."

The past day has been a whirlwind for me with my endo and getting a new test strips prescription.  It actually all started on Sunday when I went by the pharmacy to pick up a new refill for all things diabetes:  insulin, syringes, strips, and glucagon.  The cashier hands me my bag o' diabetes and I double check the strips amount because a lack in communication has occurred before.  I peek in the bag and notice that I'm short 50 strips.  I asked the pharmacist why I only had 150 strips when my prescription was written for 200x/month.  Turns out my endo wrote in parentheses after 200x, "test 5x/day".  So my insurance company interpreted that to mean only 150x/month. 

I figured this was a simple glitch on my endo's part.  So I called his office first thing on Monday morning to ask the Rx to be rewritten.  I leave a message on the nurse's voicemail, "Hello, this is Holly, birthday eleven twenty-nine nineteen eighty-four, pharmacy is 'such-and-such' Pharmacy on 'blankity-blank' road, and I need Dr. Special (not his real name, but he has a 'special' sense of humor) to rewrite my prescription for strips from 5x/day to 6x/day.  Thank you!"  Well, the little voicemail message said to allow 48 hours for prescription requests.  So I (not-so) patiently waited until Wednesday afternoon to call my pharmacy to see if the prescription had been changed.  "Yeah, I don't see anything from your doctor," the pharmacist said.  So I braced myself for calling my endo's office . . . again.

This time I refused to be sent to a mailbox, so I optioned for the receptionist to get a live person.  "Hi, this is Holly, I'm a patient of Dr. Special, and I called on Monday to have him change my prescription for strips from 5x/day to 6x/day and that hasn't been done yet?" I inquired as if asking, "And why hasn't this been done yet?"  I get put on hold for a few minutes and the receptionist comes back and says . . .

"Well, his nurse said that 5x/day should be enough since you're wearing a monitor and only need to test 3x/day."  

I stumbled for words before I finally said, "Uhhh yeah, that's not going to work for me.  I want to have 6x/day."  Nevermind the fact that CGMs are not meant to replace finger stick tests, what made me mad is that I told my endo at my last appointment that I wanted 200/month and he didn't even blink!  I really didn't appreciate that he was changing my prescription without talking to me first.  Well the little receptionist said, "We'll need to talk to the doctor about this.  We'll call you back."  Yeah, OK.  This was about 2 PM yesterday, and I never heard back. 

I was steaming after that phone call!  Forget about lowering my blood pressure!  Every vein in my body was pulsing with rage, frustration, and sadness.  Three times a day?!  Sometimes I test that many times before breakfast!  I mean I love Constance and all, but she is not accurate enough for me to rely on her 100% of the time.  The fact that my endo would suggest this meant to me that he is ignorant of the purpose of CGMs and was abusing their purpose.  However, this information was being relayed 2nd-hand through his nurse and receptionist.  I could only HOPE this was a huge error in communication.  

I called again today after lunch (giving them plenty of time to call me back) to see if I was about to make the decision to change endocrinologists.  I get the receptionist on the phone and she said, "Yes, a new prescription for test strips was sent to your pharmacy for 6x/day, 200x/month."  "OK, thank you."  So I have my strips, for now.  But I hope at my next appointment in June that my endo doesn't allude to me needing to test less because I wear a CGM.  It's an extra tool, not a replacement.  It would be like trying to use a screwdriver as a hammer, it just doesn't work the same way.  But I should trust my endo to know that! 

As much as this infuriates me, the last thing I want to do is change endocrinologists.  The next closest options for me are another office 45 minutes away or a university hospital 2 hours away!  I know my endo is not the best endo I could possibly have, but he's honestly all I've got.  And I really don't want to go through the process of changing doctors at this time in my life (see also:  planning for pregnancy).  But right now I feel like Oliver in the orphanage asking for more gruel.  I feel like I'm being punished and put through the mill for wanting to take better care of myself than what 3x/day would result. 

"Yeah, I'm gonna need to see a copy of your insurance card first.  Mmmmkay?"

Tuesday, March 15, 2011

Lows with Lowering Weight

So it's been 2 weeks since my endo suggested that I lose 10 lbs in order to lower the elevated blood pressure I've been having.  And I've stuck to my diet for the most part (usually within 100 calories of my goal) and have kept up a good workout routine including 2 spinning classes a week, jogging 2 miles around my neighborhood, and frequenting my Wii Fit Plus. 

I knew once I started losing weight that my insulin needs would decrease.  This has been evident by the increased number of lows that I've been having.  As far as the scale goes, I've only lost one pound since my appointment, but my body feels like it's more.  But I need to something about these lows because the calories spent correcting them will only hinder my weight loss.  For example, an 8-minute ride on the stationary bike at physical therapy had me at 47 mg/dL?! 

I don't think my basal rate(s) need to be messed with at this time, because my nighttime numbers are spot on if I go to bed in range (80-130 mg/dL).  The majority of my lows seem to occur after working out, which means I'm not disconnecting Arnold soon enough or I'm jacking up my IOB from my meals.  And my insulin:carb ratio seems to have my post-prandials a little lower than I like for them to be.  So I decreased my I:C ratio from 1:12 to 1:15 in hopes of avoiding these lows, and I'll make a point to disconnect Arnold (or at least turn him down) to avoid the post-workout lows. 

But I would love to hear from another type 1 diabetic who has successfully lost weight!  Please, help me figure out how to avoid these lows so I'm not wasting a spinning class on glucose tabs.  And as delicious as it is, I'm getting tired of eating spoonfuls of peanut butter before bed.  Any advice/suggestions would be extremely helpful! 

Friday, March 11, 2011

Using Diabetes to My Advantage

We all have to manage our diabetes.  We test our blood sugar, take insulin, and try to get some exercise, all for the sake of better blood sugar management.  But sometimes we can actually make diabetes work for us. 

I came across this idea when I woke up this morning to a blood sugar reading of 67 mg/dL.  Yeah, it's low, but it's not a fall-down-inject-me-with-juice low.  I can still function at this number.  The past few days I have woken up on the lower end of my fasting range, mostly due to being more active in an effort to lose weight.  I've only lost one measly pound (grrr!), but I know my body is getting stronger and building more muscle.  So I expected that my insulin needs would decrease.  Anyway, back to my point . . .

My usual routine when I wake up is to test, bolus for breakfast, and take a correction bolus to account for the dawn phenomenon (DP) and time spent in the shower.  Yesterday, I woke up to a similar number (65 mg/dL, I believe) and scarfed down 4 glucose tabs before jumping in the shower.  Well, I forgot about the whole DP thing and ended up jumping up to 153 mg/dL before I even ate breakfast.  So I decided this morning to forget the glucose tabs and the correction bolus altogether, just to see what happened.  (Note:  Please do not, under any circumstances, take this story as an example to be followed.  You should definitely treat a low with glucose as the "official" treatment.  See also:  Disclaimer.  See also:  Your diabetes may vary.)  I get out of the shower about 20 minutes later (yeah, it's wasteful but I like to "wake up" in the shower) and test again:  81 mg/dL!  Woo hoo, back "in range"!  So I bolus for my upcoming cereal and go about my day. 

It's not often that I can actually use the fact that I'm diabetic as an advantage.  It reminds me of the possibility of having an artificial pancreas, where I can manually insert glucose from my pump at any time instead of relying on glucose tabs or DP to do so.  (Pssss, take a note, pump companies!)  Besides, the less incidents of waking up chewing glucose tabs, the better. 

Have a great weekend!  (And please keep the people of the Pacific in your thoughts and prayers, especially those in Japan.) 

Wednesday, March 9, 2011

(Not So) Ruined Workout

Yesterday afternoon I went to my second (ever) spinning class. I'm still trying to figure out my insulin levels before this workout, because my greatest fear is going low during the class. Well, that fear came true yesterday.

It all started when I decided to have a snack (Fiber One Oats & Chocolate bar) in the afternoon. Dumbo me actually bolused for the whole bar (29 g) and I forgot to subtract the fiber for the net carbs, which seems to help me avoid lows on a regular, non-workout day. Also, I didn't disconnect Arnold until 30 minutes before the class. Last time, I disconnected an hour before, and even though I went for a half-mile walk beforehand to warm up my legs, I still didn't crash. So all these forces combined (like Captain Planet?) to have me at 83 mg/dL going south before the class according to Constance. I downed 5 glucose tabs as fast as I could, said a prayer, and hopped on the bike.

The class gets started. We warm up with our "leisurely stroll through the countryside", followed by sprint intervals. I checked Constance after the sprints and she said I was now 52 mg/dL heading southeast! I didn't hear her alarm over the blaring music, so I'm going to have to figure out a better scenario for having Constance in plain view rather than relying on hearing her. Frustrated, I threw my little bag down on the floor, almost to say, "Screw you, diabetes, I'm gonna keep spinning until I pass out." We start doing climbs in the standing position, and I notice that I almost lose my balance. "Hmmm, something must be wrong with this bike," I thought. Or your blood sugar, silly.

After the climbs the instructor told us to take a water break. Most people stay on the bike and keep pedaling while they grab their water from the holster below the handlebars. I finally got a level head and decide to jump off the bike and test. I could feel the 6 pairs of eyes on me all at once, but I had to do it for my own safety. By this point, Constance said I had leveled out to 55 mg/dL, so it seems my glucose tabs were finally kicking in. A test confirmed I was at 70 mg/dL, a little higher than my CGM. After that test, I felt confident enough that I could finish the rest of the 20 minutes of class. I jump back on the bike to finish out the class with some jumps.

The class ends, we stretch it out, I put my bike up, and walk back to the locker room to test my blood sugar again: 61 mg/dL. I eat 4 more glucose tabs, and call Trey, "Yeah, I'm gonna be a little while. I can't drive yet." With a mouth full of chalky remnants, I take a seat on the gym couches (really?! in the gym?) and wait out my low.

Day 67 by Arnold_and_Me
I love having couches at my gym. 
At this point my instructor comes out of the locker rooms, and she stops to say how good I am doing for being so new to the class.  "You're really keeping up with the rest of them," she smiles.  "Thanks," I said back.  "So, you're diabetic . . . " she inquires.  "Yep, type 1."  Then I go into how I wear an insulin pump and a CGM, the gizmo I was checking during class.  She seemed to be comprehending what I was attempting to explain, and finished with, "Well, you're doing great, so keep it up."  

Even though I completely wasted the calories that I burned with the amount of glucose tabs I ate, I know I'm doing more good for my leg muscles, lung capacity, and endurance.  That's the positivity I'm clinging to right now, because if I focus on the fact that diabetes stole my calorie burn for the day I would never return to the gym.  I know I'm building muscles that keep burning calories long after the workout is over, which increases my base metabolism.  And I'll keep figuring out my insulin needs, and perhaps I'll forgo the insulin for the afternoon snack altogether.  Either way, I can't give up on this.  I won't give up on this! 

Monday, March 7, 2011

Dealing with Insurace Company Phone Reps

As a PWD (person with diabetes), I rely on having insurance to cover most of my medical bills.  And by rely, I mean I expect certain things to go off without a hitch.  Like getting pre-certification for physical therapy, for example. 

My initial visit with my physical therapist was what was called a "diagnosis/recommended therapy" visit.  This means that my physical therapist (PT) took a look at my knee, how I walked, and muscle structure and submitted a recommendation to my insurance company of what kind of therapy I needed.  Said insurance company then receives the recommendation and submits a pre-certification back to my PT for said therapy.  This process, in ideal theory, should take a business day (two at most) to get done, especially when you're expected to get 3 sessions of therapy a week for 4 weeks before the next orthopedic appointment in 6 weeks. 

But . . .

Unless you stay on top of the insurance company like a rabid zombie gnawing on their neck, this process could take 2 weeks if left unattended.  The initial call to my insurance company from my PT resulted in them telling my PT that this process would take 4 business days.  This was somewhat annoying because it meant I was going to miss half a week of therapy (2 sessions) before I could come back.  Well, 4 days come and go and my PT's office calls my insurance company again, inquiring about the pre-cert. and the very vague just-trying-to-get-you-off-the-phone answer was given, "It's in process."  I hate getting this answer from anyone!  Where in the "process" is it?  How much longer should I expect to wait?  Why would you give a timeline of 4 business days, miss the deadline without notifying us, and cease to apologize?  It's absolutely a slap in the face to say "It's in process"!

So my PT's office calls me to let me know that I would have to cancel another schedule therapy session because they were still waiting on my pre-certification.  I had turned from annoyed to infuriated.  Being the very involved patient that I am, I asked for the number of the authorization office to take this matter in my own hand.  I prepared myself for the inevitable bad mood that was about to follow this phone call, but luckily this comic strip gave me a giggle. 

I called the number, went through the voice-automated responses (several times I got "I'm sorry, I didn't catch that."  Well, learn the Southern dialect Ms. Stick-up-your-butt Robot!) until I finally got a real person, in some department.  I didn't really care which department, I just wanted a live person!  Now, what irks me about calling any customer representative department is that they ask you several questions before you can even begin to ask yours. 

Below is an (exaggerated) retelling of the phone call to my insurance company customer service number:   

CR rep:  "Hello, this is Monica (names have been changed to protect the guilty), can I have your name, address, member ID number, and blood of your first born child?" 

Me:  "Ummm, my name is Holly, my address is . . . , my member ID number is . . . , and I currently don't have any children, would the blood of one of my cats do?" 

CR rep:  "Certainly!  What can I help you with?" 

Me:  "Well, I've been waiting on a pre-certification for physical therapy that my orthopedist recommended for me, and it's been 4 business days since my PT's office called for that.  Where is it?" 

CR rep:  "Let me see . . . *clickity click click* . . . hmmm, I don't see where that request was made." 

Me:  "No, it's there.  I just got off the phone with them, please look again." 

CR rep:  *clickity click click* . . . Ahhh, yes, there it is.  I just had actually LOOK at the computer!  Haha, silly me.  Yes, it appears the request is in process (grrrr!!!) and it usually takes 7-10 business days to fulfill this request." 

Me:  "7-10 business days?!  My PT's office was told 4, why is it taking so long?" 

CR rep:  "I don't have that information in front of me, that would be with the Authorizations Office." 

Me:  "Well, can you transfer me to them, please?" 

CR rep:  "Oh no, they don't deal with members directly, they only deal with providers." 

Me:  "Well, can you transfer me anyway?  My provider has tried calling several times already." 

CR rep:  "I can see.  Please hold." 

*really bad elevator music plays*

CR rep:  "Yes, I'm sorry, they won't talk to members directly, they only deal with providers." 

Me:  "Yeah, I don't care, I still want to be transferred and let them know that my provider is waiting for it." 

CR rep:  "OK, but they won't want to talk to you." 

Me:  "I don't care, they're GOING to talk to me.  Please transfer me." 

CR rep:  " . . . Please hold." 

*extremely bad elevator music plays* 

AO rep:  "This is Jennifer, can I have your name, address, member ID, and left ovary please?"

Me:  "Left ovary?  Why?" 

AO rep:  "Standard procedure, ma'am." 

Me:  "Ummm, OK.  I am calling about a pre-certification for physical therapy.  I was told it is in process, but I was wondering if there was any way to speed the 'process' so I don't miss physical therapy." 

AO rep:  *clickity click click*  "I'm sorry, that request is not here." 

Me:  "No it is there, the person I talk to before you said it was.  Please check again." 

AO rep:  *click*  "I'm sorry, it's still not here.  You need to have your doctor call to request it." 

Me:  "He HAS requested it!  It is there!  Please.  Check.  Again." 

AO rep:  "I'm sorry, ma'am.  It's not there.  I have looked."  *click* 

Me:  "Hello?  HELLO?!  Son of a . . . !!!"

Yes, I was hung up on, by MY insurance company rep.  I was fuming!  This company is there to serve me!  I am their customer, and they practically spat in my face!  I was never rude or cussed, I just kept asking for answers to my problem that no one could give me.  But I learned a few things about getting some results out of dealing with calling your insurance rep: 

  • Be polite, but firm.  I never cussed or raised my voice.  I always ended everything in "please" and "thank you".  This gives them no reason to refuse your request. 
  • Refuse to end the call until you receive an answer.  I didn't care if I would eventually be transferred to the head of the company, I was going to talk to someone until a) this matter was resolved or b) 5:00 PM, whichever came first. 
  • Have your insurance card handy.  By the end of the call, I about had my member ID memorized.  
  • Be patient.  I'm saying this to myself as well, but I refused to let another day go by without an answer.  
My PT's office called me this morning at 9:00 AM and told me that the pre-certification had come in.  "I don't know if it had to do with you calling them, but we got what we needed!"  Oh, I'd like to think that I DID have something to do with it.  ;-)  

Friday, March 4, 2011

Spinning? Insane!

So I bit the bullet yesterday and attended the spinning class I talked about.  I was actually nervous all day about it, checking Constance to make sure I was going to be at a good number before the class, and taking mental notes about my knee.  I had done some lunges the night before, and my knee was (not) thanking me for it.  But I decided I was at least going to try. 

I get to the gym and take a number for a bike; apparently, you have to reserve a spot for this class.  Another guy took a number for the class, and asked me if it was my first time.  "Yeah," I said sheepishly.  Well, the very nice gentleman gave me the run down on the bikes, how to adjust my seat, and how nice the instructor was.  "If you haven't warmed up your legs yet, I'd suggest doing so.  This class can get pretty intense," he advised.  "Thanks, but I just warmed up by doing the half-mile trail outside."  Before this, I had disconnected from Arnold in order to be "unplugged" for an hour by the time the class started.  I didn't want to take any chances of going low.  I checked my blood sugar before the class:  135 mg/dL--perfect, a little high but not crazy.  And I had Constance neatly tucked into a thigh holster I had purchased for my wedding

Apparently my pump and CGM are the same size in spandex. 

The instructor was running late, so the rest of the class members just started pedaling at their own pace as a warm-up.  I followed suit, making sure my feet were properly strapped in.  The instructor finally shows up, and the nice gentleman who helped me pointed me out to her as "We have a new person!"  Greaaaaaat, nothing like calling me out to the whole class to make me feel welcome.  She welcomes me and proceeds to tell me that my seat is too low.  We adjust my seat together, and she takes her spot at the front of the class. 

Now, anytime I've ever seen a spinning class on TV, I've always imagined a very sweaty Nazi-type lady with a perfect physique welling at everyone, "Faster!"  Turns out the devil wasn't the trainer (she was very nice), it was that stupid resistance knob!  After we warmed up, the instructor told us "Half a turn" and we would pick up the pace, standing on the bike, sprinting like our life depended on it.  My legs felt like they were on fire!  I honestly felt like stopping at one point, then the instructor said, "Twenty more seconds, all you've got!"  I thought, "I can do 20 more seconds."  I used that mindset the whole class when I felt like it was getting to be too much, "Just keep going, a few more seconds." 

We ended the class doing "jumps", which means anytime the instructor said "Up!" we had to stand up on our bike and pedal like a gazelle until she said, "Down!"  I wasn't as quick with my "jumps" as the other class members, but I held my own.  We did these jumps for about 5 minutes, then ended the class with the lowest resistance and a "nice leisurely stroll through the countryside" as my instructor said.  I kept a water bottle close at hand during the class, but I had my little bag of glucose tabs and mini meter behind my bike, just in case.  I check my blood sugar at the end of the class:  104 mg/dL!  I decided to remain unconnected for the drive home, in case my BG decided to take a nose dive after such an aerobic workout.  My knee never gave me any trouble, either, so no worries there. 

And what better way to arrive home than to my hubby making smoked salmon in the new grill for one of my favorite low-carb meals:  Salmon Caesar Salad.  And according to myfitnesspal, I burned 374 calories during my spinning class, which earned me the right to cheesecake after dinner in order to make my minimum calories for the day.  Yum! 

Oh yeah, and thank you guys so much for all the support after my Overwhelmed post.  I've realized that it's probably not just my weight that's contributing to my blood pressure problems, but also my stressful lifestyle.  I need to get out and do things that are fun, more than worrying about burning calories.  And as much as I liked the spinning class, I'm looking forward to hitting the trails again (maybe this weekend). 

Have a great weekend! 

Tuesday, March 1, 2011

Overwhelmed

Yesterday's endo appointment didn't go very well.  I wasn't really expecting it to go great, but I didn't expect it to be as bad as it was.  I had suspected that my A1c was going to increase from last time, but I figured I would land around my usual 6.5 that seems to follow me without much effort. 

My appointment was at 8:30 AM across the interstate in downtown, so of course I visited the closest coffee shop on the way to grab an Americano for the hour-long drive.  Armed with my Dexcom software graphs and coffee, I took a seat in the lobby and snapped a pic of the freakishly-empty waiting room.  (For those who know my endo or go to him for his care, you know the waiting is usually very full!) 

Not 20 minutes later, my name was called and the nurse led me to my room.  She took my weight and my blood pressure.  She was putting the sleeve back in its holster when I asked, "What was it?"  "130/90," she said.  Another elevated reading, this was something I was definitely going to bring up to my endo.  She also took my blood sugar (168 mg/dL) and began spinning my A1c.  What kills me about the A1c machines at me endo's office is that you can see the timer!  I was tortured watching the 5-minute clock slowly make it's way down to 0:00 waiting for my number.  During that time, the nurse downloaded my pump data and made sure all my medications were the same.  Finally, the clock goes down to 0:00 and I see the number before she does:  6.8%. 

I felt defeated.  I couldn't help it.  I know most people would be content, even happy, with this number.  But for me, this number is way too close to that 7.0% threshold required for pregnancy.  I immediately started thinking of changes I needed to make, but I barely had any time before the endo came in the room. 

He shook my hand and took a seat beside me, and he starts going over my Dexcom graphs with me.  This really surprised me, because my endo has been reluctant to the whole CGM thing so far.  So it was nice to see him wanting to use the tool I wanted for so long.  He said it looked like I was correcting too many times after a meal, resulting in a lot of lows.  He thinks my overall basal rates were too low, so we increased my total amount by making my basal rate one rate for the whole day.  I'm not sure I agree with this right now, but I know my basal rates are messed up, so it's best to start over with a single rate for now.  He also wanted me to increase my IOB time by 2 hours and make my target BG 120 mg/dL.  I compromised by increasing it to 1 hour and keeping my range at 100-120 mg/dL; I don't mind being at 120 mg/dL, but I refuse to treat 100 mg/dL as "low". 

Then I addressed the elevated blood pressure reading with him.  I told him I had been having a lot of appointments lately with my knee, and each time I was having elevated readings.  He agreed that he doesn't like this trend, so he took a look at my history with his office over the past 4 years and notice another upward trend:  my weight.  I've never had a huge gain all at once, just a few pounds here and there.  But a few pounds over a couple of years can sneak up on you.  He said the best thing I could do to reduce my blood pressure was to lose 10 pounds, or else we'd have to do "something".  I'm assuming he means I'll get put on blood pressure medication, which wouldn't be terrible because they could also protect my kidneys.  But I don't like knowing that I didn't do all that I could to be healthy on my own. 

So to recap:  increased A1c, weight, and blood pressure.  I debated calling Trey immediately after the appointment, because I knew it would result in tears.  And it did.  My poor husband can read me like a book, even over the phone.  And when he said, "I know you're about to cry . . ." I lost it.  "It's not the end of the world, Babe.  You're still doing great.  We just need to change some things."  We agreed that we had been calling the local pizza place too many times over the last few months when we had no plans for dinner.  And even though I've increased my physical activity over the past couple months, I need to bump it up.  I've decided to give the spinning class a try (now that my knee is feeling better.  Thank you, physical therapy.), and softball is about to start up again.  Hopefully these things will help in the weight department. 

I really don't know how to end this post other than to say I'm feeling very overwhelmed right now.  Ten pounds seems so impossible, seeing as I'm struggling to keep 2 lbs off on a weekly basis.  I can log my food with some consistency and keep up a reasonable workout routine, but more than anything I need encouragement.  I need hope that this is not an impossible feat.  I just need to find something that works for me, but first I need to know that everything will be OK.  I need to stop freakin' crying about this and find some joy again. 

Sorry, guys.  I know this isn't how I wanted to end this post, but sometimes I need to be real.  And I hate this, period. 
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DISCLAIMER: I am not a doctor, nurse, certified diabetes educator (CDE) or any medical professional of any kind. (But I did stay at a Holiday Inn Express!) Therefore, please do not use any of my postings as medical fact. I am simply a blogger expressing my highs and lows (pun intended) with diabetes. For changes in your medication, exercise regiment, or diet please consult a qualified physician.

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My name is Holly and I live in north Alabama with my hubby, two cats, and a dog.