Post Christmas

It was quite an event. Lots of family time, lots of driving, but lots of fun too.

I got some great diabetes gifts. (though when I open them I see a little look of pain in my mom's eyes, wishing that I didn't have to open things like that)

1. I got a new Salter nutritional scale and can't WAIT to try using it. I read about it on someone else's blog, and it sounded like the perfect addition to my diabetes stash. I haven't tried it out yet, and am kinda wondering where I should keep it in the kitchen, and where the "code manual" will be safe. Any suggestions?

2. I got my first set of groovy patches! O.k., o.k, they are silly, but I'm excited about them. Anything that adds a twist to the daily grind with diabetes is exciting. I changed my site last night and used one for the first time. I feel like I'm wearing new shoes or something like that. I keep lifting my shirt to look at my belly.

3. I got a bunch of banana flavored GU. I like using that for lows--I only like the banana flavor ones. Actually that's not true. I like the berry flavor, but it has caffeine in it and I don't really like having caffeine in the middle of the night. They are also nice to put in Dixie's vest because they are small and squishy, so when she is lying on her side, they don't get destroyed and they're probably comfortable too. ;-)

I'm off from work this week. Phew! I have time to try all the cool new presents and unpack everything.

Hope that everyone had a great holiday.

...Please, can I?!

I don’t like to change my pump site. It doesn’t matter that I’ve been doing it for many years. I still hate it. I hate the time it takes and I hate the pain it causes. I use quick sets, and a quick serter. My old quick serter seemed to be loosing it’s bling, so I ordered two new ones. They’re driving me crazy. The quick set doesn’t seem to “nest” in the serter, the way that it did in the old one, causing the sets to fall out when I tilt the serter toward my stomach.

I must have really hearty tissue. I have always been able to get away with leaving sets in for up to 6 or 7 days. My friends with diabetes have always gasped at this fact. “Doesn’t it hurt?” Nope. I leave it in until it feels irritated or until my fasting blood sugar in the morning starts creeping up. I know, I know, I’m going to diabetes hell. Believe me, that’s not the only reason I have a special suite ready and waiting. (darn holiday snacks!)

But for the last couple weeks, I haven’t been having great luck with pump sites or blood sugars. So I’ve been changing the set every three days. And by golly… it really does give more consistent blood sugars.

As I was standing outside with Dixie today, watching her romp through the grass and roll on her back, I was a little disappointed. Knowing that I really should change those darn sites more frequently was like I had gotten the “real” answer from one parent, and desperately wanted to find the other parent for a “better” answer.

O.k, O.k., I know… stick with the first answer. Don’t go looking for the answer you want. Stick with the one that is right.

Habits

Does anyone wipe their infusion spot with alcohol after every disconnection?
I wonder if it helps prevent infections? Or if it even matters at all. Is it worth the cost of the swabs?

I emptied all of the garbage baskets in the house yesterday. I can’t believe the amount of alcohol swab wrappers that were in the trash.

I do it. Religiously, every time. It’s a habit. In the many years of pumping, I’ve had one infection that needed antibiotics. Sure, I put Neosporin on every site when I remove them. So maybe that’s the reason I’ve been infection free.

I can’t really say that I use sterile procedures when inserting a new set. I wipe with alcohol (there’s another swab wrapper) and usually wash my hands before injecting it. When changing just the cartridge of insulin, I clamp off the tubing and hold it with my teeth momentarily, using both hands to push the pump buttons and insert the new insulin. Sterile? I don’t think so. (although I do hold my breath when I’m holding with my teeth☺)

Ah, my diabetes habits…

Back on the charts

Well…many site changes later and very frequent testing have brought my blood sugars back on the graph. Amen.

Times of wacky, unexplained high blood sugars kinda freak me out. I worry that my 12 years of pump use have completely fried my tissue. Specifically, the tissues of my abdomen. I worry that if I’m having scar tissue problems now, what will things be like with the next 12 years of pumping.

Taking a “pump vacation” isn’t really an option for me. Long acting insulin always caused more allergy problems, and so I’d have to just take frequent shots of regular or lispro. That doesn’t really feel like a “vacation,” just like setting up a tent in the backyard.

So I stand in front of the mirror, looking at my belly and hoping to see a viable place to put the catheter into, but the choices are pretty limited. I know that other people use their legs, etc.. for sites, but I just can’t do it. Or, at least, not yet. But I said the same thing about using my stomach in the past. Before I started pumping, I had not once given an injection in my stomach. Hell, the only way I would agree to a pump was to get Emla cream from my endo and numb my skin before inserting the needle. (back when I got the pump, it was assumed it would only be put in the abdomen)

I feel like I’m at a crossroad. I need to figure out other options and give my stomach a break.

For now, I’m happy that I am back in a good range and able to coast a little.

It’s comforting to read other blogs and see that other folks are dealing with high blood sugars right now. I have tested so many times in the last 10 days that my fingers are threatening to go on strike.

I usually change my set every five(ish) days. (Shhhh! Don’t tell) This last week, I changed it three times. It wasn’t that the sites were a complete bust…just seemed to not have the usual hmpff to them. Dixie has been alerting like crazy. Poor thing, she’s just not used to dealing with me with high blood sugars. I give correction after correction, but it has been taking much more insulin and much more time to bring them down the last week. Dixie doesn’t like the “waiting game.” She’s rather play fetch with her tennis ball. ☺ And quite honestly, so would I. The “wait for high blood sugars to come down” game is a sucky one. I have to be strict with myself to not test obsessively every 10 minutes and give correction insulin. Thank goodness for the “insulin on board” feature on my pump that won’t allow me to just give extra insulin willy-nilly. Otherwise at times like those, I fear that I would. Let me be honest. At times like that with my old Disetronic hTron, I used to give insulin like crazy and then bottom out a couple hours later. Is it stress? Is it a bad batch of infusion sets? Is it the insulin allergy flaring its ugly head and causing this reaction? I don’t know.

I’m frustrated. I’m confused. Dam diabetes. (pathetic sigh…)

Learning

It’s fun to introduce Dixie to new people. Especially people who know something about diabetes. It’s even more fun when Dixie alerts me when I’m low and others get to watch.

Doctors have a hard time believing that a dog can know when blood sugars are not in the optimal range. Sure, the doctors that I have contact with smile nicely and appear supportive. People think that if I just tested more, I wouldn’t need a silly dog. In fact, before I got Dixie, several people asked me if I had ever tested my blood sugar before. If only it was that easy.

Hypoglycemia unawareness is a challenging problem. I used to get autonomic symptoms (sweaty, shaking, etc.) when my blood sugar dropped under 80. (except at night when I haven’t ever awoke to symptoms.) Now I’m lucky to have symptoms when I’m 50. Most likely I don’t have symptoms until 40. Then I’m not smart enough to make good choices, and I drop even lower. It’s not pretty.

I work to keep my blood sugars in a very tight range. The side effect of this is more frequent lows. What I have found with Dixie, as many people have probably found with continuous blood glucose monitors (only my monitor is furry, cute, snuggles and can wake me up when I’m low or push the Life Alert button to activate help), is that she knows when I have too much insulin on board. She knows when I am going to drop too low. Like yesterday I finished a lunch and gave a bolus for 35 carbs. An hour later, Dixie started alerting. She was pawing and pawing at me, then jumping on the table when I was working with kids and pawing the kids. (she has learned which kids are reliable and safe to approach) I tested. Blood sugar was 134. I had some insulin on board from lunch. I had another 15 carbs of Gatorade and tested a half hour later. Blood sugar = 86. If I had not had the 15 grams of carb, I would have gotten low. This way I added a little carb, went on with my teaching, and never had to deal with confusion and low symptoms. I would have never tested to find out that I was 134. In training, I used to say “wrong” to Dixie for alerting when I was 134. Then over time I learned. She knows.

I don’t recommend a service dog for everyone with diabetes. It’s not magic, nor is it perfect. You have to love dogs. Check. You have to be able to develop a strong bond with the dog. Check. It takes work to train. Check. And in the middle of a spelling lesson, sometimes they have to go outside to go to the bathroom. (or chase rabbits ;-) For the right person, like me, it can be the best.

Dixie

I’ve always had a hard time sensing low blood sugars. After a serious reaction that required glucagon, my endocrinologist told my mom that I had a “defective adrenaline system.” As a child I had many reactions that involved my parents sitting on me trying to get me to eat something, glucagon, and/or visits from the paramedics. As an adult, I have always been vigilant about testing often, to prevent these lows. I would get up in the middle of the night to test. Many years ago, my beagle/terrier mix dog had started waking me up in the middle of the night if I was low. She would lick in my ear and bark until I got up. She died 4 years ago, and I realized how important she was to my diabetes management. That’s when I started exploring the possibility of getting a dog that would be trained to alert me when I was low. Specifically at night when I was sleeping.

A friend led me to Great Plains Assistance Dog Foundation in Jud, North Dakota. I filled out an application and started thinking about financing. The cost of a service dog from Great Plains was $15,000. I filled out financial assistance forms. Then, my colleague at school told me that she wanted to spearhead a school district fundraiser for me to get a dog. She arranged everything. I went to my dad’s Lion’s Club meeting and they agreed to give me some money. I finally got a call from Great Plains that they had a dog for me, and I scheduled training for August of 2005. My school district raised over $8,000 dollars. My sister made a donation. I had all the money that I needed.

I went to Jud for three weeks. The first day I worked with a couple of different dogs. The last one I worked with was Dixie. She was much smaller than the other labs there. They thought she was a lab/chow-chow cross, because she had a black tongue. I knew that she was going to be the one for me. The training staff told me that she was my primary candidate. The first day I sat and watched a video. Dixie sat by my feet. A couple minutes into watching it, Dixie sat up and started hitting me with her paw. The training staff had told me to test anytime she did anything “different.” I tested and was 62. My first time being really excited to be low. That was the beginning.

Dixie was only about a year and a half years old when she came home with me. Her skills continue to refine over time. When I’m low or dropping, Dixie will sit and hit me with her front paws. If I don’t respond to that, she will hit harder. If I still don’t respond, she will do other things. If I’m at school, she will jump on a table in my classroom. If I’m at a restaurant, she will break her “down- stay” and stand up and stare at me. I am not high very often. But this past weekend, we were out shopping and she kept staring at me, standing and breaking the commands that I gave her. I finally tested and was 320. My pump site was not working anymore. People ask if she has different signals for low or high. No, she doesn’t. I haven’t focused on that in her training because high doesn’t happen often and I can feel that. It’s the lows that I don’t get symptoms for anymore.

It’s not always easy or convenient to have a big, black dog around. But she has saved me over and over again, and the inconvenience doesn’t seem to matter. Now that we’ve been together for a year and a half, I can’t imagine not having her to help.

Dixie is my miracle. I am blessed.

Flu shot

I’m a wimp.

A couple weeks ago at work, there was an email with information about flu shots. If my school had enough people sign up, a nurse would come to school and give the injections there. Just show up with your insurance card, fill out a form, and BAM.. A flu shot was yours for the taking. I didn’t sign up. I hate shots. I know, I know, I have had diabetes for the last 31 years. I have taken thousands of injections and have been inserting pump sets for the last 12 years. But I hate, even more than that… I abhor shots. Especially when I don’t give them myself. I have had one flu shot in my life. I think I was about 13 years old when I got it. I’m sure that the doctor bullied me into getting it, and I’m sure that my mom was along and insisted that I get it. I remember that it hurt, so I didn’t sign up. Then another email came. My school was a couple people short in the sign up. Other teachers were asking me if I signed up. They told me that I “…really should get one because, you know, you have diabetes.” So I signed up, fully intending to back out at the last minute.

At the end of the school day today, I quickly packed my stuff up, grabbed Dixie’s leash, and put my jacket on. The door opened. The school nurse who works in my building came in. She said that she knew I was anxious about the shot (because she had overheard me complaining in the teacher’s lounge one day) and came to school just to make sure that I was o.k. Shoot. Now I couldn’t leave. This nice woman drove all the way to this school that she only works at on Tuesdays, just to check on me. I got my insurance card. She told me that she would go and get the release form, and I could just fill it out in my class. I filled it out. She walked with me to hand the form to the other nurse. They told me to sit in the chair with my back to the nurse. No way! I said that I needed to see the shot happen, and see the needle. I was feeling faint. I was talking to myself. “Get a grip Molly! It’s just a shot.” I rolled up my sleeve. I was feeling lightheaded. I started sweating. I held hands with my nurse and another teacher. The woman gave the injection in my arm. It didn’t hurt that much. But I cried anyway. Cried from fear, from apprehension, and from the loss of control that I felt. Dixie put her head on my lap and looked at me with her brown eyes. I stroked her head and took a deep breath. I walked back to my class and got my things to go home.

It’s over. I hope that I don’t get the flu. ☺