Sunday, July 29, 2012

To my partner in crime

Do you know what the worst part of being a diabetic is?  Standing like a marooned, blubbering idiot watching your husband drive away.

Wait... that has nothing to do with diabetes... oh well, I'll write about it anyway.  

After two weeks of "vacation" in Vermont, HB left today to drive back to Virginia and get back to the working grind of our daily reality back home.  It was wonderful to have him up here - to share this new aspect of my life with him and to hold his hand through the last few weeks of medical appointments.  Admittedly I'm beginning to mentally check out of my classes for my own reasons and I am glad that school ends in just under two weeks, but watching him go today made me very sad.  I'm going to miss him with professional precision from now until then, from that second his car disappeared around the bend and down the hill to the moment I anxiously open the front door back home in August...

Your nose is blue.
I know many don't understand why or how our relationship works, but for whatever reason it does and for that I'm eternally grateful.  Especially over the last few months, I've found myself awe struck by the immense luck I've had in not only finding a partner I want to work at marriage with, but an honest to God best friend that makes my world better.  Between the care he's helped provide medically, the support he's offered emotionally and the encouragement he's given freely, I feel like any number of the hurdles I individually face in life are less high and more attainable than they ever were on my own...

I can't tell you exactly what it is or how he does it that makes my everyday life, even with diabetes, everything I could have hoped for.  Perhaps some HB-centric inversion of Maya Angelou's poem "Phenomenal Woman" would be appropriate here, but I've never been known for a mastery of rhyme schemes or appropriate use of couplets.  All I can say is that it is in the little things, like:

*  when he's standing over my shoulder watching the processing line go around on my BG meter, waiting with me to see how my sugars are doing.  And when the tight-number finally appears on the screen, I love how he cheers for me as if his favorite football team just won the super bowl. 

* how he measures out pancake batter on Sunday mornings to ensure that each pancake is the same equivalent size so that I can easily calculate what number of carbs I'm eating.  Of course he rolls his eyes at me when I ask him to tell me how many carbs are in the maple syrup he gushingly poured over his pancakes, but still... :)

* when he talks with me in riddles and puns, making a game out of the English language.  Just this morning he turned that horrid song "who let the dogs out?" into a sing-along about dairy cows for GW and made us all laugh with his "moo, moo, moo" interpretation.   

Sure, sure I know this is a post off topic (and sappy), but sometimes I just have to say exactly what is on my mind and HB deserves the shout out.  Many spouses of diabetics struggle with the impact disease has on their relationship - either as a result of their own apathy for it or, more commonly, with the diabetic's apathy for it.  Fortunately this isn't the case in our house and I am very grateful for his continued support, increasing love and invaluable friendship.  Diseased or not, I feel like a million bucks around him and nothing can beat that. 

That said, I miss you and love you very much HB.  See you not soon enough. 

Friday, July 27, 2012

Carb counting challenge reminder :)

Don't forget to post your carb counting challenge answers!  Only have a couple guesses so far, but nothing correct as of yet... the prize is still up for grabs, so take the challenge and it could be yours!


Thursday, July 26, 2012

Echo Results

Halfway through the drive back from Burlington tonight, we stopped at this mom-pop type bakery on Route 7 called "The Love Shack."  Having spent a good portion of the day whining about wanting a cookie, HB graciously stopped to pacify my craving and we scoured the baked goods for the perfect selection...  Ultimately purchasing a bakers dozen of cookies out of sheer indecision, we taste tested a few on the drive home and - ironically - determined that the "Motherly Love" cookie is better than either the "Puppy Love" or "Summer's Love" cookies.

Why, you might ask, is this cookie better than the others? Made with dried cranberries and white chocolate morsels, this "Motherly Love" had the right blend of sweetness and acidity to make the perfect cookie bite (not to mention a valid parenting suggestion).  So flavor wise, the cookie was more complex and more foodie-palate-satisfying than either the chocolate and peanut butter chip cookie or the chocolate chip oatmeal cookie.  But that's not all... the "Motherly Love" cookie was better than the others because of the name and the outcome of my day.

The fetal echocardiogram went beautifully.  After spelling out the likely complications that diabetes can cause for fetal heart development, the neonatal cardiologist said that Baby's heart couldn't look more normal and that based on what he saw there is no need to do additional testing to confirm his findings.  In other words, Baby's heart is developing in the best case non-diabetic pregnancy kind of way - thanks be to God!  He was also very pleased with my weight gain thus far and the simplicity that my body-type creates for diagnosing complications in the baby - thanks be to Sean T for helping get me in the best pre-pregnancy shape possible!  

So what does this mean? It means that my BG control has rocked and that any of the complications my diabetes could cause for the baby thus far aren't an issue.  Granted, it's a bit early to straight out celebrate as BG control directly correlates to baby size/weight (that will only be determined in the final weeks of pregnancy through ultrasounds), but I'm feeling pretty good about things and we're very relieved that diabetes:Baby::baseball:daisies - completely irrelevant!

Obviously there are other issues that we still need to keep an eye on - where the placenta is, any possible issues with fetal growth and how my blood pressure is doing for preclampsia purposes (98/50 today btw) - but all of that is fortunately non-diabetes related and out of my hands.  I know and so do my doctors that I am doing everything I possibly can for a healthy baby and, at the end of the day, that helps me sleep at night.

Thanks for the support. I'll let you know how the next prenatal appointment goes when I get back to VA and can touch base thoroughly with my MFM down there. :)

Fetal Echocardiogram Today in Burlington

As I mentioned in one of my last pregnancy related posts, the fetal echocardiogram is the next big hurdle for me to clear in the pregnancy.  In all pregnancies the doctors will look at the development of the baby's heart to make sure that it is healthy and not showing malformations or irregular operations. With insulin-dependent pregnancies, they do a higher resolution more careful screening of the baby's heart because problems with heart development are more likely to happen with diabetics because of the impact abnormal blood sugar ranges have on fetal formation.

So with non-diabetic people in general, typical blood glucose ranges are between 70 and 100 mg/dl.  With diabetics, this range is very difficult to achieve and requires full attention to get even close to such "tight" control, which is why our optimal range is slightly higher between 70 and 120 mg/dl to account for this difficulty. Now, consistent blood sugars above 120 mg/dl prior to conception and during the first trimester of pregnancy can cause birth defects - specifically in the cardiac system - because of the delicacy of the fetus' system development.  Obviously this means it is completely on the mother (aka me) to give the baby a healthy heart from the get-go.  No pressure.

Wanting to give baby the best shot possible at a healthy life, I worked very hard to have tight sugar control before conception and I've had my sugars on lock down since the beginning of the pregnancy for fear that I might do something to Baby.  Today is kind of the culmination of that... whatever happens in the coming months with my placenta previa, my higher risk for preclampsia and issues with fetal growth are all irrelevant to my diabetes control and out of my hands.  But today, the fetal echo, is a direct measure of my blood sugar control and its impact on the pregnancy.  Again, no pressure.

I'll report back how it goes as soon as I get a chance...  until then, please keep your fingers crossed and us in your prayers.  We'll take whatever help and positive vibes we can get!

Sunday, July 22, 2012

Carb Counting

Thanks to Cousin Lisa, I have yet another awesome topic to write about that I wouldn't have otherwise thought to cover if she hadn't asked a great question:  how do I know how many carbs are in everything I eat?  Yeah, a completely integral part of being a diabetic, but something I haven't necessarily thought conscientiously about in ages...  great question!

Breaking things down to the absolute basics for those unfamiliar with nutritional components: the food we eat is primarily divided into three categories - protein, fat and carbs.  Protein comes from things like meats, seafood and eggs. Fats come from things like nuts, ice cream and non-lean meats.  Carbohydrates are in foods that contain fruits, vegetables, grains and sugars.   It is important to note here that these categories are not mutually exclusive and that they often blend together in each of the meals we eat every day...  taking a cheeseburger as an example you've got protein, fat and carbs in several combinations like so:

So when "carb counting" you are looking to identify how many grams of foods from this third category are in whatever food you eat and, based on the hamburger example above, you can see that carbs come from more than just bread.  As a diabetic, I have to sit down at every meal and put a number to the plate of food in front of me... does it have rice? does it have potatoes? what hidden carbs are there? what kind of bread is used? is there milk in it? is the protein breaded? what is in the sauce?  And don't forget about drinks! I've found that most drinks have more carbohydrates than one might imagine...  1 cup of milk has 13 grams of carbs; a cup of coffee only has carbs if you add sugar and milk, but you have to account for the effect caffeine may take on BG; soda - don't even get me started; and juice, talk about straight sugar in a glass!

When I first was diagnosed and had to meet with a dietary nutritionalist to learn how to carb count, I was completely overwhelmed by the prospect of knowing what was in everything.  Fortunately I was previously acquainted with reading nutrition labels and that made things much, much easier - all I had to do was grab a measuring cup and do some basic math.  But when I don't have access to nutrition labels (like at restaurants, when other people cook for me or when making things from scratch) it got much more difficult.

I remember a conversation I had with a long time family friend back in Colorado who is also T1 about how he knows what carbs are in what.  Having been diabetic since he was just a kid his response was simply that "at some point, you just know."  Now a year and a half in, I get what he means and I "sight read" my food, but it has taken much practice and research to get to this point.

So what resources did/do I use?

Not being a terribly big fan of technology (face it, I'm anti-facebook and twitter), my absolute favorite go to nutrition guide of choice is the Prevention Magazine Nutrition Adviser book (ISBN-10: 0875962254).  It breaks down most foods (not complete meals, but specific components of meals) into a standard nutrition label - so for foods that might not have a label (ie apples and bananas) it is a great way to learn the necessary stats.    I'd definitely recommend this book!

If you're an internet searching type, the website of choice that I use most often is (I believe it is also in the form of an iPhone app).  It is a gigantic online database that you can sift through for basic ingredients or for comprehensive meal choices at specific restaurants.   It mainly covers chain restaurant, fast food or ready-made grocery store meals, so it does leave a gap of information for local Mom-Pop type places, but it can give you an estimate of what the stats are of a certain dish to guess off of.  So for example, the lasagna bolognese at the Macaroni Grill has 720 calories, 41.3 grams of fat, 46 grams of carbs and 41 grams of protein.  Assuming that the lasagna you make at home contains similar ingredients and is a comparable portion size, it like has 40-50 grams of carbs as well.

Another phone app resource that some of my diabetic friends use is called "Track3". From what I understand it is a comprehensive diabetes app that provides nutrition information and an exercise/meal/BG journal.  I don't personally use this so I cannot speak to it from experience, but from what others have said it is a great resource for carb content searches and data collection.  It seems to be geared toward diabetics, but I'm sure there is a way to make it work for non-diabetics as well if interested.

At the end of the day, carb counting is about being as close as possible to the right number of carbs (within 5-10 grams is usually okay), but mistakes are inevitable.  You can miscount and under bolus sending sugars sky rocketing or you can over count/under eat and send sugars into hypoglycemic ranges. Obviously it is ideal to know what you're getting exactly and to avoid such miscalculations, so understanding how to read nutrition labels and researching restaurant nutrition information is a great first line of defense.  But once you know some basics by memory - like most rice and pasta is about 40 grams per cup, an apple is 20 grams give or take a few and bread is typically between 15-20 grams a slice - it gets easier to eyeball meals you can't measure exactly and roll on with life.

I will admit that I still struggle with foods I am unfamiliar with and I do find myself in situations that are outside of my carb counting comfort zone.  Like when going to ethnic restaurants that use ingredients that I can't pronounce, let alone identify or when someone else cooks something I've never eaten before, I'm often left to take a wild guess or to ask the awkward question of "um, what is this?"  So heads up, when serving dinner to me or any other diabetic, you might be asked to show the recipe card  for the dish or the cans/boxes your ingredients came from just so a better, more accurate guesstimate can be made. Ultimately it's the responsibility of the diabetic to read what is in front of them, but don't be surprised or offended if they ask for more information or opt out of a certain dish for health reasons.

Well I hope that this post begins to answer your question to at least some degree, Lisa!  There are other ways to watch what you eat as a diabetic - such as no-carb/low carb diets or using the glycemic index - but I'll skip that for now since they're a bit more complicated than carb counting.  If any reader would like more info on those options/what they mean, I'd be happy to go into more detail about them in a future post - just let me know.

Until then, I have two challenges for all of you:

1) Check out the nutrition labels on your food and to track how many carbs you eat during the day.  Measure your food, conscientiously note when you snack and what is in your drinks.  It's a very different perspective of your plate than you might be used to, so please feel free to share your experience in a comment :)

2) Take a look at the following pictures and descriptions of common breakfast meals.  Whoever can give me the total number of carbs (including decimals... silly engineers) in a post comment first will get a prize! (And it is a sweeeeeeeeeeet prize!)

1) Thomas' brand Cinnamon raisin bagel with 3 oz regular cream cheese.  2) A Starbucks blueberry scone and grande iced coffee with milk and two sugar packets.  3) Two scrambled eggs, two medium slices of bacon, two pieces of white-bread toast and 1 cup of home-made hash browns.  4)  1 cup multi-grain Cheerios with one medium banana and 1 cup 2% milk.  5)  Seven 4" homemade buttermilk pancakes with 1/2 cup real maple syrup and 1 Tbsp of butter.  6) 12 oz fresh orange juice. 
As soon as someone guesses correctly, I'll post the answer for all to see :)

Good luck!

Saturday, July 21, 2012

Juvenile Diabetes Research Foundation - aka JDRF

While we were in Burlington last week, I ran into a very nice man named Tony who was wearing an awesome shirt that read "F DIABETES".   Unable to resist asking him about the shirt, it turns out that he is also a T1 diabetic and that he and an entire team from NJ had driven up to Vermont for the JDRF Ride for the Cure - a 100 mike bike race to increase awareness of the autoimmune disease and to raise money for diabetes research.   In the short conversation I had with Tony I learned that his team alone had raised nearly one million dollars... amazing, right?!

I'd never heard of "JDRF" before - remember I'm still newly diagnosed with only 1.5 years of insulin dependence under (on?) my belt - so I began to do some online research.  Holy Cow is this organization an amazing source of information and a solid support community!  From my initial reading, JDRF is the leading global organization focused on type 1 diabetes research with the admirable  mission of treatment, prevention and cure of insulin dependence.   It has more information about type 1 specifics than even the American Diabetes Association and what an easy site to navigate - props to those web designers!

Now, I could boil down what the website has to say here, but I'm not going to.  The purpose of this blog is for me to share my experiences and bridge the gap between incomprehensible medical mumbo-jumbo and the vernacular for those who may find my writing style agreeable... But if there are readers out there who are interested in learning more about the Foundation, what it does and/or how to get involved, check out their wonderful website at:!

And for the record... Tony made the Tshirt he was wearing and very graciously shared with me the url for where I can get one of my own.  I ordered mine in Gray - the type 1 diabetes awareness color.  So if you'd like to get an "F Diabetes" tshirt as well (and in doing so put a smile on the face of some random insulin-dependent who sees you wearing it) go to:

Rock on. 

Friday, July 20, 2012

Our prayers go out to the Aurora shooting victims, wounded and their families.

Wednesday, July 18, 2012


So I got an excellent question the other day (thanks Bun) that hadn't even crossed my mind to write about:  how do I go swimming or take showers with my insulin pump?

Well, I don't. I don't swim or bathe while wearing the pump.  The pump is like any other non-waterproof electronic that runs off of a battery - it mechanically fails when it gets wet.  Given that I am fully dependent on it functioning... water and the pump just don't mix.

To work around this, the designers of insulin pumps understand that diabetics need to bathe and that some of the weird ones (obviously does not include me) even like this strange concept of swimming, so they created a quick release at the infusion site to disconnect the pump and tubing from the cannula.   This leaves the port in the skin until an infusion change is medically required (every two to three days), but allows the diabetic to remove the pump as necessary.

My current infusion site with the "male plug" inserted in
it; the red spots above the site are from previous cannulas -
the sites take a quite while to heal.

I can't speak to the exact set up of all insulin pumps, but what Medtronic does is provide a male and female "plug" for the pump tubing.  The female part of the plug attaches to the tubing and covers the needle while it is disconnected from the infusion site.  The male plug is inserted into the infusion site to cover the exposed end of the cannula - this prevents water, soap, whatever really from getting into the cannula and therefore your system.

The disconnected tubbing and the "female cover"
So that should cover the logistics of taking it off to be in water, now on to the consequences... well as I have explained else where, the pump delivers both a basal insulin (background insulin) and a programmed bolus of insulin to cover food.  With it disconnected, the body doesn't receive any insulin and the longer this goes on the higher a diabetic's blood sugar will go.  Without ingesting more carbs, blood sugars shouldn't go up quickly, but if the pump is left off for more than say 30 minutes BGs will progressively go up with the body's natural hormone production cycle.  It's not the end of the world to let your sugars go up temporarily in order to have fun and swim (did I just use "fun" and "swim" in the same sentence?), but if you're pregnant or sick, it's generally not worth the risk.

One additional interesting thing to point out about the use of artificial insulin and water is that a diabetic should not take a shower or bath in hot water until all of the active insulin in their system is depleted.  The reason for this is that hot water, like exercise, increases the efficiency of insulin and can cause hypoglycemia.  Since this should be avoided whenever possible, I guess that old rule of "no swimming after eating" actually has a bit of credibility.

Fair enough? Make sense? ... Marco?

Thank you so so much for the question!! And, please, if any reader has a question go ahead and shoot it my way in an email or just post a response/comment.  I'm more than happy to tailor future posts to people's interests or curiosities!

Monday, July 16, 2012

3:04 AM

I don't know if it is because of my growing baby bump that my back is bothering me as much as it is or if it is the manifestation of my stress knotting itself into reasons to lay awake tonight, but it's 3 o'clock in the morning and I've been wide awake for almost an hour.  The power light of our macbook was flashing like light house beckoning me safely home in the turbulence of my thoughts, so we'll see what this pitch-dark post makes itself out to be...

I almost dropped my pump again today when it got caught on GW's foot as I helped him step out of the truck.  Fortunately I had a free hand and was able to grab the cord before it fell too far from my infusion site and rip itself from my skin.  We were in a pretty remote part of VT at the time away from our rental place, so I didn't have a solution ready at hand were that to have happened.  I typically have an emergency SureT set up in the center console for times like this, but this wasn't my car and I don't carry around the necessary equipment to handle more than a hypoglycemic episode.  Before being a diabetic I didn't even carry a purse, I just threw my phone and wallet in the back pockets of my jeans and rolled out.  But now that I am out of college, need to carry glucagon and a requested matchbox truck or two for my son, I have no interest whatsoever in further conceding defeat by needing a full on diaper-bag, over-sized purse to replace the one I already lug around along with my book bag.

While I was surprisingly coordinated today in my pump saving reflexes, I unfortunately haven't been quite so quick or quite so lucky at other times.  One time, I turned around to reach for GW in his car seat and the infusion site I had placed on my oblique caught on the seat belt buckle and tore out... Another time, walking down the hallway of our home while carrying a bin of clean laundry I failed to notice my pump tubing loop the door nob to the bedroom and riiiiiiiiip there it went... While lying on the floor playing with one of our dogs, Gracie, she snagged a loose end of cable with her nails and spastically tugged it out in a playful bounce.  And there was this other time when snuggly-sleeping with HB that the cord somehow got wrapped around his arm and my site went with him when he rolled to his other side.  Let me tell you... between the shock of having a cannula pulled out of you unexpectedly and the pain of the tape detaching itself from your skin, it is not a fun experience to go through!!

I don't know if any of you have had an IV administered to you before, but for those of you who have, do you remember the extra caution that went into your every movement so as to prevent the tubing from becoming snagged on anything that might require the nurse to reinsert the IV?  Perhaps I simply have a more innate distrust of that tape stuff they use than other people do, but each time I've have an IV my motions are far fewer in number and much more deliberate in purpose than they are normally.  Well, wearing an infusion set is to one degree or another similar to this - but because it is always there, it's easy to forget about it or to not notice when the tubbing is hanging out farther than it really ought to.    So while I am extremely attentive to the perceived inability to flex my elbow while wearing an IV, I am sometimes blissfully unaware of my diabetes to my own detriment... blissful ignorance replaced with an instantaneous reminder of reality. Oh joy.

That reminds me of those random moments when sitting down to a meal that I absentmindedly go to pick up my sandwich and enjoy the food in front of me without remembering the loaded sentence "I'm a diabetic" first.  It's absolutely wonderful to take that bite and enjoy the quality bread and other ingredients without concern, but when the thought hits that I am savoring unaccounted for carbs, I have to put my contentment in normalcy aside, lay down my food and be the disease again.  In a lot of ways I am envious of the other type 1s who were diagnosed as kids and don't remember what it was like to not be diabetic... I spent 24 years becoming accustomed to life and eating as a healthy person and it's sometimes very surreal to realize my life has been divided into a before and after shot.

So while you're sitting there enjoying your bowl of Cheerios tomorrow morning (that is 20 grams per cup of regular - non-honey nut - Cheerios and 13 grams per 8 oz of milk), take a moment to realize how nice it is to be healthy... I didn't appreciate it enough before I got sick and hind sight being what it is, it would have been nice to make the connection of how good I had it before sugar became a problem.

Friday, July 13, 2012

Okay... so...

Today was a strange day and I'm not entirely sure how to digest it.  We had yet another prenatal appointment where the docs simply wanted to check on my blood sugars - and, duh, they're still phenomenal.  We then had our level II ultrasound to check on the baby and learn more about what is going on...

The good news is I do not have complete placenta previa like they initially thought. The bad news is that the first half of the sonogram showed a partial previa and the second have showed none, so there still remains a possibility that a partial previa exists and we'll just have to continue watching its placement as the pregnancy continues.  I guess there is some concern about potential fetal-growth issues as a result of the location of the placenta, but we won't know anything more about that until closer to the third trimester.   

I am (and HB is too) somewhat reluctant to be hopeful at this point about the prospects of being "complication free" (minus the diabetes of course) because the emotional yo-yoing of the past couple weeks has taken a lot out of me (us).  It's definitely a different kind of care we receive here in VT than in VA and, to be completely honest, I find it a bit unnerving.  Another doctor today asked me why I consider myself to have juvenile diabetes... he then followed that up by mockingly dismissing the "uptight" (aka comprehensive) doctors of NOVA and established that "well, this is Vermont... we do things at a much lower level."  Um, not too confidence building here people.  For the sake of my sanity and the copious amounts of school work I must focus on in the next couple of weeks, I'll just nod my head, say thank you very much for the exam and please mail comprehensive reports to my docs in Virginia... and then once we're back we can get into the details of what may or may not be happening and what exactly needs to be done about it.  It's out of my hands and in God's, so we'll just let him handle it between now and then. 

There was some bad news at the appointment, though, that I feel compelled to share...   we found out we're having a girl... A G-I-R-L.. meaning pink and bows, dresses and curls, sugar and spice...  I honestly don't think there is an appropriate word or sequence of words that I can put here to thoroughly express the bewilderment that HB and I are currently feeling... Don't get me wrong, we're excited about Baby and we're thrilled that things seem to be developing as normally as they possibly can, but we've just become so comfortable with our son and the idea of little boys that the idea of a daughter (that word does not roll off of my tongue naturally) is just completely foreign.

Ironically, when we found out we were pregnant with GW back in 2009 I went through several weeks of wishing wishing wishing for a daughter before we had the 20 week ultrasound.  I had this picture in my head of the Gilmore Girl's mother-daughter relationship and I found solace amidst the shock of it all in the closeness such a relationship could bring to my life.   Disappointed when we learned that we were having a boy, I promptly spent the next couple months sulking about it and slowly coming to grips with this concept of raising a son (a word that did not roll off of my tongue naturally).  But once he was born and placed within the embrace of my arms it was complete love at first sight... I couldn't remember why I wanted a girl instead of this beautiful little boy.  

GW's heart string...  3 days old.
And so it turns out that God has a sense of humor about these things... this time hoping for another little XY we're given an XX.  My prayers for a healthy baby and a healthy pregnancy have been answered, but in exchange for another little life twist.  If history is destined to repeat itself as they say so often it does, I'm sure that my current feelings of perplexity will disappear when Baby is handed to me and she grasps that heart string I've reserved just for her.   

I don't have anything else to report at this point and will touch back with you all when I do, but the next thing we have in a couple weeks  is the fetal echocardiogram to look at Baby's heart development more closely.  Based on what we saw today, it looks like we can expect that appointment to go very smoothly, but it's definitely the biggest mile-marker for how my diabetes is affecting the baby's physical development.  So we'll see how it goes.

** Thank you to everyone who sent up prayers for us 
and shared warm fuzzy positive vibes with the universe!! 
Your support and love is very much appreciated! **

Level II Ultrasound in Burlington today...

My 20 week ultrasound had to be moved to 18 weeks because of a need to watch complications more carefully.  Unfortunately I was all excited to learn the sex of the baby at the 20 wk appointment, but today I am just an anxious wreck (didn't sleep at all last night) with far too many worries about what the doctors have to say and what the next five months will entail.  I will let you know what we come up with, but please keep fingers crossed for us (and send some prayers upstairs if you believe in that sort of thing) that complications remain minor and minimal!

Here goes...

Tuesday, July 10, 2012

Miracle of Modern Medicine

I've been thinking a lot the past couple days about the immense fortune I've had in living my life in the 20th and 21st centuries.  There are many things to be said about the comforts of modern life and the wondrous convenience of living with air conditioning, streaming movies, cellular telephones and electric toothbrushes.  But in spite of my sincere appreciation for bubble wrap and some what comical interest in writing an ode to heated car seats, the thing that deserves a blog post tribute all of it's own is nothing less than modern medicine.

It occurred to me when I was moping the other day about my placenta previa that conditions like this typically killed women in the past... Unable to identify the root of the problem without such technology as ultrasounds or to preform survivable surgical techniques to remove the baby, it's no wonder that the mortality rates of women in child birth were so high in pervious centuries.  I mean the modern technique for caesarean sections has only been preformed since 1881 and one historical account I read said that sixteen years prior to this standardization similar surgeries in the UK resulted in an 85% mortality rate... EIGHTY FIVE PERCENT!

Given that in the year 2000, the mortality rates in the United States for c-sections were 20 in 1,000,000 I can't believe the incredible stroke of luck I have to be in my particular predicament in the era that I am dealing with it.  Perhaps it goes a bit far to say that having placenta previa is a "stroke of luck," because let's face it any pregnancy complication is an unwelcome complication, but the reality check that in any other century (or might I many other countries) this would likely be the last five months of my life is quite the wake up call...  whoa.

Once I made the mental leap from placenta previa to smelling the roses it hit me that this isn't the first time that I've "cheated death" because of advances in modern medicine.  Like I said in my first post, when I was diagnosed with diabetes back in January 2011 the doctors were seriously concerned by my diabetic ketoacidosis (DKA).  Not even identified as a sickness until 1886, DKA was considered universally fatal until the introduction of reliable insulin therapy in the 1920s.   It's my understanding that today the mortality rate caused by DKA is less than 1% when caught early enough and treated appropriately...  So when the doctors at Georgetown University Hospital said that I was a couple weeks away from multi-system organ failure and plausibly could have died if I hadn't been diagnosed with diabetes when I was, they truly weren't kidding... thank God for IV potassium and artificial insulin!

In my romanticized, literary perspective of the world (thank you Jane Austen), I've often been quite nostalgic about centuries past and the simplicity of life that people faced in the uncomplicated, proper societies of yore.  Longing for the world of pre-facebook and basic arithmetic, I've talked about this ideal picture in my head with HB regularly and he often laughs at my boiled down, Hollywoodized version of yester-year... okay fine, perhaps there were more disease epidemics, the "middle class" didn't really exist and literacy was a privilege of those who didn't have to work hard labor... I blame it on that game Oregon Trail, the sister that always got bitten by the snake recovered when I crossed the prairie...

But all jokes and day dreams aside, I've got to admit he has a point.  In light of the realization that my life would have ended at age 24 because of my diabetes or at age 26 because of child birth, I am extremely grateful for whatever grace of God that has me alive today rather than in the 19th century or earlier.

So here is to you, modern medicine! Thank you for extending my life expectancy and giving me the opportunity to work on my optimism.


Monday, July 9, 2012

New layers of complication...

So I need to take a step back from my discussion of diabetes for one post and talk about something else significant that is going on with me medically.  In exchanging phone calls with my pregnancy doctors down in Virginia, they informed me that I have "complete placenta previa"and that this condition elevates my theoretically high risk pregnancy because of diabetes to a new level of high risk due to an actual complication.

For those who are not familiar with the condition, here's the general gist:  placenta previa is caused when the fertilized egg embeds itself near or on the cervix rather than anywhere else on the uterine wall.  This creates a problem as the baby grows because the placenta can partially or completely cover the cervix which prevents the mother from a having safe vaginal delivery.  In some cases of partial placenta previa, as the uterus grows the placenta will be pulled upward away from the cervix and gradually reduce the complications caused by it's early low placement.   In complete placenta previa - apparently which I have - this is not the case and the issues caused by this unfortunate implantation site only increase in concern and severity as the pregnancy wears on...

What this means:

  • There is no possibility whatsoever of a vaginal delivery and I will require a c-section.
  • There is risk of fetal and maternal hemorrhaging that will, at some point shortly, require I be placed on bed rest.  What degree of bed rest is yet to be determined. 
  • If/when hemorrhaging occurs, heavy or excessive bleeding may result in an emergency c-section (regardless of gestational age) for life saving (both maternal and fetal) purposes.
  • If hemorrhaging is uncontrollable, blood transfusions may be necessary.
  • Expected delivery will be moved up to somewhere between week 36 and 38 rather than in between weeks 38 and 39 because of diabetes or week 40 for normal pregnancies.  Earlier delivery than week 36 is possible if there are life threatening complications. 

There are of course other issues that go into this condition, but I am trying very hard to remain as positive as possible at this point so as to not go into the downward spiral of "what ifs..." unless they become personally relevant to this pregnancy.  It is definitely very concerning to me that there is an additional level of issues that we need to keep in mind and that my diabetes isn't the only medical problem to be tracked...  I mean the fact that these conditions aren't even remotely correlated and that this second layer of complication is a completely out of the blue, new issue is enough to throw my mind for a complete loop.  Certainly makes the idea of "just" a diabetic pregnancy sound good right about now...

I will admit that I'm definitely disappointed that I won't be allowed a vaginal delivery since that was - no kidding - the part of this pregnancy I was most looking forward to.  I logically understand that a c-section is required to keep me and the baby alive, but I am emotionally struggling with the fact that an experience I so treasured with physically giving birth to GW is medically out of the question for Baby.  Don't get me wrong, I am completely on board with everything the doctors tell me to do to take care of this little one - heck I've been taking care of this baby since November and I wasn't even pregnant until March! - but the emotional and mental toll of diabetes and placenta previa is exhausting.

Here is a link to the Mayo Clinic page on placenta previa for those of you who are curious to know more -  I've got another appointment later in this week with the docs here in VT (oh joy...) that I plan to ask more detailed questions about what this means and how we're going to handle it, so I'll keep you posted as more information becomes available.   In the mean time, keep Baby and me in your prayers - I'm doing everything I physically can, the rest is up to God.

Friday, July 6, 2012

Hypoglycemia 101

Last week when my classes started, I informed my professors that I am a pregnant diabetic in the off chance something happens that will require medical attention.  Both profs being relatively concerned about what that means asked me to walk them through step-by-step what I would need them to do in the worst case scenario of hypoglycemia.  Seeing as neither of them have previous experience with this, I thought there might be a good possibility that readers here might not know what to do either... so I figured that this is a great opportunity to explain what hypoglycemia is in more detail, how to recognize it and what to do if I (or anyone for that fact) go into hypoglycemic shock around you.

What is hypoglycemia? 

Hypoglycemia is a condition that occurs primarily in diabetics (can occur in non-diabetics, but is relatively rare) when the blood glucose in their body drops into abnormal levels (below 70 mg/dl).  Caused by an excess amount of insulin, such abnormal bg levels require immediate corrective treatment or the person will suffer from neuroglucopenia which essentially means loss of consciousness, seizures, a coma, and ultimately death.

How to recognize it?

Hypoglycemia is divided into two phases which can be most simply described as the recognizable, moderately serious phase (adrenegeric) and the unrecognizable, potentially-fatal phase (neurooglucopenia).   I have experienced the first phase many times with bgs in the 50-69 mg/dl range and can correct the issue myself.  For me, it usually starts with a tingling sensation in my fingers and gradually becomes a full on shake or jitter.  On the occasions that my blood sugars have fallen below 50 mg/dl (lowest I've been is 34 mg/dl), I've noticed that my heart rate speeds, my temperature rises, I start to sweat profusely and my breathing becomes quite quick.

Unfortunately, sometimes symptoms don't occur in phase one or I am unable to recognize them for whatever reason.  This is when diabetics slip into neuroglucopenia and, in all likelihood, will require external help to correct the situation.  The symptoms you might notice are unexplained drowsiness, lack of coordination, slowed or slurred speech and disorientation (almost like someone inebriated).   If these symptoms are not corrected (see below), the loss of consciousness is inevitable and potentially life threatening.

Although this guy is a bit goofy, he does a good job of explaining hypoglycemia and how to recognize it:

How to treat it?

Treatment of hypoglycemia as soon as possible is extremely important, especially if phase two has kicked in.  If a diabetic seems disoriented and cannot respond rationally by checking their own blood sugar, it is crucial that the people around them provide them with fast acting glucose immediately.

Fast acting glucose includes carbohydrates like fruit juice, sugar packets, honey and straight sugar candy like starburst or jelly beans.  It is important to note here that I am suggesting there are better carbohydrate choices than others... chocolate for example isn't the best choice because the fat in chocolate slows sugar absorption into the blood; bread is another example of a carbohydrate that takes a longer amount of time (more than five to fifteen minutes) to affect blood glucose levels.  If you don't have access to fast acting glucose, any carb will do, but many diabetics carry sugar on them and that is worth checking into... I have starburst (administer at least 4) and sugar packets (administer as many as I have) in my purse at all times. 

If the diabetic looses consciousness, there are four life saving steps that must be made as soon as possible (seconds matter):

1) Make sure the diabetic is lying down on his/her side.

By ensuring the diabetic is prone and on his/her side will ensure that injury wont result if seizures begin and knock them down.  Also it will ensure that if the diabetic begins to vomit, which is probable, that they will not die of asphyxia (suffocation).

2) Administer an injection of glucagon.  

Glucagon is a hormone that the pancreas naturally produces to regulate blood sugar in non-diabetics. Just as diabetics need artificial insulin, they may require artificial glucagon to correct for excessive insulin.

Many diabetics will carry an emergency glucagon injection kit on them - check their purses, their backpacks, their briefcases, whatever they might put it in. The pictures here are of my kit, which fyi can be found in the middle zipper pocket of my purse. While there are pictorial instructions inside the cap, I'll spell them out for you here anyway:

a) Open the case.

b) Remove the cap from the syringe and also from the vial.  Inject the saline into the vial.  Pull the syringe back out and set aside (you will use it again).

c) The vial contains a powder form of glucagon.  Once the saline is in the vial, shake it until thoroughly mixed.

d)  Insert the (fully depressed) syringe needle back into the vial, turn it so the vial is upside down above the syringe.  Pull all of the glucagon solution out of the vial and disconnect the two.

e) If an alcohol swab is available (not crucial to save a life at this point), clean the injection site on the buttock, arm or thigh.  Inject the glucagon into the shallow loose tissue - not deep in the muscle - of the diabetic.

3)   If applicable, place their insulin pump on suspend or disconnect it entirely. 

It is really important if the person suffering from hypoglycemic shock that their insulin pump be suspended or disconnected so as to avoid additional administration of insulin.

I cannot speak to the programming or structure of all insulin pumps, but I can show you what to do with a Medtronic Minimed pump like I wear.

1) Pull out the pump.

2) The third button from the left, under the screen says the word "ACT" on it.  Press that button.

3) The main menu will pop up.  Using the down button on the far right, scroll down until the word "SUSPEND" is highlighted.  Press "ACT" again.

4) You will see the word "SUSPEND" begin to flash on the screen.  You need to press "ACT" once more to confirm your selection.  The pump is now stopped.

The other option is to find the infusion site - typically on a diabetic's abdomen, lower back, thighs or buttocks - and delicately disconnect the tubing from the site.  It works like a seat belt.

4) The final step (or the first step if you determine you don't have immediate access to an emergency  glucagon kit) is to dial 9-11.  

Tell the emergency operator the amount of time the diabetic has been unconscious, what you've been able to accomplish and where you are.  Ask them to send an ambulance immediately.  Keep an eye on the diabetic until the paramedics arrive... if they have been unconscious for more than 15 minutes (for this can be a point of no return) and help still hasn't arrived, call 9-11 again to update the situation.


And that is how you identify and correct hypoglycemic shock and save the life of a diabetic!  There are certain points where hypoglycemia is more likely to occur than others - like when exercising or pregnant - so it's smart to anticipate a possible issue with it and prepare yourself to know what to do.

Obviously questions are welcome and I'll happily walk you through this in person if you want me to - just ask :)

Wednesday, July 4, 2012

Type 1 vs Type 2 vs Gestational Diabetes

So I have received a couple really good questions inquiring about the different types of diabetes.  To save time I'll point out that there are basic definitions to the right in the vocab column, but for those wanting more of an explanation here you go...

So on the very basic level, diabetes is a disease that implies a person's pancreas is not functioning properly.  On a more specific level, the different types of diabetes distinguish the source of the malfunction.

TYPE ONE:  (what I have)

In type 1 diabetes, the body's immune system attacks the islet cells in the pancreas and destroys their ability to produce insulin.  As a result of this, a person with this type of diabetes becomes permanently dependent on external supplementation of artificial insulin in order to be healthy.  At this point, there is no cure to this pancreas failure and without regular injection of artificial insulin a type 1 diabetic will die from complications caused by hyperglycemia and diabetic ketoacidosis.

Type 1 diabetics are inherently at a higher risk for complications like heart disease regardless of their glucose control.  But the majority of other complications caused by this disease are predominantly avoidable with appropriate self-care.


Type 2 diabetes, on the other hand, is as a result of lifestyle choices - specifically obesity, minimal exercise and poor diet - that cause the body's over-strained system to become insulin resistant.  In other words, the islet cells in the pancreas have not failed and still produce insulin, but not in the quantity necessary to compensate for the damaged body's increased insulin requirements.  As a result of this, most type 2 diabetics are put on oral medications that a) boost the islet cell's production of insulin and b) medically induce weight loss.  It is possible for type 2 diabetics with very poor self-care to require additional insulin via injection to maintain healthy blood glucose levels, so some may become both insulin-dependent and insulin-resistant.

With lifestyle changes and dedicated effort to weight loss, type 2 diabetics can in effect "cure" themselves of their insulin resistance.   However, using the word cure isn't entirely fair because even if the symptoms of type 2 are eradicated the reality of a predisposition for insulin-resistance makes it so that a type 2 diabetic requires a permanently diabetes-conscious lifestyle.

Some of you may have come across the phrase "pre-diabetic" at some point.   This phrase refers to the initial stages of insulin-resistance a type 2 diabetic exhibits.  If diagnosed with pre-diabetes a person can prevent their diagnosis with type 2 through significant, immediate lifestyle changes.   This phrase is not relevant to either type 1 or gestational diabetes.


As a result of the complex hormones necessary to build a baby, the placenta can make a pregnant woman insulin-resistant and require the administration of medication or external insulin.  ANY pregnant woman can be diagnosed with gestational diabetes - it does not discriminate by lifestyle or any other factor than how an individual's body responds to the demands of pregnancy.   The vast majority of gestational diabetics do not remain diabetic after the end of their pregnancies and can return to living a normal, healthy life once the baby is born and the placenta is removed.

So does that make sense?   Essentially insulin-dependence vs. insulin-resistance vs. temporary insulin resistance... very different causes, but similar results if uncared for.  Let me know if you have other questions!

Tuesday, July 3, 2012

So you're a diabetic...

One thing that I greatly appreciate about diabetes is that it is one of those conditions that you can't necessarily tell exists by merely looking at a person.  It doesn't show signs of intense treatment like chemotherapy, signs of gradual physical degeneration like MS or even noticeable ailment like a common cold's runny nose. When under control, a type 1 diabetic just looks human and not like their sickness.

Granted if a diabetic (either type) lets their blood glucose go unchecked for long amounts of time, signs begin to creep onto a person that their body isn't functioning as it ought to. Obviously I experienced those signs right before I was diagnosed, but the worst-case consequences of diabetes can leave very visible, lasting marks... such consequences can include the loss of sight, amputation of limbs or organ failure.  But seeing as these outcomes are entirely avoidable with self-care and a healthy dose of responsibility, there is no reason that a diabetic could not live a normal life without such unfortunate complications. 

That being said, I was identified the other day as a diabetic before an introduction was even made.  While sitting in class, minding my own business and listening to the professor lecture my pump beeped to alert me of the necessity to test my post prandial blood glucose.  It's a relatively unobtrusive, obscure beep that most people don't even recognize as coming from my pocket... in the age of cell phones and portable technology its almost like unless you have an obnoxious ring tone we've been conditioned to ignore the notifications that come from elsewhere than our own concern. 

Anyway, at the break this kid walks up to me and makes the statement "so you're a diabetic." Not an inquiring question, a blank statement.  He continued "I heard your pump go off and thought it was mine." 

How funny.  As it turned out, he is a fellow Medtronic Minimed user and has been an insulin dependent diabetic for 17 years.  

It is interesting to me how when you open your mind to the option of viewing the world through a different lens (in this case the perspective of a diabetic) you begin to notice different things about the world around you than you did before.   That beep would have meant nothing to me previously, but  this kid was totally right in his recognition of my beep beep beep as "ding ding ding and we have a diabetic folks!"  

I remember last autumn while we were standing at the dog park my HB nudged me and pointed out a lady with her dog.  I of course checked to see if I recognized her or the dog first (which I didn't), but as it turned out HB had identified her as a diabetic.  He recognized the infusion set tubing running from her coat pocket up under her shirt. I don't think either of us would have noticed that before.   Another time I was at the Virginia Runner shoe store getting yet another pair of running shoes when a lady sat down next to me.  Out of the corner of my eye I noticed a black clip in her pocket and upon turning to look at it I realized she too was wearing an insulin pump.  It was a different brand than mine, but an insulin pump none the less. 

Just goes to show that my conceptual cloak of insulin-invisibility isn't as undetectable as I had previously thought.  Go figure. 

Monday, July 2, 2012

Infusion changes

I'll keep this post relatively short, but I had to do an infusion change today and despite the fact I've been using this particular infusion set for several months now I cannot get over the nerves of inserting it.

There is a "smiley face" on my right thigh
just under my black pump clip in my
pocket - that is a SureT infusion site.
Initially when I went on the pump, Medtronic (my diabetes supply company) suggested that I use the infusion set called a "SureT" that has secondary attachment site on surface of your skin.  The purpose of the second attachment and the benefit of this specific set is that if your pump gets caught or is pulled by something (i.e. a toddler...) the second site will detach and the infusion site remains intact in your subcutaneous fat.  While this worked beautifully for me for a while, when I really ramped up my training for running and started to notably decrease my body fat percentages the 5 mm needle that remains in your skin with this infusion set design would begin to jab my muscles and make movement - walking, let alone running - very painful.

Of course the people at Medtronic thought it was particularly funny when I called to say "I don't have enough fat to wear this infusion set any more," but all irony and joking aside they ultimately agreed that I needed to change designs for comfort.

No longer using my son as the driving factor for which infusion set I use,  I had several many new options to pick from.  Ultimately picking the most "athlete friendly" option, I've been on a set called the "Silhouette" for the past eight or nine months.  The big difference between this one and the SureT is that this set uses a cannula for insulin injection.  The benefit of using a cannula is that it is a plastic tube rather than sharp metal and instead of being inserted vertically into the skin is "injected" at a 45 degree angle into the subcutaneous layer.

Much better, right?

Well... yes, but no.  The problem with this particular cannula is that it requires a 1.5 inch needle on a spring loaded "serter" to be placed accurately...  No matter how many times I've done this (every three days) or how many times I remind myself that it really doesn't hurt all that much, it still scares the boohockey out of me to press that action button, hear the twang of release and send this needle surging into my abdomen.

I must admit that I am half looking forward to the point in this pregnancy where I've put on enough excess weight and fat to be able to swap back to the SureT and avoid this particular self-mutilation for a few months... but then again I want to get back to running, so that respite wont last too long I hope.  Of course I have an amneocentesis or two to look forward to toward the end of the pregnancy to check on Baby's lung development, so it looks like I'm doomed to large gauge needles regardless!

Well, that is enough thinking about needles and stabbing oneself for one night.  Charming topic, I know, but it's a reality I deal with on a regular basis.

Sunday, July 1, 2012

Obsessively annoying.

While lying on my hospital bed in the cardio-wing of the Georgetown University Hospital, scores of doctors, endocrinology residents and medical students paid me visits to talk about my diagnosis and the affect my condition would have on my life.  While the medical students used me as a guinea pig to practice their bedside manor, the attending doctors used their experience to define for me the long journey I would have from that very bed to a "normal life" on insulin.  Describing the transition difficulty I would experience going from a care-free healthy life to the comprehensive incorporation of blood glucose into my every thought, they laid out a time frame for typical diabetes maintenance and care:
  • six months before I firmly established a diabetes routine and lived as a functioning diabetic
  • one year, or more, before they would discuss putting me on an insulin pump
  • at least two years before I'd be medically stable enough to consider adding the complication of pregnancy to my endocrinology care
Considering HB and I had just decided in the weeks prior to my diagnosis that we wanted to try for another baby in the new year, this time frame purely added insult to insulin-injury.  I was disheartened to hear it would be a year before a pump - a significantly more convenient insulin delivery option - would even be considered by my doctors.  And I was disgusted that the white coats assumed that something as straight forward as carb-counting, insulin bolusing and glucose reading would take this diabetic six months to figure out!

Quite obviously, this didn't go over well. My stubborn-headed necessity to beat the odds and control my life just didn't jive with anything less than go-get-em encouragement.  I wont lie and say there wasn't a learning curve associated with the differences between slow-acting and long-lasting insulin, how to inject, where to inject and how much insulin to administer for any given meal/day, but I was  motivated.  Essentially thinking "this is my new life, let's get on with it" I left the hospital and made it my J-O-B to make life normal again asap.

For the first couple weeks I had doctors appointments every week, then it was every other week, eventually working out to once a month.  By the third month of four injections a day, I walked into my endocrinology appointment at GTU in tears completely annoyed with the comprehensive hold diabetes had taken on my life.  It was at that moment, while looking at my glucose logs and new HgA1C reading of 6.1, that NP Su Chin looked at me and said "let's get you on a pump."

So... in three months I accomplished what the doctors initially told me would take a year to do.  I understood my disease, incorporated it into my life and was ready to take on the more complicated technology that would ultimately make my life as an insulin-dependent diabetic easier.  Go-frickin-me! Long story short, I take my disease very seriously and, as such, I've reclaimed my life from the time frame established by "those in the know." Logically following, I only want to work with competent medical professionals that take my aggressive control and my comprehensive treatment equally as serious.

Thus when HB and I decided we wanted to expand our family, we undertook a multi-month search for high-risk OBs and Perinatologists before beginning the journey we are now on.  By process of elimination we sifted through the chaff and finally selected the Perinatal Associates of NOVA as our go-to perinatologist of choice.  They (and the hospital I'll deliver at) are an hour away from where we currently live, but they are oh-so-worth it.  They treat me like I know what I am doing and they take my condition so seriously that Baby and I receive amazing, attention to detail care.  It takes a lot for me to say I am in good hands and, folks, I am in good hands.

However, as some of you know, I am in Vermont for six weeks this summer starting a new (may I add, really cool) graduate program at Middlebury and that means I need a VT-based doc while I'm here.  Seeing as this is a high risk pregnancy and I am here for several of the big-time pregnancy tests (the alpha fetoprotien test, the level III ultrasound and fetal echocardiogram), I shouldn't work with just any OB and - I kid you not - there is only one high risk OB in this state.   So Friday saw me driving up to Burlington for my first appointment with this doctor...

Beyond implying that I shouldn't be considered high risk because of my excellent diabetes self-care (thank you for the compliment, but my obsessive care doesn't reduce the increased risks as a result of insulin dependence...), this lady had the nerve to ask me why I consider myself to be a type-1 diabetic!  FIRST OF ALL, if you don't know the difference between type 1 and type 2 diabetes, you shouldn't be a doctor.  SECONDLY, if you really want to piss of a type 1 diabetic, call them type 2 - the conditions are NOT the same thing!!  Just because I was diagnosed later in life than most typical cases of type 1 diabetes does not mean that a) my islet cells are capable of producing insulin or b) I gave myself diabetes by poor lifestyle choices. HMPH.

Unfortunately this kind of ignorance (yes, even from medical professionals) about diabetes isn't uncommon. Between the misnomers given to each type and the type-2 centric public education campaigns that are prevalent today, type 1 diabetics are often left in the contradictory position of obsessively caring for themselves while fighting off completely-misguided assumptions of their self-care apathy.  And even within the endocrinology community, as I mentioned earlier, the expectation that diabetics will be apathetic to their condition is so prevalent that the time frame for disease comprehension is drawn out over multiple months if not years...  perhaps it is a lack of personal motivation for some that colors the disease for the rest of us, but speaking on behalf of all type 1s I know the lack of public education on insulin-dependence is simply annoying.

Ultimately this is one of the best diseases I, personally, could have gotten from the (silver lining) perspective that I am 100% in control of my well being.  That optimism aside, my skin isn't thick enough at this point to externally dismiss the uneducated references to my disease as "diabetus" or discouraging inquires about "my diet improvement."  Admittedly I am more hopeful of seeing my personal development of an immunity to stupidity because of diabetes than I am of seeing a cure to islet cell failure within my lifetime.  But let the record show that if the medical community would like to prove me wrong and beat me to the punch, I'll happily eat crow when that time comes.