Dexcom Down!

I am feeling like the biggest idiot on the planet.  About four days ago, my Dexcom monitor began to doo-da-loo at me with an error message I'd never seen before: "Transmitter Battery Low.  Order Replacement."  Thoroughly confused by this message as I'd just replaced the monitor this past September, I plugged in my CGM to it's USB port and rolled on with life.

Then, at about one o'clock in the morning this past Sunday, it hit me.  The error message was so darn clear, the transmitter battery is low, not my monitor battery -- in other words, the gray piece I attach to my new sensor on a weekly basis needs to be replaced.  So no matter how well charged my blue CGM monitor is or how fresh my sensor is, with a dead battery in my transmitter my CGM is about as useful as when trash day falls on a national holiday (yes, we were hit three times recently thanks to Thanksgiving, Christmas and New Years Day all falling on Thursdays... no, I am not annoyed...).

Having contacted my Dexcom customer service rep first thing on Monday morning, I learned that it will take 3 to 5 business days to arrive here at the house.  So with a possible arrival time of this Thursday at the earliest or next Monday at the latest, I have been crossing my fingers that the low battery holds out until the earliest possible time that my replacement transmitter can arrive.  Unfortunately, however, as I was going about the morning routine today my monitor stopped reporting my glucose trends and indicated my transmitter is out of range.  As I'd seen this error message before it didn't initially register that my CGM needs more than my sticking the monitor in my pocket for a while... so you can imagine how dumb I felt after carrying this thing around for an hour to no avail when it hit me that, yet again, I'm being completely dense.

My transmitter battery is d-e-a-d, DEAD.  I have yet to receive shipment notification from my supplier that my new transmitter is on it's way.   I've officially thrown myself back to the Stone Age of diabetes management as, for the second time this pregnancy, I'm back to finger sticks to track my blood glucose.  As my insulin requirements continue to change over the course of the third trimester with the placenta making my body increasingly insulin resistant and with baby and me being incredibly sensitive to glucose swings - him and my AFI levels, apparently, responding to my in-range 70-140 mg/dL blood sugar variations; me responding emotionally to the mere suggestion of my diabetes incompetence or a potential c-section - this is NOT the ideal time to have my high tech gismo go out on me.

Keep your fingers crossed that my new transmitter arrives soon and that the mean time doesn't somehow manage to make my head explode.  I head to the perinatologist later today (solo... boo hiss) and it's my first appointment at the hospital's Antenatal Testing Center, so I'll report back sooner rather than later on how things are going... so, seriously, all the fingers you can spare to crossed are appreciated!

UPS Fail.

Okay, I know that it is the holidays and for that reason alone slack should be granted to the poor schlubs who are working exceptionally long, seasonal hours to deliver packages across the country before the good ol’ Saint Nick deadline of December 24, but right now I am beyond angry.   Just five minutes ago, my Mastiff gave me the pleading look of “oh dear goodness, I need to go outside or you need to get the Bissell” so I wrapped up what I was doing and went to the front door to let her out.  Now, our yard doesn’t have a fence and our dog is one of those freakish varieties that won’t run away, stays on our property and comes back to the door as soon as her business is addressed, so I thought nothing of it when I opened the front door, realized it was raining and stepped back to wait for my 118 lbs of pooch to return.  Seeing as she’s more terrified of rain and water than I am (and that is saying something), she ran down the front steps, skipped her typical condeming look of “wait, you aren’t coming with me?” and proceeded to run out into the darkness.  Wanting to keep a watchful eye on her for good measure, I flipped on the front porch light and waited for her to reappear with a wet-cat skulk.

Scampering up to the door, I opened it and looked down to watch her track wet paw prints into the foyer when I saw it.  A lone cardboard package sitting just beside the door on the brick landing in the puddle that perpetually forms whenever it rains.  Now, I could be mad at the person who incomprehensibly formed the stoop to be concave at just the precise location where packages were apt to be delivered, but they screwed up back in the 1970s and I am fairly positive that the statute of limitations on that one has expired.  The UPS guy, however, knows better.  Having delivered package upon package to this address over the last year, he’s aware of the circumstances that surround our house:  the stoop collects water, the dog barks when you knock or ring the door bell, we always answer the door and say “thank you” regardless of our streetability (I’ll wear what makes me comfortable, dang it, and I don’t care if we live in the “south” make-up should be optional at home), the newly awake child screaming (no it wasn’t nap time, she’s just really excited to see you), or whatever is on the stove (quick someone stir that!).  

But tonight, despite all we’ve been through and come to treat as routine, there was no knock on the door or constructive use of the door bell. There was no barky-dog to alert us of the thoroughly vulnerable package that was placed directly in to the formed (and growing) puddle.  And there most certainly isn’t an appropriate application of the word “thank you” to be found on these lips as UPS messed up R-O-Y-A-L-L-Y.  

This could have been a run of the mill Christmas package - something we ordered or someone carefully selected, packed and sent our way - but it wasn’t.  No, it was far from a frivolous purchase that would have received a muttered curse word and eventual shake of the head with ”what a shame.”  Instead, this package contained medical supplies - three months worth of my continuous glucose monitor sensors to be exact - that I use on a daily basis and rely upon for their unfailing accuracy and constant data for my glucose control.  Something that a night’s worth of sitting in the rain would have destroyed, cost me or the supplier, Dexcom, hundreds of dollars to replace and would have left Baby and me up a creek with the occasional finger prick as my source of sugar control.  I’ve long since left behind the CGM-hating band wagon and Lord help anyone (talking to you, UPS!) who gets between me and my necessary - YES NECESSARY - medical technology…  

All I can say at this point (suffice it to say their customer service will be getting an ear full tomorrow) is Thank God the dog needed to go out just then, thank God I turned on the front porch lights for her despite the need for them, and thank God I had that disparaging thought about her wet paws causing me to look down and notice the package when I did.  If this sequence of events hadn’t occurred, my head would have exploded upon finding the mushy pile of trash waiting for me in the morning.  But, fortunately, the cardboard was thick, the boxes of sensors insulated by tissue paper and the sensors individually wrapped in sterile plastic - meaning I got lucky and the damage is largely restricted to the exterior packaging.   Thank you little baby Jesus!

To the nincompoop who skipped putting the package in a sealed plastic bag, opted out of notifying us of it’s delivery and voluntarily left the box in an EXISTING puddle, whoever you are, here’s your sign.  That was excessively dumb, poorly executed and completely unnecessary.  Clearly someone up there is watching out for you, too, but come on man!  Not. Cool. 

Accessorize your Triceps!

With the littlest man growing and making my formerly soft-squishy belly the taut, thin skinned home to exclusively my uterus I've had to start moving my infusion sites and my CGM away from my go-to, formerly pain-free spots on my abdomen to both old-reliable locations and new, um, more revealing sites.  With my pump cannula pushing upwards of 55 units of insulin into my body a day (30.7 of which is now basal - which is holy cow high!), I'm swapping my infusion sites from hip to hip every few days as it's one of the few spots left around my middle with enough subcutaneous fat to avoid searing pain upon insertion.  Struggling to work up the gumption to shoot that huge needle into my skin is hard enough with that nerve-wracking claaaaaaaaang the spring makes upon release, let alone with the anxious knowledge that if I get the spot selection wrong, it'll sting not only now, but five minutes from now and - if thoroughly wrong - until I change the site all together.

As I've narrowed my go-to site options from four alternating spots (near my belly button and on my hips) down to two (hips only), the reality that my CGM transmitter and my pump cannula cannot be within three inches of each other for accuracy purposes creates the necessity to use previously avoided site locations.  As I only change the CGM once per week, I can't place it on one side and my cannula on the other because of the rate at which my cannula needs to be changed and the requirement that it be placed in a "fresh" spot every time I change.  Requiring more creativity and, well, diabetic confidence than I've previously been willing to display, I'm quite clearly wearing this inconvenience on my sleeve.

Literally.  

Both the CGM and the pump cannula are required to be inserted in a sight that will not only appropriately transfer insulin to my blood stream but to also accurately read the current glucose levels circulating through my system.  These locations, while seemingly everywhere, are actually pretty limited: the abdomen, the hips/glutes, the thighs and the triceps.  Having long since lost my comfort with my cannulas in my thighs due to running (OW!!), the options for my new CGM sites were pretty limited.. either a pain in the butt or the back of my arm.

Cannula and CGM location options

Not finding this first option at all appealing (who wants to sit on a lump all day?), I've had to swallow my insecurity to a large extent and be okay with the possibility of my CGM being visible to the world with my short sleeves shirts.  Knowing this will cause a lot more weird looks from strangers and probably several many pointed questions from curious kids, I wiped down the spot, adhered the tape to my skin and, due to the awkward angle, asked my Mother to push in the needle.  Both of us wincing at the mere idea of this new experience, it actually turned out to be much, much more pleasant a location than my abdomen had been previously.  Barely feeling the pinch of the needle, it seems that I am trading comfort for concealment...

Not quite as trendy as a bracelet or watch,
but, hey! It works! 

Fortunately, in the few days that I've been rocking this new look (note the implied confidence) I've seen more accurate readings popping up on my CGM receiver screen for my calibration tests and it showed in my endocrinology appointment this week.  Meeting with Dr. Rogacz to adjust my pump settings, get a grasp on appropriate symlin usage and run a new HgA1C I'm thrilled to report that all is looking tight and tidy.  My A1C is down to 5.6, my symlin dosages have been increased from 15 units once a day to 30 units up to two times daily and my settings are as accurate as they can be for the next five minutes.  So thank you for that, Dexcom!


Long story short, as this is my first pregnancy with a CGM, this new equipment is forcing me to actually have new experiences with my diabetes and my body.  Feeling like this whole disease is pretty much old-hat now and that there isn't much it can throw my way that I haven't already figured out, it's oddly refreshing to have to learn something new and different for a change... course I probably just tempted Murphy there (knock on wood) and will come back to redact these words in a few weeks, but for the time being, I am learning how to work my new arm-accessory and, fingers crossed, I wont ram it into too many walls or rip it out accidentally.  That would NOT be fun.

All for now.  Fetal Echo on Monday.  Keep your fingers crossed!

Broken CGM. DANG IT!

I don't know what my problem is. I seem to have this amazing knack of breaking equipment that I've become thoroughly reliant upon.  At just over three and a half years into my life as a type 1 diabetic, I'm not only on insulin pump number three, but I'm now on continuous glucose monitor number two. 

Last night, our local RWB community hosted a September 11th memorial event supporting both Team RWB and another veteran service organization, Operation Enduring Warrior.   Intent on participating in this moving tribute, I anticipated run-walking between three and six miles of this "11 on 11" relay, but my blood sugar had other plans.  Waddling almost the full length of one whole block (see how I made that sound like a loooooong way?), I reluctantly had to turn around when my CGM announced my impending hypoglycemic doom.  As I didn't have sugar on me or on the stroller (bad habit to get out of, eh?), I shuffled my way back to our start/finish line to avoid catastrophe and wait for the triumphant return of our patriotic crew. 

HB leading the event invocation (check out that growing belly! Oh my!) 

Upon flopping down on top of the large green cooler RWB provided for the runners, I set my glucose monitor, keys and cell phone on the ground beside me as there was plenty of time (11 miles, even for the fastest will take a while) before needing to pack up for the evening.  I then spent the next couple hours cheering for our athletes as they completed their laps and knocked out their memorial miles, I conducted a quick interview with a local online newspaper and I chatted with both new and familiar faces about this, that and the other thing -- none of which did I conduct near my piled electronics. 

Finally, the event completed, we packed up our belongings and made the collective family decision to scrap the idea of going out to dinner as it was approaching 10:00 PM and,  therefore, well past the hour of human/toddler decency.  Having tucked the kids into their respective beds, I came downstairs to check my BG and grab a quick piece of toast or whatever else to eat before crash landing on my own pillow… little did I know, my night was just beginning. 

Upon reaching the kitchen, I pressed the main button on my CGM and promptly covered my ears as the receiver made the loudest BEEEEEEEEEEEEEEEEEEEEP I'd ever heard.  Reading the never-seen before message on the screen saying "HWFR CALL TECHNICAL SUPPORT," I attempted to compose my angry, confused and concerned mind into a calm and collected voice-mail to the Dexcom support team.  Unsure of what happened or how to fix it, I waited next to my phone for a return call until I'd fallen asleep.  Much to my annoyance, it was only when I called them back again this morning that I began to get even the slightest hint of what might have happened and what we could do to correct the problem.

Supposing that the receiver was stepped on, dropped in the ice water or some sort of combination of horrible fates one doesn't wish for one's electronics, the Dexcom representative attempted to walk me through the "simple" process of resetting the receiver before we determined that, nope, there was absolutely no shot at saving my barely six month old CGM from warranty replacement.  

So here I sit today, up a creek without my monitor and I'm feeling absolutely lost in the world.  A year ago, I was doing exactly what I am doing right now - occasionally pricking my fingers to test my glucose levels - and it wasn't at all a problem, but now that I've become so conditioned to having CONSTANT access to my trending information I feel uncomfortably naked and horribly ignorant of my own body.  It's like part of me has been amputated and my phantom parts are just too much for me to wrap my head around…  I keep reaching for my CGM and groping the bottom of my purse in hopes that the last 24 hours didn't actually send me back to the stone age only to remember that, yep, I was in fact stupid to be so careless. 

Fortunately, since my system is so young and still under warranty, Dexcom is overnighting me a replacement receiver and I should be back up and bionic tomorrow.  However, even with this quick solution turn around,  I can't help but kick myself for the irresponsibility, the unappreciation, the negligent behavior I exhibited yesterday that cost me, yet again, a piece of technology I am thoroughly reliant upon.  In a lot of ways I find my angst today incredibly ironic given how hard I fought against this system in the first place, but it just goes to show that the mind and the body can adapt to anything and I guess I'm finally okay being part plastic and batteries.  Maybe one day scientists will make a pump and CGM that will actually be able to withstand the trials and tribulations of an active life like mine, but for the time being, let's just hope I've learned my lesson and my new electronics are blessed with a much longer life than their predecessors.  

Actively Passively Aggressive.

With HB starting a new job and our switching insurance providers (thank you US Congress for removing pre-existing conditions clauses!), the bureaucratic flaming hoops pushed my three month endocrinology check-up back from June to July and I must admit I am feeling anxious about my next A1C.  I'd been slacking back in December with a general apathy toward the world of diabetes and let my A1C increase into the abnormal range with a reading of 6.5.  Feeling self-depricating and flat out pissy about my inability to be under 6.0 without constant focus on my blood sugar readings, I remember Dr. Rogacz looking at me and plainly saying "get over it, perfection just isn't gong to happen."  You can imagine the dismissive internal monolog my brain launched into at this...

Obviously this particular "get over it" method of diabetes management is beyond my scope of comprehension, so I decided to implement a more passive-aggressive approach toward my pancreas by starting on the Dexcom G4 Continuous Glucose Monitor (CGM).  Instead of making me prick my finger or forearm several many times a day to check my glucose levels, my CGM enables me to weekly insert a (rather bulky) sensor into my abdomen and then passively glance at the number and trend line displayed on my i-pod sized display screen.  Letting the CGM do the active work of testing every four minutes (yes, essentially constant), I can pretend I'm non-diabetic all I want without having to endure bruised and sore fingertips.   Granted, I have to calibrate the sensor daily (+) so I am not test kit free, but at least there is some emotional distance between me and my pancreas that didn't exist when my apathy shot my A1C up to 6.5.  

In a circular logic kind of way, my creative interpretation of "passive diabetes management" with the CGM is actually much more actively aggressive than it was before -- even when I was testing 10+ times per day during the pregnancy with GV.  By rarely testing my blood sugar but regularly monitoring the constant sensor information about my glucose levels and trend patterns, I lowered my A1C from December to March all the way down to 5.9!  It seems that despite my continued annoyance with the reality there's no "getting over" being diabetic, I owe all credit for my sanity and overall health to the technology that I'd previously been avoiding...  ironic.

Perhaps in being curious about what another three months of CGM usage will do to my next A1C I am actually starting to take Dr. Rogacz's advice to some degree and I'm finally curbing my apathy towards my diseases.   I definitely have my hopes up that I'll have an even better reading than 5.9 this go around and, as much as I may try to pretend otherwise, that shoots my "don't give a dang" facade straight in the foot.

My July 3rd appointment can't get here soon enough.

Long over due...

I honestly can't remember the last time I sat down to write something more than an email or news letter... how sad.  The last several nights I've been mentally kicking myself for letting yet another day pass without getting back on the proverbial horse, but then exhaustion takes over and within a matter of moments my alarm clock is going off and somehow all of the good-intentioned-tomorrows became a stream of oh-well-yesterdays.   While I can't anticipate this to be terribly pretty, let this blog post be the end of that and a return to what fuels me.

The last several many months have been chalked full of this, that and the other thing - some of it important and worth mention, much of it common and likely beyond my memory at this point.  Instead of focusing on what's been, however, HB suggested I simply list out what I could have written about and move on with it (with or without further details as necessary).  Makes sense and starts a clean slate, so here goes:


* My Dad had a massive heart attack two days before GW's 4th birthday in October so we cancelled his party and flew to Colorado.  Upon arriving, GW promptly came down with a passing virus and deliriously missed the whole trip while riding out the Motrin-wave.  Fortunately, while serious, the heart attack wasn't fatal and my Dad's made as solid of a recovery as one can and GW recuperated with a few weeks to thoroughly enjoy his birthday gift (the helmet) for Halloween.

* We raced in and finish the 2013 Marine Corps Marathon in 4:50:25 (goal was between 4:30 and 5:30).  Having missed the last 10 miles worth of distance training due to unhappy kids wanting no more than two hours in the stroller at a time, I hit the wall at mile 18 and limped it in the rest of the way with excruciating IT Band pain.  Thank goodness I had amazing support from HB and our awesome friend TS, I couldn't have done it without them.  THANK YOU!

* One thing I am not thrilled with from that day is my disastrous judgement with regards to my pump... I chose to keep it on me instead of leaving it in the car so as to enable me to get food at the finish line.  Unfortunately, the sweat and salt build up that happened during the course of the race broke my pump beyond repair - effectively preventing me from eating at the finish line anyway.  Thank Heaven, at least, that we have insurance that covered the cost of getting a replacement, because otherwise the cost of running 26.2 miles just became much, much, much more expensive!

* The pain I felt in Marathon wound up leading to an IT Band release surgery that took me off my feet and out of running for two months.  My doctor said that he was glad to have done it because my Band is the thickest he's seen and that it's no wonder stretching wasn't enough.  The surgery largely fixed the issue and I haven't had issues with it since starting back into running.  At some point I may need to go in to have the right knee done as well, but as of now I am a-okay!

* I gave in... I got a Continuous Glucose Monitor (CGM).  I can't remember what it was specifically that made me change my mind, but I've forfeited another portion of my abdomen to yet another diabetic device, which, surprisingly, is very handy and not nearly as obnoxious as I anticipated.  I'll definitely have to write more about my Dexcom G4 so I will make a note to save this topic for later.

* GV turned 1 year old in November and is the biggest bundle of joy you can imagine.  She's talkative, curious, friendly, incredibly smart and very engaging - particularly when she ought to be quiet at mass.  She eagerly wants to do everything GW is doing and, in spite of his initial protests and her flagrant acts of retaliation, they appear to be growing on one another with actual (there is nothing censored about these two) affection.

*  Much of the time I would have otherwise spent writing over the last year has been spent volunteering for Team Red, White & Blue. Admittedly, it does not provide me the same sense of accomplishment I get when I've written a piece I'm proud of, but there is definitely a happiness involved in creating a positive community that enables a sense of connection and belonging that didn't exist for me - and for many - before.  At just over one year into building our local Community we have roughly 300 members and I think it's about time to reclaim some of my own life and that starts here...

In the coming weeks I hope to finish some blog drafts I've had sitting around collecting dust and, with a little bit of luck, I will actually start some new ones.  I anticipate that in a similar sense to running, starting to write again may be initially painful and it may be difficult to find my stride.  However, I have faith in muscle memory and I'm sure my fingers can find their way one after the other just as one does when starting exercise again... if not, one has hope that HB is an excellent editor and all that is irrelevant to you!

Fingers crossed.

Endo Check Up

I am so beyond frustrated with myself for having thoroughly dropped the ball on my blog posts recently... with the best of intentions I keep logging on to start writing and then immediately get distracted by something shinny and wind up hitting save after typing the most basic reference note to come back to in my "free time."  What with unpacking the new house, GW starting pre-school, GV being just moments away from walking and trying to really sink my teeth into my work with Team RWB, I've hardly had time for sleep let alone a coherently written sentence.  Fortunately for tonight, however, I told myself that I am not allowed to unpack another box until I put on background noise and, in order to do that, I decided I need to publish at least one timely blog update first.

So here it is.  

I went in for my every three month check up with the Endocrinologist this past Wednesday, Sept 11.  Beyond the issue that I couldn't provide recent blood glucose logs to her because I've lost my pump download USB in the move, I knew going into the appointment that it wouldn't be a stellar one.  The last couple months have been beyond difficult for me and not because of stress from running, Vermont or any of the other drama that has magically appeared, but because of the gosh darn fact that I'm diabetic.  I'm just done with it and I don't want to play any more.

I am sick of checking my blood sugar so often that my forearms get bruised and my finger tips are painful to touch.  I am sick of needing to count every dang tortilla chip I eat to make sure my carb counting is right.  I am tired of shopping for clothes with an eye to where to put/hide my pump rather than what actually looks good.  I'm frustrated that people glare at me in mass because my "pager" is going off.  I'm annoyed that my training runs resemble more of a staccato sprint than a crescendo of distance because of carb stops.  And, dagnabbit, I am jealous that HB gets a milkshake with his meal and doesn't bat an eye at the massive amount carbs he's inhaling absentmindedly.  It's just not fair.

Yeah, yeah, yeah, I know - life isn't fair.  And, yeah, I got it - God gives us what we can handle.  But that doesn't diminish the acrid reality that chronic is as chronic does and I don't want to "is" or "does" any more.  And, going into my appointment today, I knew that this attitude would come back to bite me  in the butt with my HgA1C reading.

Back at the beginning of June, my A1C was a 5.8  - which as you recall is within the limits of "normal." Today, it's up to 6.1, which in all reality is pretty tight for most diabetics, but is wildly loose for this one.  Between my current (hopefully ephemeral) apathy for the disease and an increasing difficulty with hypo- and hyperglycemic awareness it was no surprise to me that the numbers were up into the abnormal range, however marginal. I rationally understand that I need to do better and that it's just a matter of exerting a bit more effort into self-care, but, seriously, what stay at home Mom has time for self-care? Maybe some have figured it out, but I certainly haven't.

Of course, Dr. Rogacz was generally encouraging as usual and, knowing me far too well, she went out of her way to merely make a gentle nudge on the CGM topic rather than hit me over the head with my own bad attitude.   The latter would probably have been far more effective and appropriate, but I think she knew that I'm ready to give in to her this time anyway and give a CGM a chance since I'm already blowing off active participation in my disease... and since HB wont let me do that (however super model skinny that'd enable me to be) and our NFP requires better of me, I'm planting a white flag of general diabetes resignation and forfeiting the other half of my abdomen to Dexcom.

Sigh...

I don't know what my deal is... perhaps I'm just overextended?  I'm trying my hardest to be the best parent, wife, catholic and veteran advocate I can be, but I know I need to seriously step up my game at writing, home decorating and (oh yeah, supposedly doing a marathon) running -- maybe if I drop out of diabetes 101 the rest of life's course work wouldn't seem so heavy?  Figures, the one thing I don't want, is the absolute one thing I can't get rid of...

Diabetes, I seriously don't like you.

Endo Check Up

It seems funny to me how our perception of time changes based on whatever it is that makes up "normal" every day life.   Last fall, when I was pregnant with GV, I had so many doctors appointments that my days, perhaps even my hours, seemed to be measured in trips up and down the I-95 corridor to Fairfax INOVA Hospital.  But now that I'm back to "normal," fireman rain coats and matching wellies accent my routine far more than white coats, which are soooo last season.  Doctors appointments now merely indicate the passing of yet another three months -- either in the form of a well baby visit for GV or a routine endocrinology check up for me.

The latter is what I did today. 

The past couple months have been ROUGH diabetes wise and, to be completely honest, I've been dreading this appointment for fear of the criticism I feel is entirely appropriate for my self care.  It isn't that I have been slacking on the job or purposefully blowing off my blood sugar (although, to be fair, I simply forgot to bolus once... yikes), it's just that I'll be going along just fine and then WHAM! my blood glucose is in the high 200s and there is no simple explanation for it.  My pump will indicate that I have enough active insulin in my system to cover the correction, but my glucose will have shot up like the insulin wasn't even there and, quite similiarly to when I was pregnant, come crashing down an hour or two later.  Without understandable rhyme or logical reason for this, I've just been rage bolusing and enjoying a few extra doses of whatever something sweet I'd happen to be craving at the time (currently pecan pralines).

Thus expecting an abnormal HgA1C, which if you remember is anything above 6.0, I brought my support group along for the telling finger prick that would inevitably quantify the amount of flack I'd justifiably be given.  Dispensing with the "oh what an adorable baby" and "you must be such a good big brother" comments and getting down to it, I held my breath and gritted my teeth as I waited for the results in the same manor I did while checking the mail box for my college acceptance letters...

Doctor Rogacz entered the room.  We exchanged our pleasantries and, with little ado, got down to my diabetic trials and tribulations.  Explaining that some things have changed - I'm running more, I've been under more stress and that I'd been sick without singular cause - but that most of my lifestyle factors remain the same, I blushed in embarrassment as I handed her my blood glucose logs for the last two weeks which included daily ventures into the 200s.

"Hmm, I don't know what to tell you," she said. "The timing of these highs are inconsistent and you've got a number of lows as well.  But your HgA1C is good at 5.8 - so you're doing something right even with these numbers."

SHOCK.

Reading my face and plainly hearing HB's comments of "I told you so" (he relishes those opportunities), she then not only didn't give me a hard time about my hyperglycemic excursions she was incredibly encouraging of my dedication.

"You're never going to have perfect blood sugars, no matter how hard you try, so try to relax.  You're doing a great job!"

Frustrated with the medical recommendation "to relax" I professionally dodged her compliment with a question or three about my marathon training to which she merely said "do what you have to do to not pass out" which, in endurance running and diabetes management, I take as excellent advice.

So without jabs about my continuing lack of CGM, lectures about abnormal blood sugar ranges or prescriptions for whatever else might be ailing me, I felt like I dodged a bullet today as we walked back to the car.  I thoroughly expected my HgA1C to be in the high 7 range and I lost significant amounts of sleep last night because of anxious dread of medical criticism... but I guess all that worrying was for not.   My Nana, may she rest in peace, always said that the things you worry about never come to pass and until now I'd figured that was just her way of recommending I "relax" but, hey, perhaps she was right.

We'll see where I'm at in another three months.

3 Month Check Up

So I am having a really hard time believing that it has already been 3 months since my last endocrinology check up, but since GV is already 14 weeks old and time just seems to be flying past I guess I buy it.  Originally, my appointment was scheduled for two days ago, but seeing as this is Northern Virginia and any sign of snow makes the entire region shut down, the "snowquester" got it pushed back to this afternoon.

With GW, GV and Grandmama in tow, I met with the wonderful Dr. Rogacz for a routine diabetes check-up for the first time!  Pleased with my weight loss and new HgA1C number of 5.8 (that is down from 6.2 mind you), she announced she wasn't concerned about my diabetes care in the slightest and that I am doing remarkably well.

Inquiring about my longer term plans for additional pregnancies and care planning purposes, I told Dr. Rogacz I intend to spend the next 12+ months training for and running in endurance races.  Since pregnancies, diabetes and running don't work together in the slightest, she seemed a bit relieved to know we wouldn't be putting my body through more of that any time soon, but it did cause her to use a term that I dread from endocrinologists: CGM.

Pump with infusion site on right; CGM on left.

CGM, Continuous Glucose Monitoring, is a technology that works with insulin therapy to keep a diabetics blood sugar as tight as possible.  As an additional attachment to the body, the CGM tests blood sugar every four minutes and logs the results so as to indicate the trending direction of your blood sugar and therefore making it easier to catch it as it goes up or as it goes down.  It'd be incredibly helpful for me on my training runs, it'd ensure my safety overnight by alerting me to lows before they happen, it'd help me keep my A1C lower by giving me constant readings and I'd generally be armed with much more information than I currently get with just my Free Style Lite test strips.  Essentially it is an extraordinarily handy tool and wonderful technology to have... I just don't want it.

Here's my logic:

Because I wear an insulin pump and have an infusion site adhered to my body 24/7/365, I constantly carry a 2" by 3" by 1" visual reminder in my pocket that I'm diseased.  Granted it is an extremely helpful piece of plastic to have and I'd be worse off with out it (multiple injections are so not my thing), but I resent the fact that I LOOK diabetic because I wear this tubed device everywhere I go.  Now, if I were to add a CGM, not only would I be attached to the insulin port that is necessary for my pump to operate, I'd have this transmitting device inserted into my subcutaneous jiggle that would make it all the more difficult to hide my disease under my clothes.

I understand that it is incredibly superficial of me to be concerned about "looking diabetic" and how this beneficial technology would impact the fit of my sweaters, especially since most people don't know what they're looking at anyway, but hasn't diabetes already consumed enough of my life?  I mean I can't even have a cup of coffee in the morning without needing to compose my little grey cells enough to test my blood sugar and calculate my bolus, why should I give another portion of my abdomen over to yet another accessory for my broken pancreas?

Don't get me wrong, that was an entirely rhetorical question and I understand the benefits of it.  I mean, okay, there is something to be said for having an HgA1C estimate whenever I want and, hypothetically, it'd protect me from severe hypoglycemia by averting it's onset in the first place, but I'm incredibly sensitive to lows as is and assuming my daily readings stay within a certain range I know my A1C is where I want it to be without knowing exactly where it is.  Perhaps I am being stupidly stubborn on this, but STILL.  I'm just not ready for that.  I feel diabetic enough as it is.

Maybe sometime down the line I'll come around and will willingly participate in the next level of self-care, but for the time being my answer is HELL NO.    Sorry to disappoint you, Dr Rogacz, I'd love to be your shining star patient with all the bells and whistles, but I'll take my low-tech stellar A1C and go on my way.  See you in June.