Supply... meet demand.

So HB and I recently had to change our insurance when he switched to a new job and under this new insurance policy I am not able get the my insulin pump supplies from the same manufacturers/suppliers as I was before.  Fortunately this change didn't mandate an entirely new brand of pump, so the hoop jumping I've been doing is relatively minor in the grand scheme, but I can't even begin to comprehend why this whole process is so. darn. complicated. 

First things first, I contact my Dexcom CGM's intermediary supplier to give them my new insurance information.  I've had a horrible time of it trying to work with this company to begin with so it wasn't too much of a shock when they announced that my insurance isn't accepted in their pharmaceutical branch but maybe - only maybe - their durable medical department could assist…  they, of course, didn't return phone calls or process my prescription for two weeks until I'd practically run out of sensors (3 days were left on the one I was wearing) when finally the company's management and I made sense of what should otherwise have been a very straight forward process.   Headache number one conquered (and "case management" officer identified for my file - time will tell on how she does). 

The second phone call I made to update my insurance information was to Medtronic, the makers of my MiniMed insulin pump.  For the most part, their customer service is ON IT and I love to work with them.  This time, however, my heart nearly broke when they flat out said they don't accept my insurance directly and that I'll need to start working with an intermediary supply company to get my infusion change supplies instead of working directly with Medtronic.  Given the terrible support I've had with these types of companies before, this was a bad-news-bears kind of moment.  Having been assigned to a new company, I called them to set up my account and start my next supply order which, much to my relief, seemed to go smoothly. 

Unfortunately my sense of relief came too soon.  When my supply order arrived, I found that the supply company decided to change the reservoirs I use in my pump from the 1.8 mL size to the 3.0 mL size given my recent increase in insulin use.  This is all well and good, minus the fact that the pump I use only fits a 2.0 mL size reservoir at the largest… meaning I'm up a creek with a bunch of supplies I cannot use for the pump design I've been wearing since 2011.   AWESOME. 

I call Medtronic to see what my options are - either I return the un-returnable medical supplies that I cannot use OR I see if a larger pump is covered under my current pump warranty (expires spring 2015 - eep!) and their legal definition of "medical necessity."  Fortunately, since their customer service rocks as I said, they were quick to discover that YES! I am entitled to a new pump… but it's on back order for at least 5 to 6 weeks due to increased demand for the 3.0 mL size snazzy, updated MiniMed pump.  Knowing I can't use the supplies I have on hand and can't  go without insulin for the next month and a half, Medtronic generously covered a box of the 1.8 mL size reservoirs for me so as to get me through the wait time.  Thanks, Medtronic! Grumble, supply company, thanks for screwing with my supplies and demand!

Note the size difference... 

Long story short, my new pump finally arrived and I'm in the process of updating my settings in pump #3.  I don't so much mind the larger size of the pump, it still fits in my pocket after all, but the ordeal of programming is a pain!  I have 10 different basal settings to transfer over (total daily basal currently 24.975 units), 4 different carb-ratios (ranging from 11g  to 15g carbs per every 1 unit of insulin) and don't even get me started on the random alarm/system settings I use to keep on top of my glucose treatment.  I know it will all be for the best once this whole two-month insurance-change deal is over, but for the time being my head is still ringing from the knock-on effects this hypothetically simple process caused.  

Maybe when it comes to my next three-month supply order this fall, it'll be straight forward.  At least one can hope. 

Monday blues...

What a way to start a Monday!  So, with only 3.2 units of insulin left in my pump, I woke up this morning with the necessity to do an infusion change before breakfast.  Injecting just enough insulin to cover a cup of coffee (the only saving grace), I gather my things and sit down in front of my computer with the intention of watching the finale of Top Chef Master while jabbing myself in the stomach.

But before I get the episode pulled up and before I get a chance to doctor my coffee with the appropriate amount of sugar and cream, I open my email and find a recall notice from Medtronic about faulty insulin pump reservoirs (multiple lot numbers for models MMT-326A and MMT-332A).  Well, what do you think I have?  Yup - only recalled equipment.

Instructing me to "1. switch to your back up insulin injection plan" and "2. call us to expedite a replacement box" I find myself, pre-coffee, attempting to make long distance calls on my computer from rural Vermont to my doc in Virginia to get a "back up insulin injection plan" prescription to cover the now until... when the replacement reservoirs can get here.

Ug... no solution yet, more later.

Maximum Bolus

I had to reprogram my pump this morning.  Given my recent blog posts about new basal rates and new carb:insulin ratios, I'm sure that many of you are thinking "so what?"  And while I have to hand it to you that reprogramming my pump is definitely becoming old news, this particular change in set up is a big deal to me and an official diabetes first... I had to increase my max bolus rate.

I've probably explained this before and I know it's off to the right side here in the diabetes vocab column, but a bolus of insulin is what I inject via the pump to cover the number of carbohydrates that I eat during any given meal or snack.  Back before I was pregnant, I would typically bolus 1 unit of insulin for every 22 to 25 grams of carbohydrates depending on the time of day (it's not a stagnant ratio, our bodies aren't that simple).  So for an extremely large, carb heavy meal - say 100 grams for mashed potatoes, a dinner roll, a glass of wine and 1/3 a dessert (gotta share with HB and GW) - before pregnancy I might inject a total of 4 to 5 units of insulin.

Well, as I've perviously explained is due to dear old Mrs. Placenta, my current carb:insulin ratios are much lower than they were and now three out of four of them are actually below 10 grams per unit.  So to have a heavier carb meal (as I did this morning with GW's early-bday pancake breakfast) I am bolusing what I consider to be exorbitant amounts of insulin to cover what would have previously been "just" four or five units.  This morning I needed to bolus for 100 grams (three of HB's large pancakes with sugar free syrup) and my pump started beeping at me something fierce and the screen read "MAXIMUM BOLUS EXCEEDED."

I've never seen this screen before.

I went back into my pump and looked more closely at the numbers -- 100 grams of carbs at a ratio of 8.5:1 came to 11.75 units of insulin.  ELEVEN POINT SEVEN FIVE UNITS. Do you have any idea how crazy that is?!  Since 2011 I've been notorious with my endocrinologists for being truly insulin sensitive as a little goes a looooooong way.  But now, at just under 31 weeks pregnant, insulin sensitivity is a thing of the past and my 11.7 units now covers less than half of what it used to!  No longer is a maximum bolus of 10 units appropriate when I require more than that for a singular meal.

Sigh...

The whole point of a maximum bolus rate is to protect insulin pump wearers from accidentally injecting too much insulin at any given point.  Like when your toddler grabs your pump while you're sleeping and pushes the buttons to play the beeping noise and all of a sudden you've got 35 units of active insulin in your system to eat your way out of (happened to the type 1 medtronic employee who trained me to use my pump; scary).   Just to give you an idea, at my current ratio 35 units is just about 300 grams of carbs which is equivalent to: 5 slices of apple pie, 4.5 blueberry scones, 8 cups of Kemps Old Fashioned Chocolate Chip ice cream or 12 of HB's large pancakes.  I don't know about you, but I can't eat that much and that's exactly the point of the max bolus.

Long story short, I had to go into the bolus settings and increase the max bolus allotment - something I've never done before.  I only increased it from 10 units to 12 out of mere passive aggression toward my pancreas and placenta (what's up with me and malfunctioning "p" letter body parts?)... I'm guessing they'll retaliate sooner rather than later, but for the time being I'm relishing my effective, minor counter measure.

Take that.

Agh!

So there are points in each of our lives when we all have one of those moments/days/weeks/whatever that just aren't going in our favor.  You know what I am talking about - the day you wake up already late for work, get a speeding ticket on the drive in, have a fight with a friend over lunch and manage to drop a meatball down the front of your white dress right before an important briefing and then you get home to discover your pooch ate the heel off the left shoe of your favorite pair of heels - you know, those days.  I've felt like things have been going pretty well lately - nothing new to report with the pregnancy, grades came back from Middlebury and were where I wanted them, and HB and GW are well all things considered - and I have been fighting the good fight to good effect.  But then, out of the blue, diabetes struck again!

I don't know what it is about the last couple days, yesterday in particular, but my sugars have been all over the map.  One minute I am slightly low and my body is exhibiting major hypoglycemia symptoms (seriously, last night I could have been running a marathon in 150 degree weather given how fast my heart was pounding and how hot I felt) and the next my sugars are soaring higher than I've seen in I don't know how long. All I can figure is that one of the following has to be true:  A)  I've been off on my carb counting; B)  my insulin resistence is ramping up; or, C) my body just plain does not know what to do about the specific carbs I've been eating. 

It's probably a combination of all of the above at any given point, but it is frustrating none the less.  I mean to vasilate between correcting a low with my three (yes, repeat that, three) starburst and then rage bolusing (this means injecting extra "unnecessary" insulin to correct for a high faster than waiting for active insulin to work) to correct the unexpected high is simply obnoxious.  I'm sure there are those out there thinking some extremely useful thought like "well, just eat two starbursts, dummy" and while you might have a point, it's times like this that I'm sooooooooo not interested in commentary about what I should or could do better with my diet or diabetes management. No offense meant, but let it be known I beat myself up enough over abnormal blood glucose numbers for all of us thank you very much.

The cherry on top of my bad diabetes day yesterday was in the middle of the Sound of Music Sing-A-Long HB, GW and I went to (oh so much fun!!) my pump freaks the heck out and reads the stop-you-dead-in-your-tracks, armagedon-is-upon-us, you've-got-to-be-kidding-me error code: "motor error." AGH!!  So while the thousands of people around me were belting The Hills Are Alive while Maria is twirling on the big screen, I go into pre-panic mode and have to reset my pump all the while hoping to God that the mechanics of my pump really aren't failing.  Exposing my huge belly to the crowd to disconnect the infusion site, I removed the resevoir from the pump and held my breath as I watched the piston rewind back into the gear box.  It beeped - rewind successful.  I reinserted my old, still full resevoir into the pump and went through the key stoke commands to reset it and watched it intently for additional problems.  And - thank God - it worked fine.  I exposed my belly again to hook it back up and promptly joined in the chorus of nuns and would-be-nuns in "hallelujahs!" (Thank you to the male-mother superior sitting in front of us for the extra blessing, ha.)

Okay, so maybe that wasn't an actual cherry on top of that particularly bad bg day, but those heart-racing moments of concern that my plastic, artificial insulin life line had been cut off scared the boohockey out of me.  Granted, I have back up insulin in the pen form back at the house and I'm not completely in over my head if my pump does actually fail, but seeing as I'm not always home, I don't carry my insulin pens with me (they need to be refrigerated) and time without active basal insulin in my system is not healthy time for the baby, I would really rather not need to go there.  Further more, I've fine tuned my diabetes care to the point that my bolus doses are within 0.05 units of exactly where I need them to be at any given moment... with an insulin pen, you can only dose in whole numbers thus requiring too little or too much insulin.  Let it be sufficient to say that without the pump, I am pretty sure my diabetes management and my sanity would be out the window.

I know that Medtronic has a 24 hour emergency hotline for full on pancreas crisises like that and that they would have either fixed my pump or gotten a new one to me as fast as FedEx can move it, so it's not the end of the world to have it break.  But given the cost of replacing it, the efficacy of treatment on the pump and the necessity - at this point in the pregnancy in particular - to be as close to non-diabetic as a type 1 can get, I'd really just rather not go there. 

Needless to say I said several many more diabetes related prayers this morning at mass and increased my morning bolus ratio and my afternoon basal ratio to hopefully combat any resistance issues I'm starting to face.  From the other pregnancy and diabetes blogs that I follow, it seems to be pretty typical that things get a bit out of hand right about now and continue to deteriorate as the third trimester approaches and wears on.  Hopefully I'll get to expereince the frustration of third-trimester insulin woes for several many weeks and Baby will be delivered after wk 36, but we'll just have to see how all of this unfolds. 

I head into the endocrinologist tomorrow morning for my first A1C check up since early this summer and I anticipate that it will be a good number.  I've only had issues the last several days and the past three months have been solid, so we'll see where that officially puts me in the rankings...

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 :)

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. 

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.

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.