When everything feels like it’s falling apart

October 2013 – We trash the car and decide to rely on public transportation and the kindness of coworkers to get around while we save for a new car – avoid debt and earn environmentalist brownie points at the same time.  I also get seated on a 6 month long jury duty which takes me away from work 2 days a week.

New Year’s Eve – M’s immigration paperwork has problems – looks like we’ll have to move to Germany where Insulin pumps are not considered necessary, CSMs are nearly never prescribed, and I barely have an elementary grasp of the language.

January 2 – Dex transmitter battery is out of juice (I should be glad it lasted this long – it’s only supposed to last 6 mo and I’ve had it over a year).  And now no Dex (!)  I’ve ordered a new one, and my insurance will pay, but I’m still waiting on a signature from my Endo.

January 4 – We’ve been noticing that the Hedgehog isn’t using his hind legs as well as usual and one of his eyes is looking red and bulgy. We take him to the vet (goodbye $150 and the cost of a Zipcar rental) and receive a prognosis akin to “there’s nothing we can do that doesn’t cost a fortune and cause him more pain that he’s in now.”  We bring him home with some eye drops and a phone number to call if he takes a turn for the worse.

January 6 – While at jury duty, I receive a goodbye email from my favorite coworker.  Then I receive 2 more.  By the end of the day a third of Company X has been laid off.  Not me, thankfully, but I have to take a 20% pay cut until things turn around (and, frankly, that doesn’t look likely).  To top it off, my carpool was part of the lay-off and now my commute to work is now 1.5 hr each way rather than 25 min (because of the lovely decision we made regarding the car back in October).  We went through something similar about 6 mo ago but it felt less dire that time. Oh, the joys of working for a start-up company.

January 8 – We notice that the apartment is a bit cold and start to question when the last time we felt the radiators kick on.

January 9 – There’s a letter taped to the door of the apartment saying that the boiler is broken and they don’t anticipate heat being restored before Wed – Fri of next week.  Our options are to be cold as we attempt to heat the apartment by oven or fork out money we don’t have to stay in a hotel (see Jan 6, above).  Our lovely landlord isn’t helping at all (and we’ve neglected to buy renters insurance to cover these sorts of costs).

If the last two weeks were intended to set the tone for the coming year, I vote we skip 2014 altogether and embark on 2015 instead.  Who’s in?

New Year, New Adventures, and a Request

I don’t usually do New Year’s resolutions; I’ve found that I am more successful at making changes in my life when I initially realize something needs to change, rather than waiting for an arbitrarily later time.  Plus, this year, I need to contain most of my resolve for a potential major life change.  For M and I, it is becoming increasingly likely that we’ll need to make a move to Germany in 2014.

You see, 5 years ago I fell in love with a German.  M and I moved together from Indiana to Boston and it’s always been understood that when M’s work visa expires, we’d move to Germany for awhile. (Or forever… Don’t tell my mother…)  That time is coming in September.  Since neither of us is fully ready to move right now (I like my job, moving is expensive and my school loans are barely paid off, our current proximity to Joslin is ideal while we contemplate our future family, etc), we’re working on obtaining a new visa or a green card for M but we’re planning for what is probably the inevitable.

I’ve made some effort to learn German but am still have an underwhelming grasp of the German language.  M has decided that the remedy for this is for him to speak to me only in German from now on. This should be interesting.

More importantly (or maybe just equally important), I’ve been reading up on life in Germany for an American expat with diabetes.  Unfortunately, that info is not altogether easy to come by.  I can rely on M for info about the German social health care system, and the internet has plenty of resources for both diabetics and expats, but what it seems to be lacking is a mixing of the two.

What I’ve learned is that an insulin pump is not the standard of care in Germany and insurance coverage for one needs to be fought for on an individual basis.  CGMs are basically never covered and would certainly need to be paid for out of pocket.  My poor German language skills are certainly going to make it tricky to find a job (luckily English is widely spoken in science so I might be in luck…) so we are unlikely to be able to afford such extravagant things initially and I haven’t been on MDI in 12 years!  This is a slightly terrifying prospect and some first-hand info would be greatly appreciated. (Please help!!)

Clearly diabetes in Germany can’t be all bad.  There’s the MySugr app (Ok, it’s from Austria but they speak German so I’m counting it), Mein Diabetes Blog, many, manydiabetes online resources, etc.

Which brings me to the request.  I’m asking you, the DOC, to please comment below with your links, advice, first-hand accounts dealing with insurance in Germany, or any information at all about being a diabetic expat in any EU country; we are willing to move anywhere where we can find jobs and D covered.  I’m looking for things like insurance for foreigners, any policies regarding diabetics and driving,  access to  and cost  of insulin pumps and CGMS, etc.  I plan to do the same and turn this page into a hub full of info for any diabetic looking to make a move to the EU.

Thanks for your help!

I Blame Christmas

I’m having one of those weeks; one where D is behaving like a unsupervised 2 year old on an airplane.  Infusion sites are turning into giant purple bruises on my stomach, or becoming strange unabsorptive lumps on my thigh, or failing to stick properly and falling off within hours.  Meals are being bolused for 5 minutes late and I’m paying for it for 12 hours after.  Insulin has been behaving more like saline, requiring me to bolus at least 1.5x what I think I need to cover anything; I’ve been stacking insulin on insulin, drinking my weight in water, and keeping a constant eye out for ketones (none, thankfully!) but my BG hasn’t been under 150 for more than an hour or two in the last three days!

I’m sure the sushi buffet for Christmas, combined with the stocking full of Reese’s cups and almond Kisses, then the Indian buffet yesterday, and the complete upside down schedule involving way more TV than normal haven’t helped but I’m choosing to blame Christmas.  Christmas was the motivation for the majority of those aforementioned food choices.  Christmas is the reason I’ve had time off work to spend too many hours sitting in front of the television.  With Christmas comes cold weather and with cold weather (and no car) comes a lot more staying home to stay warm. 

I'm ready to quit!

I’m ready to quit!

That average daily dose is about 20 units higher than my normal daily dose.  You’re probably looking at the picture above (of the worst summary screen shot of my adult life) and thinking that it must not be a very realistic summary of the last 3 days, maybe I failed to enter lower numbers into my pump that didn’t require a correction?  While that’s somewhat true, the next screen shot from Dex proves my point:

Worst 3 days in history

Worst 3 days in history

That’s right. You’re looking at 3 full days with an average of 79% above target! Typically I can at least manage to reign in the beast overnight; but not at Christmas!

I am not a Grinch.  Really.  I’ve had my Christmas tree trimmed for a couple weeks and the stockings have been hung with care.  I sent out my homemade Christmas cards and decorated my fridge with the cards and pictures sent by my friends and family.  Christmas is the one holiday M even remotely gets into and I love how opinionated he is about the tree needing to be decorated only with red, the twinkle lights can only be white, and the tree isn’t complete until topped with a star.  Christmas means hot chocolate and singing and mittens and warm tidings (whatever the hell those are).  What’s not to love?

Despite all that, this year I’m thisclose to giving up on Christmas.  If it’s just going to return my love with sticky high blood sugars and teeth sweaters and an increased A1c, then I’m going to boycott.

But then today, the day after the day after the day after Christmas, I wake up with a BG of 65 and level off to 135 after breakfast and I remember that Christmas is over.  I can use the weekend to return to my regularly scheduled food/activity routine, and my blood sugars will return to normal.  I suppose this is what New Years resolutions are for, huh?

I guess Christmas can stay...

I guess Christmas can stay…

Scary 4am Low: A Cautionary Tale

I’m a little rattled this morning by the events that played out last night when I should have been sleeping peacefully.  I’ll do my best to convey them here now:

I went to a holiday party last night and both drank and a ate a bit closer to bed time than I like to; it seems the food in my stomach when I’m sleeping digests a bit quicker and I tend to spike a bit higher than I might if I didn’t go to sleep so soon after eating.  I also walked home from the party and was seeing double down arrows on Dex and a BG of 175 which from experience I knew would either level off at 175 once I stopped walking/went to bed, or would continue to raise one I went to bed and super-digestion commenced.

So, I went to bed last night expecting a bit of a BG-coaster but after a comedy of errors, what I got was so much worse.

Here’s what I remember:

Around 4am, I hear M asking me if he should get me some orange juice. I must have been feeling the low at that point because M usually responds only to my squirming and not to the sound of Dex. I also must have been pretty low because when he asked, rather than saying “no” like I normally would do and getting the juice myself, I said “please” and I put my head on the pillow and let the cold sweat drip over my skin.

He brought back a full, tall glass of orange juice (at lease 4x what I would normally use to treat a low) which I drank in two gulps.  He got a second glass that went down just as easily.  I lay there for a couple minutes to try and let the juice absorb when I decided to actually look at Dex.  58 mg/dL.  Not too bad. But 58 wasn’t really a good description of how I felt. I felt sub-zero. So I grabbed my meter and checked.  32.  That’s more like it.

I went into the kitchen and ate a few spoonfuls of pistachio Haagen-Dazs and Nutella.  M came to check that I was ok and laugh and my standing in front of the open freezer with a carton of ice cream and a spoonful of chocolate.  I went back to bed and back to sleep.

In the morning, I assumed I would be sky high but Dex was only reading in the 120′s.  A check with my meter confirmed it.

7 am BG after overnight low.

7 am BG after overnight low.

WTF? Where’s my sky high BG that should have followed my massive 4am consumption?  Looking at Dex confused me even more – this low occurred after a rapid drop in BG at 2am.  I must have awaken to the sound of Dex alerting me to a high and I must have groggily corrected my BG of 185 (as determined by Dex) and corrected with a bolus from my shiny new t:slim pump.  (Now, I know I shouldn’t be correcting from my Dexcom, but I do. And I’ve found it to be reliable enough and even when it’s not the outcome is generally not so far off to be a problem. Generally.) This is the sort of overnight correction I am in the habit of doing, and doing it is barely a blip on my radar and happens mostly on autopilot.  So, I decided to check my pump history to see if this was the case.

t:slim history screen showing a surprise.

t:slim history screen showing a surprise.

Looking at the above image, I was shocked.  I initiated a 15 u bolus at 2:24 in the morning.  Why?  Purely by accident apparently.  The t:slim displays 3 things for every bolus: the time at which it was completed (boluses can be a bit slow, in this case at 2:48 am), the time it began (2:42 am) and what was entered to initiate the bolus.  See in the picture it says “B: Food/BG” then “183 g/NA”?  This means I bolused at 2:42 am for 183 g of carbs rather than a BG of 183 mg/dL!  What should have been 2 u was 15 (max bolus allowed by my pump settings).

How can I make such a stupid mistake? I’ve only been using the t:slim for about a week and I love so many things about it, including that I no longer have to dial in  the units for a bolus.  However, dialing in that number has always provided me with a check that I couldn’t ignore before delivering a dose of insulin. The t:slim asks me 3 times before delivering a dose; it does a good job of shoving information in my face.  What it doesn’t to is engage my brain enough during autopilot to help me see the error of my ways.

This is what you see when you initiate a bolus with the t:slim

This is what you see when you initiate a bolus with the t:slim

The bolus screen clearly indicates where to enter a BG and where to enter carbs.  However, once you click, the next screen is nearly identical for each:

BG or carb keypad

BG in carb windowBG in BG window Keypad; BG in carb window; BG in BG window

Once the numbers are entered, it displays a calculated dose then you hit “next”, confirm twice, and done.  The bolus initiates and the pump vibrates quickly upon completion.   With auto-pilot initiated, I entered and confirmed and was asleep long before the vibration.  End of story.

So.  What have I learned?

  1. The obnoxious dial-a-bolus method used in all other pumps may have irked me most day,s but it did provide me with a mental check that probably would have prevented this from happening.
  2. Actually using my meter to confirm my Dex BG would probably have taken my brain far enough out of autopilot to notice my mistake and prevent this from happening.
  3. For some reason, my first instinct when I go to calculate a bolus is to click on the left most box first, and when my brain is in BG mode instead of carb mode, there is potentially a problem.

I started with the t:slim about a week ago.  While I am still smitten by it, I’m realizing I need to approach this change with a bit more caution that I have been.  I’ve had Animas’ pumps for about 12 years and I can use one with my eyes closed.  I’m going to have to spend some time focusing more on D and destroy my old auto pilot (or at least reprogram it).

t:slim touch screen

I mentioned in my first impressions of the t:slim that I was underwhelmed by the responsiveness of the touch screen. However, I want to add that I am thoroughly impressed that I can operate the pump while wearing gloves. And not those special conductive gloves you need to use your iPhone, but regular gloves that render my iPhone useless.

I’ve been attributing this (both traits actually) to there being a different touch mechanism in play with the pump verses the iphone.  An iPhone is a multi touch system that uses a capacitive material to sense touch.  This material is only activated by conductive materials (like your finger or a conductive glove) and most gloves (ie insulation) stop those signals from transmitting.

The t:slim seems to sense touch via pressure via a resistive screen. This means that it only registers a single touch at a time (which is all we need to operate a pump) and can be activated by anything capable of delivering pressure, be it conductive or insulating, thus there is no need for conductive gloves.

I haven’t taken the time to seek out Tandem’s patents or specs to know if I’m right (maybe someone else has this info?) so I certainly could be wrong.  I’m just glad that I won’t have to purchase special gloves (!).

I hate needing special equipment to use my special equipment!

More info on how touch screens work, etc: http://electronics.howstuffworks.com/iphone.htm