Damn, what a day!

My two year old daughter is sick, and was running one heck of a fever last night (103.1). Needless to say she was very uncomfortable, and didn't sleep much. I think I MIGHT have gotten a grand total of about 45 minutes of sleep all night.

So, I'm tired as hell today. Toss in some stress from work, some stress from a bit of freelance work I'm doing, and a low blood sugar to start things off at breakfast, and you've got a recipe for one hell of a bad day in terms of eating and blood sugar control.

I don't even want to THINK about how many calories I've consumed today...

I can tell you that it does not feel good - my body just feels yucky from eating crap all day.

I wish I could keep my focus strong and be disciplined enough to make it through days like today without all that extra eating.

Blood Sugars, Highs & Lows

I would love to learn about exactly what is going on inside my body when my blood sugars are not in range.

I have really started trying to tune into what I feel like when things are not exactly where I want them to be. Most of this is due to a study I've been doing at the University of MN regarding type 1 diabetes & weight loss. Nothing magic about the study, but by doing the study I have been able to meet weekly with a dietician.

I have been able to ask questions, get tips & advice, etc. I've also been motivated to stick with it because I actually go to the U and weigh in three times per week. It's very basic stuff. Calories in vs. Calories out. You have to burn more than you eat - bottom line. Over the past three months, I have lost a little over 30 pounds. Simply by watching my calorie intake, and doing a bit of exercise. Making smarter food choices to help me fill up and feel satisfied while still not consuming a huge amount of calories.

I have learned that my trouble spots are when my blood sugar is out of range. When I'm low, of course my body is SCREAMING at me to eat as much sugar as I can get my hands on, and when I'm high, there is something going on that makes me want to eat. I've commented a bit on this before. In addition to wanting to eat, depending on how high I am, I get sleepy and tired - I've commented on this too. I'm one of those who wants to eat when I'm sleepy and tired.

I figure that there must be a bunch of stuff going on in terms of signals to the brain, hormones, etc. when I'm out of ideal range. I know that when you have a low blood sugar your body responds to the "emergency" by dumping out a bunch of hormones. Two of the hormones are quick acting, and if I remember correctly they are adrenaline and glucagon, and the other two are longer lasting, cortisol and growth hormone. I can't remember if those are the correct ones or not, but I plan to do some research and post something a little more accurate sometime in the future.

What happens with those last two hormones, is they screw with your blood sugars, driving them high for many many hours afterwards. Somebody once said that the goal of controlling diabetes is to maintain target blood sugars AND AVOID LOWS (which will help you avoid highs...).

So, I start feeling low at about 70, which is pretty normal. I start feeling symptoms of highs around 180, which I guess is also pretty normal. So, I try to stay within 80-180 as much as I can. I'd say my success rate is about 25%. Which means I'm looking for extra calories 75% of the time... :-)

Diabetes, especially after almost 25 years, is 99.9% mental discipline. However, with blood sugars that are out of range, your brain doesn't always work right - throwing a big giant monkey wrench into that mental discipline thing.

I wish there was a place that had easily digestible information regarding all of the things that goes on with blood sugars that are not in target. I don't have the time nor money to become an MD, but I sure would like that level of knowledge on this stuff.

The point I intended to get across in this big brain dump of a blog entry, is that no matter what you are trying to do, good blood sugars are helpful.

Boy, what a scattered post - I better go check my blood sugar...

Pros & Cons of Pumping

I have been using/wearing an insulin pump for somewhere between 8-10 years (I can't keep track of when I started). It is my opinion that the pump may be the best tool available for tight control of diabetes.

Of course, the pump is not for everyone, and it is not a "magic bullet" that will automatically cure all of your problems, nor will it automatically bless you with the tightest control you've ever had.

It usually takes a lot of work when starting a pump to figure out the ideal settings for you, so you have to be up to the task if you decide pumping is for you.

From my point of view (read, regular guy, NOT a doctor), the pump offers these PROS:
- Incredible flexibility (no snacking to match peak times of long acting insulin)
- The ability to deliver insulin in more precise and possibly smaller increments (beneficial for those who don't require much insulin or for small children)
- The ability to have multiple basal rates throughout the day (I require a higher basal rate during the morning hours than for the rest of the day)
- It's always with me (I don't have to carry around vials & syringes)
- It's more private & discrete for bolusing in public (again, no vials & syringes)
- I can manipulate my basal rate up for sick days if necessary
- I can manipulate my basal rate down for exercise, for which I'd otherwise need to eat to match my long acting insulin
- Fewer "pokes" or injections. With a pump I only need to do an injection 2-3 times per week to change my infusion set, rather than 4-5+ shots per DAY.
- You really learn how you & your diabetes works.
- When used to it's fullest benefit, and with limited external stimuli, you can achieve incredibly tight control.


The pump offers some drawbacks as well:

- Increased risk of DKA. This is because there is no long acting insulin being used. If for any reason the supply of insulin (usually humalog or novolog) is interrupted you do not have the long acting insulin on board, and may go into DKA much faster.
- The "Pump & Munch" factor. Because you now have this wonderful insulin pump, you no longer need to take an extra shot to eat those treats - it's a simple matter of a push of a button or two. That extra shot might have been enough pain & inconvenience for you to pass on those treats. If you are not mindfull of this, you might gain some unwanted weight.
- Infusion site problems. Some people have problems with reactions and irritation to some to the tapes used with infusion sets.
- Frequent blood sugar monitoring is required. Ok, this one is questionable, because I think all diabetics need to be very aware of their blood sugar levels at all times. But, the point here is that you can head off problems if you diagnose them early (by frequent checking!).
- Troubleshooting skills are necessary. When things are going a little weird, you have to be able to figure out where the problem is, and whether it's related to the pump or not.

With all that being said, I subscribe to pump therapy 100%. I truly feel that using an insulin pump has given me the most flexibility of lifestyle and is the best tool for the job. As with many things in life, "your mileage may vary".

And I actually PAY for this?

Insurance drives me nuts. It's so very frustrating that I can hardly stand it sometimes!

As I approach my 25th year anniversary of dealing with diabetes, the game has become more mental than anything. I feel that I know how to use the tools that are available, it's just a matter of applying them to the degree that they are most helpful, and using them to gain better control.

I started looking for some mental health resources through my insurance carrier (I won't mention names), seeking both a therapist and someone who can help me manage some existing medications. (The psychiatrist that had originally prescribed the medications had left the clinic a while back, and that clinic is not accepting any new patients (but I'm NOT a *NEW* patient! - whatever...))

This insurance carrier has a website that can be queried to find an "in network" resource, with criteria such as male/female, languages spoken, location, ethnicity, area of expertise, etc. The closest I can get to someone that specializes in diabetes is "Chronic Physical Illness" as a selection for "Area of Expertise".

This brings up a list of clinician names, addresses & phone numbers. It does not include a company/clinic name. It claims to be able to tell me if the person listed is accepting new patients, but I've found that it's not accurate (ie, I'll call to set up an appointment, and they are not accepting new patients - even though the list says they are).

So, you are presented with this (sometimes long) list of names & numbers. I've had such terrible experiences with this list. It's absolutely traumatic. I called one number, and was greeted by a woman announcing "Thank you for calling the center for victims of torture, how can I help you". Another place I called was a school, where the doctors were all in training (ie, not yet qualified to be on their own). Others will only accept new psychiatric patients if you are seeing one of their therapists. Others will only see you if you can stand on one foot, pat your head, rub your belly, where born on a full (blue) moon and the numbers of your SS# add up to a sum evenly divisible by 3.

The center for victims of torture?! Keep in mind, this is a resource for people who are having problems with their MENTAL HEALTH!! Let's see if we can push them over the edge rather than get them the help they need...

I even tried working with an "intake counselor" to see if they could provide any additional help. They just pulled up the same list I had been looking at and read off some more names & numbers.

Nice.

Now there are a few names that I am aware of in regards to therapists that work specifically with diabetes (or are at least knowledgeable about it), or have diabetes. Of course, out of 4 or 5 that I know to look for, not a single one is "in network".

That brings up an interesting point that I want to bring up. I was not aware that it is not completely up to the provider whether they are in network or not. I figured that if they were not in network, that they (the provider) were just not willing to accept the discounted rates for their services. That may be a factor, but I also learned that the insurance provider limits the number of in network clinicians for each geographical area! This means that the above mentioned providers & clinicians may very well have applied to the network, but were denied because there were already enough therapists in the area. Forget about the fact that none of them currently in the network for that area deal with diabetes...

I was able to find a therapist by doing some detective work. I tracked down the clinic address for one of the therapists that I know deals with diabetes (had seen him at some events or expos). On the voice mail there were a handful of other names, one of which I thought I recognized from a booth at an expo. I check the list of providers, and that provider was listed as in network! I called back, left a message to find out if this person was the one I remembered, and sure enough it was! So I immediately set up an appointment (which is coming up next week - I'll keep everyone posted!).

How sad is it that I had to do all that to get an appointment with a therapist that knows enough about diabetes to help me with the issues I'm struggling with? Still working on a psychiatrist that can help manage my prescriptions.

And keep in mind that I pay ridiculous monthly premiums for this (non)service.