A year later

It's been roughly a year since I received a whole lot of bad news, blogged here. 

In the 11 months since that time, I've had quite a LONG year in my diabetes (and overall health) care. However, I am happy to say that I just had my blood work repeated and everything came back within normal ranges with the exception of thyroid to which my doctor has made a very small change.  When I received this news yesterday I was ecstatic.  The past year has been such a struggle and I am so happy to learn that all of my hard work is paying off and I'm once again kicking diabetes to the curb.  That's a really good feeling.  

The major thing which has changed for me this year is gluten.  Last year when my doctor saw my numbers he said I fall within the range that could be considered a Celaic diagnosis.  I took him seriously and slowly began removing wheat and gluten from my diet.  It was a struggle.  really, really difficult at times.  I am STILL not perfect at it and it is still very difficult here in Singapore but I am doing so much better and I FEEL so much better too.  And now, my blood work shows that it's working for me too.  

There's so much more to be said about what has happened in the last 12 months and what's yet to come for me and my care but I'll leave it at this for now.

Busted Pump

Went to take my lunch bolus the other day when my pump just up and broke.  The most ironic thing about that was on my to-do list for that very day was to call Medtronic and see if I needed to replace my pump due to a crack in the battery chamber that had been there for over a month.  I was probably going to make that call about an hour after my pump just quit working on me.

So, I went to take my bolus for lunch and my pump wouldn't deliver the insulin.  This is the error I received.

The crumbs on the table give it a special touch, don't you think?

So, I did what any reasonable diabetic would, and commenced to FREAK out.  I rewound the pump and reloaded the reservoir (after disconnecting) and came upon the Motor Error again.  A good friend was helping me through the freak out and suggested I try new tubing and reservoir.  I did that and still got the same error.  I tried it with a new battery and still got the Motor Error.

I called Medtronic in Singapore after searching for their number.  Left a frantic voice mail and continued freaking out.  I was pretty well panicked but somewhere in the mix I took an injection to cover my lunch.  I called my husband and he was able to dial internationally and connect me with Medtronic in the US.  

Thank goodness, because I hadn't heard back from the "local office" at all.  

I went through with support at Medtronic and they confirmed that my pump was indeed busted.  They told me that my pump is covered under its' warranty until June of 2015 so they would send me a new pump.  THAT'S when I told them that I don't actually live in the United States and that I in fact live 9,000 miles away in Singapore.  The customer service representative wasn't really quite sure what she should do but she said they'd send me a pump through their global office and that "global" would be contacting me soon.  

I searched through my diabetes cabinets for my back up pump and couldn't find it.  I guess I gave it to Hurricane Sandy victims?  I can't remember.

With the help of a friend, I was able to calm down enough to figure out a reasonable number for a Lantus dose and take that (about an hour after my pump died).  I called my local doctor and left a voice mail for him to call me back so that I could make sure I'd taken that Lantus shot correctly, to let him know that I was taking injections, and to tell him that my pump was broken.

Busted Pump aftermath 

By the way, if your pump breaks, it's good to have a back up pump.  But if you don't have that, it's a wise idea to have some long-acting insulin on hand.  I'd also suggest having your basal rates, correction doses, and carbohydrate ratios written down.  Luckily, I had a Lantus pen in my refrigerator so I was able to switch over to Multiple Daily Injections (MDI) until a new pump arrived.   I didn't have Humalog (or anything similar) in pen form, which kind of sucks, but I had syringes and plenty of bottles of Humalog so for boluses and corrections, I just used that method.  

I'm not sure if it was just by coincidence or what but later that day, the Medtronic rep was at my doctors office and after I called them back a second time, the two of them returned my call.  My doc told me that I was taking my Lantus the way I was supposed to and that the Medtronic rep had a loaner pump I could use until my new pump came from the states.

Here's how I figured out how much Lantus I should take.  I added up all of my basal rates to find my daily basal total.  I took that amount divided by two every 12 hours.  Technically, you could take the whole thing in one shot every 24 hours but Lantus doesn't quite work as well as fast-acting insulin so if I only took an injection every 12 hours, then I could adjust that amount in 12 hours instead of waiting an entire day to do so.    

It wasn't until the end of the next day that the Singapore office received word that the US team had received a report on my pump being broken and that a new one was en-route.  They figured it would take about a week.  Something I hadn't realized before was that ALL Medtronic pumps come out of California.  Asian, European, Australian, and American pumps all come from the same place.  Huh.  Guess that just hadn't occurred to me before.  At least, I'm pretty sure that's how it works.  

Anyway, about a day and a half later, the Medtronic rep came to my house with a loaner pump.  I was sure relieved to go off of MDI even though it had only been about 36 hours.  I hooked that sucker up and was off and running.  

The next day, in a moment of clarity, I suddenly remembered where I'd stored my back-up pump.  I felt like an idiot for not remembering, but was still comforted by the fact that I did indeed have a back-up should I ever need it.  Since I was already using the loaner pump, I didn't bother getting my own back-up pump out. While thinking I had donated it to the Red Cross was a lovely idea, I'm glad I have a back up.  Especially now that I know a replacement is going to take a week to get here.

It was exactly one week to the day that my replacement pump arrived.  The rep was nice enough to come out to my house again and deliver it.  I gave him back the loaner pump and hooked in to my new pump.  It's been working well since then.

When I tweeted, posted on Facebook and Instagram a picture of my "Motor Error" I was really surprised to hear from many Medtronic users that they'd experienced the same thing.  One follower told me he's had SIX pumps with errors needing to be replaced.  With the exception of my 508 having an unfortunate run-in with the banister thus cracking the screen, I've never had to have a pump replaced until the Revel.  This is now my third Revel pump.  I'm really curious if they'll be a recall on this pump due to the motor error sometime in the near future, but I suppose time will tell.  

Part 2: New Doctor, lots of Tests

So my new Doc, Dr. Lee, decided to have me get a full panel of blood work.  I was to be fasting and have all of the blood in my body drained out for testing.  Not really, but this list was LONG!  I was actually really glad though, because I've been wondering about some things and feeling like others weren't properly treated.

Anywho, I got a taxi after 40 minutes of waiting in the rain and headed down to the medical center for labs.  Little did I know, the results were gonna be scarier than that dang needle.

The same day that I had my labs done, I went to my doctors office to have a CGM inserted for my blind trial.  Again, he wanted a blind trial so that I wouldn't be interacting with the CGM but rather to collect the data and make adjustments to my insulin regimen.

One week later, I went back to the doc to upload the CGM data, review that, and talk about my labs.

The week that I was wearing my CGM, my doc wanted me to be recording all of my blood sugars, meals, and insulin doses.  Introducing the mySugr app.  Very cool, highly recommend it!  It was a great little app on the iOs and I found it was easy to use and maybe even a little entertaining.  I logged everything really well for seven days and haven't used it since. What can I say?  I gave up on logging a LONG time ago!  Plus I log all of my calories on MyFitnessPal so that's just way too much time on logging!

I digress.  So, I went back to see Dr. Lee.  First we went over all of my labs.

Testosterone & Estrogen tests were normal: no PCOS (whew!)
Lipids (Cholesterol): bad (CRAP!)
Hashimotos (thyroid): still uncontrolled even though I take thyroid meds (SIGH)
Uric Acid (proteins in urine detecting kidney function): high (SHIT!)
Celiac (allergy to wheat): Positive (double SHIT!)

Then we went over my CGM and it was fine.

So, basically, my blood sugars are under control and I don't have PCOS but other than that I'm a complete mess.

This was REALLY HARD news for me to swallow.  Really.  Hard.

I'd seen a doctor about my thyroid and possibly having Celiac previously but I was never actually tested for Celaic.  I played around with gluten free for about a month and then I decided to move across the globe and basically forgot about all of it.

This time though, it's time to face the facts and realize what I already thought I knew.  Celiac. Positive.  And no more wheat for me! That SUCKS!

As for the Cholesterol, I'm just gonna go ahead and say that I had already had a high cholesterol come back and this one wasn't really a surprise.  In the states though, my beloved Dr. Day told me I could wait until I was 35 before starting on any medications.  Not this Doc.  He wants me on a low dose of Statins.  It took me almost a week to take that first pill.  So far no bad side effects so I think I"m good there.  And if it protects my heart, then I'll do what I gotta do.

Hashimotos.  or hypothyroid.  So I've got that.  I have been taking thyroid meds for quite some time and I knew they weren't enough.  I saw some whack job at the beginning of last summer and he wasn't doing it for me so I quit him and ignored it.  Until now.  I'm on double my dose from before and finally able to wake up in the morning!  Hooray for that!

As for the Uric Acid, I got to do the ever so enjoyable 24 hour urine collection.  I never heard back from them so I'm assuming that test was fine.  Geez!  I don't want to find out that my kidneys aren't working well.  Guess I gotta stay vigilant and do everything I know to keep this dreaded diabetes under control.

Celaic.  Damn. I can't believe I have Celaic.

Switching over to gluten free has been difficult.  I think that's compounded with the fact that I live in a freakin expensive country and it's hard to pay for regular groceries let alone switch it all up and eat a different way.  I had some really good go-tos back in the states when I tried this before.  Some of those things just aren't available here and I've resorted to eating eggs all the time.  Not really, but... really!  I am so bored and need some good gluten free meal ideas.  Particularly lunch.

I guess after a few months of focusing on the big move, and home-schooling my oldest due to some unforeseen circumstances, it is time to focus on me and my health again.  It's hard when you're a mom and have another life outside of taking care of diabetes 24/7.  But it's wake up calls like this that kick your butt into gear.

I didn't reach out to many in the DOC about all this, but it's time I put this story out there.

Update on my progress to follow.

New Country, New Doctor (part 1)

I've totally neglected this blog.  And at this point I'm sure no one is reading it.  I'm not sure if I should just delete it or... try to keep it up better.  I think the stories I tell (about Diabetes) are important and valuable for some to read and I really love it when someone has a question about something specific and I realize that I've written a nice long post on the topic.  The only problem I have with consistently blogging about diabetes is that I HAVE ANOTHER LIFE.  I mean, Diabetes is my life, but it's NOT my life and I don't want to spend ALL of my time talking about it, or writing about it.  So.  Yeah.  That's why I don't blog here much.


HOWEVER, there have been a few things recently that I should really put out there.

So most of you know that I recently moved to the other side of the world and now live in Asia; one degree above the equator, in the tropics, on a tiny little island, city, country called Singapore (no, not Japan or China or the Philippines).  Anyway, there are a lot of things about diabetes which were affected by my diabetes, or maybe it's the other way around.

First of all, I had to find a new doctor.  I asked some really great resources for help on referring me to a doctor here in Singapore.  Several people suggested this one doctor in particular so I figured he would be a good one.

I basically waited until the last minute to book an appointment.  I'm not sure why I was dragging my feet.  Maybe because I had plenty of other things to adjust to what with living in a new country or whatever, maybe it's because I REALLY like my old doctor and didn't want to face the fact that I am going to be seeing someone new for the next two or three years.  Dr. Day, if you retire before I get back, so help me!

Getting ready to go see my doctor.  I was so nervous! 

He was.  or... is, or whatever.

The first appointment I had with him went REALLY well.  I was very pleased with the experience and found him to be VERY thorough in getting to know me, my diabetes, and my health history.  He took my HbA1c and looked at my blood glucose data. He decided that he'd like more data and asked me to do a week on a blind CGM so that he could use the information to adjust my basal and bolus rates.  He also ordered a FULL panel of blood work.

I wasn't really pleased with my a1c but given the disruptions to my life the previous three months, I decided to give myself a break about it and aim for better next time.

Stay tuned for part two.

Moving across the globe with Diabetes

Many of you who follow me on twitter and Facebook know that I recently moved from Salt Lake City, Utah to Singapore!  Quite the change.  And when it comes to diabetes and pumping insulin, a 14 hour time change is something to consider.

Disclosure: I am not a doctor and as always, your diabetes may vary.  

About 2 weeks before we moved, I met with my Endocrinologist.  He updated all of my prescriptions and gave me a good plan for adjusting my insulin.

The plan:

- reduce my basal by 80% the day of my flight (or upon boarding)
- check blood sugar frequently
            side note: It would have been really nice to have a working CGM but my loaner transmitter died so I was flying blind
- change pump clock to local time upon landing at destination

Some people suggested changing the pump to local time upon boarding.  I would not recommend that because of the distance I was traveling.  It takes typically 3-7 days to acclimate to the time change and changing pump settings in advance when your body isn't used to the change could be dangerous.

The results:

I took my doctors advice and the plan has worked pretty well.  About three days after I was in my new home here in Singapore I was fully adjusted to the time change and at that point I probably should have changed my pump back to the normal basal.  I did not.  And as a result had some unstable sugars which resulted in a yeast infection--- fantastic!  But, if I'm being honest, this is a side effect a lot of women with diabetes will suffer frequently.  In fact, it was how I was diagnosed 12 years ago.  So, while I understand it's gross and totally TMI, it's the facts of being a woman with diabetes.  Polly wolly crappy too!

Next time: traveling through security with diabetes.

adjusting to a new schedule

Keeping good control over diabetes means making frequent adjustments.  A friend of mine, and diabetes podcaster recently asked the question; "How often do you make changes to your basal rates?"  This questions means making adjustments to the amount of insulin your body receives throughout the day.  Basal rates are the amount of insulin your body requires at different times in a 24 hour period.  Each time I visit my Endochronologist, like I did about 2 weeks ago, we look at my blood sugars, analyze my A1c, and examine my basal rates.  Usually, we make some little adjustments.  My doctor has taught me that there needs to be a minimum of a 10% change in basal rate for an effect to take place.  I see my doctor every 3 months.  Occasionally we don't make any changes, most of the time however, we do.  I rarely make adjustments to my carbohydrate ratio (the amount of insulin I take for the amount of carbohydrates I consume) but in the beginning I made those changes more frequently.  I also made carb ratio changes when I was pregnant because EVERYTHING changes and gets really wacky when you're pregnant and diabetic.

Anyway, recently, my weekend schedule has changed.  I wouldn't say that it has changed dramatically but it has changed enough for me to notice a pattern of change- for the worse.  So, I've got to decide what I'm going to do to make some changes and adjust to this new change.

Each year, our church schedule changes.  We attend church for a three hour block of time.  Each "ward" or congregation, is assigned a different start time so that the buildings may be shared by more than one ward.  This year, its our turn to attend the 12:30-3:30 block.  AND I HATE IT!  I absolutely detest this schedule.  It's not good for me, and it's not good for anyone else in my family.  Last year we were lucky enough to attend the 9-12 block.  Yeah, it's nice to sleep in on Sundays but I'd much rather be finished with church by noon.  Also, when do you eat?  Either you sleep in and eat a big, late breakfast; or you wake up early and eat two small meals before attending church.  This is what has been really whacking out my blood sugars.  In the 5 weeks we've attended church in 2012, I've had ONE Sunday where my sugars were under control.  The other weeks, I've had one issue or another.  I've been high, I've been low, I've been quickly rising and falling fast.  Ugh.  I cannot figure out this schedule.

Yesterday, it finally clicked that something had been off for five straight weeks, each and every Sunday.  Yesterday I took the day to sleep in.  I slept until 9:00 am like a total slob (for a mom) and didn't eat breakfast until 9:50am.  At that time, my blood sugar had dropped to 59.  I didn't even feel it.  I almost always feel lows. Not this one.  So I ate.  And I ate.  And I probably did eat too much.  And I didn't take any insulin.  So, 2 hours later, my sugar was like 280.  Then I got to take my naked and free shower (where you aren't wearing a pump site or sensor) and put in a new site after my shower.  I bolused and figured I'd come right on down.  Only no.  1 hour after my bolus I checked my sugar and it was 316.  I felt super dizzy.  And super thirsty.  And it just happened to be the first week of the month which means that everyone is fasting.  So I'm taking down at the water fountain when all the adults around me are fasting from food and drink, including water, for 24 hours.  Ugh.  But you do what you have to to take care of yourself, right?
Eventually my sugar came down and I spent the rest of the day fighting lows.  Which leads me to tomorrow's post.

So, let me get to the point here, I know I've got to make a change.  And I hope it will be an easy one.  I just need to wake up earlier.  No more enjoying the ONE BENEFIT of this stupid late schedule, I've got to get up at my regular time and eat breakfast at my regular time.  As for lunch, I don't know.  I think I'll just go for a little carbohydrate and protein combo snack before church and maybe another portion when I get home and then have dinner at the regular time.  That should do it.

I'll let you know how it goes.

Doctor Visit

I saw my diabetes specialist today. The news was pretty good. My weight has remained the same in the last 4 months and my blood presure was great. My HbA1c was at a 7.1, up from 6.8 at my last visit. He did say though, that I am still in good control and that I'll just need to monitor my sugars a little more closely. He reminded me about writing down glucose levels which is something I used to be very faithful at, but haven't done in over 2 years.

One topic of discussion that came up was the continuous glucose monitor (CGM). This is a device which is fairly new to the public market that monitors glucose levels continuously- hence the name. So, this means it is taking a reading subscutaneously (under the skin) without a finger prick. But, this does not eliminate the need for blood testing because this must still be done about 3 times a day to calibrate the monitor.


The crappiest thing about this though, is that insurance is not covering the monitoring at all yet, so it is very expensive. The monitors range from $300-$1,000 and every three days a $35 site has to be changed. You can see how quickly this could add up. However, it would not necessarily have to be worn all of the time. I guess it would ideally be worn for a 2 week period to study out trends in glucose readings and would not need to be worn again for a few weeks or months. Some people use them to help themselves recognize hypogylcemia (lows) so they might need to wear it on a more regular basis.

Minimed CGM
Dexcom CGM

Anyway, I've also been thinking about upgrading my pump to one with some of the latest features. My pump is currently out of warranty but working fine. As soon as it breaks though, I'd have to buy a new pump. I am not sure what kind of coverage I have on my new insurance, but my last pump cost us $1,000 after insurance. Pretty good for 5 years of 24/7 use. I'd also like to get a glucometer that "talks" to my pump so I'd probably go with the Cosmo or the Minimed.

Mini Med pump and corresponding glucometer
Cosmo pump and attached glucometer

Lots of money in the heath-care industry.