Friday, March 26, 2010

That diabetic chip on my shoulder

Once again, a long work week has caught up with me. On top of it, in the middle of the night a couple of nights ago my pump stopped delivering insulin properly (like it periodically does), and I didn't wake up enough to recognize it for a good while. By the time I did, I had been tossing for a couple of hours; then it took another couple of hours for my blood sugar to come down enough for me to go back to sleep. But then, sleep loss is so frequent when you have a kid, I barely registered it the next day. I guess it's a bit like the training doctors go through.

I do sometimes worry that the sleep loss will affect my driving, but then I find I'm one of the safest drivers on the road, even when tired. And if I did ever pull a real all-nighter, I wouldn't let myself drive. Ironic, isn't it? Because I periodically find myself having to defend my right to drive. The latest was last year; when I went to renew my licence, I was confronted with a new form (new in that I'd never seen such a form in all my 20-some years of driving) that I had to get my doctor to sign, then submit to some committee at the DMV for review. The form, of course, was to state that I'm competent to drive - because of my diabetes.

Apparently, Massachusetts had instituted a new law. Besides that, they'd also decided to stop alerting people when we need to renew our licences (and of course, they didn't notify anyone that they'd suddenly stopped notifying us!), so I had only a few days in which to do so - and most of them were over the weekend, when the doctor was unavailable. It took some frantic last-minute calls and a quick trip to the doctor to get the form signed in time so that I could get to work the following Monday.

Actually, I did see a similar form once: the day I first went to take the test to get my licence, at age 16. I was wearing shorts and a t-shirt, yet the dour woman at the desk handed me a form for my doctor to sign, to prove I had no amputations. I felt like screaming, "do I look like I have any?!? I passed the test the following week. The instructor even liked the way I used the horn, lightly, when someone blocked the road.

Now, I wouldn't mind the harassment so much if it weren't for all the - ahem - bozos I have to avoid on the road every day, on their phones or texting, weaving and not even realizing it, or realizing it and not caring, because who's going to challenge them? Whereas I am always extra-careful because I live in fear that someone will blame my diabetes if I have an accident. Especially since pregnancy, I've been sure to test before getting behind the wheel, and I simply don't drive if I go low, until I get my blood sugar up to at least 70 mg/dL (which is rarely an issue since pregnancy). I've often been complimented on my driving, and (knock on wood) never caused an accident or gotten a speeding ticket. Yet I think a lot of my casual acquaintances don't accept rides from me because they're afraid - perhaps not even consciously, but still, afraid that I might not be competent. (I had reason to think so, again, this week; but who's counting?)

Similarly, early in my daughter's life I sensed that some people were nervous about whether I could handle her - literally, whether I might drop her. Granted, I was physically impaired for a while, having had a C-section that didn't heal right (it took two months of daily visits from nurses to change out bandages, and even now the scar still twinges occasionally).

But anyone who really knows me would know that I am hyper-vigilant, and that I'm more careful than anyone, both with my driving and with my precious child. If there's one thing I have at least as much of as any non-diabetic mom, it's the mom hormones! So I would not do anything to endanger her, whether intentionally or through neglect. But I also have that chip on my shoulder about diabetes, that I am not ever going to even leave the door open a crack, to let someone say I can't do something because of it.

Sometimes I think I'm just being paranoid - that people aren't really doubting my competence as often as I think they are. But my DMV experiences, and many others, make me think they do - sometimes without really being aware of it themselves. If I had the chance, I'd say to them, yes, diabetes can make driving risky, but no more so than having poor eye sight, and just as correctable. Yes, some people have a problem with hypoglycemia (low blood sugar) unawareness, but I'm currently not one of them - and when I was, briefly, during early pregnancy, I was even more vigilant about testing, and I also used a continuous glucose monitor that beeped to tell me when I ran low. So still, just a correctable as myopia (gee, myopia, that sounds scary, doesn't it?).

So, how about you - have you had experiences with people doubting your competence because you have diabetes? Did you confront people, or let it pass? Or were you not even given a chance to confront?

Thursday, March 18, 2010

Random updates on a tired night

I've gotten into a new routine with the infusion-set rotation. It's still not perfect -- at times a site will be problematic and I'll have to change it out, sometimes only to change it again a few hours later. But at least there's hope: I can now use both arms, as well as at least one side of the abdomen. Maybe after a while the skin on my abdomen will heal at least somewhat.

The problem, it seems, is not just the sort of damage one gets from years of injections/infusions. My abdomen still has extra blood vessels from pregnancy (yes, two and a half years later), and it's also tougher. Sometimes the infusion-set needle just pushes in the skin like a fingertip would. Who knew that would happen? I've talked with lots of medical and pump-manufacturer personnel, and no one has ever heard of this issue or has any suggestion of how to help. I just love being on the cutting edge of medical knowledge (not!). But I've got enough working sites that I don't have to consider the side of my, ah, nursing body parts, as my nurse-practitioner recently suggested, only half-jokingly.

Meanwhile, I am repeatedly jealous as several extended-family members have children with far greater ease that I experienced (three in the past 6 months!). Strangely, several of them have had trouble nursing - which is supposed to happen to only about 5% of women, according to (a great site for expectant parents and new, or not-so-new, parents - mostly for the reality check that comes from other parents' comments below each article). Now, I know my own acquaintances do not make a statistical sample - and these new moms are perhaps older than what's considered average, although not in our part of the world. But it seems odd; I think there's a conspiracy to make new moms feel bad, just as there seems to be one great big conspiracy about making parents feel bad, no matter what they do with their kids. Nurse your kid for 6 months? You gave up too soon; Bad Mommy. Nurse for more than a year? Whoa, Nature Mom! Potty train before age two? you're a pushy mom. After two - what's wrong with you, and your kid? (Yes, we are in the midst of potty training now.)

A silver lining to having diabetes in all this is, I had a good bit of skepticism about all the parenting advice, right from the get-go. I mean, when "What To Expect..." pushes all fruit for breakfast, and no artificial sweetener, ever, what's a diabetic to do? Fortunately, I've learned that my daughter does well on her own schedule, and her dad and I just have to be her cheering squad. Now if only I didn't have to carry her so much!

Friday, March 12, 2010

The stress test

Ah, Friday. Often lately, my weekends have been almost as busy as my weeks, but tonight I'm letting myself relax for a change. Maybe I feel like I can because I got a professional massage yesterday. I get these occasionally now; I actually really need them to get my back straightened out periodically, what with carrying all the extra kid stuff, in additional to my usual large purse (is it just me, or do others carry around a lot of diabetes-related stuff? I carry my meter and a small pack of extra pump supplies, insulin, and syringes, plus glucose and a glucagon kit, in my purse). Not to mention my daughter, who as I've mentioned is pretty big for her age. I feel like I'm always behind the eight ball in my strength to carry her. The masseuse said one side of my back is higher than the other; the side I carry everything on is higher, perhaps because it's more muscular, and probably also more tense!

I also really, really needed the massage to release stress - the kind that builds up so gradually over time that you don't even realize it until, suddenly, you collapse. Well, I knew I had stress in various areas of my life, but it's always hard to know when to do something about it - or what to do about it - before it overwhelms.

This got me to thinking about all the advice about stress and diabetes. You know, about how we need to limit the stress in our lives, because it can make blood sugar go up. But it's not like we go around choosing more or less stressful lives (unless you choose to be, say, a mine sweep). Stressful things happen in life. And yes, to some extent it's all about how you handle things, but sometimes it's impossible not to let things get to you (or anyway, impossible for me). And I always refused to shrink from doing interesting or challenging things in life just to keep my blood sugars in check.

For a long time, I used to deal with the daily anxieties of life by eating - usually carbs. Obviously, that's going to affect blood sugar. I tried exercise as an alternative release, and that really helped for a long time. But when I developed migraines, exercise often only made my blood sugar go higher. I had to cut back from aerobic exercise like running, to walking (if that). Now, walking is one of my stress busters, for sure. But I've added other things (besides eating), like talking (and, yes, writing); yoga; and the occasional massage. I'm shameless about asking for gift certificates for holidays and birthdays! Especially now that I'm a mom, I feel justified in doing all of these things even more often than before. I need to keep myself sane for my kid's sake as well as my own, and I'm just that much closer to the edge.

But I've noticed that the daily stresses don't directly affect my blood sugar at all. They might affect it indirectly, for example if I were to overeat, which I hardly get a chance to do now, even if I were inclined (not eating wheat makes it hard to overindulge in carbs). Stress might als make me less motivated to work on my numbers. But even sleep deprivation doesn't affect my sugars directly (that's one bullet dodged!). Good thing, as my daugher's been sick a lot lately and has reverted to wanting me with her at night. One night I held her, sitting in the chair, most of the night; the next night I went to bed early, only to wake up half way through and stay awake for hours thinking about all thing things I needed to do. So couterproductive, but insomina is not logical!

No, the real stresses that affect my diabetes are the short-term ones, like a near-accident (or an actual one). Or stage fright: Years ago, I performed in a community theater musical. It wasn't a huge affair, but I'm not much of a performer (I did it because a family member was directing). I had no more dinner than normal beforehand (maybe less than normal), yet right after the performance, my blood sugar shot up to 400. It went down below 200 about an hour later, and back to normal by two hours, without a drop of extra insulin.

I've even noticed that, on days I drive to work, my blood sugars go up higher in the hour or so afterward than on days I stay home. There's nothing like a nice drive on a Massachusetts highway to get your blood going, I guess! I actually account for that in my breakfasts on those days; I tend to eat more protein and less carb. It took me a really long time to figure this out, though, because of all the other variables: I thought I was just more active on days that I stay home, because I tend to be with my daughter. I also thought maybe it was the coffee I always drink. But even on days when I'm sitting on my duff working at home, it's better than when I commute and then sit on my duff working at the office; and the activity levels and coffee fix are the same in both cases.

So yes, stress does affect blood sugar, but not in the way that, I think, a lot of people would assume.

Have you noticed any unexpected ways that stress does - or doesn't -- affect your blood sugar?

Sunday, March 7, 2010

Testing, testing

Yesterday, H sat me down in her little chair next to her diminutive table and served me what she called silly tea. I'm not sure why she thought it was silly, but it was funny to watch her get each dish out of her play kitchen cabinet and set it on the table in front of me. When every single dish was out, she said, "I'll be right back," and ran out of the room.

Half a minute went by. "H...? Are you there?"

"Just a minute," was the reply. Then, finally, she ran back in, picked up her tea cup, and said "cheers!"

Any guesses what that was about? Yup, it was a perfect imitation of me - setting the table for dinner, settling her in, then leaving to test my blood sugar.

Growing up, I always tested in the bathroom before meals. It was sort of something I had to keep to myself. In the early years, I needed a big space to lay out all the paraphernalia - strips, huge lancets (ouch!), cotton balls to wipe the strip at exactly 30 seconds (no meter!), alcohol swabs, and the big test strip container to compare my results against.

Even when meters came along, and eventually got smaller, I still slipped off to the bathroom every time. I was always worried what other people would think about it. I know some people don't like the sight of blood; others don't like needles; still others just don't like it when people do something unusual in public. The latter never seemed a good enough reason to hide, to me, but the first two did. I guess I also didn't want people to focus on my diabetes, even though virtually everyone I was with knew I had it. It was easier, socially, to to the the loo - like everyone else did. Fitting in was really important to me when I was a teen and young adult.

But, during pregnancy, I got more comfortable whipping out the meter and, while not being blatant about it, testing right where I was, whenever I needed to test. I figured, better that than have me pass out! Besides, how many restrooms have you been in where there isn't a single surface to put a meter down on? I love the ones with little flat trays in the stalls, but so often it's the stupid round paper holder. No one asked us when they designed these places, did they? Even the handicapped stalls are no use. My own lap is the best spot, usually. I felt so liberated.

Now, I'm a lot more comfortable with testing in public - still not purposing putting it in anyone's face, but testing nonetheless, at a restaurant table, on a park bench, on a bus or train. And if anyone wants to comment, I'll give them an earful! (I felt that way when I once ate food on the D.C. metro - where eating is forbidden - but that's another story!)

I also do test in front of my daughter all the time (and she still doesn't bat a lash, though she definitely watches me doing it). But when the table's all set, I usually have to leave the kitchen anyway to get the meter from my purse, and find a spot to put the meter down, so I end up leaving the room - only briefly, it seems to me, but I guess it seems like longer to her.

I wonder, was I just overly cautious all those years, or does anyone else get nervous about testing in public? Maybe, for anyone who's only had to use the relatively tiny meters, it's not such a big deal - or is it?

Tuesday, March 2, 2010

A new sleep(less) twist

Last night, as I was getting daughter H ready for bed, my blood sugar went low. Fortunately, hubby happily stepped in, picking up where I'd left of in the bedtime story, with just a little protest from H during the hand-off. But, when I came back to kiss her good night at close to 9:00 (definitely the witching hour for a 2 1/2-year-old!), she started demanding I read another book. Instead, I set her in my lap in the chair, put the usual bedtime music on, and said, "Let's snuggle instead." Famous last words. Half an hour later, hubby was back to make sure we were okay; I eventually got her into bed without a fuss.

Tonight, same routine (minus the low blood sugar), but when I went to put her in the bed, H started crying out for me, "Mommy, don't leave me!" I used the "I'll be back in minutes to check on you" trick, which worked like a charm (fast asleep at only 9:30!).

Now, we were never into cosleeping even when she was an infant; her cradle was in our room for all of 10 minutes, before we determined she was such a noisy sleeper none of us would ever sleep under that arrangement. Sure, in the first year I held her for long stretches in the chair in her room after I nursed her (a nice, comfy chair with a foot stool, but not the same as a bed!). But she never liked to lie in bed with me, always wanting to be with me in the chair. And for more than a year, she's happily gone to bed after one or two stories. So this sudden clinginess has taken me completely by surprise. I guess she's regressing a bit now. I understand that happens, especially when a toddler is trying to master something else, and she is in the midst of potty training these days. Oh, that's another fun adventure!

But of course, I feel funny that, perhaps, my running off suddenly with a low triggered a feeling of abandonment in H. I have to leave her, for short or long stretches, so often, it's not really fair to blame it on that one event. But little events like that can have such a huge impact in a little kid's life. Whenever I have to test, or change out my infusion set suddenly, or eat, I worry that it will have a lasting impact. Well, at least I come back every time, right?

I sure hope this two-night trend doesn't continue, though. I love sitting holding H for that time, but I have so much to do in the evening after she's in bed - cleaning up from dinner (yes, hubby helps some!) and getting thing ready for her and my next day - that I can't completely enjoy it. I'm the one who prepares her food for the next day; I know more about nutrition than my husband does. Being a medical editor and writer helps, but I've learned far more from being a diabetic for nearly a quarter century. Also, it's important to me that I have at least a little control over what H eats at daycare, though she gets other snacks as well. I'd like to be more creative with her food, but by the time I get to putting it together, I'm a zombie, especially these couple of days!