Tuesday, May 29, 2007

Best Endo Appointment EVER!

Remember your toughest class in high school? Remember studying for days, weeks even, for the final exam? And although you studied as much as humanly possible, even after writing the exam and answering every question, you felt as though the result could go either way. It could just as easily be a brilliant "A+", or a disastrous "F".

I feel that way every time I go to my 6-month endo appointment.

I've been dreading this appointment for the past month, but thankfully, today was one of those "A" days. My latest A1C results came in at a 6.6% - the lowest it has ever been in the past 2 years. All other numbers were well within range as well. And best of all, my blood pressure was 110/70. Doc and I were both pleased.

I also met with my diabetes nurse/educator (I'm still not sure what her official title is). She gave me one of her samples of the new One Touch UltraMini meter, which is not available in Canada for another couple of weeks. It's a blue one though - no pretty pink or green for me. Oh well, I'm just glad to have it. It is a bit bigger than I expected, but the case is definitely more compact than any other meter I have.

I asked about CGMS and my nurse was glad to hear that I am interested in it, she is very pro CGMS. She showed me the Minilink transmitter for the Paradigm, and it's a lot smaller than I thought it would be. So I am definitely seriously considering purchasing the Minilink and a pump upgrade this summer.

I asked her if she'd heard of any patients getting insurance approval, but she wasn't sure. She recommended that I apply for the Disability Tax Credit. The amount I could potentially receive back on my taxes from this credit would be enough to cover a few months of supplies.

To give you some background, a couple of years ago Revenue Canada (our IRS) allowed diabetes to be included under the definition of life-sustaining therapy (scroll to page 7). Their criteria is proof of at least 14 hours per week spent on therapy. What stinks is that carb counting is not to be included as part of the 14-hour requirement - I don't know about you, but I think it's an extremely important part of insulin therapy. There is a diabetes advocacy group in Canada trying to get carb counting included in the definition.

I did apply for the Disability Tax Credit with my 2005 tax return, but it was denied by the paper pushers at Revenue Canada. That was back when I was still on MDI. My nurse said that I should have appealed it, but said that now that I'm on the pump I should definitely apply again since they consider pump therapy to be more time consuming. If my request is denied, she said to appeal until they approve it. She said dealing with the government is very much like dealing with the insurance companies - the first time around they usually deny requests, hoping to discourage people from pursuing the issue further.

Anyway, regardless of what happens, after I sell my house and have some extra money, I do plan to pursue CGMS.

My appointment ended on a very high note, with my nurse commending my self-care. She called me a "model patient", and said she wished I lived closer to the Diabetes Centre (I travel 1.5 hours each way for my appointments) because she would like me to be a pump mentor for new pumpers. It was a grand compliment, and certainly made my day.

It was nice to hear the "model patient" bit... it's easy not to feel that way on the days when chocolate calls my name.

Edit 05/30/07 @ 8:30 a.m.: I should include the note that a claim for the Disability Tax Credit is in ADDITION to any medical expense claims. It is a flat credit, regardless of how much is spent on medical supplies.

Wednesday, May 23, 2007

iTest (aka AgaMatrix Keynote)

I've seen the buzz on a couple of different blogs about the new AgaMatrix Keynote meter (in particular at Amy's Diabetes Mine, and Bernard's Blog).

I was feeling a bit left out and bummed that the website for this seemingly cool new meter didn't mention anything about being offered in Canada.

However, imagine my excitement this morning as I browsed the Sympatico MSN site, I saw an ad on the right side of the page for Canada's version of the AgaMatrix Keynote: the iTest. Honestly, I couldn't believe my eyes! It always seems that technology takes so much longer to arrive north of the border.

For the few Canadians out there in the blogosphere, if you are interested in the iTest, fill in a form on their site for a coupon to get a free meter (i.e. it's free with the purchase of 100 test strips, of course). They will e-mail the coupon with a list of pharmacies in your area currently carrying the meter. Handy information, since it seems that not all pharmacies are on board yet - I haven't decided yet if I will wait to see if my pharmacy is going to carry it, or if I will have my prescription moved to a pharmacy that does. I have a pretty good relationship with my pharmacy, so I think I will see if they would be willing to order it in.

I suppose I will also need to check with my insurance company to see if they cover the strips.

Not sure how soon I will get around to it all, but I will keep you posted on my progress!

Thursday, May 17, 2007

Unintentionally Untethered

This morning I woke up at 4:00 a.m. with the incredible urge to pee.

Okay, that's not an unusual event. My bladder generally wakes me up most nights sometime between 2:00 and 4:00.

But as I made my way through the darkness to the washroom this morning, I realized that I was experiencing the all-too-familiar dry, 'cotton-mouth' sensation. The unquenchable thirst. I thought to myself, "Damnit, my blood sugar must be high. I guess I didn't take enough insulin with the popcorn I ate earlier."

When I arrived at the washroom, I reached for the waist band of my pajama bottoms in order to pull them down and do my "business". Something seemed different though. Something was missing.

"WHAT THE F***?" I shouted in my head. "Where the hell is my pump?"

Turns out that I forgot to re-attach it after putting on my pajamas before bedtime. When I got back to my bedroom, sure enough the pump was perched atop my dresser. I grabbed it, and my test kit from the night table, all the while cursing under my breath. BF stirred slightly and asked what was wrong. I just said, "my blood sugar is high" and left it at that since he was half asleep.

I went back out to the living room so as not to disturb BF further. I primed the line a bit, re-attached my pump, tested at 18.9 (340), and gave myself a correction bolus.

In my 10-month history as a pumper, that was the first time I had ever forgotten my pump.

When I awoke at 7:00 a.m., I tested again and my blood sugar was down to 10.4 (187). I took another small correction, and carried on with my usual morning routine.

I took a hot, long-ish shower (longer than 5 minutes, but less than 10). I got out and wrapped myself in my thick and comfy terrycloth robe. I went out to the living room and sat next to BF on the sofa. We chatted and laughed for about 20 minutes, mostly about nonsense, as we always do.

Just before I got up to continue getting ready for work, he asked me what the commotion was all about in the middle of the night. I told him about forgetting my pump on the dresser and how I felt like a moron for doing so. As I stood up from the sofa, I suddenly realized that my robe felt lighter than usual.


When I get out of the shower, I usually re-attach my pump to its site and put the pump in the pocket of my robe.

You would think that after forgetting my pump earlier, I would be more aware and careful to not do it again. But in less than 12 hours, I forgot my pump TWICE!

Another D moment for the books!

Wednesday, May 16, 2007

The Reservoir

Filling the insulin reservoir for my pump has become a bit of a game to me.

I always try to squeeze as much insulin as possible into the 1.76 ml vial of my Paradigm 515. I usually change my site when the reservoir runs out, so it's my way of sustaining my supplies for as long as possible.

I have targets that, in my mind, indicate my successes and failures.

If I have less than 150 units of insulin left after priming the infusion set and getting all the air bubbles out, I feel a bit deflated. Defeated. Akin to a blood sugar reading being out of range. Curses to the heavens!

Between 150 and 155 units is "okay". I can live with it. But it makes me determined to do better the next time. Between 155 and 160 units is even better.

When I manage to cram over 160 units, it is like getting an "A" in twelfth-grade calculus. I knew I worked hard for it, seeing the "A" (i.e., over 160 next to "Units Left") just confirms that it wasn't for nothing.

The very odd time, I manage to pack over 170 units into the reservoir. When this happens, I usually mutter "Yessssss" to myself, and do one of those on-one-knee, hand-pump things in my mind (think Tom Cruise on Oprah).

Silly, no? :)

Tuesday, May 15, 2007

Random bits

It was a fun Mother's Day weekend (a late happy one to all you moms out there). Not only was it Mother's Day, but it was also my mom's 65th birthday. We celebrated with a family get-together in the form of a BBQ on Saturday night.

There were 3 different cakes, and yes - I sampled each one. The one with the blue icing was the best. :)

June 1st is only 2 weeks away! Yikes! This weekend will be crunch time to get the house renos DONE for the sale. Thankfully, it's a long weekend in Canada, and BF and I are both taking Friday off as well, so we should be able to finish up all loose ends over 4 full days.

Addition: I forgot to include a funny moment at my mom's party.

My 9-year-old nephew is the cutest.

My older sister was filling me in on her in-laws' side of the family, telling me about her niece who, at the age of 16, has a fake ID and has turned into a real rebel.

Mid-conversation, my sister's nephew (on her husband's side), who came to my mom's party to keep MY nephew (her son) company, interrupted and said, "Yeah, did you know that she doesn't even believe in GOD anymore?"

My nephew's response: "I didn't know she was Buddhist!"

Tuesday, May 8, 2007

Observation from a non-diabetic

We spent the weekend doing yard work at my house. June is fast approaching and I need to improve the "curb appeal" of my house in order to get top dollar when I put it up for sale next month.

(I won't get into the series of lows I experienced as a result of hours of shoveling and swinging a hammer, or the aches and pains of muscles I didn't know I had...)

On Saturday, we replaced the old, junky, chain-link fence along the right side of the yard with a new, wooden fence. I was busy digging a hole for the next post, while BF put up the first section of fence. When I thought the hole was almost deep enough, I stopped digging to get the fence post and place it in the hole to see how close I was. As I picked up the post, I caught my middle finger on a small, sliver of wood sticking out. I dropped the post and loudly cursed the stinging feeling coursing through my finger.

BF asked what happened and I showed him the wee sliver sticking out from my finger, expecting his usual sympathy and comforting hugs and/or kisses. He did reach out to hug me, but at the same time had a grin on his face and laugh welling up from his chest. Not amused myself, I asked him why he was laughing.

"I just think it's funny that you can purposely stick your fingers a dozen times a day and not flinch, but you get a sliver and it sounds like your whole finger was cut off."

The comment put my nose out of joint for a few minutes (me: "It just isn't the SAME!..." - he was kidding of course, he totally gets how the two are different), but now that I've had some time to reflect, it IS pretty funny...

Thursday, May 3, 2007

Basal rate changes

On Tuesday, I wrote that I thought my site had "gone bad" and that I wasn't absorbing insulin efficiently.

After reading your comments and realizing it's-better-to-be-safe-than-sorry, I was planning to change my site in the evening. But 2 hours after dinner, my blood sugar had stabilized again, and my sugars stayed stable throughout the night and into the next morning.

I woke up yesterday morning with a fasting sugar of 5.4 (97). Perfect, right? However again, throughout the morning and afternoon, my blood sugars began to climb again, hovering around 12.0 (216) for most of the day. It finally came down again in the evening after going for a nice walk at the waterfront.

Today, similar story. Nice fasting blood sugar first thing in the morning, but I can see it climbing again.

So, it looks like it wasn't a bad site, but a signal for a need to make changes to my basal rates.

I find it so odd how my basal rates can go off track suddenly. This isn't the first time it has happened. I don't recall doing anything different in the past few days that would trigger a change. I have been exercising more in the past 3 weeks, and if anything, that should make my basal rates go down, no?

I guess it's just one of those things I will never fully understand...

Tuesday, May 1, 2007

Bad sites

I think that my site has suddenly gone bad.

I changed sites yesterday morning, and had no problems all day. I even woke up this morning with a spectacular fasting blood sugar of 4.7 (85). But within an hour, it climbed to 8.0 (144), and my blood sugar has been increasing steadily throughout the day. I just tested, and right now it is 15.7 (283). I took a correction bolus and I'm crossing my fingers that it comes down.

Anyway, my question is: At what point do you usually decide that you have a bad site and change it?

Honestly, sometimes I'll try to ride one out for as long as possible. Sometimes, it seems that I'm still getting insulin, it just isn't all absorbing. So if the corrections are working, I'll continue correcting as necessary for the life of the site (i.e., until the insulin reservoir runs out). Or I'll increase my temp basal to like 150%.

(Of course, these methods do not work if the cannula has become completely dislodged.)

Infusion sets are too damn expensive to waste. And my insurance is pretty strict about me ordering any more than 10 sets a month.

The decision whether or not to change out a sluggish site is always a struggle for me.