Thursday, July 29, 2010

Not very confidence inspiring....

I submitted a boatload of logs and Dexcom graphs to my CDE yesterday, including the horror show from the bridal shower. Our exchange:

CDE: Looks good, let’s try to fix that persistent later day low…what are your current carb ratios?

Me: We're currently at 12:00a - 11, 12:00p - 10, and 5p - 12

Also, could you take a peek at the hourly trend Dexcom report? At 7am, my median is 90...and from 8am to 9am it's way up around 132 and 139 and then it drops again. It's the highest my median goes and it's driving me bonkers - I get this spike every weekday, but I'm not eating anything, it's not from unhooking for a shower, and it doesn't happen on the weekend. I'm assuming it's a stress reaction to rushing around to getting to work, so it probably can't be eliminated, but I wonder if you have any tips to manage the spike? Currently, I do a .3 pre-shower bolus and then put my temp basal on 112% for an hour when I hook back in 20 minutes later. This morning, I had to do an extra .6 bolus after my shower...and I still went from 71 at 7:30am to 146 right before 9:00. That's a 75 point jump! I'd consider that a failed meal bolus, so I'd love to wrangle it down. Any tips you have would be awesome.

CDE: Ok, change the 5 pm to 11 as well…I think this is driving those lows!

Me: Mmmm....so shouldn't I raise the ratio to 13 if I want to do less insulin?

CDE: Oh geez, I meant 13!


Looks like I need to just suck it up, read my Pumping Insulin book, and start making my own changes. I don't want to do this on my own, but people just don't quite seem to be listening or paying as much attention as I am.

Tuesday, July 27, 2010

Kitchen Sink Karenoa: because #Dfeast day should happen more often!

I wanted to post this recipe for Dfeast day in addition to my splendiferous mac 'n' cheese and diabetic pastas, but I got a bit busy and never got to do it. Doesn't mean I can't share now, however!

Since I stopped eating meat, I've been basically relearning how to eat as a PWD. Lots more carbs and a lot more work to ensure I get enough protein and other nutrients. Enter quinoa. This magic food is the best thing that's happened to my taste buds and/or kitchen since my French press -- versatile as all get-out (good for savory OR sweet dishes, it can be used as pilaf, salad, breakfast cereal, whatever!), this fancy-pants grain is high in protein, iron, and fiber, is gluten-free, and has balanced amino acids for us veggie types. Wonderfood, amiright?

Also, for those of us without massive heaps of kitchen skillz, it's also super easy to prepare. My method below is a little loosey-goosey, but I honestly don't think you can mess this stuff up. It's like a more resilient and flexible kitchen-sink pasta dish!


Ingredients (for the Kitchen Sink Karenoa pictured):
1c quinoa
1 3/4c water
chopped frozen spinach
1/2 onion, chopped
4 cloves garlic, chopped
kosher salt
pepper
olive oil

Quinoa:
1) Put quinoa and water into a pot -- 1 cup of grain for every 2 cups of water (I actually skimp and do 1 3/4 cups of water, as I like it a little more nutty/chewy than wet) -- and bring to a boil.
2) Add 1 tsp of olive oil to prevent sticking, cover, reduce heat, and leave to simmer while you go take care of veggies. Quinoa will absorb water and get the fancy curlicues in approximately 15 minutes.
3) Stir occasionally, and remove from heat once water is absorbed.
Note: You can also add bouillon or use broth -- I prefer to add flavor with my add-ins.

Veggies:
1) Defrost/heat your spinach in the microwave while you sautee your onion and garlic in olive oil.
2) Once the onions go translucent, add spinach to your sauteed tastiness.
3) Dump the cooked goodness into the quinoa.
Note: You can also use fresh spinach, and wilt by adding to the onions and garlic.

Whole shebang:
1) Toss well, adding kosher salt (or sea salt) and pepper to taste.
2) Fluff with a fork before serving.

This stuff is seriously amazing. I've also used vegan bouillon and added mixed veggies, tweaked with lemon juice, did a version with chunks of bell peppers -- the possibilities are endless. The only thing that seemed to consistently matter was the texture of the quinoa, and that has everything to do with making sure you don't use too much water.

Give it a whirl! Carb counts will vary with the veggie/quinoa ratio, but this crazy website (wealth of data here, folks) puts it at 39g of carbs per cup of grain.

Monday, July 26, 2010

It finally happened.

I've had diabetes for more than 16 years. In all those years, my D has been mostly a long-running show of daily baloney (shots, infusion sets, what-have-you) that I could handle on my own or routine doctor visits to get my A1c, an eye exam, or something else rather run of the mill for your average PWD.

I've heard other people's horror stories of lows where they couldn't take care of themselves, glucagon kits being used, waking up in the hospital, 911 calls, on and on with all the terrible things that we all worry about and try to prepare for. And I, too, have done the worrying and the preparation. I have glucagon kits, I wear my Dexcom religiously, I do fingersticks before driving or going to sleep -- I take all those steps. In the back of my head, though, since I've never come close to having something terribly scary happen, I always wondered "What cataclysmic event would need to occur for that to happen to me?" You see, since I'd gone 16 years without a life-threatening D episode, I guess I figured I'd just keep dodging that bullet -- I was a lucky PWD, apparently, and this wasn't something that would actually ever happen.

And then there was yesterday.

I spent the majority of the day at a bridal shower for a dear friend of mine -- lots of celebrating, lots of food, lots of prosecco. Unfortunately, there was also a rather persistent mountain on my Dexcom. My BG was coasting for hours in the mid and upper 200s and, instead of waiting patiently for the insulin on board to do its job, I made the stupid mistake of rage bolusing...in a stack.

At the end of the party, I'd become rather weepy -- I'd chalked it up to the high emotion of the event, but everyone else was rather sure I was drunk. My slurring and inability to walk in a straight line probably confirmed their suspicions, and even I'd have said I was feeling a little tipsy. Not drunk, of course, but tipsy. And that should have been my clue that something wasn't right. Everyone was acting like I was far more drunk than my actual prosecco consumption warranted, but I just decided they were being silly and I left with my ride for the train station. Without doing a blood sugar beforehand.

I don't know what my blood sugar was when I got in the car. I don't know what it was for the first ten minutes of that ride. I was just fighting to stay awake, thinking maybe I was a little more tipsy than I thought. When my poor brain finally thought "Hmm. This is BAD. Maybe we should do a blood sugar," I was at 39. Trying to stay upright, trying not to scare the poor girl who got stuck driving me to the train station, I scarfed tabs as quickly as I could without gagging. Fifteen minutes later, I was at 35. More scarfing, and now I'm panicked because I'm just so very sleepy and those tabs are gross and all I wanted to do was close my eyes. But part of my brain knew that would be a very bad idea. So I tested again -- 39 -- and, out of tabs now, started scraping frosting off the cupcake I'd brought home for B. At this point, my friend is worried and asks if she should drive me to the hospital. Obviously, since I'm not a PWD who needs the hospital, I say no, I'll be fine, let's just get to the station.

It's all very hazy now, of course. I remember that drive in little bits, like a dream that's just on the edge of your memory when you wake up. I know I was dropped off at the station, I know I bought apple juice, I know I called B all upset, I know I got on the right train and exited at Grand Central. I don't remember how I did those things, I just know I did.

I also know that B was waiting for me when I arrived in Manhattan, and I couldn't stop crying when he found me. I'd narrowly avoided something horrible -- I felt that in my bones -- and I was scared.

I have rerun the scenario in my head a thousand times now, and I know there were countless opportunities to prevent what happened. I made huge mistakes yesterday, and have learned a valuable lesson from the whole episode: I'm not a PWD who doesn't need the hospital -- I'm just a PWD who hasn't needed the hospital yet. 

Friday, July 23, 2010

Dfeast Recipe: Mac and Cheese....with a twist!

I've become a nesting fool, and Real Simple magazine is one of the ways I scratch that itch. A couple  winters ago they published a series of recipes for comfort foods with a healthy twist -- ways to make the foods you love to eat a little less bad for you. The one I tried and loved -- B did, too! -- was Macaroni and Cheese with Cauliflower.


Not that this is a diet recipe, of course -- there's plenty of cheese for us cheese hounds, and warm deliciousness for when the weather goes to crap. But it was nice to use whole wheat macaroni and slide some veggies into a dish that wasn't born that way.

I've provided the text below and the link above (commenters offered a couple tweaks I've yet to try). My own tweaks? I used ready-made breadcrumbs rather than bread, thereby eliminating step #2 of the recipe as well as a need for fresh parsley, bread, and a food processor (which I don't own). Also, I think I'd only use half the recommended Dijon the next time I make it - the mustard gave a nice tang, but I found it a bit overpowering.

*  *  *

Quick tip: Using extra-sharp Cheddar lets you use less cheese without giving up flavor. Tender cauliflower adds fiber and vitamin C.
Serves 6
Hands-On Time: 15m
Total Time: 45m


Ingredients
12 ounces multigrain elbow macaroni
1 head cauliflower, roughly chopped (I used frozen - our urban stores aren't so good for fresh)
4 slices multigrain bread, torn (maybe optional, if you use ready-made breadcrumbs)
1/2 cup fresh flat-leaf parsley, chopped (maybe optional, if you use ready-made breadcrumbs)
3 tablespoons olive oil (maybe less, if you use ready-made breadcrumbs)
kosher salt and black pepper
1 onion, finely chopped
1 1/2 cups grated extra-sharp Cheddar (6 ounces)
1 1/2 cups reduced-fat sour cream
1/2 cup 1 percent milk
1 tablespoon Dijon mustard

Directions
1) Heat oven to 400° F. Cook the pasta according to the package directions, adding the cauliflower during the last 3 minutes of cooking time; drain.

2) Meanwhile, pulse the bread in a food processor until coarse crumbs form. Add the parsley, 2 tablespoons of the oil, and 1/4 teaspoon each salt and pepper and pulse to combine; set aside. (Optional step - you can use ready-made breadcrumbs.)

3) Return the pasta pot to medium heat and add the remaining tablespoon of oil. Add the onion, 3/4 teaspoon salt, and 1/2 teaspoon pepper and cook, stirring occasionally, just until soft, 5 to 7 minutes. Mix in the pasta, cauliflower, cheese, sour cream, milk, and mustard.

4) Transfer to a shallow 3-quart baking dish, sprinkle with the bread crumbs, and bake until golden brown, 12 to 15 minutes.

Speaking of that A1c...

As I mentioned earlier this week, I had an endo appointment on Monday. I went to the center armed with lists, questions, and - I hoped - the gumption to tell my doctor what's what when it comes to my diabetes management.

We got off to a rocky start -- she had to hunt me down in the office. My BG had tanked down to the 40s and I'd had to abandon my spot in the waiting room to grab some crackers. (Shame on me for only having one glucose tab in my purse.) Obviously my endo's office is the best place in the world to have a tanking blood sugar, but it was still a little awkward. My mouth was all full of cracker when she found me, I was stuttering and losing my train of thought, I dropped all of my Dexcom graphs on the floor of her office, and I felt embarrassed -- not to mention a little less "Listen to me!" full of authority and self-confidence than I'd wanted for this particular appointment.

It turned out all the flustered low ridiculousness -- and all my preparation -- was besides the point. My A1c came back at 6.2. She gave an "explanation" for where that .6 went from my June blood draw, but it sounded like a bunch of hooey about test sensitivities blahblahblah. Not that I was going to complain about a .6 drop in my number - I was pleased, and even more so when she said that meant we were basically where we wanted to be. Just one last leeeetle tweak for the next few weeks: overnights.

Apparently, I sleep a lot. ("Not that that's bad," she hastened to add when my expression turned to one of shock and horror at such a statement.) And all those hours in sleepyland with BGs that aren't awesome means an uptick in my A1c. My numbers are steady throughout the day -- "impressively steady" enough that she can't tweak them down any more -- so all my work has to be done on my overnights.

Like any PWD, I knew where the work needed to be done. I live with my numbers day in and day out, and I knew where I had to be a little more rigid. My marching orders now are to implement that rigidity -- the doc said they try really hard to be accommodating and make life for PWDs as normal as possible, but "This is not the time for that" for me. So that's my new mantra. I'll be putting little sticky notes up all over the place to remind me of that, to help underscore the fact that there's a goal I'm working toward and this maniacal level of attention paid to my disease is not going to last forever. But until that goal is hit, there's Karen's New Night Regime, which includes
  • mantras on Post-its
  • iron-clad rules about how late I'm eating and what I'm eating late
  • submission of Dexcom overnight graphs to see what my BGs are doing
  • rounds of 3 a.m. fingersticks to make sure my basals are all aces
I'm sure KNNR will grow and adapt as time goes on, but it's nice to have a proactive plan again. Just like I'd been all prepared to demand in the first place.

Thursday, July 22, 2010

My husband: hilarious sender of flowers and my very favorite T3

I've been struggling with my morning bump lately - it drives me freakin' crazy. This morning was a successful experiment, and our IM conversation from this morning pretty much sums up why he's so awesome to have around:

me: ninety fucking two!! ninety fucking two! i kept it flat! i kept it flat!

B: you are a god damn amazement. 272 points [awarded]!

me: apparently, a good waking BG around 100 + .3 pre-shower bolus + a one hour temp basal of 110% = 92. would have been nice to know this trick 6 months ago....

B: absolutely. though i'll take it now....

....30 minutes later....

me: flat line! flat line! flat line! sorry. i think i'm actually more excited about that than my a1c

B: you and your people are the only ones who are happy when a medical device flat lines :-)

Flat line! Flat line!

Tuesday, July 20, 2010

Obvious freaking out = outpouring of support

I may have been a little overly freaked out about my appointment yesterday. Poor B felt the most of it, and responded to my bitchy snappiness as only he would:


I am lucky, lucky, lucky.

Monday, July 19, 2010

T-minus 5 hours and counting....

Today is the dreaded endo appointment. I tried to spend my weekend not thinking about it, but got a giant red F for my efforts:


I spent a large chunk of last night preparing for the big day (after two days just running over this crap in my head, hence the red F):
  • Printing out logs and filing them in my lovely green binder from Target - check!
  • Monkeying with Dexcom software so I'd have something to wave at the endo when my A1c doesn't match any of my data just like it did in June - check!
  • Snapping at poor B because I find all of this overwhelming and horrible - check!
  • Writing my list of prescriptions that need refills - check!
  • Reviewing my questions about meter accuracy (screw you, OneTouch), number of finger sticks a day, and a million other things - check!
There's just one thing my gut doesn't feel like it's checked off my pre-endo appointment list, and that's getting up the gumption to put down my foot with my doctor. I've never been very good at confronting anyone, and certainly not authority figures. Still, someone needs to stand up for me and tell the doc what's what: What happens if I can't get below 6.0? Why do I feel like I'm the only one who's concerned that I'm not moving in a downward A1c direction? Why didn't you know I'd been submitting logs to my CDE daily? What's our plan of action moving forward? Where is the line between my self-care and what my CDE is supposed to be doing?

I think what's eating at me most is that I've gone on the pump and CGM, I'm wearing my cyborg gear 24/7, I'm logging everything I do, and yet I feel less in charge of everything than I did last summer when I was doing MDI - and my A1c reflects that. What does that mean for me? Is it a failure on my part to get back in the driver seat once I learned my new gadgetry? Is it a failure on the part of my health care team to help me "learn to fish"? 

Let's remove the word "failure" altogether and focus on fixing things. What steps should I take so I can once more feel like I know what the hell I'm doing? Will my team support that effort, or does that verge into renegade territory? What's the point of logging and sending all that crap to my CDE if I don't 100% trust her decisions on where things should be moving and I want to be able to make those decisions myself?

I'm nervous about the appointment on a numbers level, of course - I always am. But having to stomp my feet and basically reset the agenda? This is not in my wheelhouse, and I'm not 100 percent convinced I'm going to get my point across and have the endo actually hear me. And if she doesn't, then what?

Thursday, July 15, 2010

Starbucks, or The Problem with Nutritional Information

I am currently drinking my very first Frappuccino:

There's no name game this time, as they initially 
screwed up my order and this is cup #2.

They're very popular during our office's late-afternoon Sbux run, and I've always been curious about them - what's not to love about a not-too-bad-for-you coffee "milkshake"? Today, as the omigodthisisthelongestdayever hour of 3:00 approached, I decided I'd try one out.

I did some carb research before I went on the Starbucks website, and I've gotta say I was a bit stumped. A grande light coffee Frappuccino - described by Starbucks as "a delicious blend of coffee, milk, and ice" - had 27g of carbohydrates.

Their "simple recipe": take dark-roasted coffee, add milk, blend with ice.

Seemed like a lot compared with my usual 13-gram cappuccino, so I decided to check out a more milky treat - the latte, "espresso in steamed milk, lightly topped with foam":


At 18g, the math still wasn't adding up. Still, for just a handful of extra carbs, I decided to hell with it and headed to Starbucks...where the adventure continued as I tried to order.

me: So, a light coffee Frappuccino? That's just coffee, milk and ice, right? No sugar?

barista: Well, there's the coffee base.

me: You mean coffee?

barista: Coffee base.

me, completely confused by "base": It's not just coffee?

barista: No, it's coffee base.

me: Um. I'm diabetic. I just need to know if there's sugar or if it's just coffee and milk like it says on the website.

barista: There's the coffee base. I think that might have some in it.

me: Uh...so if i ordered a light coffee Frappuccino I'd be getting...?

barista, grinning with understanding: Our Frappuccino with the least sugar in it.

Feeling like I would never get out of that insane conversation loop, I just ordered the darn thing. My takeaways? 1) Ten levels of frustrating: Bonus points to the helpful barista, but Starbucks's frakking website should have more detailed - AND ACCURATE - information. 2) The thing wasn't worth the hassle, as my usually sugar-free tastebuds didn't quite love all that tongue-shriveling sugar. 3) Dex says that - so far - their posted carb count info is at least correct.

So technically, today I had my first - and last - Frappuccino.

Thursday, July 8, 2010

And I'm off!

I leave shortly (why am I on here posting?!) for a bachelorette weekend on Lake George. I'm sure there will be many antics and hopefully my BGs will stay in line - not off to a great start, though. A 222 BG when I woke up, and I've finally swapped out my insulin bottle - I've been struggling too much to keep things in line and that jump is completely inexplicable. Let's hope the NYC heat wave's to blame and a fresh bottle will settle things down.

I'm bringing my logs, I'm going to try to play DD for as much of the trip as possible, and hopefully my pump or Dex won't be taking a swim...keep your fingers crossed!

Tuesday, July 6, 2010

Carb counting = not what I was expecting!

My Advanced Carb Counting class came and went on Friday. My ridiculous nerves resulted in a fun little BG pop that afternoon, but such a thing was completely unwarranted. First, I was wicked pleased with my CDE - she put on a good show and, more important, managed to be completely non-judgey or overly strict about eating habits and carb-counting skills. That's no easy feat, and it was nice to be reminded why I liked her so much in the beginning - right now, our relationship is mostly anxiety on my part (GOD, I hate this logging! Will I ever get the A1C I want? I had popcorn for dinner Thursday and was up at 187 1.5 hours later - what is she going to say?!) and almost relentless good cheer and endless number-tweaking on her part. And as much as I need the "Go team!" cheerleading, it can also be a bit maddening. Skip the "We'll get it next time!" lady - how about "No, I have NO idea why that number came up. This disease is idiotic."

I'm sure the other people in the class were also happy with her "If you don't get it right, it's not the end of the world. Just use the info for next time" attitude. I know I would have much preferred her to Evil Nan from 1993.

The first half of the class was a little more beginner than I'd expected, but I suppose any good class has to mention the basics at the outset just to make sure all participants are on the same page, right? So it was off to a bit of a slow start...and then I was met with the crushing "WHAT?! No plastic fruit?!" disappointment. I think I'd taken that "advanced" a bit too much to heart, and had expected a lot of Guess the Carbs food sitting everywhere.



Instead, we had a PowerPoint slide show and my lovely CDE. That being said, it turns out you can pick up quite a few tidbits that way. So here are my New to Karen carb counting tidbits:
  • When food logging for endos or CDEs, be sure to include any food brand names, as well as the source (homemade, cafeteria, deli, restaurant, prepackaged, frozen).
  • 8oz of meat - dose for 15g of carb. (Regular serving is that 3-4oz deck of card size. Apparently, doubling it requires some insulin.)
  • Eyeballing aids: soda can = 1.5oz, baseball = 1c, ice cream scoop = 1/2c, spread hand = 8" diameter (for wraps, etc.), palm width = 4", deck of cards = 3-4oz of meat. Now obviously we're all different sizes, and this needs to be just a guideline. That being said, it makes me want to go measure all my body parts so I can use them when eating out: "Waiter! Would you say this potato is bigger than my elbow?"
  • Dual wave bolus: recommended 2-3 hour square. I'd been doing 1.5 to 2, and am now looking forward to a pizza showdown on Thursday in Schodack.
  • Carb info: Calorie King, of course, but also the USDA. Makes sense, but who'd have thought it?
  • Carb loading: Any meals over 70g of carb or so - regardless of fat content - is going to act more like a MEF. She mentioned bagels and how they "just keep going!" Bolus accordingly, kids. And hey! Try 2 to 3 hours for that square....
All interesting tidbits to say the least, and then she whipped out her Eating Out guide. I think I'm going to write these down on a card to keep in my wallet. You all might already do that, but I'm a little slower on the uptake!
  • 1 pint of fried rice: 110g
  • Sushi roll: 5-10g per piece (the lower end is for 8-piece rolls, and it goes up as your rolls get fatter)
  • New York pizza slice: 60g (CDE: "They must have really small slices elsewhere in the country! Most guides say 40g")
  • New York bagel: 80g
  • Chinese food sauce: add 20-30g to your carb estimate if your food's in sauce
  • Sauce, general: Tack on 15g
  • Cupcake: from 35g (homemade size) to 65g
  • Breading: 15g
She had other tips, too, but I could never use them. My basal is so low at this point that my cat farting in the next room causes a BG spike, so I'm way too sensitive to be able to not dose for salad (even 5 or 7 carbs from a side salad) or alcohol (which is tricky math, but ALWAYS requires an up-front bolus for me).

Albeit imperfect, it was informative and I'm glad I went. Aside from the carb info, I also got to talk to her in person about some logs, and it was good to see how she went through the numbers and why she gave the advice she did. For example, she is WAY more aggressive about lows than highs, which I found aggravating since it doesn't help my A1C when all we worry about is the lows. But she was worried about them because they screw up the data for the entire day, not just for my safety. I can get down with that.

I want to take her out to dinner now, of course, if only to see if we could have a Carb-Off - a Wild Wild West sort of scene in which we both "draw" our carb guesses and see who gets shot down. She might win (she's the professional after all) but I'm confident I'd get a shot in.

Friday, July 2, 2010

Carb counting 101

 Oh, misery, thy name is carb counting.

At 3:30 today, I've got a carb counting class at my doctor's office. I'm dreading it.

I don't think I've had a plastic-fruit session since my diagnosis at the age of 15...and it's been a lot of years since I was 15, folks. Like most PWDs, I can SWAG bolus with the best of them. I'm a fan of certain packaged foods (like my super hippie whole wheat bread with flax) that have carb counts handily printed on the label, and I'm a diligent food-weigher when I'm making my lunch at home. But when your daily BG averages need to come down by a just 10 points or so, let's just say that the ol' S needs to get a leeettle bit more scientific.

Enter: Advanced Carb Counting. (Hmm. Advanced. Maybe it should be Carb counting 201?)

My endo's office provides classes on a whole range of topics (I loved both their Considering the Pump? and the one on CGMs - super helpful), and carb counting happens to be one of them. I am unclear what the class will entail, but am coming with a notebook, my log binder, and an anxious stomach. There's something about this that just dredges up a whole bunch of issues. Obviously, food's a big one of them as it is for many in the community and has been for me since college. There's also the issue of learning you're doing it wrong, when you've been doing JUST FINE all these years, thankyouverymuch. Plus, I really do just hate the nutrition stuff (no, I'm sorry, I'm not going to eat just 4 pumpkin seeds for a snack just because then it can be considered "free"). And there's the awkwardness of the fact that it's being taught by my CDE - will she judge my logs now? Is this going to affect the way we interact when she looks at my info? Will she not trust me and my carb estimates? What if she sucks and now I don't trust her?!

I'm going to try to keep an open mind. I'd love to pick up any tips I can, and I know that I got a great deal out of the nutritionist at the ACT1 speaker series - I'm hoping that I'll come away feeling like I've learned something and that I'm better armed to get my BGs even lower.