Thursday, September 1, 2016

I Guess I'm in College Now

Well hello everyone. Since I'm posting this you can now rest assured that I am still alive after my first (almost) month of college. Do I like it so far? Absolutely not. Will I survive anyways? Probably. My first weeks of college have definitely not been my favorite weeks of my life. Let's just say I cried and called my parents almost (sometimes simultaneously!) every day the first week. I still haven't finished my Diabetes for Dummies binder for my roommate and I'm running behind on everything else, too. That's college for you though, isn't it?

Rush week was exhausting, but also super fun. I was worried that I would be low all the time, since everyone is constantly walking to new houses in the hot August sun. Thankfully, there were snacks at all of the houses throughout the week, so that never happened and I got to stockpile a bunch of snacks. In case you aren't familiar with rush, it's basically a week of speed-dating to find find a group of girls you get along with and are similar to, so you end up in the right sorority. Rush days can run from 6 AM to 7 PM some days. To add to the stress, you have to be asked back to by the sororities, so there is a chance that even though you paid to participate in the entire week of rush, you may not be allowed to. I did end up getting into a sorority, which I loved, but I dropped out because I'm not all about the #collegepartylifestyle and the cost of being in the sorority was too much for me to justify right now. (Plus I don't have enough time at the moment.)

Besides rush and crying episodes, my life hasn't been too exciting. I missed my first 8 AM class Monday and I blame the fact that for the last month, my blood sugar has been low and it takes until 1:30 or 2 AM to go to bed, and then I'll get up and be low again. It's awful. My friends from camp recommended eating something with protein before bed and starting a -10-20% temp basal to make sure my bg doesn't drop, so I'll be trying that ASAP. Let's cross our fingers and hope that works because I'm exhausted by all of these lows. (I guess on the positive side, my A1C is probably great because I'm low all night...) Update: my blood sugar has now been running high for the last two days. Go figure.

The aftermath of a month of lows: juice boxes, granola bars, and two empty jars of glucose tabs.
I'm getting involved in UGA's College Diabetes Network chapter, as well as Wesley, choir, quiz bowl, viola lessons, and probably 20 other things I've forgotten, so I'll be sure to update you all on how those are going as time goes on.

Moral of the Story: I'll let you know when college becomes fun.

Saturday, July 30, 2016

Life Updates

I wanted to go ahead and update everyone on what's going on in my life, in case I go MIA on the blog for a bit. I began writing this while on vacation in Isle of Palms, which is a barrier island off of the coast of South Carolina. I love it because it's not too touristy, but is also not completely in the middle of nowhere. (Which is always preferable, for me at least.) My life is about to become crazy because I have so much going on.

I came back from vacation Thursday because I leave for camp on today, so I had a day to unpack, relax, and then re-pack all of my things for camp. I get back from camp the following Saturday, then I'm going to a Twenty One Pilots concert with my sister that night, and after all of that, I head off to move into college on Sunday. Needless to say, my life is going to be extremely busy.

This is my motto for the next few weeks/ months because of all of the change that's about to happen:

A photo posted by Sarah (@sarahspillerr) on

I'll be going through sorority recruitment before classes start ad the classes begin on August 11th, so I'll be thrown into the mix of college life pretty quickly. That probably means that my blog posts will slow down a bit. I'll definitely have plenty to write about: camp, rush, college, and everything else happening, but I'll probably have to take more time writing posts since I'll also have tons of classes to study for, viola lessons, and everything else going on in my life.

So don't worry too much if I'm not posting as much. I still want to blog and I will, I might just have to figure out how to budget blogging into my schedule before I get back to posting weekly.

Tuesday, July 26, 2016

Orientation & the DRC

I got back from orientation a few hours ago and I am absolutely exhausted. I had so much fun, but there was so much to do, so I am inevitably ready to sleep for 12 hours and I already took a nap on the car ride home. Needless to say, so much happened at orientation that I couldn't talk about it all, but I'll try my best to talk about as much as possible!

Day 0: (aka the day before orientation)
My dad and I took the 1 1/2 hour drive to UGA from our house because I had an intake appointment for the Disability Resource Center. (Which will now be referred to as the DRC because 3 letters is easier to type than 24. And I'm a little lazy.) I never had a 504 plan in high school, so having to get all of the paperwork from my endocrinologist and knowing what to ask for, accommodation-wise, was a little strange. At the Dawgs for Diabetes campus tour I went to last November, it was recommended that all diabetics going to college get involved with their campus disability resource center, since they can do a number of things to help out diabetics on campus. This includes writing letters of introduction to professors, so they know you are diabetic and also so they can list out the accommodations requested. I asked to be able to have food and water in class. (In case I have a few professors that don't usually allow any in their classrooms.) I'm also asking to have the ability to move test days/ have more time on tests in case my blood sugar suddenly drops or my blood sugar has been running high all day, since my ability to concentrate on anything decreases when my blood sugar is super crazy. (Side note: I don't plan on abusing that just because I haven't studied for a test. Even though I'm sure it may be tempting at some points...)

At my meeting, my dad and I met my disability coordinator. She's the person in charge of making sure I receive all of my accommodations and is the person I can call whenever I'm having any issues related to my diabetes and doing things on campus. She was really nice and we went through my medical history, my previous accommodations in high school, (aka none) and talked about teacher letters. She said that those might be emailed to teachers, but I might also have to take them to my professors myself, which I don't mind, since I plan on introducing myself to teachers anyways. She also gave me some tips about the gym; apparently, bags aren't allowed in the actual gym, so if I ever have issues bringing my blood tester or supplies in, I can give her a call and that should be cleared up. My meeting lasted around 20 minutes and was pretty to the point, which I can always appreciate.

We spent the rest of the day going to the music school to ask about the cost of private music lessons, since I'll be continuing viola lessons at the university. After that, we went to Target to get a shower caddy and sheets, since I was going to stay in the dorms for the night. Then, we headed back to the hotel and I worked on doing my alcohol and sexual assault online education courses that I'm pretty sure all colleges require now. (That's an hour and a half of my life that I'll never get back.) During the marathon of online courses, my mom called to let me know that my CGMs had been shipped (finally) and, needless to say, I was happy about that. We ate dinner at Taziki's Cafe, which has yummy Mediterranean food. (I recommend the grilled veggie gyro; it was delicious.) Of course, we had to go visit Insomnia Cookies for dessert. Everyone in Athens is obsessed with their cookies (probably because they deliver until 3 AM) and I got a Chocolate Peanut Butter Cup cookie, which was so good (and probably definitely had tons of carbs).

Cue my obligatory Athens photo at the MLC: (I took this same photo last time I went to Athens.)

A photo posted by Sarah (@sarahspillerr) on

Day 1: (aka day one of orientation)
We had to be at the residence hall I was staying in for the night at 7:30, so I could move in and leave all of my stuff in my room. I was on the ninth floor and let me just say, I'm very thankful that I'm only on third floor in my actual dorm. After this, orientation began. Cue 20 million different panels/ meetings that included introductions to orientation leaders, talking about life at UGA, learning about the specific college your major is part of, and how alcohol inherently leads to anything and everything bad that ever happens on campus. As I was leaving the music major room to ask a few questions about minoring in music, a mom stopped me to ask if I had a pump and we talked about how her younger daughter was diabetic. She asked about what I was doing diabetes-wise to prepare for college and asked if my roommate knew about my diabetes. We talked for 5 or 10 minutes while my dad and my friend played Pokemon Go. (I refuse to play it.)

Later that day, I ended up getting on a bus super late and made some remark about how holding on to the straps on the ceiling of the bus would be fun, since I'm super short. A guy offered his seat to me, since he was way taller than me (which was very nice of him). I sat down and had to cover the lunch I just ate and got into a conversation with his mother about diabetes and endocrinologists. She told me that if I'm looking for a new endo, she recommends SEED, since she goes there. (That's two diabetes encounters in one day... I couldn't believe it.)

My friends and I had dinner made by the dining hall and let's just say that the veggie burgers, cupcakes, and everything else there was definitely a food highlight. I got back to my room after going to the resources fair, where I talked to a few people at the College Diabetes Network Booth and a ton of other organizations. This is also the point when I walked up nine flights of stairs to get to my dorm. #notfun I also found out that community bathrooms are not as bad as I thought they were and then I proceeded to go to bed because all of this in one day was absolutely exhausting.

Day 2: (aka the final day of orientation)
My roommate and I woke up late (as usual) and rushed to get to breakfast. Thankfully, we were only five or ten minutes late. I went to more sessions about how alcohol is bad. (Do you see a reoccurring theme here?) There were sessions about Greek Life and then I had my advising meeting, so I could start registering for classes. There were a few chemistry related class crises, but those were thankfully fixed. My dad and I also managed to lock the keys to our car in the trunk in the midst of all of this and having to break into the car to get those was definitely interesting. After all of this, we could finally head home. Orientation was super fun, but so tiring, so I was glad to be home.

Hopefully you guys didn't mind the word dump, but I wanted to share as much information about the DRC/ orientation as possible. Also a reminder for anyone going to orientation: make sure to bring snacks/ low supplies for nighttime because dining halls take forever to get to and I'm not sure if there are vending machines in the dorms. I forgot to bring glucose tabs, but the school gave everyone puppy chow, so luckily, I had something to eat for my annoying low that night.

If you have any questions about the DRC or orientation, feel free to comment below and ask thos or shoot me an email!

Thursday, July 21, 2016

Trouble in (CGM) Paradise

Okay, I have been having quite the trouble getting my new CGM. I'm upgrading from a Dexcom with Share to a G5, which you wouldn't think would be that big of an issue, but apparently it is. This all started about a month ago in the middle of June when my transmitter started giving my a low battery alarm. I figured I could call customer service and ask if I could upgrade, since I've had my current one forever and I would love to be able to see my CGM data on my phone. I called on the Sunday I started having low battery alarms and was nicely told to call back Monday during business hours, so I could talk to the people in charge of upgrades to get started

After calling them during lunch hours at the day camp I was volunteering for, I was told that I would need to call my distributor (Liberty Medical, which recently bought out my old distributor, Neighborhood diabetes) to get everything ordered and ready to go. I then called Liberty, and was told I was approved to get a new one; all they had to do was confirm my insurance info and then send out my prescription to my endo and I should have it in the next few weeks. Two days later, my mom got a call asking to confirm some insurance info, so I called Liberty back and gave them my info, assured this would happen pretty soon, especially since my transmitter was dead.


A few weeks later, I still hadn't gotten my shiny, new CGM, so I gave Liberty a call and they told me that they were waiting on my endocrinologist to send in their prescription. I gave my endo a call and left a message for her assistant and my call was never returned. Yesterday, I got fed up with all of this and gave Liberty another call. Apparently my endocrinologist still hadn't sent over my prescription, which was ridiculous, since it has been almost a month. I called the doctor's assistant twice and left a voicemail, but wasn't sure if I had called the right extension, since there was no message saying I had reached my endo's assistant, just a generic voicemail message that said to leave a message after the beep. At this point I was furious because no one was telling me anything and I couldn't reach an actual live person. My mom told me to call the practice manager to talk to him, but he also didn't pick up, so as a last resort she recommended calling the scheduling department because they usually have to pick up. After calling twice, someone finally picked up and I explained my situation. She said she could transfer me to the person in charge of CGMs. Relieved, I let her transfer me and then got a voicemail message saying that this person was on vacation until July 27th. I was so fed up with this at this point, but I left her a message and hung up.

At this point I was desperate for at least a transmitter and I called Dexcom to ask if they could try to send me a replacement transmitter until I could get my new CGM. I was told to call Liberty because they are in charge of all distribution, so I did and the woman on the line told me she couldn't do anything to help. After that I started crying because I was so mad at everyone for seeming to not care one bit about whether I have an actual, working CGM. My mom reminded me that we had an endo appointment the next day, so we decided to talk about it with them, in person. That way they at least had to talk to me, rather than sending me to voicemail.

The next day, my mom asked if she could speak to the practice manager and talked to his assistant. Apparently the endo sent the prescription last week and that Liberty should already have it. I called Liberty and explained my situation for the 10,000th time, and after talking to the documents department I was informed that they did in fact have the prescription and had been in possession of it since July 1st. An entire week ago. They told me that they would now be sending my insurance the info for approval and I asked how long it would take: "Oh probably 7-10 days for approval; we're not sure when you'll get your CGM." Great. So now I'm waiting for my CGM for an unspecified amount of time.

I'll be calling back next week to make sure everything is still going into motion, so I know what's happening, since Liberty obviously has no clue what the heck is going on. My endocrinologist also mentioned that Liberty has been moving very slowly ever since they merged with Neighborhood diabetes, so that's always promising.


While I was sitting in my dad's hotel room the night before orientation, (There will be more to come about that soon!) he called my mom to let her know that we were safely at the hotel. While on the phone, my mom told him that my CGM had been delivered to my house! I honestly thought I was going to have to call them sometime Thursday during orientation, so this was definitely a pleasant surprise, even though I couldn't use it until Thursday night. I asked my dad to call Liberty to check and see if my Dexcom sites had been shipped too, since you never really know with distributors these days. (See above post...) Thankfully, my sites came too, so all is well for now. At least until 3 months from now when I have to order more sites...

Moral of the Story: I can finally wear my owl GrifGrip and that is the real important thing here.

Tuesday, July 19, 2016

I'm Being Opinionated, For Once

Disclaimer: I don't usually like to get involve in very opinionated things around the DOC, but today I felt like I wanted to get involved, so naturally, this post is really really long, so if you don't want to read it, please don't feel obligated. This is my own personal opinion on the possible FDA re-labelling of CGMs, so feel free to disagree because it is an opinion, but please don't be mean about it. (Even though I know the DOC isn't mean, I have to include that.) Oh and a final note: take my opinion with a grain of salt. Now, enjoy reading this too long and MLA cited post about why I don't want the FDA to re-label CGMs.
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After reading Ally's blog post (Apparently I've been very inspired by her lately!) about the pending FDA approval of CGMs as devices that can be used to dose insulin off of, I realized I totally agreed with her opinion on the matter. Before reading her post, I hadn't thought much about whether or not I supported the FDA re-labeling of CGMs. I understood that most, if not all of the DOC support this re-labelling, as it could potentially increase accessibility for patients that have difficulty receiving approval from doctors or insurance for use of CGMS. This change could also potentially help the members of the DOC campaigning for Medicare's approval of CGMs as devices covered by their policies. I am in no way against any of these things. I love my CGM and wish that everyone had the same access to these medical devices, since they are extremely helpful in diagnosing blood sugar problems and patterns; unfortunately, I don't think this re-label of CGMs would reach the desired goals of many activists and this re-label could lead to many undesired consequences.

The FDA is planning on having a hearing with its Clinical Chemistry and Clinical Toxicology Devices Panel of the Medical Devices Advisory Committee to discuss "a proposed change in intended use of Dexcom, Inc.’s, Dexcom G5® Mobile Continuous Glucose Monitoring System (CGM) device so that, in addition to tracking and trending interstitial fluid glucose concentrations, patients can use the device as a replacement for their blood glucose meters and make treatment decisions based on the interstitial fluid glucose concentration reported by the CGM" (Warner). This panel will be open to the public to comment on and possibly help influence the decision makes regarding approving CGMs as devices that can be used for dosing purposes.

Most diabetes advocates have been supporting going to this meeting and advocating for this approval by the FDA, since "[many] individuals are already making treatment decisions off CGM readings, but currently, this is considered 'off-label.'" ("They Are Not Waiting. Neither Should We.") As an individual that occasionally uses my CGM to dose, I know that the FDA's approval of this simply doesn't matter to me or the many other diabetics that also use their CGMs to dose. The FDA also doesn't approve the use of CGM sensors in places other than the abdomen, yet many people, me included, put their sensors on their arms, legs, and hips without regard to the agency's current stance on this. Because of the fact that most diabetics already do these things, I honestly do not think that re-labelling CGMs as a primary care devices will change anything that diabetics using CGMs do.

Many people also support this re-label because the, "CGM needs a label replacement claim before it can qualify for a Medicare benefit category. Until that happens, Medicare will not even consider covering it." ("Sign diaTribe's Letter to the FDA Supporting Use of Dexcom CGM for Making Treatment Decisions - Due By July 13.) If Medicare refuses to support coverage of a device that is not labelled as a 'primary care device,' then the problem is not the FDA's lack of a certain label, but instead it is with the rules that Medicare has put in place to be used when reviewing devices for their own coverage approval. Yes, this re-label may solve the singular problem that diabetics are having: needing Medicare to cover CGMs, but it isn't solving the overall problem that could affect our community later on, if a similar situation occurs to the diabetes community, or the countless other communities also affected by Medicare's rules regarding approving certain medical devices. This solution to the problem could lead to the intended result of having CGM's approved for Medicare, but it could also be a dead-end. This re-label would simply lead to Medicare considering coverage for CGMs; it is not a guarantee.

I am less concerned about the re-label's possibility of success when seeking Medicare coverage, and more concerned about the actual safety of making this re-label without scientific research in support of this. Many report that CGMs have more accuracy than the average blood tester has, since the Mean Absolute Relative Difference (MARD) of the Dexcom G4 Platinum is 9.0%. According to Dexcom, "CGM accuracy is measured by [Mean Absolute Relative Difference] from a patient’s reference values obtained from blood glucose measurements from a lab analyzer, YSI (Yellow Springs Instrument)" ("Dexcom G4 Platinum CGM Performance & Accuracy"). A lower MARD indicates higher accuracy of the readings from the CGM when compared with the actual blood sugar of an individual, so this number is amazing and much more appealing than the 15% margin of error most blood testers have. This MARD, however, does not show that readings from interstitial fluid (the fluid used to test blood sugar levels with CGMs) are often much less accurate in times of blood sugar instability. According to the study "A Tale of Two Compartments: Interstitial vs Blood Glucose Monitoring," interstitial fluid readings are only truly this accurate when blood sugars are stable, while they are much less accurate when blood sugars are rapidly changing, which is often when CGMs are needed the most to be used for blood sugar monitoring and potential dosing. The study states the following:
Because continuous glucose sensor manufacturing has not progressed to the accuracy and precision of blood glucose meter strips, sensor glucose signals must be calibrated against corresponding blood glucose meter levels. Such calibrations transforms the sensor signal into a glucose value and assumes that the plasma-to-IF glucose gradient remains relatively constant. This assumption will not be valid if sensors are calibrated during rapid changes in plasma glucose, which is a major source of sensor error. The effect of sensor lag on performance is most obviously seen during periods of rapid glucose rate of change (either up or down). Sensor levels may trail glucose levels by 5–10 min during periods of rapid change, but the most important effect on lag is to introduce error during calibration, which affects long-term sensor performance. Moreover, changes in plasma–interstitial gradient in certain physiological conditions, like insulin-induced hypoglycemia, may be misinterpreted as sensor inaccuracy (Cengiz, Tamborlane).
This study proves that interstitial fluid testing, when compared to blood testing can be much less accurate. As I read Ally's post, I actually had to retest my blood because I had been running high that night. My CGM said I was 248 with a straight right arrow, meaning that my blood sugar wasn't changing much, but my blood tester told me I was 301 and 329. (I double checked, to make sure it wasn't a fluke.) That is up to an 81 mg/dl difference, or a 2 u of insulin difference, which is huge for me. Covering for the 248 would have brought my bg down some, but not into my target range, and I would never know better if I only used my CGM. This huge difference is a major issue for me and I don't want to imagine accidentally covering someone for a false high and then having them go low because of it.

If studies done by scientists show that blood readings from CGMs are not as accurate as our meters, I'm going to trust them. My own personal experience shows this, too. Sometimes my CGM is more accurate than my meter, instead of being the other way around; however, that is because I don't wash my hands/ use an alcohol swab/ change my lancet before every check. That is something I could change (if I felt it was worthwhile); on the other hand, my CGM sensor checking my bg from my interstitial fluid cannot be changed by anything I do, so it's inaccuracies are not caused by user error, but by device error itself.

This potential re-labeling could also lead to a forced choice or lack of access to test strips and blood testers because if CGM's are given the label of a 'primary care device,' insurance companies may decide that since blood testers are also of equal importance (even though blood testers do not have this label, interestingly enough) and they will force consumers to choose one or the other, rather than being able to use both. Insurance companies may also simply disregard the label because blood testers and CGMs will be considered equal, but test strips and blood testers will still be incredibly cheaper than CGMs, so they will naturally lean towards only covering the cheaper of the two options. If insurance companies choose to approve individuals using both devices, they may begin to limit the number of test strips being allowed for daily use. Since CGMs must be calibrated only two times per day, this may be the new allowance of prescribed test strips for a day. Two test strips. That sounds awful and could lead to huge issues when someone is trying to ensure their blood sugar readings from their CGM are accurate, especially in times when blood sugar is increasing or decreasing rapidly.

If we want CGM's to be approved as accurate testing devices, why not go the scientifically proven route and petition for scientists work on improving CGM technology, so they are actually more accurate, instead of petitioning law-makers and FDA officials to support the re-labeling of a device that isn't supposed to be used for the purpose these officials are approving it for? Yes, this will lead to more CGM access, theoretically, but there are better ways of going about this. If we don't want to wait for science, we can work on teaching law makers, representatives, and healthcare company executives about how important CGMs can be for supplementing blood testing and improving blood sugars for diabetics. By doing this, law makers and representatives can push for CGMs to be covered by all insurance companies, including Medicare, which seems to be a large reason why people are supporting the campaign. We could also attempt to help influence law-makers to attempt to change the requirements for device coverage from Medicare, which would not only help the diabetes community, but also many other health communities.

Being 'off-label' also hasn't stopped anyone from putting CGM's in their arms or legs, using sensors for more than 7 days, or dosing with their CGMs, so this vote shouldn't change anything in that area. Instead, this action may lead to a situations Ally described, where people may accidentally cover a CGM high that is actually a mid-100s bg or people's access to test strips may be drastically reduced to off-set the costs of CGMs. And no one wants these things to happen.

The potential pay-off of making the "off-label" choices you already make approved by the FDA, and the possible increase of access to CGM's for all isn't worth these uncertainties to me and I don't feel comfortable supporting a cause that could unintentionally lead to the endangerment of people's lives.

Sources:

Cengiz, Eda, Tamborlane, William V. "A Tale of Two Compartments: Interstitial vs Blood Glucose Monitoring." Diabetes Technology and Therapeutics. June. 2009: S-11-S-16. Web.

"Dexcom G4 Platinum CGM Performance & Accuracy." Dexcom. Dexcom, n.d. Web. 19 July 2016.

"Sign diaTribe's Letter to the FDA Supporting Use of Dexcom CGM for Making Treatment Decisions - Due By July 13." The diaTribe Foundation. The diaTribe Foundation, n.d. Web. 19 July 2016.

"They Are Not Waiting. Neither Should We.." We Are DPAC. Diabetes Patient Advocacy Coalition, 28 June 2016. Web. 19 July 2016.

Warner, Jill Hartzler "July 21-22, 2016: Clinical Chemistry and Clinical Toxicology Devices Panel of the Medical Devices Advisory Committee Meeting Announcement." FDA. US Food and Drug Administration, 24 May 2016. Web. 19 July 2016.

Tuesday, July 12, 2016

An Endo Update

Today was my third quarterly visit to the endocrinologist and as usual it was exciting and simultaneously unexciting because that's how endocrinologist appointments go. The night before, I introduced my little sister to Diasend because both of us are eternally lazy when it comes to logging and this program makes it easy to upload data from all of your medical devices onto one easy to read chart that my endo likes. (And it's a little important that the endo likes it, since she is the one helping interpret the data.) My sister has a t:slim, so she can easily plug in her pump and upload data. I felt inspired to do the same with mine, but mine is an Animas Ping. That means that I had to pull out an IR Reader. 

At this point you may be wondering: "Sarah, what is an IR reader?" Oh well in the ancient days when I began using Animas pumps, they used these things to wirelessly transfer data from the pump to the computer. I even remember using one to change the song for my pump alarms. They may seem innovative/ easy to use, but it's not the wireless/ bluetooth type thing you're probably thinking of. I have to take my pump off, suspend, it, place it on a flat, non-moving surface with the back facing the reader, and hold it as still as possible until the green light that confirms it is lined up stays solid green. This process takes way too long and I may have had to hold my pump in place for an amount of time that made my arm sore. #thanksanimas (Here's a video if you care to know how this thing actually works.) Now back to your regularly scheduled endocrinologist-themed programming. Let's skip to the next day because all that happened after that was complaining about the previously discussed ancient technology and printing charts.

I was awoken at 6:45 in confusion because we had to leave at 7:15 AM to get to our appointment at 8:45. (You know, to compensate for Atlanta traffic.) Apparently everyone is on vacation and we didn't get the memo because we got to Atlanta at 8. That's uncalled for record speed. So of course, we did what any group of tired people that got up way too early for a doctor's appointment would do: we went to Starbucks. In case you were wondering, I got a hot chocolate with a shot of hazelnut (because #nutella) and an egg and cheddar biscuit, my mom got an Earl Grey tea and a blueberry muffin, and my sister got a iced green tea lemonade. I'm sure the endo was very happy that we all had a bunch of sugar before coming over.

We left Starbucks and arrived fashionably late (by two minutes) because that's just how we are. I signed us all in and I got to sign my own HIPPA release, so my parents can still see my medical files. (The excitement of being an official adult.) My mother also talked to the office about my CGM upgrading issues. (There will be a whole blog post for that next week because the story behind that is too long and exciting for just half of a blog post.) Thankfully, those should be mostly solved by next week and I should be getting a CGM soon. 

My A1c, which never seems to change according to my sister, was 7.2%. (It went down by 0.1%, so her point may be proven.) I'm not complaining about it, but I definitely want to work on going below 7%. We changed some of my sensitivity factors, since I always seem to be going to bed high as well as my evening basal to combat highs. I'll be sending logs in next week after I test those changes, so we should be able to see if those help out soon. We also talked about college and talking to my roommate about diabetes, as well as the Disability Resource Center, since I'm being put into their system next week. I'm doing this mainly so I can have testing accommodations. I'm having my official meeting with the DRC next week, so I'll share more about that in the next few weeks. I'm also super excited for my sister because she will be getting a Dexcom soon! I love my CGM and I think it will help her a ton, so I'm psyched for her.

I'll update you all on how my basal/ ISF changes worked, my CGM woes, and college, so stay tuned for that. I promise it's coming!

Thursday, July 7, 2016

Weird Dreams

Sorry for the lack of posts last week. I'm trying to begin posting weekly, but sometimes it takes to for exciting diabetes related events to occur...
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I should have known that a few days after reading Ally's post about having crazy, diabetes related dreams that I would have one too. I really should have. But I lack the foresight that hindsight bias thinks I should have, so here we are with a blog post about it instead. I digress. On to the dream.

In my dream, I was sleeping and then woke up with low blood sugar. (And as my friend and I talked about the other day, those are always the worst because you don't think you actually need to wake up in real life.) It was one of those really bad lows where I didn't even have the physical motivation/ strength to move the four inches to get my blood tester, so I was mentally yelling at myself to move and get up because I knew I needed to test my blood or things would have gone downhill.

After mentally yelling at myself, I woke up and was totally freaked out, thinking that I needed to test my blood because I was obviously low. It turns out I was actually in the high 100's and didn't have any blood sugar issues. It took me a few minutes to actually realize that most of what had just happened was actually a dream. I don't recommend having this kind of dream. It sucks.

I've heard of low blood sugar induced weird dreams, but I never expected to have an actual dream about something so real, if you know what I mean. It was definitely a chilling dream to have and I'm glad I don't have these kind of dreams often. (#fingerscrossed it doesn't happen again)

Moral of the Story: As soon as you read about it on another blog, it will happen to you.

Tuesday, June 21, 2016

I Feel Personally Victimized by Food

On the way home, I was thinking about Waffle House and how it ruined my BG the one time I ate there, and then I thought about all of the restaurants and foods that seem to always wreak havoc on my blood sugar. So I bring you my definitive list of places and foods I can't eat (at).
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Movie Theaters
Every single time I go to a movie theater, my blood sugar is high or it goes up really quickly. I blame the butter-filled tub of popcorn I enjoy eating and the strange movie theater carpets. I should also probably cover my popcorn before I eat it, not in the middle of the movie when I suddenly realize that I've forgotten to cover it.

Waffle House
I already don't like Waffle House because it's just kind of gross in there, but the following story definitely adds to my distaste for the place. The morning before my AP Macroeconomics exam, my class met up at a Waffle House near to school to eat and chat before the exam. I got a waffle and some eggs and of course put syrup on my waffle. Needless to say, my blood sugar went up to the 300's (even though I covered my breakfast) and stayed there until their convenient drop to the 100's right as the exam ended. My site may have also been bad, but I'm not 100% positive. Thanks Waffle House.

Pizza
No one likes pizza's strange effects on blood sugar. My sister told me that on her first day of camp this summer, pizza was served and all of the counselors and clinicians were not exactly happy because a couple hundred diabetic campers were about to have some weird blood sugars. I'm pretty sure way too much of the camp's supply of insulin was used that night. And I'm also pretty sure that I use up way too much of my own insulin on pizza night as well.

A picture from one of my many Starbucks runs. Also featuring the keys that are currently lost.
Frappuccinos
This is the most tragic item of all on my list. If you know me, you know that I love Starbucks and frappuccinos, so when my dad mentioned to me that I should consider putting them on my banned food list because I always complain about being really high hours after drinking them, I was not very happy. I'm still mourning it to this day. Now I enjoy Iced Chai Tea Lattes and Strawberry Açaí Refreshers with coconut milk to make sure I get my Starbucks fix.

Ice Cream
After years of experimenting with combo boluses, I've finally figured out how to bolus for ice cream. (I do a 60:40 combo bolus over 1 hour, but of course YDMV.) But before approximately a month ago, I would cover my ice cream and then go low an hour later. Every single time. (Who knew ice cream could actually lower blood sugar. Maybe I should eat it more when my A1C needs to go down...) My sister also complained about how that wasn't really a problem, but it stopped me from eating ice cream. And does a teenage girl deserve to be deprived of her ice cream? I think not.

Instant Oatmeal
This super easy to make version of oatmeal is not so easy to deal with when it comes to my blood sugars. It causes a major spike and then a huge drop all within a few hours after breakfast. The instant oatmeal phenomenon also affects my sister, and I'm pretty sure she's more hurt about it than I am.

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What is one of the foods/ restaurants on your banned list? Or do you have any bolusing suggestions for frappuccinos? (Because I really miss them. #addict)

Thursday, June 16, 2016

My Tips for High School Students with Diabetes

As an official high school graduate, (and as a person that appreciates advice) I thought that it would be a good idea to share what I learned, diabetes-wise during high school. This includes anything from dealing with teachers and students to having fun. (And the crowd was shocked when they heard people with diabetes could have fun.) I hope these tips can help a few people out. Or just provide you with entertainment for the next couple of minutes.
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1. Introduce Yourself
Seriously. Go introduce yourself (and your diabetes) to the school nurse and all of your teachers at open house or during the first few weeks of school. Having a school plan and supplies in the nurse's office will make your life and her life easier if anything ever happens to you/ if you're having a really bad blood sugar day. My school nurse usually emailed my teachers to let them know I was diabetic, but I also took it upon myself to introduce myself to my new teachers. I would always do this because teachers often skim through emails and it's a lot easier to put a name to a face when you introduce yourself, rather than by looking through an email and roster.

2. Get a 504 Plan
Not having a 504 plan is one of the (many) mistakes I made in high school. Luckily, I didn't ever need one at school because my teachers were very understanding about my blood sugars and didn't mind if I had to take a test at another date or time because of an awful high or low. I recommend a 504 plan because if you ever want to apply for accommodations for standardized testing, or if you have a less-than-understanding teacher. If you want accommodations to allow for extra breaks due to blood sugar issues during your SAT or ACT, they will ask for legal proof of your disability and the accommodations you already receive at your school for testing; it is so much easier to apply for these when you already have a 504 in place. You can find info about making your own 504 plan from Children with Diabetes and Beyond Type 1.

3. Figure out a spiel, if you want to answer people's diabetes questions
Tons of people will see your pump, look at your CGM site, and watch you test your blood, and some of these people will have questions. If you don't want to answer their questions, you can just tell them you don't feel comfortable talking about it. If you're fine answering questions, come up with a short blurb that explains what this whole diabetes thing is and what your devices do. Mine goes something like this:
"I'm a type 1 diabetic, which means that my body can't convert the food I eat into energy, so I give myself my insulin, medicine that allows my body to do this conversion through my pump. I test my blood so I know how much insulin I need to take, along with using a CGM. My CGM is a tiny device with a wire under my skin that tests my blood sugar every five minutes and this displays on my receiver. It tells me what my blood sugar is and if it rising or falling, which helps me figure out what I should eat and how much insulin I can give. Any questions?"
Short-ish and simple. (Kinda...) Having this little speech already in the back of your mind makes it easy to explain everything to the general public, without using up too much of your own time.

4. Take advice from the boy scouts and be prepared
There will seriously be days when your pump site leaks, your blood sugar is through the roof, and your parents won't be able to bring extra insulin/ sites/ shots. Learn from the billion times I forgot to bring extras to school, (I may be the most forgetful person I know. Oops.) and keep an extra site change, shots, insulin, and glucose tabs with you. Throw them in your locker, backpack, purse, or leave them in the nurse's office so you'll always be prepared for the worst.


5. Know your limits and respect them
Recognize the point when you can no longer focus in class, take a test, or properly study due to your blood sugar and figure out what to do about it. Ask to go up to the nurse, so you can get your blood sugar up or down and be able to step away without getting too worked up over it. I tried to stick it out my physics class when my blood sugar starting going low and let me tell you, it didn't work out well. (Learning about the intricacies of torque while having a blood sugar of 60 just doesn't work.)

6. Learn how to react to people's words
Sometimes people, even your friends, can make a comment that suddenly puts you in an awful mood because it reminds you that you are the different, diabetic one. Most people don't realize how harmful their words are and end up making some pretty dumb commentary on diabetes and the things people with diabetes have to do. If your friends or others consistently say stuff that is rude and hurtful, call them out on it and ask (preferably nicely) for them to stop. If they don't, they really aren't worth spending your time with.

7. Remember that most people won't make diabetes a big deal
Unless you are constantly bringing up your diabetes, people usually won't care at all about it. Of course, know that sometimes making a deal out of it (if you need to slow down because of high or low blood sugar) is necessary and okay. You shouldn't feel bad about your own self care.

8. Find a support system
Having a group of people you can vent to about diabetes, without having to explain the entire backstory of diabetes to is vital. Talk to camp friends, go on twitter, instagram, or tumblr and search through #diabetes to find someone to talk to. Everyone needs friends to help them get through the worst of DKA/ diabetes burnout/ life with diabetes in general so find these friends and stick with them.

9. Don't take diabetes too seriously
High school is stressful enough as it is, and adding in diabetes to the mix can make it even worse. Don't worry about having bad blood sugar days or the high you get after going out to an amazing restaurant with friends. Don't forget to cover your food, but don't forget to have fun too. Find a cute bag to throw your diabetes stuff in, (I'm partial to this bag from Myabetic or this clutch from Prikkedeif) cover your devices with cute stickers from PumpPeelz, (I love the citrus print, these cute blue flowers, or the option for your own custom skin), and hold your site in place with a cute seahorse. Do fun stuff and don't let diabetes be something that stops you. High school is a time to have fun, (and of course to do schoolwork to get into college) so take advantage of that.
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Now that you've read through these, do you have anything to add? Or could you do your girl (aka me) a favor and give me some tips for surviving college with diabetes, since that will be my next endeavor?

P.S. I totally wasn't sponsored by any of the companies I linked to in this article; (even though I would love to be!) I just love their products and wanted to pass them on to others.

Tuesday, June 14, 2016

As Usual, I Forget Everything

When one of my friends invited me (and a bunch of of my other friends) to go to a house in, and I quote, "the middle of nowhere," I wasn't the most eager. (I'm not exactly a fan of the middle of nowhere, especially when there is no internet connection.) But after a little convincing from my family and friends, I decided to go. I packed up all of my things for a three day adventure to a house on a river and of course, ended up with an entirely full carry-on bag, Northface backpack, and tote bag. I like being prepared, and a trek into the middle of nowhere definitely required that much stuff. (Obviously.)

As I packed up everything the night before, I realized that I didn't have any extra insulin in the fridge or in my bag. Of course, it was probably 12 in the morning, so I just decided to ignore it and hope I could take my sister's extra insulin, instead of doing anything about it. Fast forward to the next morning. I wake up and tell my dad that I have no insulin and he kind of freaks out, (sorry Dad) and of course, Anna's extra insulin has also gone missing. My dad desperately tried to fill my prescription and then we had yet another great revelation: my dad can no longer fill my insulin prescription because I turned 18 a few weeks ago. (Imagine how much more happy my dad was after that...)

My dad frantically made me an account, so he could fill my prescription and then we had our third realization: CVS doesn't open until 9 and my friends and I had to leave by 8. This story ends with me calling a random CVS in Birmingham on the way to the river house and all of my friends laughing at me as I explained to the random pharmacist why I needed my prescription transferred from where I live to Alabama. Comments included: "Sarah you told that person way too many details!" and, "They probably didn't even care."

We stopped at the CVS and I picked up my insulin; I asked if anyone had a cooler in the car after I grabbed it, and then I found out that my friend's mom's car has a cooler built in to it. Who knew? She, of course, let me use it. (And was also as excited about this new discovery as I was, since she had been waiting to find a practical use for the cooler box.) After that little adventure involving insulin, a few more things seemed to go wrong.

The beautiful view we had at the house. Photo credit goes to Michael, since I apparently forgot to take pictures.

At one point on the river, my pump site came out, so I had to walk up 207 steps to get back to the house. (Those steps were evil and let me tell you, my legs burned after walking up them.) My blood sugar also seemed to always be obscenely high before meals, so I sadly had to wait until 10:30 pm at one point to eat some absolutely delicious ice cream. (I'm sure the billions of bags of doritos/ cookies/ cheez-its I ate were the cause of that, though. #irresponsibleeating)

All of the mishaps didn't cause too much of a dent in the fun I had that weekend. I jumped off of a cliff into the river, (side note: don't cannonball from a two story high cliff) helped rescue a canoe my friends flipped over (my t-rescue skills from camp finally came in handy), swam in the lake for forever, and played a ton of fun board games. (I brought Sorry and it was everyone's favorite.)

Moral of the Story: Bring a site with you on the 207 step trek to the river. Because your current one will fall out.