Continuous Glucose Monitoring: One Month In

So for those of you keeping track at home, it's been just over a month since I started using my CGM. And no, I haven't been sailing yet.



I just wish that box has contained the keys to my yacht and not an insulin pump, but alas.

You might remember that I was fairly nervous about all this, but it has gone remarkably well. I spent an hour and a half getting trained on how to use everything, and how to change my sensor location every three days. It was a lot to take in, and I was very grateful for my more visual and technical husband when it came time to insert the sensor on my own for the first time. I've got the details of that (thankfully, pain-free) process down now, but it doesn't always go smoothly. Since I'm not using the insulin pump, I'm not physically tethered to anything, but if I'm apart from the pump for about 30 minutes, an alarm will go off. So the pump is always on my person, usually in my pants pocket. (Side note: am now on a quest for more pants with pockets.)

There's also a lot of STUFF required with all this. I am constantly restocking my needles and testing supplies, since I'm still required to test at least three times a day, plus five insulin shots a day. I'm fortunate to have access to three month prescriptions, but that means boxes and boxes of needles, lancets, test strips, sensors, surgical tape, alcohol wipes, and of course, insulin. I haven't figured out where to store it all yet.

BUT. The information. It is so, so much information. At times, it's completely overwhelming to know what my glucose level is 24/7. It's infuriating to see high numbers when I think I've been eating well or exercising. And yet, it's totally amazing that this little thing is figuring me out all the time too. I finally can see the times my blood sugar is rising all on it's own, and figure out how to cut off those highs. My AMAZING doctor is totally convinced we will solve the puzzle of my body and how best to treat it. We've been tweaking my insulin a lot over the last few weeks, adding shots at different times and reducing other ones. It's ever-changing and variable, but I know CGM will be an excellent tool in decoding just what's going on. It's also a great safety net, sounding alarms when I get too low, which is a frequent issue for me at night.

Finally, thinking so much about diabetes has made me look for other resources to compare experiences, and of course I found those on Twitter. I've found some great people to follow and it's been really helpful for feeling a bit less frustrated with this journey. When I see other people posting crazy results or combating lows, I know I'm not the only one dealing with it.

So that's why I'm posting all this - in the hopes that some newbie out there will find it some day and get a more detailed account from a real person of what CGM is all about, at least so far for me. If you have a question on any of it, feel free to ask me in the comments.

And yea, no sailing, but maybe this guy is more my speed anyway.

Triage

During my freshman year of college, I took a 110 hour training course to become the most basic level of a licensed Emergency Medical Technician (hi, old BEMCO friends!). When I signed up, I'd been pre-med, but so was 2/3 of the Brandeis Class of 2000, and by the time the class started, I'd moved on to economics. But I followed through with the class and licensing anyway, and used my training in a very limited way while on campus.

I knew, however, that I wasn't going to hack it as a "real" EMT when I discovered the concept of triage. Our book said the concept originated with the French, and the translation of the word was "to sort." I was horrified by the idea that I'd be responding to some major disaster and have to determine who would get help and who would have to wait, and really, who was beyond help and would have to be passed over. The idea has stuck with me, and while I'm not responding as an EMT, my life often feels like a constant triage.

Yesterday afternoon I got a call at work that Hannah had fallen and hurt her wrist badly. I quickly called Marc and the pediatrician, told my boss I was leaving and made it home on the T in record time. Marc and I took Hannah to one hospital for x-rays, then went to the pediatrician, and eventually ended up at Children's Hospital to get 3/4 of her arm casted in a bright green hue. Hannah was such a trooper - she didn't cry much after I arrived, and complied with all that was asked of her. It was a very late night, but she still got up and went to school on time today and in a good mood. She's even given Marc and me her blessing to continue on to our planned trip to Montreal this weekend.

The triage yesterday was totally obvious - Hannah gets highest priority (while still taking care of Max, of course). Work emails could wait until I got home at 10 pm. I stayed home from work today, and scheduled the follow up appointment, as well as a first visit to the eye doctor after the pediatrician confirmed yesterday that was needed yesterday (yes, I do think this is all related). And now I'm going through all of the rest of what needs to be done today, making all of the millions of little decisions that add up to a life lived.

If you ask me (and it's my blog anyway), I think I stayed remarkably calm through all of this. I think I'm pretty reliable in a crisis, even if it means my adrenaline shoots through the roof and keeps me awake for hours afterward, replaying the entire episode. I never imagined I'd think back on the triage concept as often as I do, but maybe I would have made a good EMT after all. Or maybe it was the best training I could have gotten for the life I'm living anyway.

On a Lighter Note

Here are some of the fun things making me happy recently:

- Hannah went to a play date with four other kids from her class where they filmed a "movie." The mom in charge is still editing it, but I'm told one of the kids was a dog for most of the filming, and that there was a "dance club scene." I'm really looking forward to seeing that.
- Sunday night we went to the Hanover Theater in Worcester to see Cathy Rigby is "Peter Pan." The kids have watched this version of the show many, many times on Netflix On Demand, and I couldn't resist getting tickets to see it in person. Cathy Rigby was amazing, and it's just such a fun performance. It was Max's first big show, and he behaved really well. Which means I'll want to get him tickets to see Mary Poppins the next time that's in town.
- Halloween went really well this year, especially compared to last year's double fever edition, when neither kid got to go out for trick-or-treating. Hannah was a "rock n' roll witch" and Max was the lead character from the PBS Kid's show "Super Why." Both of them really liked their costumes, which always helps. We went to the Bowen Elementary School Halloween party on Friday night, and then last night I left work early to take them to the village and around our street. The kids also painted their pumpkins this year.
- On a totally silly note, my Mom bought me a pair of Uggs for my birthday, and I'm just breaking them in today. I have wanted a pair for a really long time, thinking they must be worth all the fuss or they would have stopped selling them years ago. They really are super warm and comfortable.
- I'm really enjoying the new Coldplay album. Jennifer Weiner has a new short story out that I'm planning to read soon. And Mindy Kaling's new book is high on my list to start too. And there's a new episode of Glee tonight featuring my favorite guy from The Glee Project.

What's been making you happy?

34 (A New Diagnosis)

I turned 34 last week. Thirty-four isn't worth a lot of fanfare, but it was a pretty nice birthday. I got some wonderful gifts this year, all things I wanted, nothing I truly needed. I recognize how very fortunate I am to be in that position, to be able to get things off of the "it would be nice to have..." list. Despite us being very well off, I'm not very good at doing or buying the things I need just for me, especially the extras. But this year, I felt I really need to treat myself well.

It's not something I talk about much, but I was diagnosed with Type II diabetes at 24. Over the years I've tried a few different medications, and was on insulin throughout both of my pregnancies. I am by no means a good patient. I always take my meds, but I haven't always been very careful about what I eat, and I don't test my glucose levels as often as I could. Many days, other than when I was pregnant, I didn't give it a lot of thought. When I did try to be "good," I'd often have a middle of the night awful episode of low blood sugar. Plus it's not like I haven't had other medical issues that took up more of my time - not being able to walk trumps glucose levels (which were actually very good during that time, since I wasn't able to get myself food very easily).

A couple of weeks ago, I had a new blood test done, and it revealed that instead of Type II I have what's referred to as Type 1.5, or latent autoimmune diabetes of adults (LADA). I'm not an expert, but basically it means that my pancreas doesn't work. As the link above says, "simply stated, autoimmune disorders, including LADA, are an "allergy to self.”" For years, I have blamed myself for not trying hard enough, not having enough will power, to just eat better, exercise more, and make the diabetes go away. I always thought that when Max turned three, I'd make my efforts to get better (and I have, with this whole gym thing). Now my doctor has said I can stop beating myself up, that's it's not going to happen.

It's been pretty devastating news to receive. I know there are many, many worse things that can happen in life, that this is just a tweak to what I already knew, but it's still hard to hear "this is forever" rather than hold that hope alive that it wasn't for the rest of my life. I just always assumed that some day I'd be done with this.

So I've had the last few weeks to process this information and get ready for the next phase of tackling it. Later this week I'll be getting a continuous glucose monitor to use in tracking my blood sugar levels at all times. It requires inserting something under the skin of my stomach, and I'll be wearing a device that resembles a pager to track it all. It's actually a really cool technology, and should help give me better information to modulate my medications as needed. And it comes in a purple case, so you can't beat that. I'm doing insulin shots with meals in addition to my long-acting nighttime insulin, and depending on how things go with the monitor, I will consider the possibility of adding an insulin pump. But one thing at a time - this one change is overwhelming enough. But as my friend Stephanie said, today it seems like a mountain. Soon, it will just seem like a blip on the radar.

Did I need some treats to make me feel better as I faced this? Absolutely. Was it better to buy a new watch than eat an extra slice of birthday cake? Definitely.

It's funny, but you (or at least I) look back at your life and see the blessings and challenges that each year held: first full time job at 22, married at 24, baby #1 at 26, finished graduate degree at 28, baby #2 at 30, back surgery at 32. Thirty-four is starting off this way. Hopefully, I'll be able to look back and see that this wasn't the defining moment, even if it feels that way now.

Catching Up and Slowing Down

Well, my faithful handful of readers, I only managed to blog twice last month, so this is one of my catch up posts. September was a difficult, ass-kicking month for me. It seemed everything needed doing and usually at the same time.

The kids went back to school and all is going well so far. Hannah likes her teachers and is keeping up with all of the new homework demands this year. Most of her homework is done on the computer, which can be a bit complicated because she doesn't have much computer knowledge yet (lots of "Help, I clicked the wrong thing!"), but she's doing a good job with it. She started piano lessons, and is taking swim lessons instead of karate for now. Hebrew school is also two days a week now, often with its own homework component too. Max is happy in Room K Koalas, and we're hearing more and more about how he's spending his days. He got to be Shabbat Helper last week, which is always a highlight for him, and seems intrigued by their new class pets: a bunch of worms that they'll follow through the year.

Work has been incredibly busy, but we were excited to see our new fund launch at the end of September. We have had an institutional product for a long time, but this is our team's first foray into the retail market, and it's very exciting. It's been very interesting to see all that goes into a fund launch, since I've never been on that side before, and a challenge to add all of that on to my normal responsibilities.

We're also in the middle of the month of Jewish holidays that come every fall. We spent Rosh Hashanah in Newton, with Marc cooking two really nice meals, and we had a great time on the second day with the Weitzman family. After a chaotic day we made it to Hartford to spend Yom Kippur with Marc's family, and while it wasn't the smoothest trip, we had a great time being together. We put up our sukkah last weekend and are looking forward to having lots of people over to join us in it this Saturday afternoon.

After going weekly for the past couple of months, I am no longer going to physical therapy and have resumed going to the gym and working out on my own. My therapist was able to quantify my improvement, and I'm no longer as scared of hurting myself when moving my body. I even made it to the gym three times in a week once, which was my goal when I started working out in March (though I haven't done it again, 2x a week seems like the most I can do right now). It's getting easier, and I'm hoping to stick with it.

And in the midst of all this, there's been lots more. A couple of birthday parties, plus celebrating Marc's birthday one Shabbat evening. The annual Temple Emanuel BBQ. Back to school nights. Apple picking at Tougas Farm. Touch-a-Truck. The Lion King in 3D. Yo Gabba Gabba Live in Concert. Dinner out with Room K parents. Taking both kids to the dentist. Thankfully, this all didn't happen on the same day, though sometimes, it felt like it did.

But I did manage to carve out some downtime in the last few weeks, if you can believe it, and I realized that I'm really no good with downtime. With too much of it, I get depressed and anxious, or all wound up trying to figure out plans for next summer. It's just easier to always be doing something.

Which is probably why I have three parties on the calendar for this Sunday.

So what have you been up to?

Yea, I Kinda "Know How She Does It"

SPOILER ALERT: This contains some details from the movie, including the ending. If you don't want to know, don't read on!

This weekend the movie version of the book "I Don't Know How She Does It," by Allison Pearson, was released, starring Sarah Jessica Parker. The film depicted SJP as a married financial analyst living in Boston with a young daughter and son, and her struggles to keep up with all of the demands (sometimes self-imposed) that those roles entail.

Gee, I just don't have any clue at all *how* she does it.

Or as my friend Jenny said, perhaps I was the inspiration for it all.

But no, the book came out in 2002 - two years before Hannah was born. It appears that I read the book then too, since I own the hardcover copy, and had started my MBA in January of 2003 (and got pregnant in May of 2003), so chances are I wasn't reading anything for pleasure at that time.

I remember reading it, and being a bit scared about how I would some day balance it all myself. The book takes place in London, and harried doesn't begin to describe lead character Kate Reddy's existence. There is never enough time for her marriage, she frets about not knowing the extensive details of her children's lives, has a complicated relationship with her nanny, and fights to be taken seriously in the office. Each chapter ends with her list of things to remember, which keep her up late at night.

But without yet having children myself, well, I couldn't possibly know just how much I would come to identify with Kate. Keeping track of the treasured comfort item, planning birthday parties, Power Point slides on daily average liquidity, kids obsessed with Mary Poppins - none of that had happened to me yet. But boy, has it happened. In an episode of the book I'd forgotten, Kate's daughter pushes her to read the book "Little Miss Busy" to her one evening at bedtime, and that book influenced my chat screen name being LilMisBusy when Marc and I met back in 1999, it's a theme I've kept up with for a long time now, and must have laughed at reading it at the time.

Having the movie set in Boston took all of the coincidences to another level. Of course there were many landmarks I recognized (and I think the entire audience snickered at the very fake "Boston Children's Hospital" edifice), though we never once saw SJP descend into the T on those stiletto heels. Near the start of the movie, her toddler son crawls in bed with her in the morning, and she sings "I Love You, a Bushel and a Peck" to him, and that was sung to me, and I have often sung it to Hannah and Max. Before the movie began, I had discussed a recent work issue with Stephanie, and an incredibly similar one was mentioned in the film. So yea, it was a lot like my own life, but with fewer high heels, and bosses who look nothing like Pierce Brosnan (sorry, guys).

So being a book and a movie, neat and tidy endings are required. In the book, Kate eventually quits her job, sells her house in the city, and spends a lot more time with her husband and kids, but shows an inkling towards going back to work in some capacity. In the movie (and perhaps owing to today's economic realities), Kate keeps her job but seems to get a bit more flexibility after having a major office success. She basically admits that life will always be crazy, but says she'll try harder to slow down.

With so many similarities, I can't help but compare where I'm at with the book and film. I may be kidding myself, but I don't think my life is as chaotic as Kate's, particularly because I don't have to travel for my job. I did get the flexibility I needed this year with my one day a week working at home, and it has had a profound impact on my stress level. As the kids are getting a little older, some things are easier. And I recognize how fortunate we are that we're not dealing with some of the major issues that affect so many and can completely derail what you had expected out of life. But at times I am truly overwhelmed and feel like I'm drowning.

And yet there are entire spheres of life that I just don't handle. Marc is completely responsible for all things car and landscaping-related. Anything needing fixing or building is also his domain. I am house-blind to a certain degree as well. If you calculate the number of drop-offs and pick-ups as 10 per week per kid, Marc generally does 13 out of 20. He is largely responsible for all food-related activities too, and the list goes on. So in my mind, that's not me "doing it all." That's having a very committed partner who makes it possible to do the rest of it. Hopefully he'd say the same about me.

But I do feel like I successfully juggle an awful lot of things, and manage to keep my husband, children, extended family and bosses reasonably happy with the job I do. Often, I'm happy with multiple pieces of the juggle at the same time! Every day is different, and there are some days where "doing it all" works out a lot better than others, but I'm not sure I could do it any other way. I know that giving up any of the pieces wouldn't make me a better person. So the challenge in life continues to be adding more pieces to the puzzle - time to exercise, more time with friends, even more time writing here - while still keeping the other pieces together.

Does anyone have a book on that?

Thoughts on the Tenth Anniversary of 9/11/01

I wasn't there, and I have no delusions that my perspective on today is worth anything to anyone but myself. So please feel free to skip this post if you're avoiding this topic today. I get it, and part of me is avoiding it too.

But I felt compelled to write something today, and I'm ignoring the challah crumbs all over the floor of my house to find a few minutes and write this. I can't believe it's been 10 years. In the days after I can actually remember thinking about what the tenth anniversary of this tragedy would be like. Would that compulsion to help others, and the pride everyone exhibited toward our country, still be such a prominent part of life? I doubted it, and unfortunately, I think I was right about that.

I've written before about my experiences that day, and reading many others stories in the last few weeks has crystallized a few things for me. The fact that strikes me first is that I'm still very much in love with Marc. I remember how angry at him I was that day when we were all walking home from work and I couldn't find him. Clearly, I wouldn't have been that angry if I didn't love him that much, and I know that ten years later, I would still feel just as angry.

I've been thinking about the day in the context of my children too. Max is still too young, but we've had some preliminary conversations with Hannah on the topic. But then I'm reminded how young she is too - almost eight, yet still innocent about so many things. You try to bring the threads together. She knows soldiers fight in Afghanistan, but she doesn't really know why. She knows people died, but she doesn't know why I put our flag up on the house today. I read somewhere that you should tell children that "some people did a bad thing," instead of saying they were "bad guys." I'm struggling about how to explain it all to her, so instead we left it open - if you hear something, or have a question, feel free to ask us. I'm trying to limit the discussion to only what she wants to know.

Today we're spending a lot of time at our synagogue. Before the start of religious school this morning, a ceremony was held outdoors, the shofar sounded, the Kaddish recited. This afternoon we'll be having our annual community BBQ, an event I've helped organize for the last few years. The Shabbat after 9/11 Marc and I visited a new synagogue for the first time, where a friend had gotten us tickets to spend the upcoming High Holidays. It wasn't the right place for us, but it was still comforting to be within a community at that time. Ten years later, it is an entirely different emotion to be among friends and feel at home within our synagogue, and I am grateful for that.

My anxieties about 9/11 have also evolved and caught up to the present day. Last night I barely slept, filled with nightmares about similar events happening now, in my office tower, with my family and friends affected. They are paralyzing thoughts, even when I consider how remote the odds are. And so I read the stories, and think about all those affected, and pray for all those who are suffering today and every day because of this senseless tragedy.