Sunday, August 4, 2013

goal setting

Goal setting will probably be a recurring theme for me. It is hard to set "SMART" goals that add up to better A1C's.  So maybe I need to think about things differently from A1C goals. And differently from avoiding complications. How do you focus on each and every moment, action and thought on something as abstract as an A1C.

I feel better if my blood sugar is better. So rather than focusing on success as being a number. How about focusing on keeping myself in range or getting back to range as soon as possible because that is when I feel the best and function the best.

In short, my goal is to feel good. That typically means that I want my blood sugar in range, and sometimes that means I might prioritize something else over a perfect blood sugar, but I won't enjoy other things in life if I am too high or low, so I think this might work. Maybe if I ask myself, "what should I do so I feel good later?" then I will be working toward something more concrete.

My goal is to feel good.

Saturday, May 18, 2013

Diabetes Art Day!

Definitely check out some of the other art!

Click for the Diabetes Art - Saturday 5/18 Link List
This year Diabetes Art moves up from the Wildcard choices as we all channel our creativity with art in the broadest sense. Do some “traditional” art like drawing, painting, collage or any other craft you enjoy. Or look to the literary arts and perhaps write a d-poem or share and discuss a favorite quote. Groove to some musical arts by sharing a song that inspires you diabetes-wise, reworking some song lyrics with a d-twist, or even writing your own song. Don’t forget dramatic arts too, perhaps you can create a diabetes reality show or play. These are just a starting point today – there are no right or wrong ways to get creative!

Diabetes was here.

Diabetes is everywhere. It is a mostly invisible disease. Sometimes that makes it feel a little more lonely. Even with the people I know personally and the DOC. It is nice to have hints that others with diabetes are around and doing what then can to take care of themselves.

Friday, May 17, 2013


Diabetes Blog Week
Click for the Freaky Friday - Friday 5/17 Link List
Just like in the movie, today we’re doing a swap. If you could switch chronic diseases, which one would you choose to deal with instead of diabetes? And while we’re considering other chronic conditions, do you think your participation in the DOC has affected how you treat friends and acquaintances with other medical conditions? (Thanks to Jane of Jane K. Dickinson, RN, PhD, CDE and Bob of T Minus Two for this topic suggestion.)

If I could switch chronic diseases...Well, I'd like one that does not involve too much home monitoring and tweaking. I'd also like one that is not associated with a lot of long term complications.  It would be nice to have one that is not very affected by stress and diet. I would trade for hypertension, for hyperlipidemia, IBS, and maybe for celiac. To me these would be one step up, so if I only got one step, Id think about these. I think these all are a little less involving than T1D, but I would not like any of them they are all still a lot of work and involve whole lifestyle approaches which is tough. If I could, I think I would go for hashimoto's hypothyroid because I could take one pill a day and that would be a lot easier than some of these others.

I definitely appreciate the struggles of people with other chronic illnesses, especially Type 2 DM much more since getting involved with the DOC! I am much better informed of the impact that all of these illnesses have on peoples lives. It is not to be underestimated!

Thursday, May 16, 2013


Diabetes Blog WeekClick for the Accomplishments Big and Small -Thursday 5/16 Link List
We don’t always realize it, but each one of us had come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years, you’ve done something outstanding diabetes-wise. So today let’s share the greatest accomplishment you've made in terms of dealing with your (or your loved one’s) diabetes...

One of the biggest accomplishments I have made in terms of dealing with diabetes is admitting it is a big deal.  I have spent so much of my life convincing people that diabetes is not a big deal and hiding and minimizing all the work that I do that I even convinced myself that it wasn't a big deal. I do not want pity. I do not want people to worry about me, or try to help me if I don't ask. I do not want to be marked by diabetes. But I am. And it is a big deal. And that's OK.  I can still be awesome anyway. It took me a while to be OK with that. I am still working on it. Now, though, I am better at making time to take care of myself, I am better at asking for help and I am a better diabetes advocate.

Wednesday, May 15, 2013

Second year reflection

So second year…
Well I am not a huge fan of the end of year journal when it doesn’t seem like the end of the year yet. However, a lot has passed since the beginning of the year.  I am tired and more worn out and frustrated than last year; but step 1 is 3.3 weeks away so I guess that is to be expected.  I had a harder time this year balancing school and life, but I think the workload has also been higher. If I had to do the year over, I think I would have done some things differently, but not dramatically. I am excited that this is the end of classroom-based learning, probably for the rest of my life. However, I will miss the flexibility and independence that it has allowed. 

My challenge now is to keep motivated until Step 1 of the medical boards. I am over it emotionally, but I know it is important. My mentor helped when he reminded me that I could just study the stuff I want to learn more about, and while it might not be the best for my score, it would be fine. [At this point in my study schedule.] We have spent so long talking about what we have to learn that it was really good to hear him say that. It was a good reminder that I am here because I want to learn medicine and to take care of people, not just to take tests. 

I am looking forward to being able to focus on clinical skills next year, and applying all of the pathology that we have been learning. I have moments of clarity now when I hear a chief complaint and I can grasp a differential diagnosis, without looking it up, and can ask all the right questions, do the right set of physical exam (I think). I am looking forward to that feeling becoming more and more common. It all makes more sense when that happens.

As for my new year goals, I got my A1C blood draw today so we’ll see how that went. I am still married although lately I think it is somewhat by default because we are not spending much time together. I am very lucky for the support and patience of my husband. I will have a few weeks off before third year to spend with him and also with myself. I am hoping to recharge and relax so I can start third year fresh and excited.  Thinking about how to do that is going to be a very different from how I have been and at this very moment seems tiring. Ironic, I know.


Click for the Memories - Wednesday 5/15 Link List
Today we’re going to share our most memorable diabetes day. You can take this anywhere.... your or your loved one's diagnosis, a bad low, a bad high, a big success, any day that you’d like to share. (Thanks to Jasmine of Silver-Lined for this topic suggestion.)

In high school I attended Clara Barton Adventure Camp. It was a spin off camp where we spent two weeks backpacking, rock climbing, kayaking or similar. It was an amazing way to learn how to manage diabetes and how to be safe doing such variable activities, for hours at a time, away from the safety net of ambulances.

One morning we left our camp site for a day of rock climbing.  On the way to the climbing I was getting very very car sick. I tend to get car sick so I had been sitting in the front seat of the van for the whole trip.  Today, for some reason I felt sick anyway. When we got to the parking lot where we were going to hike up to the rocks, I said I felt very sick and I thought I was going to throw up. My counselor tried to calm me, said we were out of the van and I'd start to feel better soon.  A moment later I dashed to the edge of the driveway and projectile vomited into the woods. (Sorry for the visual, it is the part that makes it so memorable.)

"I guess she was serious," my counselor said.  Once I collected myself and we got all our gear together we set off to hike up to the rock climbing site. It was a 20min light hike up. I wasn't feeling any relief from emptying my stomach so I just sipped my water from my camelback trying to convince myself it would pass. I drank 2 of my 3.5 liters of water on that hike.  At the top the guides were setting top ropes and I sat down for a break. Moments later it happened again, slid down the rock ran a couple steps and threw up 2 liters of pure water (weird right, has anyone ever thrown pure clean water).

It was not until that point that one of my brilliant peers suggested I test. I was 300something. Our nurse counselor gave me a ketostick and I had the new experience of peeing on a strip in the woods...(doubt many people get to do that). It was dark purple.  As dark as dark can be. I checked my hip and sure enough, my pump site was out.  It was still stuck to me, but one corner of the adhesive was off and the tube was out and kinked and happily dosing my shorts all my morning insulin.  It had probably pulled off in the early morning so that my fasting blood sugar of 200ish was not alarming.  And my car sick history tricked me into ignoring my body.

Everything worked out fine from that point. I changed my site (because we brought all back up supplies with us.) I injected my correction directly. My friends shared their water with me since I was getting low on it (despite bringing so much along). I sat out the first round of climbing, but by an hour later I was feeling better and a few hours later I was feeling fine. By the end of the day I was loving rock climbing.

This was my first DKA experience since I was diagnosed 4 years before and my first experience since being on the pump with a true site problem. This lack of insulin thing has happened to me since then. But now I know that feeling. The pasty mouth, nausea, weird feeling in my lungs. And I know now how to handle it.  I know that if I immediately try to down water, I will throw it up, but if I inject insulin, wait about 30 minutes and then start flushing, all will return to normal by the end of the day.

I remember this first DKA experience vividly. I think that being in the wilderness for it and learning how to handle it has served me so well over the years. It has taught me to be prepared (can you imagine if I hadn't had back up supplies with me?!) It has taught me not to panic. And it has taught me that even surrounded by 10 other people with diabetes and a nurse who is there explicitly for that reason, diabetes can be sneaky. I might have caught the DKA earlier, but I didn't and neither did anyone else, and it turned out OK.

Tuesday, May 14, 2013

we, the undersigned

Click for the We, The Undersigned - Tuesday 5/14 Link List
Recently various petitions have been circulating the Diabetes Online Community, so todaylet’s pretend to write our own. Tell us who you would write the petition to – a person, an organization, even an object (animate or inanimate) - get creative!! What are you trying to change and what have you experienced that makes you want this change? (Thanks to Briley of inDpendence for this topic suggestion.)

We, the undersigned want everyone who is treating someone with diabetes, related to someone with diabetes, friends with someone who has diabetes to carb count for one meal and wait 15min for the insulin to kick in before they eat.

Monday, May 13, 2013

Share and Don't Share

Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one's daily life with diabetes? On the other hand, what do you hope they don't see?  (Thanks to Melissa Lee of Sweetly Voiced for this topic suggestion.) Other DBlog Week posts

What I'd like my doctors to know?

I  don't know everything.
Even though I am going to be a doctor one day if all goes well, I am not one yet.  Furthermore, even if I decide to become an endocrinologist, I will not be one for at least 8 more years. Even then, I will have a lot more to learn.  So even though I know a lot about how sorbitol might cause microaneurysms in my eyes and may damage the schwann cells in my feet, it doesn't mean I know what to expect with my diabetes.

I am afraid.
I am afraid of judgement. Of assumptions. Of you.  Even if you have never done anything to lose my trust, other doctors have. Other doctors have insulted me and berated me and scolded me without knowing anything about my life, and without offering to help me get better (my pet-peeve). So while you haven't done anything to lose my trust you have to do some thing to gain it. You have to fill back in the hole your colleagues dug you into.

I won't tell you everything unless you ask.
Man do I get frustrated when I talk to patient instructors and they tell me I didn't do a good job setting the agenda.  But somewhere in my heart, I really love it. As a patient I have a lot on my mind. I usually have an agenda in my head and sometimes it is even written down so I don't forget. The worst feeling is leaving an appointment with things left on that list, wondering if you'll get to them again in 4 months at the next 15min appointment. I actually have something on my agenda that has been there for 4-5years.  It is not urgent, and it is sensitive, and I still haven't brought it up with any of my doctors.

Im not the only one who is smart.
While I may be a super-educated in the "going-to-be-a-doctor" kind of way, med school wasn't even on my radar 4 years ago and I was very much the same kind of patient. Many patients are more educated than you give them credit, and just because I have taken the MCAT doesn't make me the only patient in history to know something about my disease. I live this disease 24-7-365. So do a lot of other patients. That's when I learn about it. Just because some people have low health literacy, does not mean that most do.

What do I not want my doctors to know?

I will avoid telling them things if I think it will disappoint them, or if I expect judgement. I also don't want them to know that I am very unsatisfied with my care right now, because I need help with my diabetes, not just with my basals.

Thursday, May 9, 2013

Loss of innocence.

Reading Kerri's post today made me think about what changed when I was diagnosed, what I would change back if I could. It was interesting to read other mothers comments and other PWD's as well. Someone commented that they remembered being very sick so that having treatment when they were diagnosed was such a relief. 

In general, I do not really remember what it was like before. Diagnosed at age 11, I got in a lot of running around before I was diagnosed, but it happened at such a transition age that I do not remember a before and after, it all kind of blends in. Thinking back reminded me of my first low blood sugar. I came home from the hospital on Sunday and some family friends came over to meet us and I guess to support my parents, although I never thought about it.  I was doing my thing with my friend Emily and I remember pausing.  I remember walking down the stairs to the first floor and thinking, 'Oh, this is what they told me it would feel like if I had a low blood sugar.' And I can just imagine myself yelling to the other room "MOM...I think I'm low." (A phrase she heard many more times over the years, especially in the middle of the night when I often asked for help. It is interesting thinking about it now. I am pretty sure that I was not "actually low" at the time.)  I vaguely remember being in the 70s and knowing that it did not meet the criteria, but I was 538 at diagnosis and this was definitely my first time below 100 since then and I was probably dropping. Lows are so impossible to really describe, but with the adjectives they gave me, I knew it was it.  Was that the moment I lost my innocence.

It's kind of sad to think about now, but it is interesting, I do not feel sad for me. I do feel sad for my 11 year old self. I do feel sad that I had to grow up in at least part of my life. Maybe my continued naivete about the world is holding on to some of that lost innocence.

I am still stuck on what I would change about diabetes though, because I don't think my loss of innocence is what I would make go away. I think I would try to take away the judgement and protection that other people impose on me. I would take away people's telling me that "I would probably be healthier" when I was smart enough to know wasn't true.  I would take away people's fear of telling me about complications, so I could learn about them properly, not secretly by finding bad information, like I would have done for sex-ed if they did not teach it in school. (In high school I truly thought that I would be blind or well on my way by now, no matter what.-17yrs in) I would take away the feeling that I should never have questions about them because if I don't talk about them, maybe I will never get them. And mostly I think I would take away the idea that if I get complications, or even admit that I could get them, then I have failed.

Thursday, April 11, 2013

Do you have any glucagon?

So today I had a nasty stubborn low.  It sucked (pardon my inarticulate language).

I was in a hospital seeing a patient for practice. I am a second year so we are rarely in the hospital and had no home base.  I had my white coat as full as I could imagine with keys, phone, paper, pen, reflex hammer sugar etc, but I had no bag with me because I did not have a secure place to leave it.

I finished talking to the one person I was supposed to see and went out to look at his chart and Dex alerted me to a possible low... I have had this sensor in for a couple weeks so I wasn't sure how to trust it since it has been skipping a little, but I was nowhere near my glucometer so I went with it.  I had one small airhead (7-8 carbs) which will often bring me up from a low sufficiently.  I kept reading the chart and about 5 min later the low symptoms kicked in.  Dex was not rebounding yet so I had another airhead, figuring that was sure to get my bg back up. 

My symptoms went away and I returned to my group where we all took turns presenting our patient encounters. Dex said I was still low so I ate another airhead just to be safe, sure that it was wrong because my symptoms were gone. 

Problem was, then I was out of sugar.  I didn't have my glucometer, I didn't feel low, but Dex kept saying I was low. I didn't have an easy way to step out of class and even if I had, my best plan was to walk half way across the hospital and down sugar packets at the cafeteria.

The feelings:
I felt guilty for not having enough carbs on me, not having cash (although I didn't see any vending machines), not having my glucometer.  I was skeptical that I was even low because of the age of the sensor and my lack of symptoms. I was embarassed at the thought of asking for help. I am sure my preceptors and classmates would be horrified that I didn't go to the caf for sugar or ask them for some, but also would have made such a big deal out of it, when it wasn't emergent, just urgent.
Frustration- I had already loaded my pockets ridiculously full with things including way more sugar than I would usually need, is it possible to be truly prepared all the time?

My classmates and preceptors know I have diabetes. A classmate even asked if I had any glucagon to keep him awake.  I told him I wished, that I needed some and I flashed my dex at him.  He looked panicked, but told him I had eaten and was waiting (all true).
But then I didn't go back up. How long do I wait for it to rise and when it doesn't what do I do? What point would I have had to reach before asking for help?

I did get back to my car and my blood sugar was 57. Not as low as dex said (42), but definitely low. Usually I am symptomatic and have a ridiculous glucagon response and usually 23g of sugar would be way plenty to get me back up to 200, but not today. Needless to say I binged on more airheads and half a bagel, so now I am likely to hit 300. (I also waited to drive)

I wish I could say that from now on, I will be better prepared.  I will probably be better prepared most of the time.  I will stash more in my pockets and try to keep a bag closer with the back up stuff I usually carry.  Unfortunately, though, I am sure this will happen again. It is impossible to have all the things you need all the time especially when you are on the go. I just hope for availability of sugar packets and my glucagon response. I also hope that I continue to be lucky with good people around me. 

Wednesday, March 27, 2013

Quick Update

So my A1C of the week (with my new G4!) was 7.2%!
Goal of the week is to put every exercise event into the G4.

Sunday, March 10, 2013

SMART goals/ A1C of the week

My previous work experience introduced me to the ideas of SMART goals: specific, measurable, attainable, relevant and time bound. I have been reintroduced to them at school this year as well. Normally, I do not worry so much about the structure of my goals because normally they have a defined endpoint like an exam at the end of a course. I find SMART a useful strategy to consider with longer more nebulous goals, especially with diabetes management which has no end point.

I’m going to try something new. To me, getting my A1C down always seems like a daunting task. 
In my head I say “how am I ever going to do better for an entire 3 months.” It seems nearly impossible and I always tell myself that it is about making small changes, but then a small change happens in the wrong direction and I don’t worry about it. That change cancels out one I made in the right direction. I need to find the difference between, not getting mad at myself and not caring.  I need more “how could I do that better next time” conversations in my head. So to encourage myself to do this I am going to try working in intervals less than 3 months. 
My goal has a weekly part and a monthly part.  Once a week, I am going to upload my CGM data, look for glaring patterns and get a weekly “average bg.” I know that it will not be perfect for the same reasons the CGM isn’t perfect, but I think it will give me an idea of where I am at.  Based on this I am going to try to set a small goal for the next week, e.g. less variability, better overnights, better post dinner, better average by 5pts.  Overall, the point will be to do a little better than the week before. I will also set a limit of not spending more than 10min on the “project.” (Set up for download, study/ do other work, look at the results and decide on a goal)

Then, once a month I will spend an hour looking at these on my own. The goal of this time will be finding patterns that are more sneaky, or realizing that it is worth making bigger changes, like dinnertime combo food limits (e.g. once a week, not within 4 hours of bed). (Improving breakfast foods has made a big difference for me, but it takes work so I have to see where the effort has the most impact.)

1.       Download dexcom every week between Wed at 6pm and Thursday at 6pm (between SCP and date night)
2.       Look at numbers and make a goal for the week.
a.       “A1C of the week”:
b.      Goal of the week:
3.       Monthly, spend 1 hour myself looking over data and making goals (Day 11-19 of the month)
a.       What should I do for more information:
b.      What changes should I make:

Realistically I need some more specifics for this so: must do weekly goals at least 3x/month. Re-evaluate April 15th


I have thought about creating a blog for a while.  It feels like a lot of pressure so I have been hesitant. I doubt I can do the things necessary to keep up a good following (like post regularly). My goal with this blog will be to post my goals and strategies and experiences. I want to shed some light on diabetes and on becoming a doctor, the two things that are most prevalent in my mind lately. In addition sharing my story, I would love to help the #doc understand health care providers a bit better, and health care providers understand diabetes and a life of chronic illness management better.

 I haven't really worked on my full disclaimer yet, this is a draft based on other blogs I read:

1. this is not medical advice.  While I am training to be a doctor, I am not one yet.  I am certainly not your doctor.  I can share what I do and ideas for the challenges I face with my own health and I can share anecdotes from people who will let me, but I can not tell you if they will work for you, some may harm you. This brings me to my next point...

2. YDMV = Your Diabetes May Vary
Everyone's bodies, lifestyles, management are different with diabetes. Any ideas that you get from me or anywhere else on the diabetes online community (#doc) should be run by your health care team. There are so many complexities to diabetes that I cannot possibly chronicle all the different sides of the issues.  For instance, in my first post on goals, there are lots of other things I do for my diabetes management, but I am not going to tell you all of them in this post or probably any of my posts. 

3. Medical school is a complex and intense process.  I am so grateful to be doing it, but sometimes it feels like it swallows me whole. I will likely have commentary about it as part of this blog. I may also narrate my thought process about figuring out what I want to do with my career. I am new to navigating health care social media (#hcsm) so if I commit a faux pas either let me know so I can fix or forgive me (or both).

This is the beginning of my diabetes posting. We'll see how it goes. I will update this disclaimer from time to time.