Livin' La Vida LADA

Diabetes Baggage

2012-02-01T11:06:00.000-08:00

This week, I've been cleaning out my closets. Some of the diabetes-related things I've come across date back to my diagnosis (March 2005). That whole period was terrible - being constantly sick and worn down, getting diagnosed with "typical Type 2," receiving inappropriate treatment (i.e. none), the things people said to me when they found out I'd been diagnosed with Type 2, the friends I lost, the nine months I spent trying to get treated, the last conversation I had with my mother. It all came rushing back to me. I realized I'm still frustrated and angered by it. Somehow, it still feels so unresolved to me.

Why am I holding on to these feelings when it is resolved? Whatever happened then, happened. It's over now. I need to let it go.

Holding pattern

2012-01-16T15:39:00.000-08:00

I always meant to come back to this blog, but I guess I feel like I don't have much to say. I certainly don't have much to say about diabetes. I just do it and don't think about it much. What's really getting me down lately is having celiac disease. I thought about it, and I think a large part of what's bothering me is the abundance of treats at work. The treat area is on the other side of my cubicle wall (and can't be relocated). So, I spend most of my work day smelling doughnuts, cookies, bread, pastries, and cupcakes, whether I want to or not.

I never even liked most of these things and didn't eat them much before I got diagnosed with celiac. Still, there's something physically about smelling it that affects me. I know that this situation will eventually change in eight months to a year, but right now I am finding it a challenge.

Maybe it's weird, but it's not so much that my diabetes affects me as that diabetes affects me in concert with all the other things I have. The other things are always the tipping point where I start to get burned out. Right now I'm stuck circling the airport, hoping to land someday.

Second verse

2011-07-25T07:24:00.000-07:00

I feel like I gave the Ping a good try, wearing it for almost a year. In the end, though, it just wasn't for me. Oh, I love the technology, the color, the precision. After switching to the Ping my average TDD dropped from 29U to 17U. It really did seem to make a difference.

The problem turned out to be the form factor. No, I'm not joking. The shape and size were bothering me. In fact, I didn't realize how much until I put my 522 back on. Then all the little things that had been bugging me became apparent. I thought I would love the Ping meter remote, but in practice I almost never used the remote function. I wasn't checking my bg as often, but I couldn't figure out why not. I never even used the carb database, since it worked differently from how I'd been told. Little things abounded - like after I tested I would immediately forget what the number had been.

When I switched back to my 522 and UltraSmart, the problems disappeared. I have no trouble remembering the number from the UltraSmart (and yes, I know that's weird). The 522 and its clip are flat on the back and much smaller than the Ping. The display goes the other way, which makes it easier because I like to wear my pump on one side.

With all this in mind and the fact that my MM warranty expired last year, I decided to upgrade to the Revel. It's been rocky (although nothing like the ordeal I went through with Animas), but I got my new Revel and hope to start on it soon.

CWF FFL 2011

2011-07-15T10:10:00.000-07:00

It's time for my annual blog post! Er, that was a joke.

I had a great time at the Children With Diabetes Friends for Life 2011 Conference.

It was my first time going during a Disney year. In some ways, it was challenging - it can be tough to be a disabled person with diabetes. However, now I have a much better idea of what the challenges and can plan better.

It was great to see old friends and new - Kerri, Scott, George, Sara, Kim, and many others. It's great to see so many adults with Type 1.

One highlight was seeing Crystal Bowersox perform. I'd never heard her before, but wow, is she talented! What a treat! They never know who the VIP will be, so that was a nice surprise.

Hope to see everyone at CWD FFL12 next year!

LADA Awareness Week

2010-10-18T08:08:00.000-07:00

It's LADA Awareness Week.

- What is LADA?

Note: This article mentions "double diabetes" which is different from LADA, not another name for it - I'm not sure where that particular misconception is coming from.

- Could you have LADA? (PDF)

- LADA Awareness Week on Diabetes Mine

Trial Time

2010-06-27T08:57:00.001-07:00

Ping and 522
Originally uploaded by lilituc.

Anyone else feel like pump technology hasn't advanced all that much recently? I've had my 522 for about 3.5 years now, and the new "upgrade" seems to be features that other pumps already had before I got mine.

So I'm looking into other options. I feel like I know way too much about other pumps and why they wouldn't work for me. The Nipro Amigo is cute, but only has one infusion set available, and I'm allergic to it. The Accucheck Spirit comes with a PDA, which I love, but it doesn't talk to the pump; it just calculates your dose because there's no bolus calculator on the pump itself.

So I'm doing a trial of the Ping.

Long Time

2010-03-28T18:15:00.000-07:00

I've been absent from the blogging world, mainly because I got a job last year. Pretty much all I do these days is work. We don't have personal-use internet where I work, so I've been away from anything I can't access from my phone.

Since I've been working again, diabetes has really shifted to the background. I haven't been testing as much as I want to, or looking at the data as much. I suppose it's my upcoming endo appointment, but I want to try to get back to that.

My pump warranty is up soon, so I will be looking at what's available now. I just found out about Colorware last week - am I the only one who wishes we could do that with our diabetes devices? Awesome.

Average Response

2009-05-18T16:39:00.000-07:00

You can tell a lot about how much someone knows about diabetes by telling them your average bg - when they ask, not just for fun. My average for one week was 110. Anyway, here were the responses I got:

Optometrist: I guess that's okay.

Oral surgeon: Wow, really?

Endocrinologist: Wow! Unbelievable! How do you do it?

Internal medicine doctor: [No response because there was nothing about it for us to discuss]

Dental hygienist: Well, that's not *that* bad. You should really be careful, though.

FU Diabetes

2009-04-22T15:23:00.001-07:00

FU Diabetes
Originally uploaded by lilituc.

My check-in slip for my endo appointment today made me laugh out loud and startle all the waiting people.

You all knew that stands for "follow up," right? ;)

Wait, what?

2009-04-15T12:50:00.001-07:00

I like the Diabetes In Control newsletter (which is for doctors) and I like to take the quiz. However, the new one stumped me. Well, in that I didn't see any of the answers I wanted in the list. I did end up picking their "right" answer (after saying, "What? How is that? What?")

Anyone else know what I mean? ;)

carbowhat?

2009-04-09T23:41:00.000-07:00

So I went to a Seder last night and my daily total was 176 grams of carbs. I went to another one tonight and my daily total was...394 grams of carbs. That's a new record! I should note that last night I ended up high because I forgot that grape juice has 40 g per cup so I did underbolus. Anyway, 394g? Wow.

17 boluses, but I don't know if that's a record because I don't look at that much. With a situation where you eat over a long time, I bolus each time I get food. I saw someone once who seemed to think that was wrong, but in the end I guess they can't argue with my results, even if I can't win them over with logic (why *wouldn't* you bolus each time you eat?).

Good thing I don't eat like this every day, though. Before tonight my average carbs per day was 154g.

PSA: Calibration

2009-02-05T16:05:00.001-08:00

It seems more than a few people are under the impression that doing a control solution test calibrates your blood glucose meter, and that this needs to be done often to keep it working. I keep seeing control solution tests referred to as "calibration" and people being told to "calibrate" more often.

Well, doing a control solution test DOES NOT calibrate the meter. It doesn't actually do anything to the meter. It just tests the control solution, which tells you if the meter is operating within normal parameters. That's it. I think in three years, I've only ever done it three times. Twice it just told me what I already knew - my meter needed replacing.

The only way you as an end user can calibrate today's meters is by coding. So when you put in the code on the side of your test strip vial (if you're using a coded meter), then that is how you calibrate it.

I don't understand where this idea that control solution tests calibrate the meter comes from and how it got so widespread. Does anyone know?

Incorrection Part 2

2009-01-29T12:18:00.001-08:00

Well, after an hour on the phone with MM (during which I was asked to read them the data three times), they are overnighting me a new pump.

I think I may actually have figured out where it was getting the numbers from (although I can't compare enough data points since the Bolus History only goes back so far). I really think it's just a minor software issue, but since it's a medical device, better to not take any chances, you know. I wasn't worried or anything.

So now I am eagerly awaiting a ~~new~~ pump. I hope it's as nice as the ~~new~~ old one.

Incorrection

2009-01-28T23:18:00.000-08:00

So I love my ~~new~~ pump and all - the buttons are all stiff, it's all shiny and new-looking. Lately, though, I've been noticing a disturbing trend.

The other day I was looking at my daily totals when I came across something odd - it said that day my correction percentage was 12%, 2.7 units. Huh? I'm pretty sure I would remember that! I checked the bolus history and no, I did not correct that much, not even close.

Tonight, I reviewed today's total. I did quite a lot of exercise today so I didn't end up doing any corrections at all. The screen tells me that I had a total correction of 1.2 units, 8% of the daily total. No, no, I didn't.

I checked another day I didn't do any corrections and that one is correct. Out of the 16 days I've had this pump so far, four have incorrectly high correction totals (all at least 100% too high) and the rest are correct. I can't see anything different about those particular days, either.

It's so strange. I mean, how does this even happen? I can't figure out where it would even get those erroneous numbers from. I always use the bolus wizard, almost never change the recommended total, and, well, my old pump of two years never had this problem. It was always...correct. The only difference is that this one has updated firmware (and the only difference I've seen is a tiny one in how it handles selecting bolus type).

I guess I'll call the hotline tomorrow (and try not to sound like a crank), but, um, any ideas? I know I'm probably the only one who uses this information... ;)

Don't dream it's over

2009-01-12T18:54:00.001-08:00

Uhoh
Originally uploaded by lilituc.

Today I was setting my pump down when the light hit it just right: so pretty and yet immediately I knew it was Wrong.

Yep, it's a hairline crack. Don't worry; a ~~brand new~~ refurbished pump should get here tomorrow morning.

All I know is it wasn't there two days ago, and I haven't dropped my pump. I have had it just over two years, though, and these things happen.

Goodbye, pump #1!

Old and new

2009-01-11T14:01:00.001-08:00

Old and new
Originally uploaded by lilituc.

Anyone remember that forum post about the battery cap symbols that caused so much confusion? I finally got to see them when I got my new battery cap. Here it is with the old one on the left.

Meetup

2009-01-07T15:51:00.001-08:00

Meetup
Originally uploaded by lilituc.

I was able to meetup with Scott Johnson when we were in St. Paul. We had a great time chatting.

Holidays

2008-12-30T08:25:00.000-08:00

Somehow I find myself in St. Paul until Thursday.

Well, I know how. We came in through MSP and drove across Minnesota to visit my family. Then some of them left early and it threatened to snow and we had to come back early. So that's how it happened.

Would you believe I've never been to anything here? I hear you guys have a mall...

Hey, I need that

2008-11-10T10:43:00.000-08:00

I was supposed to see my endo in two weeks, but she's having a baby (!) so they rescheduled me to this week, meaning I'd have to scramble to go get my labs done in time.

I hate fasting tests. Hate. If I get into the shower before I've eaten, I usually get very nauseated. And you wouldn't want to see me without coffee. It's not pretty.

Anyway, I got up at 7 so I could get to the lab when it opened (and not prolong the fasting). I turned my basal down to 70% because my bg is usually low by the time I get to the lab. I had just gotten out of the shower and thought I'd be done in 10 minutes. Then I happened to glance down at my tubing. Um, it's not supposed to be *that* color. Hey, I need that!

So I had to do a set change, which added a bunch of time. I didn't prime it quite all the way because I knew if I did, I'd be really low by the time I got there (my body is really weird and I'm pretty impatient).

I finally got to the lab and tested at 96 before they drew me. Woohoo. I bring coffee with me in a travel mug so I can chug it as soon as they let me out of the pen. No, really, this is for the safety of the other patients. Of course, today I also spilled coffee on myself.

Now I just need to upload my data so I can print out the reports for my endo. I have never used a paper log.

D-Blog Day

2008-11-09T21:30:00.000-08:00

How about that D-Blog day?

Other diabetes

2008-11-04T09:04:00.001-08:00

Other diabetes
Originally uploaded by lilituc.

I was looking for something else and came across this table.

Other diabetes

2008-11-04T09:03:00.001-08:00

Other diabetes
Originally uploaded by lilituc.

I was looking for something else and came across this table.

Packing

2008-10-23T11:14:00.001-07:00

Packing
Originally uploaded by lilituc.

I spent days and days packing, from a master list I had prewritten. I had finally gotten close to the end when my husband got home from work. He took his stuff out of the drawer and put it in the suitcase. Elapsed time: about 45 seconds.

Surprise!

2008-10-06T13:15:00.001-07:00

4 October 2008 Day 362
Originally uploaded by lilituc.

All, things considered, it didn't end up being that bad. I had an extra set of short tubing with my spare set, so I changed it until I get could home and get another set of long tubing.

Extreme Diabetes Makeover Type 1 Conference

2008-09-23T10:36:00.000-07:00

Is anyone going to this? (Somehow I'm always the last to know). It's not only for pumpers, but that's who this particular message was going to.

What happens to children with type 1 diabetes who outgrow diabetes camp or their pediatric endocrine team? Diabetes Solutions of Oklahoma (DSOK), a non profit organization, is offering an exciting opportunity for young adults, age 21-40, who have type 1 diabetes. DSOK is hosting a conference Nov. 7-8, 2008, for young adults with type 1 diabetes at the NCED Conference Center in Norman, Oklahoma. This is the EXTREME Diabetes Makeover.

The goal of the conference is to tear down old ideas and negative attitudes about diabetes, build a framework for a healthier life, and redesign and style diabetes to fit peoples' lives. This is the age group who is most disconnected from other people with diabetes. This conference will address the need for socializing with other
individuals facing the same daily struggles. It is designed for anyone who must fight the daily struggles of type 1 diabetes management. As insulin pumpers, you have the greatest tool available to help you manage your diabetes. However, as you well know, successful diabetes management is 20% knowledge and 80% attitude and outlook.

Special guests include actor and comedian Tom Parks, who also has type 1 diabetes, and Dr. William Polonsky from the Diabetes Behavioral Institute of Southern California and author of the book, Diabetes Burnout: What to Do When You Can't Take It Anymore. For more information or to download a registration brochure, please visit http://www.dsok.net or call Diabetes Solutions at (405) 843-4386. What have you got to loose? Check it out and sign up soon, space is limited!

Arrrrrrr!

2008-09-19T10:40:00.000-07:00

Arrr, I be breakin' my camera yesterday! How will I be postin' mah photos? Too late; the cable already be broken!

Avast, in other news I opened a new box o' Silhouette and the tubin' be changed! Arrr, ye scurvy dogs have changed it to Quickset tubin'! It be scratchy and uncomfortable!

I be orderin' another camera, but sorry to say I think most of my photos be missin' forever.

*dejected arrr*

Diabetes is like D&D

2008-09-10T13:20:00.001-07:00

What induces perfectly logical people to think the human body is like a simple engineering problem? Yes, on some level, you put something in and get something out. But is it always the same? Then why do people think Type 1 diabetes is the same way? You put something in and always get the same results. If you get a bad result, you did something wrong.

Even doctors do this, which still astounds me (although it probably shouldn't). They think diabetes should be easy to control. Oh, and even diabetes doctors do this. I read the following in a book about managing mainly Type 1 diabetes (which I'm not going to name here but my version says 2006): If you take insulin, then tests must be made at least three times a day - before breakfast, dinner, and bedtime. In times of stress or illness, add a fourth test, before lunch. There's rarely a need to do it more often than that. Right! Because blood sugar is always completely predictable, am I right? It goes on to note: To complicate your life, here's more advice. To determine whether you are taking enough very fast-acting insulin such as Humalog, NovoLog, or Apidra before each meal, for a couple of days check your blood again two hours after lunch, dinner, and bedtime to see if you're in the ballpark. That sounds like a lot of tests. Good thing it's only for a couple days. The book reassures: On the other hand, some compulsive patients insist on checking their blood sugar as often as five or six or seven times a day and taking insulin accordingly. This is not necessary. Oh, great, I can stop checking so much and just expect my body to behave in a completely predictable fashion. Surely insulin-to-carb ratios and basal rates will never change, right? There's no such thing as bg going wacky due to illness, stress, hormones, the diabetes fairy. Only crazy people would think so! (The book continues with such gems as one should NEVER eat sugar, even children, and that insulin doesn't need to be refrigerated).

See how easy it is? We should all throw out testing more than three times a day, adjusting insulin, basal testing, insulin pumps. Forget it! All you need to is take the same amount of insulin and eat the same amount of carbs per meal, and you'll always be fine!

Well, as we all (hopefully) know that this isn't true. If I (with LADA) can't get good control without testing 8 times a day, I don't know how anyone else could. I eat the same breakfast every day, and have for at least three years. So do I get the same result every day? Of course not. I can look for the patterns, of course, but some mornings I'm going to need a correction, and others I might even end up low, without changing any of the other factors. So every time you have a situation, you act, the dice roll, and while you can increase the probability of an outcome, there's no guarantee you're going to get the result you want. I do think that following the advice above will lower the probability significantly. But even if you "do everything right," get educated, pick up the latest tools - you're still subject to the whims of the dice, or the diabetes fairy.

What's weird is that even when it *is* predictable, people still don't get it. "Why is your blood sugar low?" Well, guys you told me I couldn't eat anything for 12 hours and then made me walk 1/4 mile to the lab and fill out a bunch of paperwork. I could see that coming a mile away. "Why is your blood sugar high?" Well, I was planning to go shopping, so I took less insulin with lunch, but for some reason you decided you didn't want to. "Why don't you start eating right away? It makes me really uncomfortable." Well, I have to wait for the insulin to kick in, and I'm not going to take it before the food comes because I have learned my lesson there. "Why did you get upset after I stole half the food off your plate after I told you I didn't want any? That's rude!" (Left as an exercise for the reader).

Anyway, back to another day of rolling the dice and wishing for a +12 Stick of Clue.

What Would You Do?

2008-08-21T14:43:00.000-07:00

Let's say you have a close friend that has a problem with lows. For one, they tend to get combative when low and will start arguments or say really mean things (I mean, the things they think but shouldn't say type of things, not things they don't actually think). They get angry if you try to get them to test, and refuse to test again after treating. They don't like to carry supplies with them, and will often leave the house without even taking a meter, and usually don't have anything along to treat a low with. (Despite this, their control is not that bad, if you don't know about what happens during lows.)

Now let's say this also happens while the person is driving. Needless to say, testing before driving is right out. They get angry if you realise they are low and try to get them to pull over. Or if you, as I did recently, refuse to get back in the car until they test and treat, then get angrier when you insist they test again before leaving (still low). I know the anger has a lot to do with the being low, but there is obviously a serious issue in there. I guess I feel like even if they don't, I have to take my own safety seriously. (I have given up on trying to be concerned about them because it's not welcome). In the past, I have refused to go anywhere with them driving, but eventually I was unable to stick to it, because I don't drive. Plus occasionally there will be periods where they start acting more responsible.

No amount of cajoling or lecturing will make this person listen to me. Any hint of concern just annoys them. I finally just resigned myself to always carrying five times as much sugar as I would need, and always having lancets so I can switch them out and they can use my meter. That is, if I can talk them into it. I think there are two things going on here - 1. the belief that there's no need to be prepared, because nothing "wrong" is going to happen, despite all the evidence to the contrary, and 2. the idea that they're not impaired while driving with low bg, which I can say is untrue.

So...what would you do? Assuming you are still going to be friends.

Dude

2008-07-30T09:53:00.000-07:00

I was kidding. Ha! Ha! Ha...ha...ha? Ha?

So I'm told people can't tell when I'm joking. Not really sure what to do about that.

my new career as a crank

2008-07-28T00:03:00.000-07:00

I was reading a post on CWD for parents about "who were you before D?" It's interesting. For me, it's hard to answer. Before diabetes, or before diagnosis?

The years just before diagnosis for me were a haze of chronic fatigue, repeated illnesses, slogging through college classes when I couldn't concentrate, because otherwise I'd lose my health insurance. I was lucky to have an excellent GP, a professor of medicine who took me seriously and wanted to get to the bottom of it. With every new diagnosis, a new piece of the puzzle fell into place, but still something was missing. I say this a lot, but diabetes was just the last diagnosis. Once I had that, the last big mystery was solved, and I dropped out of school because I didn't need their higher level of coverage anymore. (My GP had already left for greener pastures).

So before diagnosis, I had been barely treading water for quite awhile. I'd always had most of these things and just learned to live with them, but I started to get really sick when I started my Master's degree in 2002. I wasn't diagnosed with diabetes until 2005, when I was 27. People seem to define themselves in terms of their careers, or their aspirations. My aspirations were things like getting through the next day, or even the next hour, and my career motivation was what I jokingly referred to as, "get to work or you're fired."

I don't define myself by my career. There was a time when I really wanted to be a librarian (surprisingly while working in a library), so I went to library school. By the time I got there, though, it just didn't seem as important. I arrived at a much less accessible campus than where I did my undergrad, and discovered for the first time in my life that I'm disabled. I know, I know. It had just never occurred to me before. As they say, life got in the way, and I fell behind in my career because I wasn't up to a full time job. I spent several of the last few years unemployed, because I can't do physically demanding jobs anymore (or fake it well enough), and people are pretty puzzled by my resume since I didn't take the usual career path. I would still love to go back to school and seriously take all those classes, but I don't have the stamina.

On the other hand, I am lucky now to be in a better situation so that I can sit at my computer all day without it being excessively painful. I'm in much better health now. On the other hand, I'm not young anymore. I hear some groaning out there, but it's true. I've always loved to learn and to research. So now I spend my time researching diabetes. I got so frustrated when I was first diagnosed and couldn't find any information that made sense. I even went to the medical library and checked out all the textbooks, but they didn't make sense, either. Now, I get it. They didn't make sense because people just didn't know any better. Of course sliding scale regimens are great! Of course Lantus is scary and untested and not safe for pregnancy or small children! If you're laughing, consider that many people believe it because the long term studies haven't been done yet on these new things, so they couldn't possibly recommend them to patients. Seriously. Hands up, how many people want to go back to R and NPH? Anyone want to convince an angry toddler that they have to eat more carbs to feed the NPH?

Before diabetes, I was just someone who liked to learn, and somehow now I've become someone who likes to learn about diabetes. Someone sarcastically asked me recently, "what, do you just research diabetes all the time?" I laughed, because...I do. I've learned the hard way that the other things I used to do were too stressful, or I didn't really enjoy them, whereas now I have something to do that's interesting and important. I will stop when doctors stop telling people they have "borderline diabetes," to lose some weight and see them in three months. I will stop when people understand one kind of diabetes, maybe even two! I will stop when people know that there is still no cure for Type 1. I will stop when large organizations stop telling people they need to eat more starches to treat Type 2. So, yes, I spend all my free time learning about diabetes and annoying people on the internet. There you have it.

everything police

2008-07-14T22:17:00.000-07:00

I guess I don't have much to say lately. My endo appointment went well. Well, the actual appointment - the day wasn't so great. It's July and I got a call from my grandmother a couple weeks ago. She wanted me to fly out and surprise my mother who was visiting her the next week. The problem with that (besides the timing) being that I haven't spoken to my mother since July of 2005.

They say she's doing better now, after going to rehab (again) six months ago. She's been trying to contact me pretty much the whole time, but six months ago the 3 am phone calls stopped and more reasonable attempts were made. Still, I don't think people change that much in even six months. I don't know if I'm up for the journey, either. I put a lot of time and effort into helping her before because she managed to keep me alive for 18 years (you can't hear me, but that's kind of a joke because really it was more in spite of her), but it was all for nothing. My family are all mad at me because they seem to think it's my job to keep "helping" someone who refuses to fundamentally change. They think I'm bitter and unfair and it couldn't possibly have been as bad as I say. They don't even know the half of it, actually. I'm not even bitter about it, just pragmatic.

Do I really want someone back in my life who is going to constantly nag me in a completely unhelpful manner? Who judges my life choices and always criticises no matter how I succeed? Someone who's only seen me once in the past ten years and never saw me eat for ten years before that, but thinks it's perfectly acceptable to repeatedly tell me I got Type 1 diabetes because I "eat a lot of junk food?" (For the record, I don't, and never really have). Someone who can't stop herself from commenting on my personal life (or what she thinks it is, which is totally off base) in public, often, and loudly? I mean, intellectually I know that what she says has nothing to do with me or my reality. It's all about her, her insecurities, and her fears. She actually knows what causes Type 1 diabetes, but she can't mentally allow me to be who I am because she feels like it's somehow a judgment of her. Knowing that doesn't make it any easier to actually be around her, though.

Still, there is a family event coming up where I know we would have to be there, and I'm already having trouble picturing her constant nutso criticism and me not just getting up and leaving. With the diabetes, I have kind of a short fuse when someone does it in person, while I'm doing stuff. I am totally willing to talk about diabetes, but not while I'm actually doing it and need to think about what I'm doing. My mother is like the Everything Police. Then, the usual techniques don't work, either and tend to exacerbate things. If you try to shame her about what she's saying (in a Miss Manners style), she just gets more agitated and insistent. Family situations are also a huge trigger for her, and I find them difficult to deal with as well, because I kind of feel like people are trying to force me into a role I never even had. Coming up on three years now, and this is what's on my mind.

Urf

2008-06-18T17:41:00.000-07:00

I got a phone call a few days ago about my labwork. The nurse said it was "perfect." Since they won't give the actual numbers over the phone, I didn't say anything, but I had my doubts. Anyway, my cholesterol was excellent now (although my HDL was lower), which is great. Last time I was in the normal range, but just out of the diabetic range, if you know what I mean. My A1c was much like last time: abnormally low. I don't know why this has been happening, just for the last year. The endo didn't seem too concerned about it, since we know what my A1c *should* be, and that's not really worrying. It's just confusing to other doctors who of course first want to know what my A1c is, and then I have to explain it. Not that I really have an explanation. Anyway, I just read this about donating blood yesterday in the Diabetes In Control Newsletter:

The donation of red cells does indeed have an effect on A1c levels. Since the test measures a type of hemoglobin in the red blood cell that attaches to glucose, the amount of red blood cells in the blood has a direct correlation to A1c levels.

We already know that patients who have a high turnover in red blood cells, such as those with sickle cell anemia, have an artificially low A1c, because they are making a higher number of new red blood cells. This is similar to what happens when red cells are lost due to a blood donation. A normal donation may require up to four weeks of new red cell production and a double donation may take eight weeks.

It takes about 8 weeks for new red blood cells to attach to glucose and raise the A1c to pre-donation levels.

A1c levels can actually be decreased by 4 to 8% for the first 4 to 6 weeks after a donation, and if a double donation A1c can be as much as 16% off for even a longer time.

Based on this information it is important to tell your patients that they should have their A1c done just prior to the donation, and more importantly we should ask if they have donated blood when they see us for an appointment.

Information from Practical Diabetology June 2008
Richard Benjamin, MD, CMO American Red Cross Blood Services

I don't donate blood. I don't have anything obvious, like sickle cell. I do have recurring anemia and have to take iron or it comes back, but they've never really found an underlying cause (other than the most obvious one). So it sounds like the problem could be too high turnover of red blood cells? I guarantee I am not secretly running low or anything. If anything it should be higher than any past A1c, just due to progression. Oh, and if I saw this A1c for a Type 1, I wouldn't say it was "perfect" - I'd be quite worried.

Administrivia

2008-06-10T10:58:00.000-07:00

Someone recently asked me, "don't you ever have any good news?" Of course, that was after she called me over and told me in detail about all the terrible things that had happened to her, and then asked me a lot of questions about our (now ex-)landlord. So, I don't know.

I was supposed to see my endo on the 6th (after making the appointment six months ago), but two days before, they called me and said she won't be in that day, so it got changed to the 25th. I took a big hit for that paycheck-wise, because when you take time off, you not only lose the pay, but you lose the health insurance subsidy normally paid by the employer. It was too late to work those hours, and I'll have to take more time off on the 25th, so it was pretty significant. Anyway, I figured I had plenty of time to review my labs, so I called the receptionist (the lab at this place doesn't do copies). She said cheerfully that the doctor hasn't reviewed them with me yet, so I can't have a copy until the 25th. I asked if she was sure, because I'd never heard of anything like that, and she said yes. Okay. The more I thought about it, the more confused and annoyed I became. Doesn't HIPAA say you have to be allowed access to your medical records? I wanted to see the results before my appointment so I could get an idea of what was going on and because I'm totally anal like that.

I called back, and this time I told the cheery receptionist I thought they couldn't do that. So, she transferred me to the nurse, who made more sense, but said all the wrong things. She said it's the doctor's policy not to release labs without reviewing them. She said I don't have to wait until the 25th, just until the doctor is back in the office in a week and that normally this is never even an issue. Then she said, "unfortunately, you picked the week when the doctor is out of town." Aargh (like I picked the week). She said they do this because they had a problem with patients misinterpreting the results. Well, okay, but I think the law allows them to do that, and I don't think I'm that patient. Although now they'll probably all think I'm difficult.

I really love my endo, but I have a really low tolerance for this kind of administrative stuff. I may have to look into other options. I mean, does anyone see why this is annoying?

Meme

2008-06-09T14:00:00.000-07:00

a. Type your answer to each of the questions below into Flickr Search.
b. Using only the first page, pick an image.
c. Copy and paste each of the URLs for the images into mosaic maker.

1. What is your first name?
2. What is your favorite food?
3. What high school did you go to?
4. What is your favorite color?
5. Who is your celebrity crush?
6. Favorite drink?
7. Dream vacation?
8. Favorite dessert?
9. What you want to be when you grow up?
10. What do you love most in life?
11. One Word to describe you.
12. Your flickr name.

#6 isn't actually my favorite drink, but it is my photo and it came up on the first page. Heh.

Huh?

2008-05-06T11:13:00.001-07:00

The other day I was surprised to read someone with Type 1 saying, "diabetes will eventually kill me, anyway." Then a lot of other people agreed.

Really?

Am I the only one who doesn't think diabetes will eventually kill me?

In one ear and out the other

2008-05-01T07:59:00.000-07:00

I've met some new people lately, and had to tell them I have diabetes. For the most part, it's gone well, but this one woman I think is convinced I have Type 2 for some reason. I'm not sure, though, and I don't really even want to get into it.

Her: You have diabetes?
Me: Yes, I have Type 1 diabetes. *explains what that is for 5 minutes*
Her: Wow, you have a lot on your plate.
Me: I guess so.
Her: I have this friend, but she has juvenile diabetes and boy, does she ever have it hard. *explanation*
Me: ...

I don't really want to say "juvenile diabetes" because I think that's why so many people are convinced that 1. only children get it and 2. it goes away once they stop being children. Still, it seems like even people that should get it, don't.

Doh

2008-04-29T20:10:00.001-07:00

Uhoh
Originally uploaded by lilituc.

I was so excited about getting my UltraLink! I'd been waiting for it for so long. Then, I opened it, and discovered there's no backlight.

That's a dealbreaker for me, unfortunately.

Augh

2008-04-18T15:47:00.001-07:00

Augh
Originally uploaded by lilituc.

It had to happen sometime, right?

Raise your voice

2008-04-14T09:42:00.000-07:00

I am raising my voice for Type 1 diabetes, although I admit this content has appeared before. I think it's important, though. It's about LADA (Latent Autoimmune Diabetes in Adults).

This information comes from research, but mainly from experience and reports from out "in the field."

LADA is autoimmune diabetes just like regular Type 1, but it is often misdiagnosed as Type 2. That's because it occurs in adults over 25 and because the onset can take 6-8 years. (While regular Type 1 can occur at any age, the onset is sudden).

How to tell the difference between LADA and Type 2:

- Positive antibody test -- while a negative antibody test is not conclusive, a positive result indicates Type 1 or LADA.

- Weight -- Type 2s on the thinner side are very uncommon except in certain genetically susceptible subgroups of Native Americans, Asians (South Asians, Japanese), Hispanics, Scandinavians, and African Americans. It would be unusual for someone very thin or underweight, and/or in great athletic shape to develop Type 2.

- Family history. Someone with a long family history of diabetes is more likely to have Type 2, although it could be argued that many of these could be unrecognized cases of MODY.

- Weight loss -- Unexplained weight loss before or around diagnosis is associated with Type 1 or LADA, not Type 2.

- Ketones -- Moderate or high ketones are rare in cases of Type 2 and generally only occur in people who have had Type 2 for a very long period of time and no longer make insulin. Moderate or high ketones at diagnosis tend to indicate Type 1 or LADA.

- Progression to insulin -- LADA results in insulin dependence much sooner than Type 2, even within a year of diagnosis. This is working from the outmoded belief that insulin should be prescribed when it's no longer avoidable, though.

- Response to oral medications -- LADA does not respond well, or for very long, to medications used to treat Type 2.

- C-peptide -- This level will decline rapidly as compared with Type 2. In some people in the very early stages of LADA, C-peptide may actually be elevated and seem to indicate Type 2. However, the ensuing quick decline in C-peptide is indicative of LADA.

- Insulin resistance -- LADA is not associated with insulin resistance, although see C-peptide.

- Triglycerides and blood pressure -- these are usually elevated with Type 2, but not usually with LADA.

- Low carb doesn't work -- Assuming none or only moderate overweight, going on a low carb diet does not work to control blood sugars.

- Hypoglycemia -- anecdotal evidence suggests a history of hypoglycemia prior to diagnosis might be associated with LADA.

- Inconsistent blood sugars -- The honeymoon phase in LADA can last several years. During this time, the beta cells often work or not work somewhat intermittently.

Why does it really matter if it's LADA or Type 2?

- Seriousness -- Sadly, Type 1 is often treated more "seriously" and aggressively by doctors and insurance. It can be difficult to get adequate treatment or have insurance pay for the right treatment unless one is classed as a Type 1 rather than a Type 2 (insurance companies only believe in two types of diabetes). Insurance companies will often only cover insulin pumps for Type 1.

- Treatment -- People with LADA should be treated like early Type 1s, not like Type 2s. Early treatment with insulin is believed by many to reduce the workload on the beta cells and preserve their function longer. This is important because retaining some insulin production for as long as possible reduces hypoglycemia and the risk of DKA. Also, background insulin can for most reduce the unpredictability of the beta cells working intermittently.

- Danger -- LADA is subject to the same dangers as Type 1. A few people are diagnosed in DKA (usually as Type 1), but after treatment have a sort of "remission" due to the extended honeymoon period. Still, DKA can occur on rare occasions if insulin production suddenly stops.

So how can I tell if I have LADA instead of Type 2?

- positive antibody test (you can stop now) or low C-peptide?
- quite thin or active and in good shape?
- unexplained weight loss?
- no insulin resistance?
- have you had moderate or high ketones?
- low triglycerides and normal blood pressure?
- high or variable blood sugar despite oral medications and/or low carb diet?
- quick progression to insulin?

Meme

2008-03-26T16:16:00.000-07:00

I was tagged by Minnesota Nice.

Six Word Memoir Rules:

1. Write your own 6 word memoir
2. Post it on your blog and include a visual illustration if you'd like
3. Link to the person that tagged you in your post and to this original post if possible so we can track it as it travels across the blogosphere
4. Tag 5 more blogs with links
5. And don't forget to leave a comment on the tagged blogs with an invitation to play!

I like stuff. Okay, some stuff.

Bet you weren't expecting that! And yet, it's so true. Anyway, I tag Emm, Tiffany, Rikki, Mel, and Christine.

Photographic evidence

2008-03-22T17:24:00.000-07:00

I've kind of hit a plateau with Diabetes 365. I haven't missed any days, but I'm feeling less enthused about it and it's been longer and longer between uploads. Mainly it's that I don't think my photos are very good and what was okay for an occasional shot looks different when you have hundreds of them. To some extent I am limited by equipment, but also I just don't know a lot about photography or shooting objects.

For some reason, I feel strangely drawn to the original 365 project, 365 Days. On the one hand, I feel it's kind of weird to take photos of yourself, but on the other hand, I have very few photos of myself from the past seven years (because I am the only photo taker) which I find kind of disappointing. In a way, it seems strange, because I grew up in a family that despite its numerous issues took photos of absolutely everything. I guess that's the way it goes, though.

I feel like doing a new project will actually infuse new life into my older project, instead of taking away from it. I'm still trying to decide, though.

In other news, recovering from the flu and still quite tired, but my toe is better and the government sent us some of our money back.

Purses

2008-03-18T13:24:00.000-07:00

I've been meaning to mention this for awhile, but the place where I get these kinds of purses:

is now making a smaller model for all those of you who can get by with a smaller bag (not me). Here is the smaller one which comes in a lot of colors:

I really like the inside of the smaller one, but I just have too much stuff to carry, so I got another larger one. I love them, and I'm pretty hard on bags.

Enough already

2008-03-10T19:11:00.000-07:00

Well, around Thursday I started getting really tired - much more tired than I had been. On Thursday night, I tried to go into the store to buy one thing and discovered I was so tired I could barely make it out of the store again. Like my limbs just wouldn't go. I also had joint, muscle, and nerve pain. Joint and nerve pain is pretty standard for me, but this was way worse. I only get all over muscle pain if I try to do something, like clean something, give the cat a bath, etc. Since I just *had* given the cat a bath on Wednesday, I figured it must be that, even though it was much worse than usual. The pain didn't go away, though. The surprising thing is how high my pain level is given all the painkillers I'm taking (for me). I've also been sleeping 10-12 hours a night and still feel so tired all the time that I can barely lift my arms, or anything else. I don't feel like eating at all.

Anyone else see where this is going? Well, I didn't until today. I heard my husband coughing because he stayed home from work sick (which he NEVER does), and something "clicked." Duh, I have the flu. How does one have the flu for five days without noticing? Well, I normally have chronic pain, I've had chronic fatigue (not CFIDS) in the past, I normally have all these transient things, I'm on a lot of painkiller for the whole teeth thing, and my body doesn't really do fevers because I have an autonomic nervous system disorder. I'm not coughing, but I've had the flu once before, and I didn't cough then, either.

At least if this is day 5 for me, it should be over soon. My husband is definitely getting the short end of the stick here, since he's never sick and isn't used to this sort of thing the way I am. It's too late for him to get Tamiflu, unfortunately.

More and more

2008-03-05T13:02:00.000-08:00

Well, I got a recommendation for a good dentist. Drawback: he's 18 miles away. I didn't really care; I've seen enough bad dentists in my life. They were able to get me in on Monday, too!

I took a copy of my panoramic x-ray, although the receptionist said it was basically useless. Well, as it turns out, the dentist kept referring to it, the assistant made notes on it, and I had to convince them to give it back to me (since it's my copy) when I left. Anyway, I was telling the assistant I thought #14 had a cavity on the panoramic. She scoffed and said it would have to be the "world's largest cavity" to show up on that. Then she did a full set of x-rays - luckily I had taken the good painkiller, because no one's ever successfully gotten a full set out of me before. My mouth is too small, apparently. They also measured my gums. Again with the painkiller. I will have to remember that in case I ever have it done again. I did really like the dentist, though, and he also does implants.

Well, the result of the x-rays is that I have the world's largest cavity in #14. I also have multiple cavities in every tooth I own. I wasn't too surprised by that, since I have weak enamel and my teeth are too soft. It's just something that you're born with. Anyway, I have to have a root canal, so they referred me to an endodontist.

The endodontist wasn't able to get me in until the 17th! Still, that might even work out better for me (despite the obvious drawback of waiting) because I can't get any more time off. They're having me come in next week for an "evaluation." They said that during the evaluation, they decide whether a root canal is actually needed. I think I burst out laughing when they said that.

And again

2008-03-03T08:51:00.001-08:00

Well, I went to see my internist on Friday and he was appalled I didn't get any treatment from the dentist (and even worse, it's his dentist). So he wrote me a Z-pac just in case and told me Darvocet could be cut in half. I tried it at night first and it seemed okay, so I tried it during the day. It makes the pain somewhat bearable.

At one point I discovered one of my teeth (#14) is more painful than the others. It already has a lot of fillings. I looked at it more closely and it looks like it's cracked. Frankly, I would be glad if that's the problem if it's just a matter of a root canal and filling it in. It's not like it's in the front. You can see it on the x-ray here if you want. Compared to #3 it looks like it might have a cavity.

So after taking the painkiller I had some time to think. Why did the dentist refer me to a prosthodontist for a serious dental and health emergency? Now, I do need to see the specialist eventually, but for this? I called his office and they confirmed they don't handle this kind of work. So it looks like I need to find another dentist! I don't want to go to just any dentist; I've had all kinds of bad luck in the past. I will check around.

I'm almost tempted to try to go back to my old dentist in Bellingham. None of *his* crowns have fallen out of my mouth, and he was always excellent. He's apparently having some legal troubles right now, though (nothing I'm that concerned about) so I'm not sure if he's still practicing. Also, he's not open on the weekends so I'd have to get up to Bellingham during the day (I don't drive) and that's a lot of time. So I don't know.

And now for something a little

2008-03-02T17:28:00.001-08:00

2 March 2008 Day 146
Originally uploaded by lilituc.

Here I am with Gary Scheiner (in what has to be the most unflattering light ever). He was great, though!

I spent this weekend at the Children With Diabetes Focus on Pumping conference. It was very interesting. One of the pump reps remarked that it was such a different atmosphere from the usual - where everyone "gets it." That sums it up pretty well.

I don't know if the larger conferences are the same way, but it was definitely focused on parents of children under 18. Many of the speakers and reps were adults with Type 1, and a couple of the parents were, but otherwise it seemed like I was the only one there without a child. Yet while the focus was more on children, I could still apply the information, knowing the differences between management of children and adults.

My husband decided to sign up for a TrialNet study, since his father has Type 1. They take a blood sample, test it for antibodies, and will let him know the results in 4-6 weeks.

Toothache, headache

2008-02-28T09:07:00.000-08:00

There's nothing to get me riled up about healthcare like dental care. I only have dental insurance until the 29th. For those of you outside the US, dental insurance is not as exciting as it sounds. Common plans pay 50-80% of "covered" expenses, and there's an annual maximum they will pay, like $1000 or $2000 (that's for your whole family). Consider that one root canal and crown costs $1200-$2000.

Anyway, I've been having this excruciating pain in my mouth (top and bottom) for two days. It's unclear where the pain is coming from, if it's related to the surgery I had in December, what. Then yesterday a crown broke off and fell out of my mouth, all by itself. It's not even near the painful area! So I did what any American is supposed to do - I went to see my dentist as soon as he could get me in. (Woe to those who don't have a regular dentist.) He said the crown took too much with it and can't be put back, so I'm looking at another $2500 implant in addition to the one I already have to get.* What about the pain? Well, he didn't even want to do an exam. He said that as a general dentist, he doesn't feel comfortable treating me, and I need to see a specialist. The specialist can't get me in until next week, when I won't have dental insurance, and like most dental professionals they expect to be paid the day of service or they won't perform it.

What this means is that I don't know how long I'm going to be living with this kind of pain. I can't afford to see a specialist and pay all of it out of pocket. Once again, I can't chew, and even when I can, my chewing is impaired by all the holes and other things in my mouth. It's not surprising the tooth with the crown broke when you look at my teeth - they're extremely soft and they've always been. So I have these problems.

What gets me about this sitation is that 1. dental work is so expensive and there's not really any facility to help. (Don't even get me started on how Medicaid "covers" dental work). I can't go to a dental school or low income clinic, although in other places for other people that may be an option. The care you receive there may not be the same, though. Then there's 2. why is the mouth not considered part of the body? This pain won't let me eat or sleep and makes it difficult to drink. I have ketones, which yesterday were moderate. My bg is acting really stubborn. I woke up at 3 am really nauseated and had to throw up (no, not low). If I didn't stay on top of the ketones, I could end up in the ER, which I'm sure my health insurance would tell me isn't covered because it's my teeth.

Someone from Australia asked me why I didn't just go to the dental clinic and tell them it was an emergency. Do you really have those there? I wish we had them.

* Getting an implant is a long process - they have to remove the remaining tooth, seat the implant, wait 6-8 months, and then put the crown on it. I can't get a bridge or anything else due to the condition of the other teeth in my mouth. Both of the problem teeth are in the front of my mouth.

So...

2008-02-26T15:04:00.000-08:00

Who's going to the CWD Focus on Pumping next weekend?

Meme time

2008-02-21T12:28:00.000-08:00

I don't think I got tagged by anyone, but here you go!
8 Things I’m Passionate About.

1. Real food
2. Diabetes advocacy
3. Trying to help people on the internet
4. Learning
5. ADA restoration
6. Cheese
7. Software that works
8. Civil liberties

8 Things I Want to Do Before I Die.

1. Finish learning Mandarin, German, Latin, Japanese, and Hebrew
2. Learn how to program (the real way)
3. Get a passport
4. Get out of the US
5. Go outside
6. Visit Israel
7. Build my own hobbit house
8. Pat a bunny

8 Things I Say Often.
1. WTF
2. What the hell?
3. Are they on crack?
4. What in the crap?
5. Who's my little brattywatty? (to cat)
6. WHAT?! (to meter)
7. Why am I so tired?
8. Oh noes!

8 Books I’ve Read Recently. (or not so recently)

1. The Rabbi's Cat by Joann Sfar
2. The Liar by Stephen Fry
3. Walking the Bible by Bruce Feiler
4. The Discovery of Insulin by Michael Bliss
5. Rashi's Daughters, Book 1: Joheved by Maggie Anton
6. A Tale of Love and Darkness by Amos Oz
7. The Jewish Book of Why by Alfred Kolatch
8. Kitchen Confidential by Anthony Bourdain

8 Songs I Could Listen to Over and Over.

1. Fleetwood Mac - Beautiful Child
2. Violent Femmes - Color Me Once
3. Ednaswap - 74 Willow
4. Black Sabbath - Paranoid
5. Duran Duran - Ordinary World
6. Jonathan Coulton - Mandelbrot Set
7. Elton John - Wake Up Wendy
8. The Gap Band - I Don't Believe You Want to Get Up and Dance (Oops Upside Your Head)

8 Things That Attract Me to My Best Friends.

1. Humor
2. Sensitivity
3. Fun
4. Understanding
5. Listening
6. Helping out
7. Having a good time
8. Exchanging ideas

What's in my bag?

2008-02-13T09:57:00.001-08:00

13 February 2008 Day 128
Originally uploaded by lilituc.

Endo shortage

2008-02-04T21:00:00.001-08:00

Today I came across this interesting article about the shortage of endocrinologists in the US. Conspicuously absent is the reason for the shortage - compensation.

Liquidation

2008-01-20T23:04:00.000-08:00

Every now and then, I come across something that really gets me. For some reason tonight it was the liquidation notice for an insulin plant.

It's just stunning sometimes for me to stop and think about where these tiny vials that keep me alive come from.

Oy

2008-01-04T12:17:00.000-08:00

Wow, where do I start? Well, yesterday I got a very strange headache. It came on like immediately, and the pain was on top of my head. I got up to take something for it because it was really bad, but when I opened the cabinet, a can flew out and landed on my toe - the same toe I broke in 1994 that never healed right. I honestly can't tell if it's broken because it's always been painful to manipulate and every time I stubbed it, it hurt for days. It felt like the first time, though! Anyway, they don't really do anything for broken toes, and I have tape. I'm just glad I can hobble around on my foot. Those first few hours where I couldn't were not fun because I can't hop.

New Years Eve, our hot water heater stopped working. I guess it must really be considered an emergency, because the landlady got someone to come in and replace it on the 2nd, which is some kind of record. I didn't realize I would have to empty most of the pantry so that the contractor could get at the water heater until 30 minutes before he was supposed to show up. No problem, right? He showed up 30 minutes early. So there I was trying to empty the pantry really fast while he made fun of me for not realizing. What annoyed me about that is that I'm disabled and I had to stop in the middle to suck down some juice because inevitably I'd go low from all that. Oh, and I asked him twice if I needed to remove the shelf above the water heater, and he scoffingly assured me he had "plenty of room." Guess what's covered in scorch marks from the blowtorch now? Oh, and he wrote on the heater that he installed it January 2007. Maybe some people shouldn't make fun...

On the brighter side, I can almost chew things now. The company that laid my husband off called and asked if he wanted to take a six month contract, working day shift, so he accepted that. He's still working through a temp agency, so no benefits, and it's at the same company, so he's still looking for something else, but it's better than nothing. Day shift is also better because then I see him during the week.

For some reason my pancreas has been working overtime since the surgery. My basal went from 11.5U to 8.5U. My insulin-to-carb ratio went from 1:8 to 1:11. I don't know how long it will last, but I'm not complaining.

My night at the ER

2007-12-22T16:26:00.001-08:00

16 December 2007 Day 69
Originally uploaded by lilituc.

I was doing so well, and then on Sunday afternoon, I started vomiting. Nothing had changed, so it was pretty odd. I didn't have ketones and my bg was fine. My husband called the doctor on call - again Dr. S. This time he made Dr. S listen to my entire medical chart and wouldn't let him talk over him. Dr. S said it was no big deal and he'd call in a suppository. He also said to stop taking all the medications I'd been prescribed. He said we could go to the ER if we wanted to, but made it sound like we were being overly paranoid and there was no point. I'm not going to tell you what we call Dr. S in private!

Normally I'd wait longer than two hours to go the ER, but it was already 5 pm and I hate waiting all night long and not being able to sleep, so I figured we might as well go right then. We got to the ER just after 6 and I didn't get triaged until 7:15. To be fair, they had their hands full. There was a woman in her early 30s with severe abdominal pain, a two-year-old who'd had explosive diarrhea for several days, and an elderly woman with a possible broken hip. Actually, I can say "probable" after observing her for 20 minutes. So they triaged me and then I didn't get seen until 9:30. I had to keep getting up to vomit while I was waiting.

By the time they saw me, I had moderate ketones and was pretty dehydrated. They didn't check until after they'd given me one bag, so they kind of went overboard and took a bag right out of the fridge. I warned them cold fluids would probably make me nauseated (because of another medical condition), but they were all, "you need fluids" and wouldn't hear it. The weird part was another nurse randomly came in, walked over to me, taped the line up and down my arm twice, then left. So I was a million times colder. In retrospect, I should have just pulled off the tape, but I was kind of confused at the time. Anyway, I got really nauseated.

That's when they went into overdrive! I thought it was odd they thought that was such an emergency. The doctor came running in and the nurse and then they gave me Phenergan and I was out. So I didn't get to ask the doctor the questions I had or get a copy of my labwork. I was discharged around midnight.

For those of you who work in the healthcare field...what do you think of this - it's the best ER in town, but they don't have private rooms. The patient on the other side of the curtain was a homeless veteran who called 911 because he wanted to commit suicide, and while I was getting my fluids we basically overheard everything. The poor guy.

I had a surreal moment the next morning when Dr. S's nurse called to find out what happened. I explained to her about what had happened, but she didn't seem to grasp that diabetic + ketones + dehydration = super bad. Also, when I told her the Phenergan knocked me out, she actually said, "No, honey, you're thinking of the painkiller. Phenergan isn't sedating. Does your tummy still hurt?" So glad I didn't get Dr. S as my surgeon!

They never figured out why I was vomiting. I've been okay since then in that I've been progressing normally.

Oy

2007-12-15T15:19:00.000-08:00

Well, I had the surgery yesterday morning. The surgeon said she'd talked to my doctor and they thought it would be better if they didn't sedate me. I wonder which one said that; I can't think of why they would. Still, I'd rather not be sedated.

They had trouble getting the IV in. Not too surprising since they decided not to use a heplock because I'm allergic to Teflon. They didn't have one of those brace things so they ended up strapping my arm to a board they found somewhere. I forget to tell them I'm allergic to heart monitor contacts, but they never mentioned they were going to be using them, either. Since I'd had 50mg of benadryl before the surgery, the reaction wasn't too bad. So the surgery mostly went well, although the anesthetic started to wear off at like #2. I was not upset, because that's usually what happens to me. It all went pretty fast, anyway.

When I got home I was pretty dehydrated, but I couldn't drink anything because we were supposed to try to stop the bleeding. You have to bite down hard on some gauze for 30 minutes, then make sure it's stopped and repeat if necessary. Well, we did this for about five hours and it didn't stop, even after we tried tea bags like they suggested. So, my husband called the office and got the doctor on call. It was one of the other surgeons, Dr. S. Well, Dr. S informed him that it was only bleeding because I wasn't biting down on the gauze right because I was groggy after the surgery. So basically, we were doing it wrong. He wouldn't listen to what my husband was telling him at all. That's interesting, because I wasn't groggy at all, and we weren't doing it wrong. I'm glad I didn't get that surgeon! Anyway, we tried the gauze again (by this point we'd run out of their gauze and had to use our own) and it mostly stopped, so I was able to eat some things and get my ketones down. It did start bleeding again three times that night, though, even though I wasn't doing anything when it happened. Nothing was even moving in my mouth; I was just sitting there and it started. And yes, I am being super careful. So I may end up with dry socket even though I followed all the instructions.

I was in a lot of pain the first day, when I couldn't take the painkiller right away due to the bleeding not stopping. It went right up to 9. I think some people would call it 10, but I've had 10 before. The odd thing is that Darvocet was abused in the 70s, but it doesn't make me feel high at all. It does work on the pain, which is great, but that's it. I'm not even sleepy. The pain was only as bad this morning as it is when I normally wake up, so like a 5 or a 6, but now it does hurt despite the painkiller, probably because of the swelling. I have to apply ice packs for the first 36 hours. The swelling should go down on day 3. It takes about a month to heal completely.

I'm supposed to eat a lot of protein (which makes sense because my body is making new tissue), so I've been having Boost Glucose Control, Trader Joe's nonfat Greek yogurt cups, Special K protein water, and tofu pudding. I do have some pureed soups, but they're higher in carbs and much lower in protein. It's been hard enough keeping my bg down. I'm at 175% basal and 190% bolus from normal.

I am trying to get some rest, but I'm not even tired. Certainly not what I would have expected!

Constant vigilance!

2007-12-08T23:08:00.000-08:00

Something I read on Amy's blog reminded me of this. Last year, right after we moved back to Seattle, we went to a local restaurant famed for its homemade breakfasts. I tested my bg while looking over the menu - it was in the 80s. I ordered coffee and noticed there was a cream container on the table. I asked the waitress if it was real cream, and she said, "yes, it is." Our housemate also got coffee, and takes it with cream. So we both had some coffee with cream. Our food took quite awhile to arrive. After about 30 minutes of waiting, I started to feel odd, so I tested again. My bg was almost 140.

I was confused for a minute, then realized I'd been drinking the coffee. I got out my diastix, tested the coffee, and it was right in the middle of the range. I tested it with my meter: same thing. It hadn't tasted any different than half-and-half, but it was pretty diluted in the coffee. When the waitress came back, I asked her again, "are you sure this is real cream?" She said, "yes." I said, "it's important to know because we're both diabetic, so are you absolutely certain it's real cream?" She said, "yes, it's real cream." I showed her the strip, explained it and said, "well, this container is full of sugar, so can we get a new one?" (I assumed that someone had poured sugar into it). Know what the waitress said then?

"It's nondairy creamer. We don't serve cream here."

Okay, so as it turns out, this restaurant only has nondairy creamer (loaded with sugar), 2%, skim milk, and margarine, presumably for "health" reasons. The food was actually really good (although some butter would have been nice), but we've never been back. I mean, she lied! Repeatedly! I can't understand why someone would do that. I've known people who are allergic to nondairy creamer. Anyway, what I learned was that creamer isn't a free food, so be careful out there!

Surgery

2007-12-07T10:28:00.000-08:00

Well, the consultation was interesting. They did panoramic x-rays, which I like because the small ones are painful and don't fit in my mouth. The big x-rays were much clearer. Disturbingly clearer. the nurse and I both said, "oh no" when we saw them. Basically, I have bone loss and my teeth are really impacted. Then, the oral surgeon came in. She's from the former Soviet Union and very direct, with no sugarcoating. She kept asking me questions like she was testing me (she's a professor), and I guess I passed. She asked me how I would treat my diabetes for the surgery. I said I would reduce my basal by 50% and not eat anything for 8 hours, which was apparently the answer she was looking for. That was that, too; she didn't want to discuss it further. I thought she was great!

Since my wisdom teeth are right on the nerves, I have to get a CT scan next week. I will also need to have a bone graft. She said she usually doesn't do it in diabetics due to poor outcomes, but I showed her my A1c (LOL). Both the oral surgeon and the nurse told me there is a significant chance I may lose two back molars. I'm not that upset about it, because one is useless already and the other isn't very useful, either, being only partially erupted. (I don't have enough room in my mouth for my teeth already.) I'd be more worried about potential complications. Also, I have to have general, which I hate, but after seeing the x-rays I didn't really argue.

The doctor agreed that I need to take my other medication (asthma, beta blocker) before the surgery, although most people don't. They also want me to take Benadryl before, since I'm allergic to Teflon and so many other things. It may also help with the painkiller. I took Vicodin once and vomited for 24 hours, so I can't have anything similar and even what they're giving me (Darvocet) may cause me to react. Some people with my reaction don't have it if they take the medication with Benadryl. I really hope it works, because the backup plan is 600mg of ibuprofen, which I already know does barely anything for me. When people who never take painkillers tell me they needed the Vicodin for this, well...

As it turns out, I will need to have surgery again next year for a different problem. They said they could do it with only local, though. Unfortunately, that surgery is mostly not covered by my dental insurance. This one is really complicated, though, so it's a lot more than we thought. So each of the surgeries will cost about...27% of an insulin pump. They're going to make a good show of billing my health insurance, but it's unlikely they will cover it, since as we all know, your mouth isn't part of your body. ;(

Numbers lie

2007-12-06T11:16:00.000-08:00

I saw my endo yesterday. My cholesterol is still good, but slightly worse than last time so I suppose I'll have to look into that. My A1c is what it's been the whole time I've had it tested at this lab: insane. It's lower every time, too, despite my bg not changing. Now that we've kind of ruled out lab error, the only thing I can think of is that there's something weird going on with my hemoglobin.

Previously I had A1cs like 5.8%, when my postprandial numbers were a lot lower and I didn't spend a lot of time out of the normal range, although that was at a different lab. This last A1c was under 5 and I don't believe it could possibly be accurate. I've tested in the middle of the night to make sure I'm not having lows or anything. What do I think? I think my A1c should be somewhere between 5 and 6, closer to the middle. I mean, yes, it's definitely a great number, but I just don't think it's an insanely good number...for a nondiabetic. What I know about my bg doesn't support that.

So, today I'm going to have a consultation for oral surgery. That's right, my wisdom teeth are horribly impacted and they have to come out now. I haven't been able to chew in a week. I am not looking forward much to the consultation, where I have to explain not only about my insulin pump, but about the millions of other special conditions that will affect it. The surgery is already scheduled for next Friday. Eeek!

Well

2007-11-27T17:32:00.000-08:00

I spent three days installing software on my husband's computer and updating Ubuntu on this machine. I thought the upgrade would help, but now it just runs a lot slower and a lot more things are broken. For example, now it won't open Word documents at all. Okay, then. I get burned out on these things pretty quickly, though. I did manage to get the camera software working on my husband's machine, but his display is not at all like my old one, so I can't tell what the photos look like. They look a lot different on this machine because the display is pretty wonky. So, I'm sorry if the photos look bad!

I have an appointment to see my endo next week. The receptionist called me today to tell me I'm supposed to get labs done tomorrow morning (I was going to anyway, but apparently they actually scheduled me for it and never mentioned it to me) and that they were fasting. Since I hate fasting tests, I know that I just had my cholesterol done six months ago. I asked her to check with the doctor because I'm pretty sure I don't need to have it done for another six months. (My cholesterol was really good, so I'm not sure why I'd need to get it done more often.) She said she would call me right back once she talked to the doctor. I was going to ask if she'd ordered the urine test when she called back, because I think I haven't had that one done in a year. Why they like to schedule the urine test when I'm fasting I don't know, but they tried to do that last time. It, um, doesn't work that way.

Well, it's 5:47 now. So do I fast (UGH), or just tell them to rewrite the lab slip tomorrow? I think she'll give me a hard time about that.

Meme

2007-11-20T11:35:00.000-08:00

I've been tagged by Beth and Chrissie.

The Rules:
1. Link to the person’s blog who tagged you.
2. Post these rules on your blog.
3. List seven random and/or weird facts about yourself.
4. Tag seven random people at the end of your post and include links to their blogs.
5. Let each person know that they have been tagged by posting a comment on their blog.

1. I've never been to Mexico, but I speak Mexican Spanish.
2. I don't have any tattoos and I don't smoke, but those are the things people seem to assume about me the most.
3. I wrote my first novel when I was in the first grade. It was over 100 pages, about a little girl who had adventures. I haven't written any novels in the past 15 years.
4. I didn't started getting carded until I was 19. It seems to have stopped a year ago, at 28. And I mean I got carded for R rated movies.
5. I love hobbit houses.
6. I have been a vegetarian for 13 years.
7. I was born in Minot, North Dakota. In my 20 years outside ND, I've only met one other person who was born there...but not on the base.

I tag anyone who hasn't been tagged yet!

Okay then

2007-11-18T21:50:00.000-08:00

Short story: my computer failed. I don't know when I'll be able to upload photos to the Diabetes 365 project again.

Long story: It's almost certainly a hardware problem. It's a laptop that's given me hardware trouble since the day I got it (March 2004). I've replaced the hard drive twice, the DVD drive once, the power cord twice, and the motherboard once. It just turned itself off, and now it will attempt to boot its little heart out, but it never gets past the "boot Windows in safe mode?" screen. The hard drive is ok and I can get the files, but I really need the software. We have a drive enclosure, but nothing can boot from that, and even better, the drive isn't a SATA drive. In many cases, just installing the software on another machine is not enough. My husband's machine used to have the software all set up, but it failed a month ago (it was even older than my laptop), and we can't get his new machine to boot from the old hard drive.

Since the problem with my machine isn't something easily accessible like the hard drive, the chances of repair are low. The case is so broken that if we opened it up all the way, it would be impossible for us (or a repair place) to get it back together again.

Bottom line: I need a "new" laptop. We haven't ever replaced this one partly because I need a matte screen, a trackpad, and Control keys on both sides of the keyboard. That rules out about 99% of laptops. The other part is, of course, that they're expensive.

Goodnight

2007-11-17T10:53:00.000-08:00

Chair thief
Originally uploaded by lilituc.
Marrakech
June 22, 1995 - November 16, 2007

We got him from the Humane Society in Salt Lake City, Utah. There were four fuzzy kittens, all in a ball. They were half Siamese and half Norwegian Forest Cat. About two years ago, we learned about a cattery that had tried to cross the two for some reason. Coincidence? I doubt it. I wonder what ever happened to the other kittens.

Kechie loved corn chips, crackers, and playing with his bell on a string. He figured out how to open doors, turn off lights, and tell us what he wanted. Two days ago, he told us, "something is wrong." The vet examined him and said he thought it was probably cancer, on top of the chronic renal failure. We took him home and gave him painkiller. Last night, he laid down and didn't get up again.

Up Close and Personal

2007-11-16T19:14:00.001-08:00

16 November 2007 Day 39
Originally uploaded by lilituc.

I will tell you a secret. When I feel something is wrong, I test my bg (75 cents) and test for ketones ($5.60) not because I think I will see something, but because I want it to be something that I can fix. I want it to be something manageable, like diabetes. Some of my health issues are only partly manageable. Right now one of them is managing me.

I lived with chronic pain from about 1994 to 2005. I say "lived" because the pain went from 5-6 to 1-2, not because I was not having any pain after that. Anyway, I got used to it. OTC pain medications didn't do anything for it, so I didn't bother taking them. I saw a long line of doctors who, I guess because of my circumstances, told me I was "hysterical," that it was "all in my head," acknowledged I was having the pain but said they couldn't do anything about it (?), who said I needed acupuncture (tried it), meditation (do it), needed to relax more (did it) and who sent me to specialists who were even nicer than that.

Now, they did find out that I have some very serious conditions, which they started treating in 2003. Most of the seemingly unrelated diagnoses I have are related to nerves. Please don't tell me to see a neurologist; I've seen two and neither was interested in actually diagnosing or helping me in any way. I've given up on that for now. I'm pretty convinced now that the real issue is that when they were passing out neurological systems, I drew the short, twisted straw and it is manifesting partly as some conditions that don't even have names right now.

I'm not sure why the pain (mostly) went away. It went down when I went on a beta blocker, and dropped significantly when I went on insulin, as did my chronic fatigue, but there's really no explanation in that, is there? Now, I did have bad days here and there where I was back up at 5 or 6 and an occasional 7; this happened mostly when the pressure changed outside.

These past two weeks, though, I've been firmly at 7. The first couple days, OTC medication worked, but not since then. I am not that active to begin with and now I'm having trouble with things like getting around my house. I can't seem to regain my lost skill: getting used to it. So, next week I have to go see my somewhat new Internal Med doctor, whom I have never chatted with about the chronic pain before, and tell him that the pain is back, and that no one ever found a reason for it. But what can he do? Give me a stronger painkiller? Will I have to take it forever? I am worried.

15 November 2007 Day 38

2007-11-15T11:47:00.001-08:00

15 November 2007 Day 38
Originally uploaded by lilituc.

Sometimes, being diabetic is an advantage. These syringes are for my cat. He's going to be getting injections of painkiller three times a day. The way that our vet reacts tells us that many people must be unwilling or unable to give their cats injections or subcutaneous fluids. We have no problem with it and find it's much easier for us and for the cat. They can't feel the injections.

The vet was also pleasantly surprised when he didn't need to explain to us why we should give a cat with renal failure an ACE inhibitor, a phosphate binder before meals, and Pepcid.

I didn't actually want the short needle, but the pharmacist was looking at *me* when she got them. They seem to be durable enough, though, whereas my syringes are not.

D-Blog Day

2007-11-09T19:08:00.000-08:00

Happy D-Blog Day, everyone!

I would be nowhere without the Diabetes OC. I am a librarian, so I know how to do research. I've read tons of books on diabetes, endocrinology textbooks, read studies and journal articles. I've been told (with a straight face, no less) that I have more training in it than some doctors. Yet something was missing, and I kept hearing false notes. At first, I didn't understand. This is what doctors read. Aren't they supposed to be the experts? Isn't this information supposed to be correct? Forget my own diabetes; what I learned didn't really fit with my experience having a close friend with Type 1.

Recently, someone asked me for a good book on LADA. And, well, there is no good book on LADA. There is no book on LADA. There are only a few books that even mention LADA. So where is the book? It's in our heads. It's in our experiences. We are the experts. I sure hope that the medical establishment catches up, but until then we are out there, sharing our experiences.

Without the experiences of other diabetics, I wouldn't really know anything about diabetes.

Surviving

2007-11-08T22:31:00.000-08:00

That is what I'm trying to do..survive. To somehow put my life back together. Some days it's like an emptiness, and other days it's like a punch in the gut. I try not to think about it, but it's hard, because every day it's something. I think, "I have to tell Jennifer about this great blog" or "what would Jennifer think of this story" or "Jennifer would laugh herself silly if I started saying, 'shalom out.'" All the other people have moved on, but for those of us who really knew her, well. A friend told me her mother died six years ago, but it's still the same for her.

So, I've been trying to keep busy. I've been going to classes again, and I like them a lot better than the first place I tried. I've been studying Hebrew and finding it much easier than I thought it would be (although keep in mind the vowels are marked and everything). I have no explanation for it.

Somehow diabetes fades into the background. I think it's like driving is for people - I'm not ignoring it; I just do it on autopilot. Test, bolus, eat, test, bolus, repeat. So far I haven't gotten any job offers, but I'm stepping up my search for a full time position (even though I really don't want to work full time) because my husband hasn't been able to find anything with benefits, and our COBRA runs out in January. And so life goes on, just like it always does.

Type WHAT?!

2007-11-05T15:05:00.001-08:00

5 November 2007 Day 28
Originally uploaded by lilituc.

So I've actually seen the words coming out of her mouth on Inside the Actors Studio. It's not better than what was reported; it's worse!

Halle: I had no understanding of what diabetes was. I instantly thought I was going to die, because I heard, "disease" and "okay, after disease there must be death." And I got a very quick education about what diabetes was, and I realize that I probably had it for most of my childhood, but when you're diabetic, nothing hurts.

James Lipton: Is this Type 1?

Halle: It is really Type 1, but classified now as Type 2 because I'm no longer insulin dependent. I was for awhile, and I've managed to wean myself off of insulin, so now I like to put myself in the Type 2 category.

James Lipton: You control it with diet and with exercise?

Halle: Yes.

This is our JDRF spokesperson?

Stress

2007-10-22T23:28:00.001-07:00

22 October 2007 Day 14
Originally uploaded by LilituC.

Both higher and lower than I expected. Huh? Well, it should have been much higher, but for the last hour I've been involved in a stupid argument on the internet. After I read a particularly ignorant statement about diabetes (low blood sugar, in fact), I felt I had to correct the misinformation. Still confused?

Well, one way I'm different than a typical diabetic is that stress lowers my blood sugar. Yes, lowers. So I was expecting a low number (and it's probably still dropping). This isn't as great as you might, think, though. Getting upset, crying, getting angry, and general stress all cause me to have lows.

My theory, which also would explain why my diabetes is so weird and my hypoglycemia before I was diabetic, is that my liver doesn't dump sugar when it's supposed to. I've never recovered from hypoglycemia without eating, no matter how long I wait.

19 October 2007 Day 11

2007-10-20T11:15:00.001-07:00

19 October 2007 Day 11
Originally uploaded by LilituC.

My cat takes B12 injections. When we picked up the supplies, I noticed that they charged us $15 for 12 insulin syringes. I said, "Wow, I could get a whole box of 100 syringes for less than this!" Everyone in the room stared at me.

Finally the tech said, "uh, are you in the health care industry?" I said, "no, I have Type 1 diabetes." After a long pause where she looked like she wanted to say something, she said, "me, too."

These syringes came from J., though, since the needles on mine are too small for cats. ~$1 for 10.

Pump bath

2007-10-15T11:41:00.001-07:00

14 October 2007 Day 6
Originally uploaded by LilituC.

I don't remove my pump when I take a bath. The last time I did that, my blood sugar went up over 100 points. Yes, I know it doesn't make sense, but there you have it.

In some ways, this project is going to be challenging. I'd already taken a photo of my sharps container, a photo of the inside of my bag, and a photo of my diabetes cabinet. But what better to illustrate?

Breakfast

2007-10-13T18:38:00.001-07:00

13 October 2007 Day 5
Originally uploaded by LilituC.

This is what I eat every day.

12 October Day 4

2007-10-12T12:22:00.001-07:00

12 October Day 4
Originally uploaded by LilituC.

New purse

2007-10-11T17:52:00.001-07:00

11 October 2007 Day 3
Originally uploaded by LilituC.

I got the black one!

10 October 2007 Day 2

2007-10-10T16:56:00.001-07:00

10 October 2007 Day 2
Originally uploaded by LilituC.

Duct tape

2007-10-09T12:36:00.001-07:00

Duct tape
Originally uploaded by LilituC.

Because I need something to do, I am joining the Diabetes 365 Flickr project.

About Diabetes 365

This is a group for diabetes-related pictures that you take as a 365 day project.

Basic rules for now. You must post a daily picture by the end of each week. Number each one consecutively and tag them with 'diabetes365'.

Each daily photo must illustrate some aspect of daily living with diabetes and help explain what it's like to live with diabetes every day of the year.

Let's try and show the world how Diabetes is something that we work at and live with all year round.

why

2007-10-03T17:12:00.000-07:00

This morning I was awakened by a phone call, offering condolences. What? My best friend, Jennifer, is gone. She passed away some time in the last two days. Her family said that it looked like she had slipped and hit her head on the bathtub in her apartment.

She was beautiful, brilliant, vivacious, caring, perceptive, opinionated, and funny as hell. She was only 34 years old. I still can't believe she's gone.

May her memory be a blessing.

Fashion loss

2007-10-01T03:55:00.000-07:00

I've long struggled with what kind of purse to carry. I like to have my diabetes supplies accessible (not in a case in another case), as well as all the other ~~crap~~ stuff I need to carry around. The first purse I got after becoming diabetic was this one:

I really liked this bag, but it had a couple drawbacks. First, beige canvas + diabetic = !! (it's lighter than the picture). The second is that it's huge. Seriously huge. I looked at the measurements, but didn't quite get the full effect until I could see it. While I could fit all my stuff in it, I kept thinking I looked dorky carrying it around.

The second bag I got was this one:

It's pretty similar to the first one, but the strap is in a different place and I didn't really like the look of the faux leather, so I decided to get leather next time:

I had it about three months before it looked like it'd been through a war. It turns out I'm really hard on bags and leather can't really take it.

At this point, I decided to branch out in a different direction, a more "fashionable" bag:

When I got the bag, I found out that it's not really brown; it has tiny black and brown stripes, and it's really shiny. So it didn't go with the things I already had. Psst, could use some better pictures in this case. Once I got over my initial shock at the small size of the bag (especially compared to what I'd gotten used to), I pared down everything and stuffed it in there. It was cute, super cute, even. The problem? I started to learn all the advantages of the previous bag for a disabled person.

The previous bag has a flat surface on top, which I used quite often at the store, because stores are just not that great at accessibility (I'm looking at you, no-accessible-checkout TJ's) and I need the extra surface. It's also flat, so I could jam it against a flat surface and open it with one hand. I also appreciated the long strap, because it distributes the weight better when I wear it crosswise. The new bag falls off my shoulder because I don't really have the strength to keep it on that well. There's also my giant fear of having my purse stolen; with the last one I knew no one was getting that thing off me. I also didn't get backaches after carrying it for ten minutes. I didn't need to put it down on something and use both hands to open it. I remember it being a problem at restaurants when I was sitting at a two person table, but I've had to get used to putting my bag on the floor, and I finally got a hanging thing for my cane. With the prospect of having to go out more often, I need to have something sustainable for me, something that helps rather than makes things harder. I'm sure the new bag is a great bag for everyone but me, but I think I'm going to have to go back to the old one. Fashion loses.

The question is, which one to get. The beige canvas performed the best for me, although it was hard to keep clean. The faux leather had a different weight distribution. The leather didn't last very long with me using it. This is the coat I have now, although it's lighter and brighter than the picture, not really an olive or "fatigue." Decisions, decisions.

Book meme

2007-09-19T23:33:00.000-07:00

I got tagged by Nicole! Okay, so she tagged everyone.

Total Number of Books Owned: A little over 1456

Last book bought: The Discovery of Insulin by Michael Bliss. Very interesting. What a lot of drama went on.

Last Book Read: Harry Potter and the Deathly Hallows. (I actually reread the whole series after reading DH originally.)

Five Books That Mean a Lot to You:

1. Using Insulin by John Walsh. Seriously.
2. Type 1 Diabetes by Ragnar Hanas. Makes me want to move to Scandinavia.
3. The Silent Language by Edward T. Hall. Really, most of his books. Completely fascinating and explained things I had been wondering about (and struggling with) for a long time.
4. Longer Views by Samuel Delany - Amazing writer, amazing book.
5. Fire in the Lake: the Vietnamese and the Americans in Vietnam by Frances Fitzgerald - I was stunned when I first read this. I had to check the publication date repeatedly because I couldn't believe it. I even met a Vietnam scholar who didn't know this book. Apparently the least known and best book on the subject? No wonder it seems history is doomed to repeat itself.

Best Five Books You Read in the Last Year: I haven't read a lot of books in the past year because of my eyes (not related to diabetes)

1. Mama Might Be Better Off Dead: The Failure of Healthcare in Urban America by Laurie Kaye Abraham - I knew a lot of it already, but the book really brought it home.
2. Abraham by Bruce Feiler - About the role of Abraham in Judaism, Islam, and Christianity. Boy did he ever do some crazy things! And yet it all worked out somehow.
3. Medicine and Culture by Lynn Payer - I think "Sicko" left some things out when praising France's medical system, heh. I'm not going to tell you; you'll have to read about it.
4. Native Speaker by Chang-Rae Lee - can that man ever write. It was refreshing just to read something that well-written.
5. Okay, not a book but a series: the Mas Arai series by Naomi Hirahara. Pretty good mysteries and felt pretty familiar to me. I think she got it right.

I guess I will do the open tag thing, too. Do it if you want!

Arrr

2007-09-19T16:56:00.001-07:00

arrr
Originally uploaded by LilituC.

It be International Talk Like A Pirate Day!

The Diabetic Athlete

2007-09-09T01:57:00.000-07:00

Dr. Sheri Colberg is revising her book The Diabetic Athlete. The first edition came out in 2001, and I know I've been hoping for a new one. She needs input from diabetics who exercise - should be all of us, right? ;) - so go here to fill out her questionnaire.

Are they going to eat that?

2007-08-20T18:25:00.001-07:00

This diabetes thing has been a long, strange trip. Just kidding, it hasn't been that long; it just seems like it. Lately, I've been struck repeatedly by something odd: I forget that other people aren't diabetic.

I see people heaping their plates with pasta. I see a person at the next table in a restaurant eating Banana Spring Rolls (that's the value for 1/2, not a whole dessert). My husband just made me a cake for his birthday (don't ask *me*), and it takes me a minute to remember that he *can* just eat it. All those other people probably have no idea how many carbs (or calories) are in whatever they're eating. It's just seeming strange to me right now.

I don't know why this is happening. Maybe it's because I've been often having dinner with J for about five years now. Maybe it's because most of the people I talk to online are diabetic, too. Maybe I'm living in diabetic world. (Woohoo, where are the t-shirts?) Or maybe more people should listen to "Pancreas" by Weird Al.

Diet?

2007-08-15T17:42:00.000-07:00

People seem to think I am weird for carrying around Diastix. Sometimes even people who later ask to use them. Well, they're cheaper than test strips for testing drinks.

Lately I've been having bad luck with drinks. I went to dinner with my housemate at a new restaurant and we both got diet RC. His was diet and mine was regular. Huh? The waiter said he pressed the same button, so we concluded it was the machine (although you kind of have to say that or people get offended). In fact, he got pretty agitated anyway (he kept insisting it *was* diet, up until I showed him the strip). I don't really get what happened, but I guess sometimes when it runs out it can switch over to another tank? He got us some water and then never came back to our table. Now I have to wonder if he got so worked up because they ran out of diet and he thought we wouldn't notice.

Then we were having dinner at a large chain restaurant and we both ordered diet Sprite. We both got regular. The waiter said he'd have them check the machine and then came back with some diet. No need to get all upset, heh.

A couple days ago we went to see a movie. I got a large diet Coke (aren't they all large?). Our housemate watched them pour it, so he knew it came out of the "diet" dispenser. I tested it and got inconclusive results, so I tested it with my meter (as control solution, of course) and got 150. Diet is "error" and regular is 500-700. I drank it anyway, but bolused for 10g. It seemed to be okay.

The oddest thing is that even though I can always tell regular from diet, in all those cases it was unclear to me because the mix was pretty off. Sometimes fountain drinks can taste really odd. Still, I've sure learned to trust that nagging feeling!

Doctors With Disabilities

2007-08-12T13:22:00.000-07:00

A friend is involved with the launch of a new site: Doctors With Disabilities, for health professions students and health care professionals. It's wiki-style, hosted by the Disapedia, a disability wiki. There's also a forum for messages. Diabetes is definitely included.

It's not just for doctors and med students; those in allied health professions are very welcome. The focus will be on sharing tips among students and people interested in the medical field and those in practice. Check it out!

No kidding

2007-08-11T22:14:00.000-07:00

While I was browsing an online pet pharmacy, I saw an insulin section. Well, of course I had to go take a look. This phrase stopped me in my tracks:
Please note: All Insulin must be shipped by 1 day air service.

Why on earth is it that the pet mail order pharmacy has this down and the *human* pharmacies do not?

Is it real

2007-07-30T03:56:00.001-07:00

Is it real
Originally uploaded by LilituC.

It hits me at the oddest times. Tonight, after a very long day of fighting stubborn bg including 120% basal, rage bolusing, and trying everything to no avail, my purse was full. As I emptied it onto the table, I was suddenly struck by what I saw. For a minute, I couldn't believe they were mine.

Then it passed, and everything was normal again.

It works!

2007-07-08T02:59:00.001-07:00

I was quite shocked the other day to be told by a (nondiabetic) friend that my insulin pump never works. I guess my blog gives that impression. Just for the record: yes, it works. It works probably 99% of the time. I blog the exceptions because they're of interest to me and I want to be able to review them later. If I wrote about every time something didn't go wrong, I would quickly drive myself nuts.

Why do I have so many exceptions? Well, step one is noticing. I'm really observant, know my body very well, my diabetes is usually really consistent, and I have excellent control. So, I can generally come up with the answer or a couple possible answers as to why something happened. It's (as you undoubtedly know) not the same for other diabetics. I blog about when the diabetes fairy visits precisely because it's so rare. It makes sense that if the diabetes fairy visited often, you'd have to give up trying to figure things out just to keep from going nuts.

Another important part is that I can tell when my bg goes over 120. I actually get physically ill. This is extremely rare; I've only heard of 2 other people that say they can do it and only one of them gets sick. That's what enables me to do what I do, or, more precisely, requires me to do it. Other factors include my small Total Daily Dose, my unusually consistent insulin absorption, my psychic ability to detect patterns without having a doctor look at my numbers on a chart (hey, I can't explain it), the way John Walsh has no explanation for most things about me. So my diabetes is different from almost everybody else's diabetes, and I find that interesting, so I blog about it. I haven't included a disclaimer in every post because I guess I figured people would remember the disclaimer. Probably I should actually write a disclaimer.

In the scheme of things (for the people that know me), diabetes isn't that huge a deal. Really, I'm much more likely to pass out because I have dysautonomia and neurocardiogenic syncope than from the diabetes.

Insulin soup

2007-07-05T19:12:00.000-07:00

I could swear I need a checklist of everything that can possibly happen so I can start checking these things off. The trip to the Bostonish area went mostly okay. I didn't have any significant change in insulin requirements, but the first day we were on the island, I had to lower my basal by .05 and bolus by one g/carbs. After that, everything was normal. I anticipated how much extra insulin I needed on the plane and was right. That was great.

Now, for the weird part. The first day we were there, the place we were staying was around 90° and up. By the end of the day, the insulin in my pump had gone bad. I then had to refill it with cold insulin. I do have a pump frio, but I didn't think it would be warm enough outside to bring it. It wouldn't occur to me that I'd need to use it inside, since I can't be in that kind of heat due to another medical condition. In retrospect, we really should have rented a car and gone to a hotel. I did bring a frio for insulin, but it didn't really keep it cool enough. I did make sure to water it enough and let it breathe, so maybe it's because I used the waterproof inner bag? I'm still not sure why. When we got back, I just ended up throwing out all the insulin I took with me since our flight had been delayed and it had been hot, etc.

Despite all these precautions...the vial of insulin I opened upon our return (from my fridge) was bad. The first day, I thought it could be a million things and used 11% more insulin. The second day, I used 25% more insulin. Today, I woke up out of range for the first time in six months and was using 50% more insulin (!) when I finally went, "hey, wait a minute..." After I'd decided to return the insulin, I remembered that J. once had to return some bad insulin to the pharmacy (and we use the same one). I asked him when and he said a month and a half ago. Sure enough, that's when I picked mine up. So, I took them back to the pharmacy and got replacements. The pharmacist was quite surprised and looked grim when he said he'd have to pull everything from that lot. He didn't remember J. returning his. That got me thinking...if a whole shipment of insulin goes bad, why do so few people notice? Are most people getting it Type 2 and it doesn't make much difference? It's very noticeable to me because my TDD is so low. Do people not test very often? I wonder why that is.

I like cases

2007-06-23T17:02:00.001-07:00

cases
Originally uploaded by LilituC.

Cases for my pump.

Guess who's coming to dinner?

2007-06-22T14:10:00.000-07:00

I've had dinner with J lots of times, and usually it doesn't turn into a Diabetic Dinner. Then, last night, we took an ill-fated trip to CPK. I'd been running high since lunch, when I tried a new frozen entree and decided not to guess at how many more carbs it contained than the box said since I didn't want to end up low. Well, it turned out to be a lot, and now I know that everything from that brand is going to be higher than it says. That was around 2, and at 8:30 I will still trying to get my bg to come down!

We got to CPK around 9:20 and I was at 86! I decided to have pizza. Now, for awhile I had to stop having pizza when we went there because it was too difficult to get right, but now that I can dose so well, I was excited, especially since my bg was good. Well, my favorite, the Pear and Gorgonzola pizza, was gone! The waiter said it was really popular, too! Unfortunately, I don't like any of the other pizzas. I grudgingly decided to try to the new curry mango pizza (minus the chicken). J got the mushroom pizza.

I did a dual wave bolus over 30 minutes in case I didn't feel like eating it all, and J took some insulin. I actually didn't feel like eating the whole pizza. It was okay, but as they say, "not worth the insulin" for me. J. thought his pizza should have come with red sauce and only ate half of it, quite unusual for him. I was cranky because I couldn't have my favorite pizza (ever! again!) and I'd been avoiding it until my control was better. J was cranky because he had a lot of insulin on board. So he had to have dessert to cover the extra insulin.

Memetime

2007-06-08T00:33:00.000-07:00

1. When you looked at yourself in the mirror today, what was the first thing you thought? I need to dye my hair.

2. How much cash do you have on you? Zero.

3. What's a word that rhymes with DOOR? Moor.

4. Favorite planet? Neptune.

5. Who is the 4th person on your missed call list on your cell phone? J.

6. What is your favorite ring tone on your phone? The silent one a friend sent me for when people give out my number to unwanted callers.

7. What shirt are you wearing? Green button down.

8. Do you label yourself? No, I'm a label-hater!

9. Name the brand of the shoes you're currently wearing: We don't wear shoes in the house.

10. Bright or Dark Room? Neither? Too bright or too dark will give me a migraine.

11. Why is there always a missing question? Pasting is hard.

12. What does your watch look like? Silver and black Timex.

13. What were you doing at midnight last night? Reading a book.

14. What did your last text message you received on your cell phone say? Coming home now

15. Where is your nearest 7-11? I know there's one a mile away because that's where we turn.

16. What's a word that you say a lot? CENSORED!

17. Who told you he/she loved you last? I don't remember, actually. One of the usual suspects.

18. Last furry thing you touched? My cat.

19. How many drugs have you done in the last three days? Many prescription, none illegal.

20. How many rolls of film do you need developed? None that I know of.

21. Favorite age you have been so far? 29.

22. Your worst enemy? Culture of conformity.

23. What is your current desktop picture? The moon (one of the defaults) because if I use a cooler one I get weird looks when I take it somewhere.

24. What was the last thing you said to someone? "No, he loves the litter box."

25. If you had to choose between a million bucks or to be able to fly, what would it be? If I had a million dollars...

26. Do you like someone? Who doesn't?

27. The last song you listened to? Joan Osborne - Midnight Train to Georgia.

28. What time of day were you born? 5:23 am.

29. What's your favorite number? 17.

30. Where did you live in 1987? Billings, MT. I also know the address and phone number.

31. Are you jealous of anyone? Not really.

32. Is anyone jealous of you? I doubt it.

33. Where were you when 9/11 happened? Online in my home office in Las Cruces, NM.

34. What do you do when vending machines steal your money? Shake my tiny fist.

35. Do you consider yourself kind? Yes, although I've grown wary.

36. If you had to get a tattoo, where would it be? On you.

37. If you could be fluent in any other language, what would it be? Besides Spanish, Japanese, German, Latin, and Mandarin? I've always wanted to learn Hebrew and Norwegian.

38. Would you move for the person you loved? Been there, done that.

39. Are you touchy-feely? Sometimes and sometimes not. It hurts (literally) to be touched so I have to be careful.

40. What's your life motto? Screw you guys, I'm going home.

41. Name three things you have on you at all times: The kitchen sink! J/K my pump, medication, meter, insulin, extra pump supplies and all the other stuff.

42. What's your favorite town/city? Seattle, Twin Cities, Chicago, Manhattan, Boston.

43. What was the last thing you paid for with cash? I think we shook the car for money to feed a meter.

44. When was the last time you wrote a letter to someone on paper and mailed it? 2003.

45. Can you change the oil on a car? I can't even drive a car.

46. Your first love: what is the last thing you heard about him/her? He's still drinking.

47. How far back do you know your ancestry? 1500s for some, 1800s for others, about two generations for my father's side.

48. The last time you dressed fancy, what did you wear and why did you dress fancy? I dressed up to go to the Melting Pot for my birthday. I wore a purple and black kimono dress.. I put the pump in my trouser sock.

49. Does anything hurt on your body right now? Everything always hurts on my body; but I'm used to it. Today my back and legs are bothering me, though.

50. Have you ever been burned by love? Literally! Heh.

51. Do you have a crush on any bloggers? Who doesn't?

52. Where would you like to live? Twin Cities, Chicago, Manhattan, Boston...if I had a million dollars.

Extra pocket

2007-06-03T16:29:00.000-07:00

Check out what I ran across when I was looking at clothing online, ladies:
Nothing Bare Pocket Hipster.

I admit that page doesn't do the best job of explaining what it is, so here's the original, sans pocket. You're meant to wear it under a shirt. Admittedly, you'd need to make a hole in the pocket, and I don't know if the pump would be too heavy, but I still think it's pretty cool!

Travel fun

2007-05-29T11:09:00.000-07:00

Well, I'm finally back after our annual trip to Tahoe for a conference. This year, we decided to take advantage of living in Seattle and drive, since we hate to fly and we need to take a lot of stuff with us. Driving did make things hugely better, but our car broke down in Yreka. So we lost the extra day we would have spent picking up supplies and getting things settled. I'm sure Tahoe is a wonderful place if you're not there for a conference. Every year, we go there and every year we don't have time to do anything else. Sometimes we even miss the small window in which stores and restaurants are open -- if you go, don't do that! It was nice to see people, albeit briefly, though.

Since I've travelled by car before, I knew I would probably need more insulin. Last year, I needed about 8% more. This year, I needed 40% more every day that we were in the car. I'm not joking! I was really conservative about it the first day and spent a good part of it over 200. Once I'd gotten up to 40% and stuck to it, everything was fine. I had read that a lot of people needed less insulin at high altitudes, so I went back to my normal insulin amount once we got to Tahoe. Actually, I needed 30% more on the first day (for other reasons) and 20% more after that. When we got back in the car to drive back, I went back to 40% and it worked out great. On the one hand, there were some really crappy days in there. On the other hand, I managed to figure it out and the last 3-4 days everything went really well. My housemate had about the same experience - he needed tons more insulin in the car and some more in Tahoe. He told me that 40% was ridiculous and couldn't be right, but I guess I think that until he keeps track of his own insulin intake and proves to me it's not 40% more, he can stfu. ;)

There was one day where everything seemed to go wrong: our first day in Tahoe. In the morning, I had settled on 20% and everything was going fine, but by afternoon I kept taking insulin and it seemed to have no effect. I was pretty sure my insulin wasn't bad and my set looked okay. I did have a low a couple hours before dinner, so I ate 28g of chips (low fat) and then bolused for most of it. When I sat down to eat dinner, I was at 171. Wait, what? I bolused for dinner even though we hadn't ordered yet - about 10 units. I checked again about 40 minutes later and I was at 220. I still hadn't eaten anything yet. I can assure you that I wouldn't see a rise from eating chips after more than two hours, so I was completely puzzled. We ate dinner and hurried back to the hotel because we were supposed to be somewhere. When I pulled my set, guess what happened? About 12 units of insulin came pouring out! This was only the third day for it, and normally I change after two because it's a needle set, but tunnelling never happened to me before. Once I'd changed it, everything was back to "normal."

The best part is that I have an endo appointment tomorrow! Heh. I wish all of you less "interesting" trips.

I can has cabinet

2007-05-03T01:38:00.001-07:00

I can has cabinet
Originally uploaded by LilituC.

I finally got a cabinet to put all my diabetes supplies in, since I was tired of them being all over the house. I especially wasn't enjoying storing my sets on the floor. I absolutely love this cabinet! Here's what it looks like closed. I got it from this site.

Thoughts on service

2007-04-16T14:20:00.000-07:00

So I called MM and explained what happened. They want me to return the sets (including a used one, ew) and they will send me new ones. Or rather, they sent me one box of new ones and envelopes and canisters to return the old ones. Once they receive those, they will send me the other three boxes. I can understand it, but it doesn't entirely alleviate my panic at only having half a box of sets. Anyway, I sent the old ones back but I don't know how long they'll take to arrive at MM.

Now MM has been dinged for their customer service (even by me). One problem that I see became clear after talking to the same person in sales and supplies more than a few times. It seems that the sales people are not trained on the products they're selling. I learned that this person had never seen a data cable and didn't really know how infusion sets worked. I am a lot more clear on how I was mistakenly sent IV-3000 instead of IV Prep - they're just words on a computer screen to someone who doesn't know what they are. If people call up and don't know the name of what they want, they have to talk to the Helpline.

Last time I had to order tubing (from the Sils), they tried to talk me out of it because I'd just ordered sets (Sure-Ts). When I finally convinced them that yes, I wanted to buy more sets because I only needed the tubing, they tried to get me to order the box with 5 sets of tubing and 10 cannulas for $100, instead of the box with 10 sets of tubing and 10 cannulas for $116. It took 5 minutes to get them to understand why this wouldn't work (during which they kept trying to get me to talk to the Helpline). I think the major issue is that we might as well be talking about floobles and gargs for all they know. I think it's a problem when people don't know what they're selling. I know they can't give out medical advice, but they should at least know what people are talking about when they say they want to buy something. If they solved that, they might solve a lot of the complaints.

Enh

2007-04-11T01:00:00.000-07:00

I did end up getting sick. Then, I got better. Go, antibiotics! It took me awhile to feel a lot better, though, because my blood sugar has been higher overall. Now, I did gain 5 lbs since the beginning of the year(!), even though my caloric intake has trended down and my activity level has gone up. I'm starting to wonder if moving to Seattle made the difference - maybe the climate is having an effect on my metabolism. Anyway, since that happened more gradually, I don't think it's why I suddenly need more insulin. A more plausible explanation is that my insulin production has dropped again. It's not a huge change - from .35/hr to .40/hr. So far I've only changed my breakfast ratio to 1/12, but I need more data on whether the others need to be changed.

I've been having issues with my Sure-Ts lately. Basically, the failure rate has been pretty high - I'm getting concerned about how I will be able to pay for enough sets if this continues, since they aren't cheap. My insurance does cover them, but they won't cover the extra ones you have to throw out. I've having to change them 1-2 times a day, and that's with letting it go as long as possible. I got these Sure-Ts in my last order a couple weeks ago, and the needle isn't exactly at 90°. Maybe 105°? I can't figure out if they were always like that, although I don't think they were. I don't have any old ones left. The sets I have are two different lots, so I opened up the second lot and they were the same. Wait, I just remembered I had an old Sure-T in my purse. I checked and it looks like it's perfectly at 90°. The second problem is that the pliable wings are slightly off on one side. So I put in the set, but when I go to tape it flat, flattening the wings makes the needle move. Aargh! I hate having to return things to MM. Maybe I can just try to bend them back into position (carefully); that's what I did with the last one. Or, okay, maybe I will also try calling them tomorrow.

For Chrissie

2007-03-25T12:54:00.001-07:00

precision xtra
Originally uploaded by LilituC.

So last night I was stuck in a rage bolus cycle, trying to get my bg to go down. It wasn't super high, but I just couldn't believe it wasn't going down at all despite all the insulin I kept taking. I checked my prime screen and discovered it had been two days since I changed my set (somehow it always sneaks up on me). So it was time to change anyway. It looked totally normal, too.

Then as I was leaving the bathroom I was stunned by a big wave of nausea. Wait, what? I didn't feel sick at all otherwise and I usually feel it right away. Still nauseated, I thought maybe it could be ketones, so I checked. I'm not sure why even small ketones make me so nauseated; I get the impression other people don't feel them until they're higher. I tested my bg and got 109.

I still have no idea what happened. I felt better after an hour or so and my bg is back to normal now. I didn't test for blood ketones again because I just can't afford it. I did wake up with a sore throat this morning, but I did every day this week. I had just figured it was normal. Except my housemate got diagnosed with strep throat this morning, so I foresee a trip to the clinic to get tested in my future.

Surprise Color

2007-03-24T17:39:00.001-07:00

surprise color
Originally uploaded by LilituC.

It's subtle; I didn't notice until I put the pump on a white surface.* That skirt I got at the thrift store really *was* new - the color bled!

*White surface not featured here due to lack of light.

okee then

2007-03-12T03:27:00.000-07:00

So in my neverending quest (I'm kidding) to have everything ever happen to me in the shortest time possible...tonight I got the dreaded NO DELIVERY alarm.

You see, we went out to the Melting Pot for my birthday and I had to bolus for the tons of food I ate with no nutritional information to guide me, and actually I did pretty well - only had to do one correction. Wait, what's that? Get to the point? Oh, right.

Awhile after we got home, we were going to eat my birthday cake. I had just changed my set, and I bolused for 50 g of carbs, but in the middle of it, NO DELIVERY. I looked at the set, pulled on the tubing a little to loosen it from the tegaderm. Well, okay, so the tegaderm was covering a bit more tubing than usual, but it was like an inch. Surely that couldn't make a difference? Then I tried to bolus the amount remaining. NO DELIVERY. I pulled off the tegaderm, but not the set. I think this was only possible because I had just put it on. Then, I tried again, and it worked. Except then I didn't know how much insulin I'd actually gotten. The pump said I'd gotten all of it, but who knew. So I slapped another tegaderm on there, bolused for 48 g and figured I could have a snack if I started dropping. Well, I never ate the snack. I *know* I got the last 1/3 of the first bolus, and the cake was probably around 38 g (I didn't know my husband put Splenda in it) so I totally should have started dropping, but I never did. I guess, as I read somewhere recently, the diabetes fairy must have visited me today.

ahahahahahaowhahaha

2007-03-10T01:06:00.000-08:00

So I was clicking around on Novo Nordisk's Changing Life With Diabetes website. I like to check out new tools and see what I think of them. I got to a screen where it was asking me to input my current status and then my goals. Question one: how many times do you check your blood glucose daily?

The form would only take a single digit.

no news is good news

2007-03-09T22:18:00.000-08:00

Besides my endo, I also love my eye doctor. Amazingly, she's not an opthalmologist, but you know what? I insisted on seeing only doctors for years, and not one of them ever did anything for me. I'd tell them about my severe dry eyes, my headaches, my nausea, and they just gave me a bored face and said there was nothing they could do. Here's your prescription, now get out. Whereas my optometrist has been absolutely amazing! She said of course there were several treatments for dry eyes, she figured out why I was having headaches and nausea in less than 10 minutes, and at one point she said, "oh, I wrote my thesis on that!" Yes! Oh, and my endo thought it was perfectly alright for me to see her.

So after many appointments with her for the above, today I had my diabetic eye exam and my last appointment for the next year. I had a dilated eye exam four years ago (before I was diabetic), so I wasn't expecting anything. She didn't find anything diabetes-related, but she did say I have some thinning of the retina, which happens in really near-sighted people but diabetics need to keep more of an eye on it. She was really surprised that the thinning wasn't at least mentioned to me after the last exam. I was and I wasn't, if you know what I mean...