Another Day with the Doctor(s)

Holy shit, do I have a lot of doctor appointments.

I just put my next gig with the high-risk obstetrician on my calendar — May 14 at 8:00 sharp — and realized that, between now and then, I have an eye appointment, a meeting with my Certified Diabetes Educator, a lab stab, an echocardiogram and a visit with my regular-people obstetrician. All, for some reason, scheduled on Monday mornings.

My last visit was with both OBs (high-risk and regular), and it included a sonogram and a check-in on all things diabetes-related.

My husband and I hit the high-risk OB first for an ultrasound and a chat with Dr. Gaudier, the cheeriest damn OB/GYN I’ve ever met. The technician greased me up with a gratuitous amount of sonogram gel, a substance that’s always warmed for aesthetic purposes, but feels grosser to me the warmer it is. (Cold feels clean, clinical — almost refreshing. But when you squeeze a blob of heated-up goo onto my belly, it feels like something that just came out of another warm-blooded animal. Gross.)

It was time to spy on the baby. There’s the heart, there’s the brain, the kidneys. There are the teeny bones forming in its arms and fingers. At one point, the technician pointed to a shimmering mass of black and white static and said something about the baby’s “waist”, and all I could do was imagine it wearing a cummerbund.

Then, the moment that would make it all a little more real. “This baby’s looking pretty girly to me,” the technician said. “Yep. See those three dots? You’re having a girl.” She was so nonchalant about the revelation that it almost didn’t register, but when it did, I was thrilled. Not just because hey, it’s a girl and that’s awesome, but because so many people were hell-bent on the idea that the baby was a boy. I’d felt the girl vibes all along, and I’m the mommy, and damn it, I was right. It’s a glorious feeling.

After we’d identified a few other essential body parts and I’d wiped most of the slime from my abdomen, Dr. Happy came bursting through the door. It was like an early morning surprise party. “Heeeey! So good to see you! Both of you! How we doing today? Good! Good!”

He gave me a high-five for my latest A1c, and went through all the standard questions about scary symptoms that I’m grateful not to have experienced. Then he explained the (not so stellar) results of our first trimester screening, and all of our other screening options, in a mostly one-sided conversation that went something like this:

“There may be something wrong with your baby, but probably not. But maybe. If there is, there’s nothing you can do. So if you want, we can take a big giant needle and pierce your uterus and suck out some juice and test it to see if there really is anything wrong, but there’s probably not. But maybe there is. Also, if we do this needle thing, there’s a chance you could lose the baby, but that’s only slightly less than the chance that there’s something wrong with your baby, which there’s probably not.”

Bob and I decided weeks ago that we weren’t going to do no stinking, panic-inducing, false-positive-free-for-all prenatal testing, and so we declined the amniocentesis. But that wasn’t the end!

“There’s also a non-invasive option. We can draw your blood and look at the fetus things in your blood to see if there are any neural tube or genetic defects.”

Once again, we declined. The doctor went on to discuss what was visible in the sonogram — all in the most upbeat possible way.

“When we look at the umbilical cord, we want to see two arteries and one vein. It’s weird, because it seems like there should be one of each, but there are usually two arteries. Your baby is missing an artery here, so she only has one vein and one artery in her umbilical cord.”

Splendid.

“We don’t see any problems now with the kidneys or the heart or the bones, so it’s very possible that this baby will be just fine. We just have to keep a close eye on the development of the organs, which we’d do anyway because of your diabetes.”

I can’t quite capture it, but really — this doctor could deliver news of a zombie apocalypse and leave you thinking, “Hey, no big deal. Those zombies are only after me because I have such attractive brains, anyway. And I’ll get plenty of exercise outrunning them!”

His only recommendation was to exercise more. I suspect that recommendation comes from the generally accepted idea that exercise is good for you as much as it does from the doctor’s curiosity about the state of my heart. When this pregnancy began, I was well on my way to becoming a Team WILD 5k superstar, and the fact that I was able to run/walk for significant periods of time without any shortness of breath or discomfort helped give everyone a little more confidence in my cardiovascular abilities. Now, though, my sport of choice is napping, and I guess that’s not as beneficial as jogging for 120 minutes a week.

Next we headed downstairs to join the uncomplicatedly-pregnant masses at the regular obstetrician’s office. I’ve been happy with this place so far, with two exceptions. First, the entire office is covered — covered — with glamour shots of each physician’s family. Children on the beach, half-naked couples with their eyes closed and their newborns in their arms, draped in sheets, families in matching khakis and polo shirts assembled on grassy knolls. It’s like being stuck in a personalized Christmas card, only it smells like disinfectant and there are stirrups and speculums at every turn. Second, when the main nurse told me what my first A1c was — 6.5 — she prefaced it with, “It’s a little high.” (To which Bob responded, “Are you kidding me?”)

Anyway, that appointment went off without a hitch. The midwife listened to the baby’s heartbeat, which was galloping right along, and I made sure to tell every nurse I saw that I would NOT be needing a glucose tolerance test at my next appointment, thankyouverymuch. I think they just wanted to make sure that I was still pregnant and that I understood the intricacies of the billing process for baby-birthing. Affirmative to both.

I know these appointments will get tedious, but right now I’m looking at them as mile markers in what seems like an unending march toward my due date. I will get there, and when I do, all the generalized panic and glamour shots and warmed-up sonogram goo will be worth it.

I’m totally registering for this stuff. Then, in the months after the baby’s born, I can heat it up in the microwave and rub it all over my tummy, just to relive the good ol’ days.

You Can’t Munch This

“I can’t eat that.”

It’s a phrase I’ve spent two decades struggling not to have to say.

Yes, I have Type 1 diabetes, but I also have this shit (mostly) under control. So bring on the ice cream, and the marshmallow peeps, and the pizza and the cereal. Just please bring them with an accurate carbohydrate count and a few measuring cups. And maybe a food scale.

But now I’m pregnant (in case you forgot), and I’m finding it hard to maintain my cautiously rebellious relationship with off-limits foods. Which foods are off-limits for a Type 1 diabetic who happens to be harboring a tiny fetal passenger? It might be easier to talk about what’s not forbidden:

  • Water
  • Cashews
  • String cheese

It’s possible there are a few additional foods to choose from, but from my experience, the above three seem to be the only safe bets — especially when you consider the dangers posed by high blood sugars, low blood sugars, listeria, mercury, alcohol, caffeine, artificial sweeteners, and any other threats announced by the paranoid sadists at American Congress of Obstetricians and Gynecologists.

In times of yore (read: six months ago), I’d avoid a post-restaurant-meal high blood sugar by ordering something low in carbohydrates, but high in excitement: an ahi tuna salad with avocado and glass of wine. Perfect. But now the tuna’s out to destroy my unborn child, and the wine’s right there to back it up. It’s the same deal with meat and cheese plates, sushi, caesar dressing, turkey sandwiches, sprouts, brie — even SALAD IN A BAG, people!

Dun Dun DUUUUUHHHHHHN!!!!

Food that’s deemed safe for pregnancy tends to scare me on the diabetes front. After forcing down some quinoa salad or even a cup of yogurt, I can rest easy in the fact that I’m not directly poisoning my child, but the obsession over the blood sugar kicks in. Did I count all the carbohydrates correctly? Will I be under 120 in an hour? Am I dropping too fast? Should I have had more protein? Would a square bolus have worked better? How will all of this look when I upload it and print it out next week?

I’m trying really hard not to spend this entire 40 weeks freaking out, or complaining — or freaking my husband out with all of my complaining. I just want everything to be okay, and at the same time, I’m struggling to hold on to as much of my non-pregnant, semi-normal life as I can.

Only 170-something days left, and then I’ll be welcoming our little Wojcik into the world with a stick of pepperoni, a tub of raw cookie dough, and a big glass of champagne.

The Bigger Diabetes Picture

After months of struggling with my Minimed Continuous Glucose Monitor Carelink settings, I’ve finally done it. I’ve figured out how to upload all of my CGM information to the big Carelink cloud in the sky. And I’m uploading that information every few weeks, so that I, and my Certified Diabetes Educator, can look over all the pie charts and line graphs and color-coded calendar icons and make changes to my basal rates and carbohydrate ratios on a more frequent basis.

I should be proud of myself, and I am — to an extent. This whole baby-growing-in-my-diabetic-body thing kind of forced the issue, so I finally committed myself to spending an hour and a half on the line with Minimed’s technical service team. Some poor soul named Aaron patiently walked me through the wonky process of tricking Java into working on my home computer’s operating system (it’s a long, nerdy story), and for the first time since I’ve had the CGM, I felt like a full-fledged diabetes robot.

The first few uploads were thrilling, as ridiculous as that sounds. Here was my entire diabetic life, recorded in detail and illustrated in full color, ready to share with the world. Unfortunately, it only took me a few weeks of uploading and reviewing to realize: here was my entire diabetic life, recorded in detail and illustrated in full color, ready to share with the world — and that picture isn’t always a pretty one.

Skiing, anyone?

I call it “Still Life with Dead Pancreas.”

During my first pre-natal visit to my CDE, she brought out several weeks’ worth of printed records. The lines on the graphs peaked and plummeted, jerking up and down according to those diabetes variables we all know and love: food, stress, exercise, baby-building hormones. A devastatingly narrow green rectangle ran the length of the chart, representing the range that those lines should have been confined to. Instead, they were dancing all over the place.

“What do we think’s going on here?,” my CDE asked, gesturing to a mountain range that spanned the 6 p.m. to 10 p.m. landscape of the chart.

“I’ve been low a lot in the late afternoon,” I guessed. “I think some of this may be me over-treating the lows right before dinner. And I had pizza a couple of those nights.”

She pointed out a few other trouble areas, and we made some small changes to my afternoon and overnight basal rates — no big deal. But ever since then, I can’t look at my 3-hour or 24-hour CGM display on my pump and not imagine how it will look when it’s printed out in a few weeks at the Mayo Clinic.

It’s not particularly healthy, but I’d gotten used to viewing my blood sugar fluctuations in tidy little easy-to-swallow snapshots.

This never happens, by the way — which is why I took a picture of it.

The ridiculous thing is that this is why I signed up for this CGM adventure in the first place — to get this vulture’s-eye view of how diabetes behaves on a day-to-day basis. It’s just that now that I have it, I miss my days of relative ignorance.

Diabetes is just one of those things that’s infinitely easier to deal with when you take it one niblet at a time. If I woke up every day thinking about all the blood sugar checks it’ll take to keep me on track for the rest of my life, I would never get out of bed. It’s the same thing with these graphs, even though they’re retroactive. I look at those lines and that little green rectangle and, even though I’ve been doing this for 21 years, I think, “Wait — this is my job? I’m supposed to control this shit? Every day?”

Yes, the graphs are useful — even the Pac-Man pie charts that show you how much your management sucks or succeeds on any given day — but each one challenges the “A1c is just a number!” mentality of self-forgiveness I’ve worked so hard to cultivate.

The perfect response here, I understand, is to view this information as motivating. After all, it’s there to help, right? I need to remember, especially now, that even though everything’s not completely within my control, I’m lucky to have the technology it takes to kick diabetes’ ass, no matter how unattractive the big picture is.

Dealing with a Different Diagnosis

It’s not often that I wax poetic about the things I appreciate about life with Type 1 diabetes. Over the past 13 weeks, however, I’ve come to recognize that diabetes isn’t that bad, after all — mostly because I’m used to it.

After 21 years of diabetic livin’, I know how to navigate this world. I know that sugar-free candy is poison sent straight from the depths of Hades, that the simple act of waking up on a weekday is enough to give my blood sugar a swift kick northward. I know that I don’t really have to change the lancet every single time I prick my finger, that one or two rogue high blood sugars aren’t going to kill me or necessitate a foot amputation, and that sometimes the 15-15 rule is impossible to follow. Oh, and that the Bible Cure (along with the cinnamon cure) is total bullshit.

But now I’m pregnant! And in a cruel twist of fate, I still have diabetes — and I feel like I don’t know what the hell I’m supposed to be doing. I’m lucky enough to have some smart, supportive PWD mommies in my life, and that has definitely helped. As has my attachment to Cheryl Alkon’s Balancing Pregnancy with Pre-existing Diabetes, a pregnancy book that actually reads like a normal person wrote it. My Certified Diabetes Educator is more than supportive, and my main OB has total confidence in my ability to handle my blood sugar levels with my CDE’s input.

So why do I feel like there’s way too much information out there, and — at the same time — not enough?

Every pregnancy-related website has a series of simultaneously uplifting and condescending stories about bonding with your unborn child and enjoying your new extra-large boobs, right next to a Q&A about birth complications and a banner ad for one of 7,000 special doohickies I’ll need just to keep the baby alive after it arrives.

I’ve received recommendations and advice from real-life friends regarding hypnobirthing, epidurals, C-sections, inductions, doctors, doulas, Bradley Method birthing classes, day care, maternity leave, maternity bras, maternity pillows, maternity clothes, diaper selection, prenatal testing, genetic counseling, and a million other things that will probably keep me up for the next 189 nights.

They didn’t have Freaked Out and Very Confused Expectant Mother Parking. I checked.

I appreciate all the input. (Really, I do. I love it.) But I can’t escape the fact that there’s so damn much to process. And I’ve only dealt with this condition for a few months — not 21 years — so I can’t pick out the Dr. Oz and Halle Berry stuff from the Mayo Clinic and Mary Tyler Moore business. And even if I could, how do I know what’s right for me? After all, I’m sure those know-it-all fools at Mayo would expect me to change my lancet 6 times a day.

I like to think my bullshit detector is pretty refined, but all it takes is a cheesy picture of a baby in an Anne Geddes getup or a mention of placenta preservation to turn me off of what might otherwise be a reputable source of information.

I guess what I’m looking for, and what I’m afraid I won’t find, is the pregnancy equivalent of the Diabetes Online Community. I need a group of people who are simultaneously crazy and completely normal, who are non-judgmental and supportive and honest and will tell me everything will be okay — without throwing in a caveat about birth weight or getting sufficient calcium in my diet.

I just need someone to travel to this coming September, observe a happy and healthy outcome to this pregnancy, shoot back through the space-time continuum, and assure me that everything will be okay.

Any takers?

About that Baby Thing

Remember a few months ago, when I reflected on my cardiovascular and diabetes-related health, and the less-than-encouraging advice I’d received from cardiologists and high-risk obstetricians, and decided to forgo biological baby-having activities in favor of adoption at some later date?

Well, as it turns out, the universe is one hilarious prank-playing S.O.B., because I’m pregnant.

I’m at 12 weeks, and I still can’t believe it. It feels weird even typing out that phrase: I’m pregnant. In the family way. With child. Eating for two.

Surprise, bitches!

I was terrified when I found out. And since it’s my thing, I immediately imagined the worst-case scenario, which I will not type out for superstition purposes. Suffice it to say that the worst case involves very bad things, and lots of people shaking their heads and referencing Steel Magnolias.

I felt like an irresponsible teenager, calling all the people who’d advised me not to get pregnant to tell them that I’d done just that. Because she’s awesome, my Certified Diabetes Educator was optimistic and supportive, and promised me we’d do our best to make sure everything turns out okay.

The nurse I spoke to at the OB was slightly less awesome. I explained my situation to her, and told her I’d stopped taking my super scary ACE inhibitor since, from what I’d heard, it makes unborn babies develop eagle talons and ESP. “That’s the last thing you want to do,” she said, brimming with judgement. “You should never stop taking your medication unless you’re instructed to do so by a doctor.”

I took one of the 6,022 deep breaths I’d take that day. “I was instructed to do so. By my cardiologist.”

Then I had to call that cardiologist and make an appointment with her. I don’t know if it’s the trauma of my adolescent-year endocrinology appointments that’s scarred me so irreversibly, but I fully expected to get yelled at. Thankfully, that didn’t happen.

Jodie Poundstone came bounding through the door with a big old smile on her face. “Congratulations!” she offered. I was so confused. Where was the naysaying Debbie Downer I’d talked with just weeks before?

“We have to be careful with our recommendations,” she explained, “but honestly? I’m not convinced you ever really had a real cardiomyopathy issue. I think you’re going to be fine.” She went on to say that she was more concerned about the state of my diabetes and about the effects of the ACE inhibitor on the baby, and was relieved to hear that I’d stopped taking it. (Take that, mean OB nurse.)

That was all six weeks ago, and I’m still wrapping my mind around this insane turn of events. So far, things seem to be working out pretty okay on the health front. I was shocked to learn that my A1c was below 7.0 around conception time, and that pee test I had to endure? No protein there.

I’m slightly more relaxed, and I feel like now I can start to focus on the issues that non-diabetic pregnant people obsess over: How many toes will it have? What kind of diapers should we use? Where should I bury my social life? When can it get a job?

I’ve been exhausted and moody and nauseated and terrified, but I’m finding that the sentiment I’m most overwhelmed with is one of unspeakable excitement and humility and anticipation and love and other mushy things you’ve heard a million times from other expectant moms.

I can’t believe this is happening to me — to us — but I’m so glad it is.

In Praise of Pain

Somewhere along the line, it was decided that the absolute worst part of living with diabetes was the finger prick. Not so much the process of checking one’s blood sugar: the washing of the hands, the alcohol swabs, the selection of a minimally calloused fingertip, the insertion and coding of the test strip, etc. Not even the test result. No, the worst part of diabetes was determined to be that very moment when the sharp metal tip of a lancet pierces your precious, delicate finger skin.

Exhibit A: This commercial.

No wonder people are terrified of this awful disease. Not only do people with diabetes have to worry about exorbitant health costs, possible complications, crazy carbohydrate and medication ratios — they have to stab their fingertips with ice picks, kitchen knives or shards of broken beer bottles! The horror.

Of course, everyone’s diabetes experience varies. But in my little reality, the blood sugar prick (not stab), is mildly uncomfortable at worst. I’m at least 37 times more anxious about what the results of my test will be than the process of procuring a teeny drop of blood.

Which brings me to Exhibit B: This little guy.

Available at Sephora and specialty lancing device boutiques everywhere.

It’s the One Touch Delica, a wee spring-loaded miracle that promises to turn each blood sugar test into a virtual fingertip massage. The Delica comes with a special lancet that’s no wider than a unicorn’s eyelash, and the spring system inside is designed to minimize vibration or some such nonsense. What the Delica is best at, though, is forcing me to prick my finger at least three times in order to harvest enough blood for a single test.

No one enjoys a fingerstick, but I’ll take the extra finger pain and the luxury of a usable blood sample over the agony of an Error 5 message on my meter. Or worse, the practice of milking my calloused pinky finger like a dried-up goat teat, all in the hopes of getting just a little more blood to test before the stoplight light turns green or the TV turns dark and I can’t see the test strip anymore.

I’ll be the first to admit that my issues with the Delica are largely a result of user error. Or user laziness, as the case may be. Delica lancets, in addition to being more expensive than the standard variety, turn blünt in an instant. I know that in some alternate universe, there’s a colony of diabetics who change the lancet after every single test. I wish I lived there, but I’ve already got a place in this universe, where we change the lancet every few weeks — or worse.

So, although I’ve got two Delica devices and a relatively fresh box of accompanying lancets, I think I’m going to go back to the old school contraption I’ve counted on for years.

Call me masochistic, but I appreciate a productive stab.

24-Hour Potty People

Nothing reminds you that you’re the lucky owner of a chronic condition quite like a jug of your own urine ripening in the refrigerator.

Ah, yes — it’s the 24-hour urine collection routine. One I hadn’t experienced since college, but had the good fortune to relive this past weekend.

And what a routine it is. Start in the morning, and collect every darn drop until the same time the next day. I became vigilant in my bladder awareness, afraid that I would find myself having to use the bathroom somewhere far away from that damn orange jug. What if I forgot? What if I lost it? (What?! Where would I lose it?) What if a representative from Self magazine dropped by to do one of those “What’s in your fridge?” profiles?

They’ll tell you that the purpose of the 24-hour urine test is to detect the presence of protein in your pee and, therefore, any possible kidney issues that diabetes hath wrought. I’m convinced, however, that the 24-hour urine test is an ongoing joke between prescribing doctors, lab technicians, and the manufacturers of gallon-size orange plastic jugs. Because really, what’s more entertaining than watching a bleary-eyed diabetic stumble into a hospital first thing Monday morning, carrying a jug of her own pee?

Image via I HEART GUTS

The first time I participated in this experiment, back in 1999, I was a student at Truman State University, which was a good 3-hour drive from the endocrinologist I was seeing at the time. Instead of transporting my own urine across the great state of Missouri, I was instructed to perform the test at my school-home, and then drop the specimen off at the campus health clinic.

I managed to make it through the collection process itself, which isn’t easy when you’re sharing a single bathroom and a refrigerator with two other young women (those poor girls). The real adventure came when it was time to drop the jug off. For some reason, I decided against concealing the container in any way, so I marched up to the campus clinic with a very conspicuous urine sample in hand. I must have expected the place to be empty, because I remember being quite surprised to find that it was flu shot day, and that the waiting room at the clinic was packed with fellow students, a few of whom insisted on asking me what was in the container.

I don’t even remember my response. What could I have said? Saliva? Stale beer? Unicorn tears? I just recall butting to the front of the line to drop the thing off and getting the hell out of there as quickly as possible.

This time I was a bit smarter. After spending almost all of Sunday within 100 feet of our refrigerator and the J.O.P., as my husband called it, I got up early this morning to take the goods to a nearby lab. I put the container in a Walgreens bag. Then, I put that bag in a Target bag, and tied it up. Then, I put that bag in a fashionable blue shoulder bag — perfectly sized for carrying snacks and cosmetics and gallon-size jugs of urine.

When I arrived at the lab, one of the technicians looked over my paperwork, then ducked into a room. She popped out moments later with one of those little cups, and explained that I’d need to provide a “sample.”

“Uh,” I didn’t know what to say. I’d been too successful in concealing my pee — and now I’d have to give more! “I already have some. I mean, I have a lot. In here.” I nodded toward my blue bag as if it contained a severed head or a stash of cocaine. Luckily, she understood, and whisked the whole thing away before bringing the blue bag back, empty.

And that was it. The whole exchange felt so anticlimactic, so . . . clinical. I mean, I know they’ll perform some tests and get back to me and let me know what’s going on with my kidneys, and I dearly hope that what’s going on with my kidneys is “nothing.” I guess I just expected a little more magic after all the effort I put into the process. Maybe I expected a lab technician to read the stuff like tea leaves and foretell my diabetic future. Maybe I expected to see it blessed like holy water or sprinkled ceremoniously into the St. Johns River. I don’t know. I feel like I at least should have received a badge or a medal — even a sticker — some reward for enduring the ordeal.

In exchange, I’ll appreciate the thought that I won’t have to do another marathon pee test for at least another several years. I never thought I’d be so grateful to use the bathroom like a normal person.

Wild Glucagon Chase

Sometimes, when everything seems to be as stupid as it can possibly get, a few wonderful people step in to remind you that there is normalcy and kindness in a diabetes world run by insurance companies.

Last week, I called my CDE to request a new glucagon prescription. I’d been without one of those trusty red boxes for a few months, and had been reminded by my husband about 673 times to get a new one. My CDE told me she’d send one in to the Walgreens down the street from my house, and I went on my merry way, happy to have half of an annoying errand behind me.

I got a call from her secretary the next day. “It looks like your insurance company isn’t covering your glucagon,” she said. “So Cathy’s going to type up a letter of necessity and put it in the mail tomorrow.”

As distraught as I was at the possibility of fighting another battle with my insurance company, it was good to know that my CDE had my back. The woman never lets me down, and is always there to tell some doctor or insurance company how it is.

When I got to Walgreens that evening, the pharmacist echoed my CDE’s message. “It’s not covered,” he said, and handed me my other prescription. Which had this note on it:

What are these glucose tablets of which you speak?

I didn’t see the note until I got home, and when I did, I laughed. Hard. OTC glucose tablets available for low sugar? That’s like handing someone with a deadly peanut allergy a note that says “Epi pen not covered by insurance (or insuranse). OTC Benadryl available for allergies.”

I couldn’t NOT share this comedy gold with the rest of the world, so I tweeted the picture right away and posted it to Facebook. I expected some commiseration, but my DOC Fairy Godfather would take it a step further. The next morning, I got an email asking for my address. “I can get you some glucagon. It’s $30 on my insurance, I think. I’ll put it in the mail as soon as I can get my paws on it.”

I was touched. Not only was a fellow DOC-er and real-life friend coming to my diabetes supply rescue again, I would also get to participate in some illicit insurance-defying supply-swapping. I would get some glucagon after all — even if it was delivered in the dead of night by a carrier pigeon wearing night-vision goggles!

The next day I went back to Walgreens to pick up another prescription, and saw my favorite BFF pharmacy tech at the window. It was the perfect opportunity to bring up the “glucogen” issue.

“Okay, I know you didn’t do this, because you’re normal and cool,” I began.

“Oh God. What happened?” she asked.

I explained the glucagon and the crazy note, and I told her that if insurance wouldn’t cover it, I’d have to go ahead and buy it myself, because, well, I needed it.

“Of course you need it! What the hell is wrong with them?” Then: “Uh, do you know how much glucagon costs? It’s like 300 dollars.”

She told me she’d try to run it through a discount program. While she did that, I wandered around to survey eye shadow and shake weights. She had a surprise for me when I came back!

“It’s covered!” she called out of the little pharmacist cage. “They made a mistake the first time. I ran it again, and it’s covered! Thirty-five bucks!” We both did a little dance.

It was a happy ending, but I felt a little guilty. Here I’d inconvenienced my CDE, a friend, and all my poor Twitter followers who had to put up with my complaining a few days before. It wasn’t even my insurance company’s fault!

Of course, it was a frustrating experience, but it gave me a renewed appreciation for the helpfully wonderful and wonderfully helpful people in my life.

Here’s hoping I don’t need that glucagon, anyway. I’d rather take the glucose tabs.

Schooled

It seems like the more I learn, the stupider I feel.

That goes for National Geographic specials about the origins of the universe, the mechanics of the Internet, and — of course — diabetes gobbledeegook.

No one knows everything about diabetes management, of course, and none of us is perfect. But when I signed up for a few classes with Type 1 University, I thought I’d just be brushing up on a few of the main points and tactics that I’ve been incorporating into my daily life for the past 20 years. The remote classes are free throughout the month of January, so I didn’t see any harm in spending a few more hours soaking up some of the d-genius of Gary Scheiner.

It’s been two weeks, and I’ve taken two classes, and it turns out I am way dumber than I thought.

Did you know that the Ice Fish has an antifreeze substance in its body instead of blood? Also, I can use my CGM graphs to find out how long my boluses last!

The first class I sat in on was Mastering Pump Therapy. It was great; I received a PDF of the slides for the class earlier in the day, along with a link and a password for the online presentation. Then, I sat and listened and followed along. My husband sat in the next room, where he could hear the audio part of the presentation.

Every once in a while he’d say something like, “I didn’t know that! Did you know that?”

“Well duh,” I’d respond. “Yeah. I mean, no. No, I didn’t.”

I have a dog-eared copy of Gary Scheiner’s wonderful little book, Think Like a Pancreas, so there were lots of familiar points: how to test basal rates, adjusting insulin to carb ratios, etc., but there was so much more to learn. Like how to use temporary basal rates to cover PMS and exercise, and the advantages of dual and square boluses — tools that I’d never really employed before.

This week’s class, Making the Most of Continuous Glucose Monitoring, was even more enlightening, in part because I’ve only worn the CGM for about a year and a half.

It’s not necessarily that I’ve never gotten this information before, it’s just that I haven’t absorbed it all, I think. I’m so used to viewing diabetes education as boring and useless and largely terrifying. Part of my brain is still stuck in the old days, when it was all about remembering to eat a protein exchange before bed and promising to never wear sandals.

Type 1 University is all about strategy, though. I feel like, instead of being confused or frustrated by a slew of information, I’m learning how to pimp my diabetes — or at least my CGM.

Not surprisingly, all the classes for January are full, but I’m totally paying for a few more in the months to come. It’s a stupidly empowering feeling.

*No, no one paid me to write this. But the crate of baby sloths and lifetime supply of white cheddar popcorn I received certainly didn’t hurt.

**Just kidding.

The Beat Goes On

Since there’s nothing more riveting than reading about someone else’s health problems, I thought I’d close out the year with an update on my cardiomyopathy adventures.

Go ahead — pop some corn and grab a beer. I’ll wait.

So, since my last discussion of heart stuff, I spent about six weeks abstaining from alcohol, had two separate tests to determine my ejection fraction, and have received zero definitive answers. But I’m okay.

After a high-risk OB advised me of the dangers of baby-having with Type 1 diabetes and cardiomyopathy, she sent me to another cardiologist for a second opinion. And this cardiologist — who looks like Jodie Foster and sounds like Paula Poundstone, by the way — advised me to stop drinking for several weeks before I underwent more tests, just to make sure that alcohol isn’t a contributing issue for my heart problems.

Three weeks and many mopey evenings later, I visited the office for a MUGA scan, which is pretty cool in an I-can’t-believe-the-things-they-do-with-medicine way. First, the technician inserted an IV in my arm and drew a small vial of blood. Then, he sent me to a waiting room down the hall to watch Divorce Court and drink some water while he zapped the blood with radioactive thingies. Fifteen or so minutes later, he injected the radioactive blood cells back into my arm while I relaxed on a moving table. A giant camera moved around and took pictures of all that nuclearized blood moving through my heart, giving him and my cardiologist a better understanding of its strength.

“This doesn’t look like anything to get too excited about to me,” he said as he scanned the results. “But then again, I don’t have an MD behind my name.”

It was a small assurance, but I’d take it. I went back to speak to Jodie Poundstone the next week, and she echoed what the technician had said, and followed it with: “I don’t have any answers for you.” She didn’t see a significant change from my last echocardiogram, so she wanted to do another test — another damn echocardiogram. Which meant I’d have to go another three weeks obsessing over my health issues without a glass of wine to take the edge off. And in the meantime, no one had managed to get my records transferred from my previous cardiologist.

I was so frustrated. While my friends sat around on the weekends with cocktails and cold beers, I joined with my grapefruit La Croix, bitching to whoever would listen. “It must be SO NICE to be a Doctor! I mean, you don’t have to actually FIGURE ANYTHING OUT, right? You just order tests! And then when you don’t get a clear answer, you order MORE tests! And then you  get a billion dollars!” (I must have been a joy to spend a Friday evening with.)

I went back for my echocardiogram several weeks later, and then back again for another follow-up. Jodie Poundstone still didn’t see any difference — my ejection fraction was hovering in the low 50s, which is, as she called it, “low normal.”

“You’re asymptomatic, and you’re stable, and it doesn’t look like your EF has ever been lower than 49. I’d say keep taking the medication, and it looks like pregnancy is still going to be pretty risky for you.”

It was pretty much what I expected her to say. “Okay,” I replied.

“There’s always adoption and surrogacy and lots of other options for children,” she assured me.

“Yeah, I know. I keep telling my husband we can just order a baby off the Internet.”

“Well,” she said. “It’s not quite that easy.”

Yes, she thought I was serious. She really thought I was going to try to order a human infant from Babies R Us and have it shipped to my doorstep via UPS or StorkExpress or whatever.

It's the widest selection of babies around! On sale this weekend only!

She asked me if I had any other questions. Yes, I did. “Does this mean I can have beer now?” A girl’s got to have something to look forward to, right?

“Yes,” she said. “You can. This is not alcohol-induced cardiomyopathy. We still don’t know what caused it, but it does not appear to be influenced by alcohol.”

And that was that. I haven’t been back to the high-risk OB yet — and I’m not sure there’s any reason to. I’m stable (cardiologically speaking, at least), I feel healthy, I’ve got a solid supply of medication, and I’m okay. Christmas and work and a new house (and diabetes) have kept me busy, and I have a lot of things to be excited about — particularly the TeamWILD WILDfit program I just signed up for.

I may not be able to order a baby on the Internet, but there still are a lot of options out there for me. It could be that I don’t know what I’m talking about, or I don’t know what I’m missing, or I’m in denial, but I don’t feel like I need to have my own biological child, you know? Am I crazy?

Possibly.

In any case, I’m looking forward to 2012 being a relatively calm year (fingers crossed), in which I can get used to new realities and get better at adjusting to old ones. At the very least, I get to ring in the new year with real live champagne.