Double Duty Test Strips

After sitting down and taking a good look at my blood testing habits, I decided it was time for a change in the old routine. I was drawn to this conclusion after obtaining and implementing a copy of Kevin’s data tracker program. It shows a line graph representation of the BG readings for the day, week, weekend, and even averages for these. It also showed me a lot of gaps in my testing through the day.

I decided eight tests a day would be a reasonable goal to shoot for and went forth to make it so.

I knew from my past experience that if I just started increasing the number of times I test, I would run out way before my insurance would allow a refill. So I set out to the pharmacy to request more strips per insurance cycle. They informed me that a faxed request would be sent to my doctor and they would give me a refill size worthy of the 8 a day prescription, when it was approved.

Well… I went back the next day, then the next day, then the next. No response from the doctor’s office. A part of me thought it could be due to the fact that I had not seen this doctor in over eight months, having recently moved to a distant city.  Regardless of the reason, I was officially out of test strips that day, and the pharmacy crew, especially the pharmacist on call, sympathized with my plight. “Out of test strips? That won’t due”, he piped up with. He ended up writing a prescription for me himself, for 200 test strips. Not as many as I had originally hoped for, and no refills either. No worries. This stash, I knew, would get me through the month.

The biggest shock was at the price. At $104.99 for a box of 100 strips, I expected to pay twice that for the double dose I was about to receive. To my surprise, the bill ran up to only $147.05. I had no idea the per unit price would be cheaper if bought in excess amounts! So now, each test strip would cost me $0.73 cents instead of the more gruesome $1.05. That was a bright side to the situation if I ever needed one.Now I await next month’s supply, in hope that all will be resolved.Here’s to eight times a day!

Berry Blood Sugar

Pancakes for breakfast!

Now, normally I would not get excited about pancakes. Truth to tell, I am not much of a breakfast person at all and prefer my mornings to start with the basic cereal/fruit tag team. Cherrios and a banana please! But this day, however, is special. Julie whipped up some ‘cake batter and a very delicious (semi)homemade topping as a treat.

It started the day before at Trader Joe’s, the local grocery with all the essentials… that even extend to the exotic and organic in nature. The necessities list looked like this: 

• 1 bag frozen mixed berries
• 1 bottle maple syrup
• 1 carton eggs
• 1 gal non-fat milk
• 1 pint buttermilk
• 1 bag whole wheat pastry flour
• 1 bag whole purpose flour

The grocery checker inquired what kind of dessert was in the process. I shared with him that no dessert would be happening tonight but… the pancakes may have an early appearance if I’m not patient enough. It was looking like a solid flavor wave of foodstuffs.

Fast forward to next morning…

Ingredients were masterfully put together for the pancakes and began their trips to the burner. One after the other, slowly and surely cooked up and placed in the ember-like heated oven to keep warm. While those happened, the frozen berries were blended, heated and strained. An accompaniment of maple syrup stirred in with the berries and it was ready-to-go homemade Berry Syrup.

A natural insulin bolus insued and the matching amount of ‘cakes and syrup was devoured. Yum!

It was one of those instance when guessing is the best one can do. I really had no idea exactly how many carbs were in each pancake. Or how glucose rich each tablespoon of syrup was. Past experience and a little diabetes know-how led me the direction I needed to go. Sugars turned out good afterwards!

I decided it was time to put the berry syrup to the test, however…

Here’s non-diabetic Julie with a well formed syrup “blood” drop on her finger.

She can test with the best of ‘em!

And the results are: Five, Four, Three, Two, One…

Ooooh. That’s some sugary, berryful, stickable, lickable goodness!

If I Were a Number: I Would Be “65″

That’s right, “65″. It seems like every time I turn around, my blood glucose meter is spitting out a “65″ at me! It is getting to the point where I think “60-64 and 66-69″ don’t even exist, all defiantly rounding to “65″. How can so many morning, post-meal, and otherwise random blood sugar checks lately end up at this attention deprived little number?

I have a theory…and a solution.

• I am stressed out.(that’s the theory)
• My body is pulling in extra glucose to keep me caught up with the stress.(continued theory)
• Down with the bolus and fine-tune the basal.(the solution)

Not that I am particularly worried about my lowly number’s common debut, I can always catch it in time and, honestly, I think it just stops there. Or maybe… by the time I feel low and test, the glucose is always at the same point. Whatever the case, I can function fine short term there, and am taking action against it.

I deduce that the arrival of semester finals, the summer work search, new health insurance hunt, and insane California gas prices (had to throw that in… $3.69 a gal…. grrrr) have me a little more worked up than usual. And all of that time-consuming stress has increased my carb needs and slightly lowered my insulin needs too. Did you know that they say that peforming mathematics increases brain function and also need for energy too, thereby lowering glucose levels? Neat, I know! But also an added culprit in my lows.  

So my morning routine is to crawl out of bed, poke a finger and get a fasting blood result. Then comes the daily dose of Lantus. “Thirty-four units please”, I tell the fridge door as I pull out the lonely vial. I say lonely because, come on… locked away in the butter compartment with only some solidified, churned milkfat as a bunk-buddy… not my idea of good company! And then, some days, after the Lantus, and depending on the fasting result, a friendly Novolog bolus is taken.

I have decided that cutting back on my morning Lantus cocktail is needed. I think “Thirty-two units” sound better anyway. It is the number twenty-three in reverse, a well-known number in my family! We’re talking three birth dates, and an anniversary date in my immediate family alone. I have lowered my basal dose in the past when needed, and it definitely helps.

Lastly, I have cut down a little on the after meal bolus calculation. (Yes you pumpers- I am still doing them in my head… though not for “long”, I hope). And when I say cut down a little, I mean just a small percentage less. I normally go by these figures: One unit of Novolog for every 10 grams of carbohydrate intake. I figure about a 30 percent decrease in that figure does what I need.

ie: If my meal has 60 grams of carbs, I will take 4 units instead of the usual 6. This is just a rough idea though, as trial and error has shown me that certain foods still need their own special dosing… as do special situations.

I feel comfortable making this change as I have done it in the past also. As long as I maintain blood sugar checks throughout the day, it will be all good. And hopefully leave me a little farther north of that “65″ that tries to keep me down. 

Reviewed: Kaplan-Mayer

My desire to start insulin pumping led me to seek out some expanded information on the subject. I felt like I knew the basics… the cannula site goes under the skin, the tubing feeds to the pump and fills up with rapid-acting insulin, and the pump sets the stage to deliver the desired amount. A carb count here… a bolus wizard calculation there, and all is good. Right?

Well, Gabrielle Kaplan-Mayer delves deeper into the expanded world of pumping in her book, “Insulin Pump Therapy Demystified“. For the better part of seven years, Kaplan-Mayer herself has been on insulin pump therapy. She takes her experiences and knowledge, along with many testimonials from other pumpers, diabetes experts and other health professionals and puts them in this book. The goal- to make insulin pumping less confusing and much more relatable to those possible pump candidates out there.

Select sections include: Sex with the pump, cost of pumping, help choosing the right pump, sleeping with the pump on, and even airport security checkpoints…and the pump.  Most sections begin with just a brief overview of the topic at hand and widen into more detail with lists, tips, asides, and relatable info. A lot of the pages are written in question/answer format also. As if written coming from the mind of a to-be pumper, questions are formed in bold print and promptly answered by easy to read and to-the-point succinct paragraphs.

This book is for the pumping novice. It is for those who like their answers in no-nonsense form, free from jargon or lengthy additives. It is for this reason that I found myself wanting more after my paper bound excursion. I was fairly adept to the grand pumping scheme of things. I knew the “nuts and bolts”. And through my expansive blog network on all things diabetes, I had read first hand a lot of tidbits from OC pumpers themselves. What I was hoping to find was more detail on the mechanics of the pump and deeper interpretation of the menus and functions that await inside. What exactly does a square-wave bolus do? A dual-wave? How are basal rates determined and what ease is there to programming them into the pump? These kinds of things are not discussed in the book and must be searched out in other places.

Overall, “Insulin Pump Therapy Demystified” was a short and easy read that helped organize and answer those curious questions about life with a pump. I felt there was room for more elaboration on pump types and a further expanded list of manufacturers.  Also, somehow overlooked, there was a small bolus calculation example towards the end- with an error in the math. Small things like this may have taken away, a small fraction, from the overall satisfaction for me, but I do not regret the time I put into the pages.

I mostly appreciated the authors interviews and real life success stories from high, and low, profile pumpers. It definitely showed how beneficial pumping is to a majority of insulin dependant people with diabetes.  Kaplan-Mayer is a highly positive writer with a knack for making the reader feel at ease about pumping. I am looking forward to my journey of pumping insulin and I will say that the $15.95 Barnes and Noble price tag was worth the added comfort and excitement it brought about my new upcoming venture.

In part: buy this book if you are a true novice to what insulin pumps are and how they affect daily life.

Pop-Top Lantus

Day number twenty-eight was upon me. And how about that- the Lantus vial <loading syringe>….is…tapped…out. Good timing I would say. No wasted insulin and no early trip for a refill. Nice!

I went to the fridge, lifted the butter compartment flap and pulled out the new vial, all boxed up and sanitary. I activated the calender on the computer and counted- one, two, three, four weeks to make note of the twenty-eighth day upon which the new vial would expire. May 30th it is. I pull out a pen and jot it down on the outside of the box. I know if I don’t write it down immediately I will hopelessly lose track of when it should be tossed out. Maybe I can go twenty-nine days or even thirty-plus and be okay, but I don’t want to risk having ineffective long-acting in my system.

I neatly lift open the top tab. Pull out the paperwork of insulin info, and also pull out the vial. Flip the paperwork upside down so it makes a u-shaped “pouch” and push it back into the box. This makes a nice cushion for the vial and keeps things from shaking around more than necessary.

I grasp the new vial in one hand, and with my thumb under the purple cap, flick upwards- as if flipping a coin to decide punting order for the big game. With my intentions being to catch it mid flight, I watch as it flies across the room and smacks the wall. ”Man, I need to practice my execution”, I think.

What I hold in my hand after, is a little bit of an oddity. The punched-out “metal cap thing” was still hanging on by a thread. I assume it was not properly punched out at the factory and was able to luckily escape it’s way into my fridge. No worries, pinch and pull and it is gone.

One of those weird situational happen chances that I wanted to share. And despite the small defect, I still love my little life giving vial all the same.

Stain Be Gone- Tide’s Formula for Ease

Julie to the rescue! My fully prepared girlfriend springs into action yesterday… saving my shorts.

On our way out the door, I took a thigh injection to do a small blood sugar correction. All was good and I was ready to continue with the day. A sharp annoyance, however, caused me to do a double-take on my recent site. With down-turned eyebrows and forcibly wrinkled lips, I lifted up the cuff of my shorts and inspected the perturbance. A smear of blood on my leg and wouldn’t ya know it… two small spots of blood had soaked through my shorts. Wonderful.

I wasn’t so much upset at the stain as I was the hindrance on my forward progress in the day. Diabetes had lassoed me in, forcing me to see who was really running the show.  

Making me deal with the situation at hand- both of us delay our planned venture. “Hold on, let me run this under cold water and clean up”, I tell Julie… already on my way to the sink. She stops me and suggests her own remedy. Tide pen to the rescue.

Out from the purse and poised for action, the stain removal pen was quickly activated for duty. I steadied the fabric with my hand pressed underneath. She quickly dotted the first blood spot.

A foamy chemical reaction occurred and it bubbled up in the shape of the to-be vanquished spot. A couple more dottings and a good swirl for safe measure. The spot seemed gone.

The next spot had time to watch, and knew it’s short lived life would also be ending soon. Sure enough, in under a minute of time, all the blood was gone from the fabric of my shorts.

What could have been a cold, wet, messy clean-up was rather quick and painless. Julie suggests we should go buy one for my own supply…stowing it somewhere in my truck for future “emergencies”. I quickly brush off the suggestion, in my head, and make some sort of manly pose. A stain removal pen… for cleaning laundry… stored in my truck? Wasn’t gonna happen.

The fact of the matter is… if I had my own stain remover I risk losing some of that personal attention that I so need now and then. Having someone there to look after me in my fleeting times of need sure is a comforting thought.

Thanks, Julie, for having my back.

Needles Anyone?

It would seem that I was the one responsible for not being able to hold on tight enough to that cumbersome Merry-Go-Round. However, after thorough CSI style investigation, it appears to have been sabotage after all.

I went to the pharmacy to pick up some more insulin pen needles and was greeted with bad news. “It appears to be too soon for pick-up on these-your insurance won’t cover them until four days from now”.

Par for the course-issues at the RX counter!

In need, I decided I would have to pay for them out of pocket. Thirty-Five dollars for a box of 100 novofine needles. “When did I have these filled last?”, I asked. Typity typity typity…… typity typity goes the pharm. tech into my account history. “It was a while ago, this can’t be right”, she says.

She continued talking, incoherently mumbling some sort of whodunit theory. ”I’ll call the insurance company, give me a minute”, she says.

<behind the counter>-rambling off prescription codes into the phone, and pharmacy store numbers, and her employee number and title…..then my name and date of birth and other necessary stats… I wander off.

Not two minutes later I make eye contact and see she has completed her investigatory stint.

Here’s the story:

My insurance lacks the ability to separate syringes and pen needles for my coverage. Even though they are two separate prescriptions and have different uses(for different insulin even), syringes and pen needles are one in the same on their end of the tug-o-war rope. The computer saw that I picked up syringes a week earlier and then concluded it was too early for more needles of any kind. Agreeably, they ok’d the coverage of pen needles for that day, under my usual fifteen dollar copay, and instructed for them to be called in the future every time I need pen needles within close proximity to syringes. Geesh! One more step in this game we play!

What kills me the most is their inability to just (Fix!) the problem. Instead, it is now on me to keep track and have the pharm. tech call the blasted insurance company (Every Time!) this scenario of prescription pick-ups occurs.

Hooray! Diabetes is fun!

Merry-Go-Rounds Are Fun…Usually

It’s only syringes I tell myself. They gave me twenty more to get me through until the shipment. I can go back next week and pick up the rest.

I don’t want to go back next week!

I feel like my schedule is ever revolving around my prescriptions. It’s like a merry-go-round that, when gripped properly, and given complete focus can be a smooth breezy ride. Don’t lose your grip though- or a future of tattered clothes, bruised  appendages, and mega grass stains will be in your future. 

-This was two weeks ago.

I ended up picking up my syringes refill (box of 100) last week. (A little delayed to post about… but today’s pharmacy excursion made it all relevant again!)- More on that in the next posting.

Why is this happening? The pharmacy tech fills me in that they “don’t have them”. That’s helpful. After some coercing and brief conversation I find out that the shipment they were supposed to receive did not come in. Why are they so under stocked- that they need to operate shipment to shipment? I deduce that tiny pill monsters hidden in the medicine bottles must have screwed with their inventory. I go with this theory because I don’t want to believe any other real world scenario.

One day when I move out of my apartment and into a house (with a safe porch for deliveries), I will bypass the pharmacy and get supplies delivered. Maybe this will help eliminate the back-and-forth needed to keep my drawers stocked.

Time will tell. Gotta deal with the present for now.

Reviewed: Hirsch

James S. Hirsch covers the spectrum in his book, “Cheating Destiny: Living with Diabetes, America’s Biggest Epidemic”.

I recently ended this book’s journey of diabetes. I will say- James Hirsch writes a compelling story/autobiography/scientific journal. Covering the gamut of diabetes related topics, from the history of diabetes and insulin… to intimate personal stories… to others’ stories… and to new technologies and the future of the disease.

I found myself looking for perfect locales to devour the pages. While on campus, sunny corners abound and give of themselves as a place to relax. A pyramidal concrete structure became my unfailing sit while reading. Above grade, a ledge allowed my left leg to hang down, and a patch of grass for my bag lay to the right. Even the trail of ants in the connecting concrete corners did not detour my readings. Save when a good flicking was needed to halt their climb on my bare toes.

Any person with diabetes can relate to this book. Unwelcome “HI” messages, and stories of unquenchable thirst are discussed in the pages. The unfortunate timing of Hirsch’s young son’s development of T1 wells up your eyes and makes you demand a cure-right along with the author. Any person without diabetes can embrace it also, obtaining insight on a whole new world.

James S. Hirsch skillfully shows his passion for the disease along with his expertise in creating superb literature. Former reporter for The New York Times and The Wall Street Journal, reading his words was a pleasure. 

The author’s outlook on diabetes can at times be grim, often cursing the lack of forward progression of a cure. As you read he will discuss a technology, a management technique, or the like, and write a sentence or two of his own thoughts-be it of support or criticism.

Lastly, be impressed by the extensive research and personal interviews he conducted. People touching the diabetic world are introduced all throughout the book- ending with researchers and doctors who offer insight on the future.

After hunting two local Barnes & Nobles and a Borders(to cover my bases), I ended up ordering the book in-store. After a quick phone number, home and e-mail address, I was in the system and contacted, shortly, days later. At $25.00 retail, and a 20% off customer card, I scored “..Destiny..” for a comfortable $20.00.

Many others have also read and reviewed “Cheating Destiny” and posted on their respective websites. Check out some other blogs to soak up more observations.

In part… Read this book