Saucy

My husband I have just returned from a very nice dinner out with his grandfather, who happens to be 94 years old. He also happened to travel 2 hours from New York City to Providence...just to have dinner with us. He's truly a fantastic individual.

Selecting a restaurant is a bit of a tricky task when he comes to visit -- we have to find a place that qualifies as fine dining (he has a discerning palate) but also one that is quiet enough to carry on a conversation considering his hearing is not what it used to be. The typical corner joints usually don't fit the bill, and so we end up at places that get quite creative with their menus.

Eating out in general is always an adventure in blood sugar management. See how positive I was with that descriptor? It's an adventure. I always pick dishes that SHOULD be low carb, but somehow end up with blood sugars that skyrocket in defiance of my choice. Sauces are almost always to blame...restaurants are SO GOOD at hiding sugar in pomodoros, Indian curries, Thai sauces, etc. But tonight was a particularly ridiculous example.

Upon scanning the varied menu, I skipped over pastas and demi-glazed meats in favor of a dish simply called "shrimp + scallops". The plus sign was probably foreshadowing all the insulin I'd be adding to myself afterward. I swore the sparse caption underneath mentioned pearl tomatoes and fingerling potatoes. Totally carbohydrate countable options -- minimally guessing required.

What I received defied my taste buds. The shrimp and scallops were artfully placed over three side-by-side mounds of what I thought, on first glance, were grated potatoes. My first forkful sent my tastebuds into a sugary explosion, prompting me to finish the first mystery mound just trying to figure out what I was eating. There were bits of sweet corn imbedded in the display, so at first I thought it was just really ridiculously sweet corn. But my carbohydrate radar was going haywire. It couldn't be the corn.

When the server returned to refill water glasses, I asked him to remind me what I was eating as I pointed to the remaining two mystery mounds under the seafood.

"Oh yes, " he said as he clasped his hands together in delight, "that is spaghetti squash prepared in a bit of olive oil and then thoroughly doused in pure maple syrup."

I choked on his words. He used the words "doused" and "maple syrup" in a sentence describing my plate.

Who am I? Buddy the Elf? Who does this to dinner food?

Needless to say, I made my husband finish off my plate (because I felt like it would be rude not to finish an entree the server was so excited about) and I neurotically checked my continuous glucose monitor for the remainder of the meal. I've been dousing myself in insulin ever since.

Nail-Biter

During my first year of Pedi Endo training, I hold the on-call emergency pager for 6 months out of the year. It can go off at any time of the day, as many people have the number. Mainly, the doctors in the children's hospital and Neonatal Intensive Care Unit call with any hormone-related questions or about our admitted patients, the community Pediatricians call (for the same reason), and every single one of our patients has the number for any issue that may arise. Every single patient.

It can make for a lot of pager ringing.

When I hold the pager, I put other things on hold. Things like going to the movies or nice long baths, because it wouldn't be worth it if I got interrupted by an urgent call. I don't mind this in the least -- it is what I signed up for -- but I am sure to take advantage of the time I do NOT have the pager.

So last week I went to get my nails done, something I don't dare do with the pager in tow. It was a late Friday afternoon and the salon was packed. I picked out one of my favorite colors (a grey hue named Smokin' Hot, which is partly why I love it so much) and flashed a peak at my continuous glucose monitor. It was telling me my blood sugar was 80 mg/dL with a southeasterly arrow indicating that I was potentially headed toward a low. I popped a sugary mint in my mouth and dialed down my insulin pump before I sat down for some pampering.

Half-way through my manicure I start to feel smokin' hot, but not in the way the nail polish intended.  I had suddenly broken out into a clammy/flushed/word fumbling mess. I asked the nail lady to please hold on as I gingerly tried to search my purse for sugar without ruining her work. During my search, I didn't find anything sweet but I DID find my CGM all red and angry, screaming that my glucose was 55 mg/dL and dropping. After what my hypo-brain thought was 5 seconds but was probably closer to a minute, she asked if something was wrong. 

"Do you happen to have anything with sugar in it?" I meekly asked her.
"Do you have diabetes?" she asked, her eyes widening in concern.
"Yes, and it's so dumb because I always carry something with me but I switched purses and forgot to transfer it," I replied.

She shot out of her seat, ran over to one of her co-workers and whispered in her ear. They both started frantically searching the drawers in the nail work stations. The woman sitting next to me took note, and her eyes caught mine.

"Listen, I don't want to intrude but I overheard your conversation and I just wanted to let you know that I'm a doctor and I'm concerned about you," she whispered to me.

"That's so funny! I'm a doctor, too! It's pathetic. And you know what is even more pathetic? I am a Pediatric Endocrinologist. I TREAT KIDS WITH DIABETES AND THIS IS STILL HAPPENING TO ME," I confessed to her.

"That IS pathetic," she said with a smile.

At this point, the entire salon was searching for something sweet to give me. Finally, a woman in the far corner triumphantly shot her fist into the air, her fingers tight around a tube of Mentos as if she had found the holy grail. 

The salon collectively breathed a sigh of relief and I gratefully stuffed my mouth with 4 or 5 of them. Fresh-maker indeed. I was feeling much better after a few minutes and my manicure resumed. Turns out I didn't even need to be holding the endocrine emergency pager to have an endocrine incident interrupt my me-time. 

Freaky Friday - DBlog Week, Day #5

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

So many chronic disease, so little time.

The truth is, I appreciate that Type 1 is a chronic disease that - if done right - is one that can potentially make you healthier than you'd be otherwise. All that carb awareness and exercise. Good stuff. And even though pricking fingers and injecting insulin can sting, it doesn't hurt nearly as bad as a Sickle Cell crisis or Rheumatoid Arthritis. 

But if I HAD to switch, I'd choose a chronic illness that is way less high maintenance than diabetes. And being that I work in Endocrinology, you know I simply must choose something hormonal.

So I pick Hashimoto's thyroiditis, otherwise known as autoimmune hypothyroidism. It's still an autoimmune disease that destroys a hormone-producing part of your body, but replacing thyroid hormone is like pre-school compared to the university-with-summer-school-followed-by-grad-school that is insulin replacement. 

One tiny little pill per day instead of multiple injections? Only worrying about taking the pill on an empty stomach instead of timing insulin 15 minutes before eating? No immediate adverse effects if you forget a dose? Not having to count every carb? No thyroid hormone swings with food, exercise, stress, or just breathing? One doctor's visit per year instead of every 3 months? One lab draw per year instead of 8+ finger sticks per day plus annual lab tests? Yes, please! PLEASE!

And I know there are plenty of people with diabetes AND hypothyroidism. About 10% of Type 1's, to be more precise. But the deal is to swap, not to add on. If I can't swap out for hypothyroidism, I'll just stick with my current sweet ol' type. 

Click for the Freaky Friday - Friday 5/17 Link List

Accomplishments Big and Small - DBlog Week, Day #4

We don’t always realize it, but each one of us had come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years, you’ve done something outstanding diabetes-wise. So today let’s share the greatest accomplishment you've made in terms of dealing with your (or your loved one’s) diabetes. No accomplishment is too big or too small - think about self-acceptance, something you’ve mastered (pump / exercise / diet / etc.), making a tough care decision (finding a new endo or support group / choosing to use or not use a technology / etc.). (Thanks to Hilary of Rainie and Me for this topic suggestion.)

I would not be writing this blog today if it weren't for my decision to finally start seeing a counselor for my very deep dark Diabetes denial.  I was a perfectionist in every aspect of my life - especially school. I was incredibly hard on myself in order to achieve my best possible results. Except with diabetes. And because I wasn't conquering it, I started ignoring it entirely. Guessing insulin doses, not testing for weeks on end...this went on for almost a decade. 

During this time I was on a horrible 3 month cycle -- diabetes appointment with horrible A1C, ugly cry with empty promises, repeat. Each time I convinced myself that I didn't need anyone else to help me. Every other goal I had set out to conquer I was able to accomplish all by my lonesome. Diabetes was supposed to be no different, but it was.

Something clicked inside of me during one of my subsequent ugly cries in front of my Endocrinologist. The words "I need help" came creeping ever so quietly around the lump into my throat and into the open air. Exposed, vulnerable, desperate words.

I was given the number to a counselor who only treated people with diabetes. She was a godsend, and I credit her with saving my life. She didn't just save it, she gave it back to me all shiny and new.

Through counseling I realized that suppressing my fears and anxieties about diabetes was incredibly exhausting all those years. It was even more exhausting to expel them, to open myself up to a stranger about a topic I couldn't even talk to myself about. But after each session I would float out of that office, lighter than helium. I was free floating into happiness and health and a normalcy I didn't know could exist alongside diabetes.

I started talking to other people through support groups. I got introduced to the DOC, and the DOC blogosphere. I now have the best A1Cs of my 20 years of this disease and I look forward to (hopefully) tackling a scary thing like pregnancy in the future. I never thought I could do it, but I am.

I am. 

Click for the Accomplishments Big and Small -Thursday 5/16 Link List

Memories - DBlog Week, Day #3

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

It was 2 months after my 9th birthday. Only 6 weeks after my diagnosis. 

I sat in my parents' bathroom. My skinny, bare legs pressed against the cold marble step leading up to the bathtub. I noticed how the orange plastic cap of the syringe in my right hand perfectly matched the skin of the orange I was holding in my left. My eyes darted from the syringe to the orange, the orange to the syringe, but otherwise I was paralyzed by fear.  

I had practiced injecting the orange and now my left thigh was slated to be the next target.

My father was right next to me, but he sounded so far away as he whispered words of encouragement. "You can do this, it won't hurt. It doesn't hurt when we give you your shots." 

I was frozen. A fat, salty tear rolled down my cheek and several more followed suit. They threatened to melt me into a puddle on the bathroom floor. 

I sat on that step in the bathroom for over an hour. I did not question why I had to learn to self-inject that day, instead of the next day, or instead of years from then. My third grade brain did not process that it was just too young to take on such a responsibility because it was just that - too young. I could see the worry furrowing my father's brow and kind, patient eyes as I refused again and again. I didn't like for my parents to worry, so I tried to stifle my sobs. It only served to make them louder.

As I proceed through my Pediatric Endocrine training I sometimes look back on that day. I've asked my parents about it and they explained that they were instructed by the medical team to make me as self-sufficient as possible. They were told that the earlier I learned to do things like injections myself, the more successful I would ultimately be. 

That belief has been shattered across the years, with study after study showing that the earlier the diabetes independence, the poorer the outcome. We encourage parents to continue to inject their children for as long as the child allows it. Hopefully, this memory remains just a memory for me and never a reality for future newly-diagnosed little ones.

We, The Undersigned - DBlog Week, Day #2

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

We, the teeth in mouths of Type 1 Diabetics everywhere, petition to end hypoglycemic reactions that occur immediately after we have been brushed.

I mean seriously, diabetes, seriously?! Right after a good brushing and Listerine-ing? It seems as though you sit quietly, rubbing your scheming diabetes-hand together until we have finished our bedtime cleansing routine. That is the only period in a 24 hour day when we DO NOT want something sweet and delicious swirling around us. Have you ever tried orange juice after minty toothpaste? Not a delightful combo, which is impressive considering almost everything is palatable when feeling low. 

What that, diabetes? Glucose tabs, you say? Like we really want to mash and grind SUGAR into our pearly white selves after undergoing vigorous scrubbing and flossing? That seems like a good recipe for insanity.

Being teeth, we are all privy to the fact that poorly controlled diabetes increases plaque formation and cavities. This is supposed to be from increased sugar in saliva when blood sugars are out of range. The head in which we rest is trying real hard to keep those numbers under control, but sometimes out-of-range stuff is inevitable. But you know what doesn't help AT ALL? Forcing us to chomp and get rinsed in pure, sticky sugar when we're at our very cleanest. 

So give hypos after night-time brushing a rest, diabetes. Cause we could really use some rest, too.


To read other blog posts on this topic, click for the We, The Undersigned - Tuesday 5/14 Link List

Share and Don't Share - DBlog Week

Hurray for DBlog Week! Here's today's prompt:
Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one's daily life with diabetes? On the other hand, what do you hope they don't see?

This topic is especially interesting to me, considering that I am a Pediatric Endocrinologist in training and that my Endocrinologist also happens to have Type 1. What are the odds?
That fact that we are both in medicine and both have the disease we treat makes for a peculiar clinic visit. On one hand, it's great because he completely understands the struggle. Not just what it is like to live with Type 1, but what it is like to live with the disease while juggling an insane medical training schedule. I enjoy discussing the differences between how my office runs compared to his, and the colleagues we have in common. When it comes to my diabetes, he talks to me professionally in terminology that is not watered down. I appreciate that.
With other providers, I worried deeply that I would be judged for numbers and A1C's that would not meet the expectation one would have for a physician with diabetes. With him, I can be completely honest about how I know that carb-heavy meals screw up by numbers but that I choose to eat them anyway, and that I still really, really suck at guesstimating the carb count in restaurant food. There really isn't anything I feel I cannot share. I feel much more at ease with this doctor, and although I still get the traditional pre-checkup palpitations, I find that I am harder on myself than he is on me. That wasn't always the case with previous Endos.
On the other hand, I wonder if this unique situation makes things too lax. He is definitely available if I were to need him, but he has verbalized that he trusts I can manage changes on my own. I worry that he puts too much trust in my judgement and my decisions because I am an Endocrinologist as well. The freedom is flattering and quite nice, but I wonder if I'd be better off if he insisted on keeping a closer eye on things himself.
If he was reading this, I'd want him to know that I love the candor and professional courtesy, but to not forget that I am in the patient role during my appointment, not the doctor role. But all things told, I feel incredibly lucky to have such an amazing Endo on my side :)

Click for the Share and Don’t Share - Monday 5/13 Link List.

Journeys

20 years ago today I was over 2,000 miles away in Mexico City and my parents were unable to wake me up from a nap. My 9 year old self was rushed into the hospital and I was discharged as a little adult, forced to mature overnight for Type 1 Diabetes.
I have never commemorated the anniversary of my diagnosis. Diabetes, or conquering another year with it, did not cross my mind as cause for celebration. It was just something I lived with and, for many years, ignored. 
Oddly, I find myself insisting that my patients remember and celebrate their diagnosis date ever since I began my Pediatric Endocrinology training. Seeing the struggle from the outside has given me stronger convictions about focusing on the positive.
One of my most favorite patients in diabetes clinic is a middle-school aged girl who was diagnosed almost one year ago. Her journey with Type 1 has been particularly grueling, as it is laced with anxiety and fear that stems from seeking perfection from an imperfect disease. She has avoided social activities and outings because she can only assure tight glucose ranges in the controlled environment at home.
Recently, she told me her family had plans to go on spring vacation to a beach across the country. She was so nervous about the thought of traveling and eating out at restaurants every night that she refused to go on the trip, and her family was so torn over her anxiety that they canceled it.
In a heart to heart conversation, I told her that I most definitely want her to learn how to do things like calculate carbohydrate ratios and inject insulin by herself, but that if she learns only one thing from me, it is that she cannot let diabetes hold her back from living her life to its fullest.  She promised me she would try.
Despite our exchange, I was sadly convinced she would not take that beach trip or any other for a long, long time. Work kept me busy for the weeks that followed, and so I was surprised to get a call from the clinic secretary announcing that my special patient was there to see me.
I quickly walked over to the clinic. I was so curious to know what prompted her visit, as she was not due for an appointment for 2 more months. She was waiting for me outside of the clinic doors with something hiding behind her back. With a beaming smile, she handed me a tote bag emblazoned with the name of the beach she had spent the last week visiting!  She excitedly told me to look inside, and I pulled out a beautiful photo album.
It was full of pictures from their beach vacation, along with hand-written captions. One depicted her on the beach, treating low blood sugars with juice and crackers. In another, she was swimming in the ocean, because “exercise helps keep blood sugars stable." The most touching picture of all showed her with an a bowl of ice cream the size of her head, with the caption reading, “My first time eating out since diabetes.”
Standing there next to me, she was pride personified. With misty eyes and a full heart, I hugged her and the gift that so beautifully represents the journey on which we Type 1’s are forced to embark.
So in honor of her, I will proudly acknowledge the anniversary of my diagnosis this year and each year to come. My 20^th Diaversary is today, her first is tomorrow, and we both have so much to celebrate.