Tuesday, February 27, 2007

Giving In

Today, was our quarterly planning session for work. The weather was springlike, and I had been staring out the conference room winow from 38 floors up much of the afternoon thinking of what it would be like to be outside, rather than discussing new products and team dysfunctions.

When we finished up at about 4 pm, I felt truly blessed by the opportunity to dash home and head out for a run in the park. Sort of like I was getting away with something naughty but fun even though none of us were heading back to the office. BG had been running high all day, and before I left for home it registered 228. Not great, but a good run should bring it down. So I cut my basal in half and drove home.

Changed clothes, leashed dog #4 (Katie, my running buddy), and headed out. Walked a little to warm up and then we started to run. Felt absolutely devoid of energy from the get-go, but figured I just needed to get the kinks worked out, get into the groove, or maybe find just the right song on my ipod. A half mile later, felt even less energetic. Thought "no way could I be low coming off that 228 and a reduced basal". Then I noticed that I was getting dizzy and felt detached from my body. The meter was at home, so I ate four glucose tabs and made a turn that would take me home. Katie was acting awful and trying to veer into the yards along the way...definitely NOT helping.

I got home in some state that felt like floating and lumbering all at the same time, and registered at 56 on the Flash meter. Not that bad, but that was after 16 grams of glucose about 10 minutes before. Made half a peanut butter and banana sandwich and sat down, just in time for hubby to arrive home. He asked if I was low, and I said yes. I don't know why, but peanut butter is a favorite low chaser for me, and he knows this.

Instead of treating the low and then getting on with life, I gave in to it this time. Told hubby that I wanted to skip the gym tonight, to which he was totally agreeable. I felt terrible, still devoid of any energy or drive to accomplish anything. It is such a desparate and out of control feeling. When my BG is coming back up, I have a tendency to get cold, so I covered up and invited Katie to lay down with me. We napped for about 20 minutes, and then got up to make a dinner of frozen thin crust pizza and watch American Idol.

Giving in to a low like that, skipping a workout night, and not marching on feels like a defeat in some ways. But on some level it also feels like a victory in allowing myself to be vulnerable and human. This disease is a teacher in forgiving myself and others, and for that I am grateful. But it is also a b-i-t-c-h!

Saturday, February 17, 2007

New Endoc Visit

After going to the same endoc for over 10 years, I went to a new one this week. I got my A1C results in 7 minutes, as opposed to waiting over a month to get them from the previous endoc. Also got my cholesterol results right there. A1C was 6.5. down a smidge from 6.6 last time. At least I'm consistent. Total cholesterol 170, and HDL (the good kind) over 100. I guess the exercise is working since my HDL was in the 70's last time. Newbie doc seemed knowledgable, but not pushy or arrogant.

Noone wanted to download my meter. I offered it to the nurse, but she declined. The doc asked about my sick day mgmt plan, which is a good thing to review every so often. Since I knew about basal testing, insulin to carb ratios and correction factors, he commented that I had already been well trained, and didn't really offer any suggestions. We did talk a little about how I handle exercise, but no new suggestions. We talked about options for replacing my pump and I got current #'s for the local pump reps. We talked about the pros and cons of CGM. He is close to home and work, affiliated with my local hospital of choice, and knows my other doctors. He checks cholesterol at every visit. And he will not insist on seeing me every quarter, and said every 6 mos is OK. Ran some other lab work with results to come later.

Overall, I think it went well and am comfy making this change, but I still left feeling just a little let down. This is such a self-managed disease, and most of me is really glad for that since I'm pretty independent by nature. But there is another small part that would like to feel that someone knows some tricks that I don't. Or that someone wants to look with me at the downloads from my meter and help me to differentiate the forrest from the trees. The only person who has ever done that with me was my dietitian/cde, who is now working for Abbott. I think I miss that a little bit.

Saturday, February 3, 2007

Wellness Program or Intrusion?

On Friday, I and a couple of others from my company met with a sales rep from a national chain of health clubs that is venturing into the wellness and health insurance brokerage arena. They can bring folks in to do blood draws and adminster health risk assessment questionaires to our employees, and then provide each employee with a nice color booklet with their results, explanations, and graphs. They will also provide the company with a composite snapshot of the same, just with no names associated, so we might know what wellness activities to target. For folks who have severly out of range test result(s), they will have a nurse call the employee to recommend a course of action (likely...get thee to a doctor). So far I'm OK with all of that.

From there we started to talk dollars and measurements. We asked...if the company invests in these things, how do we know its doing any good and can it help with our health insurance rates? Mr. Sales Rep suggests offering incentives...those who participate pay a lower percentage of their insurance premiums than those who don't. One of the offerings is a "life coach" who will help employees who are identified through the testing as at risk or with health conditions. The employee will talk to their life coach and get pointers on managing their condition or risk factors.

At this point, my business hat is pushed aside as the hair stands up on the back of my neck. I maintain my cool, but inside am thinking...no way, no how, do I want someone from a call center who probably doesn't know anything about me or the difference between T1 and T2 "coaching" me. I can hear it all now...

Me: Hi Coach, I cannot figure out why my overnight basal rates are working some nights and not others. Some morings I wake up at 120, and others at 225. What gives?
Coach: Carol, we would suggest that you take your insulin as presribed and get exercise at least 3 times a week. Oh, and 120 is above the clinical guidelines for fasting glucose, you may want to see your doctor.
Me: I know that, I pump Novolog, run 20 miles a week and lift weights 2 to 3 times. Now could we get back to my basal rates?
Coach: What is a basal rate, and what does inflating your tires have to do with anything?
Me: Slams the phone down, knowing I will be labeled as noncompliant and that I'll pay more for my health insurance because I don't want to participate in the wellnes program.

I guess this is a selfish view, because I know that there are folks who would be helped, primarily those who have not sought out information about their conditions or risks on their own. But the thought of spending more time on diabetes, especially if it does not help, is enough to make me want to scream.