A First-Person Shooter for the Chronically Ill

So, Day One and Day Two out of the way. On to Day Three of my experiment, but first, an analysis.

Think of all this terrifying looking math like you might a first-person shooter game. I've found thinking of this like a game is the surest coping mechanism. You're the shooter, you have a targeted goal, laws to follow, certain weapons and tools to help you, and some shifty little characters (namely glucose and insulin) that are sometimes friendly, sometimes dangerous. Here are the parameters:

Target blood sugar is 130mg of glucose (milligrams of sugar) per dL (deciliter) of blood (teeny tiny amounts of blood). 

Basal Rates (the steady "drip" of insulin throughout the day measured in percentage of a unit [U]):
          3pm-4am .50U
          4am-3pm- .55U

Insulin:Carb Ratio (how much insulin I get for every gram of carbs I eat):
          12am-1230pm- 1U of insulin per 11g carbs
          1230pm-4pm- 1U of insulin per 9g carbs
          4pm-12am- 1U of insulin 8g carbs

Correction Factor (mg/dL reduction per U)
To get there, I get 1U of insulin for every 36 mg/dL over 130 mg/dL I go.
           12am-12am (doesn't vary) 36 mg/dL:1U

My game here has yielded some interesting results. On Day One, I started out high at 281mg/dL, then had fabulous sugars most of the rest of the day. Around dinner they started to creep up, to 144mg/dL, then 224mg/dL, and then crashing from 157mg/dL to 31mg/dL. And a lot of frenzied rationalization ensued.

Yesterday, Day Two, was almost exactly the opposite in terms of results. My activities stayed the same (which is to say, next to nothing, unless you count reading Vonnegut's biography as strenuous), but the sugars were on some downward spiral. 113mg/dL to 251mg/dL, then 85, 43, 76, 59, 41, 38, and so I could finally get some rest, we ended the night with 113mg/dL.

While I'm tempted to let my frustrations get the best of me and call the whole game off, I have to keep in mind that it takes three days to establish a data set and determine what the trends may be. So whatever the results are for today will be the key to it all, I believe.

Test-Bolus-Eat-Wait-Repeat

So, before I get started, I would like to get my excuse-making out of the way. With the best of intentions, I had planned to blog once a week or so, but as irony would have it, my diabetes got so out of whack that there hasn't been much time for anything besides day to day activities and total panic.

But, in trying to turn that panic into something productive, I will pick up here with my exciting weekend plans.

At my last visit to the endocrinologist, I came in at an impressive 7.0 Ha1c reading, the best I've ever achieved. This puts my average blood sugar around 150 mg/dL; not low enough to make my husband feel relieved, but enough to bring my anxiety down to a low-grade ridiculous. However, starting on November 27, things went from ok to terrible. I managed to reach a new low, at 28 mg/dL during a sales meeting, in which I found myself slumped over an office chair for almost an hour while my friends and co-workers tried to bring me back to the land of the living. I couldn't be more thankful for that. Ever since then, I've noticed my sugars yo-yo pattern become more and more extreme.

This has become extremely stressful. Anxiety about unstable blood sugars is bad, and anxiety about unstable blood sugars accompanied by obsessive-compulsive disorder reaches a whole new level of hysteria. In an effort to try and regain some control, I reverted back to a lot of the tendencies I've had some success in suppressing: hair splitting and pulling, intrusive thoughts, compulsive organizing. Like any good obsessive-compulsive, I could see the crazy for what it is, and decided to make an early trip to the endocrinologist. Really, there are only so many times you can review closed customer files for phantom updates before I have some awkward explaining to do.

Basically what I was directed to do was a diabetic reset. My pump's settings were put back to a baseline, and I was instructed to stay in as stable an environment as possible and monitor continuously to find the trends and, therefore, the problems. Not the "Erica had a bad day so now her sugar is 248" or the "Erica had a blueberry muffin and couldn't find the exact carb calculation for that particular muffin, so now her sugar is 53" kind of a problem.

So here I am, at home for the next three days, recording all my food, insulin, stress, and activity. I feel very inert, but maybe that's what I need to keep me from being unstable, as fun as that hysteria is.

Obsessing over your holiday party? Or, compulsing around the Christmas tree.

It's the holiday season (as the incessant Christmas music insists), and around this time many of you may be planning a  party to celebrate the special day of your choice. You may have your own traditions, but my family is decidedly secular, bordering on hedonistic. This year, we decided to throw a tacky sweater party. It's a great way to kick start the holiday season (apologies to your Nonnas' and their wardrobes for the mockery I have made...), and if you would like to throw one or something like it, I have prepared a list of important considerations below:

First and Foremost- Get Your Attire Together
(A clothing-themed party requires more obsessive nit-picking than usual)

• Any old sweater simply won't do; it must be obtained via home crafting, a legit thrift store, or an old lady's closet, preferably one that doesn't get the joke.
• The appropriate level of tackiness must be met; too little embellishment and you simply can't dress, too big or small and you'll be too uncomfortable in your ill-fit sweater to enjoy the party.
• Dangling ornaments or flashing lights attached to said sweater are a major plus; but only if you can somehow wash it before wearing. (Very important!) 

Second- Write Your Guest List
(Even numbered lists are best, if possible)

• Determine how many people can comfortably mingle at your place. Don't forget to account for your furniture when calculating your square footage!
• Couples always make for the easiest lists; if you have single friends, invite them in equal numbers.

Third- Food and Drink
(An area ripe for the obsessive-compulsive picking)

• The food must follow a theme. Off-theme food items are obviously inedible.
• It is critical to estimate the confirmed number of guests:snack ratio. 
• Once the ratio has been determined, snacks must be arranged symmetrically on appropriately festive serveware (asymmetrically arranged food is also inedible). 

Fourth, and Most Importantly- Decorating
(Ah, the crucible of holiday-esque compulsive activity)

So many choices! The tree is a great place to start, and remains my focal point.

• How symmetrical is your tree? Do you need to trim any of the branches to even things out? Don't be afraid to prune!
• Are there an appropriate number and variety of ornaments? Are they spaced proportionally around the tree? Because, you know, if they aren't it's going to be a major distraction and ruin the entire party.
• Does the tree skirt need ironing? Will a tree skirt made entirely of cheap poly-blend and glitter glue melt if you try to iron it? 

Ah, now the house is complete, and you can throw your tacky sweater (or insert alternate theme here) party. Everything is appropriately spaced, placed, ordered, and obsessed over. You may even be able to pay attention to your guests instead of scrutinizing your efforts. If you survived the party-planning process, you may just make it through your get-together in a convincingly sane fashion. Cheers to you, I wish you good luck and happy holidays!

Black Out

I was laying in the backseat of my car, trying to keep the interior from spinning by counting all the little squares that make up my upholstery. I keep thinking, "Please make it stop, body really, this is no fun at all...man, this is a phenomenal waste of time."

This has happened more than once, but for different reasons. Once or twice, it was because I was drunk and close to blacking out, hoping that by counting and trying really hard to focus on everyone's conversations that I'll be just fine soon. More often, and as was the case this afternoon, it's caused by a low blood glucose reading. Much more frequent, and far less fun.

Even though there are around 3 million type 1 diabetics in America today, the disease's behavior isn't common knowledge, and I find myself frequently trying to explain what it's like to be diabetic. The most accurate description I have ever come up with is that being diabetic, and being sick with it, is like being drunk. The longer it goes on, the worse you feel and the harder it is to bounce back and feel right again.

Now, I may need to clarify a bit here: I can sense your reaction from here! I don't mean fun-drunk, like being out with your friends at a happy hour that just kept going, or like challenging yourself to walk a straight line in your stilettos without falling on your face (and laughing about it if you do). No, what I mean is that it's like being scary-drunk, when you're not sure how you got where you are and there's no one around who can tell you the how behind your why. With a very low blood glucose reading, the room spins, your vision comes and goes, and thoughts come more slowly; with a very high blood glucose reading, you're angry and irrational, making decisions you might not otherwise make, and you're so goddam thirsty! It's like you've been wrung dry of any hydration or reasonable thought.

The thing that really gets me, though, is all the wasted time. When you're blood glucose is out of whack, you're powerless, and there is nothing to do but wait for your body and your brain to return to a normally functioning state. Sleeping off a metabolic hangover, if you will. It might be the equivalent of pocket change in the big scheme of things: 15 minutes to bring up a low, three hours to bring down a high, but it's so much more than that. It's an afternoon gone, or calling in15 minutes late to work in the morning, or being too sick to do the things you need to do. It's complete blocks of lost time without any means of retrieval. It's recognition of my disease's control over my body and my mind. It's like being black-out drunk, this loss of control, uselessness, and wasted time. If I'm going to forfeit chunks of my life, I wish it was the result of a potentially fun mistake, rather than what it really is.

But What If I Can't Use the Digital Keyborad?

Well, I finally did it. I broke down got a Smart Phone. I sort of feel like a sell-out; doesn't getting a Smart Phone imply that I've lost a little more respect for actual human contact and genuine interaction? Will I find I've ignored important tasks, like feeding the cats or getting out of bed, because I couldn't look away from that tiny screen? Has ADD become an inevitability? 

The bottom line was, my Dumb Phone™ (or as Verizon graciously calls it, a "Basic Phone") was on its last leg. Arguably the two most important buttons on the phone (Send and Message) were busted and only 50% reliable, and if I'm going to pay for a phone it should at least take calls and send messages. 

Of course, it couldn't be as simple as walking in to the wireless phone store and asking for a salesperson's advice. No, before I could talk to someone who actually knows the products, I had to know them first. There were lists to be written! Comparison charts to create! Data to be compiled and analyzed! Then, with my little notebook of information in hand, I apprehensively made the trip out to the Verizon store. 

I was tempted to stick with what I knew: would a significant change in my cellular phone usage be a significantly good one? Even upgrading to a QWERTY keyboard on the last phone was a big step; and what would I do if I couldn't figure out how to use the new digital keyboards? But the benefits here could outweigh the costs, aka: the possibility that I'm moving further away from reality, the big benefit being apps. 

Being a Dumb Phone™ user for so long, I had little context in which to adequately judge these apps. Why do I need access to even more distractions than I already have at my fingertips? I don't even like games. However, my "research" did indicate there were apps to help me with carb counting (prescribed by my endocrinologist), meditation (prescribed by my therapist), and the things I'm already obsessed about (money management and list writing); so perhaps getting a new phone wouldn't be the end of my tiny, highly structured world. I did wind up with a Smart Phone, the Samsung Galaxy Stellar (I think), and who knows? It might even prove to be helpful...

It’s Times Like This, I Know I’m Not Alone

Woke up. Woke up earlier than necessary. Had to get dressed, made up, and packed up for work today because it wasn’t a normal work day: it’s Election Day! 

I’ve heard OCD described as the doubting disease, and I know for me it’s all about check-check-checking. I check my bank statements, I check locks, I check the stove, I check my to-do list at work. And they can’t just be looked over; they have to be frantically and constantly reviewed. This usually elicits concern from my husband and annoyance from the friends who notice these things, but today is one of those days where I see a little bit of this frenetic energy coming out from everyone. 

Elections bring out the worst and the crazy in people. I can attest to this primarily based on my time on the Tim Kaine for Governor Campaign back in 2005. There was plenty of crazy to go around—from loyal democrats trying to give me various personal belongings, to equally loyal republicans trying to shoo me off their porches with their rifles. But it’s Election Day after the polls close when the obsessive/compulsive tendencies really start to take the stage. 

I don’t know for sure, I have no data, but I’ll bet you, too, are watching at least three different projection tracking sources and listening to live streaming coverage on the TV, online, or maybe both. I’m so excited, I love elections, and thank you for joining me in the incessant watching!!

l'exposition

It was Thursday night, and the time had come to expose myself.

No, unfortunately for my husband, this was not going to be sexy. It was going to be tedious. 

Halloween night at 8:30 pm Kaitlyn gave birth to her first baby, Ryan, who arrived perfectly lovely and healthy. Having done the exciting thing and gone to bed shortly trick-or-treating ended, I didn’t hear the news until the next day at work. I knew a couple of things inherently: when your friend has a baby, you should go to visit them in the hospital, you should bring them some kind of a present (Liquor? Sedatives?), and you should look excited to be there. The other thing I knew was that this was an opportunity for exposure therapy that I couldn’t pass up/avoid. 

In order to work through my tocophobia (and other things with fun Greek language origins), I see a cognitive behavioral therapist. Mostly we talk, rationalize, and cry (that’s just me, not her), but with something like tocophobia it became necessary to take things a step further and carry out some exposure therapies. As I’m informed, the idea behind exposure therapy is to get me used to and eventually comfortable with the things that now frighten me; it is not a test of how quickly I can devolve into a panic attack. So off to the maternity ward I went. 

You might not be able to believe this, but not only have I never been to a  maternity ward or been face to face with a legitimately “new mom”, but I’ve never actually held a baby. Never. The youngest child I’ve ever picked up was over 18 months old; you have to get pretty lucky as a babysitter to score jobs where every child is old enough to walk themselves places. So that was the plan: go to a maternity ward, see someone who had just given birth, and hold a baby. 

So many questions and so many new potential phobias. Would I walk past rooms where women were actively delivering babies? Would I see that room full of newborns they always show on TV? What exactly does a newborn baby look like? What do I do with it once I’m faced with one?

As usual, my preconceptions were skewed and inaccurate. Walking through the maternity ward it was eerily quiet—no screaming, no talking, and almost no people present at all. We walked past the “nursery”, but there was only one baby in there and you couldn’t really see it from the window. Approaching Kaitlyn’s room, I was completely thrown off by finding her in-laws out in the hallway with baby Ryan. Oh, now I was definitely going to have to hold a baby. Sure enough, they tried to hand him to me first, but I managed to dodge and have my husband, Joe, go first. The only problem with that was that he knew I was supposed to hold a baby, so over to me he went. 

I was shaky, and nervous, and holding my breath. My mind was racing: What if I accidently drop him? What if I don’t support the neck and cause early stage brain damage? What if I breathe on him and compromise his tiny new immune system? And now that I’m holding him, what do I do?? 

It turns out I didn’t have to do much. Just stand there and look at him. It was weird, but kind of nice too. He was really warm and quiet, and much lighter than I was expecting. Joe was right, they are pretty tiny. He was just pretty and I was just nervous. I don’t know how long I held him, but his grandma wanted him back and I didn’t feel guilty about breathing again. Since I haven’t gotten any messages from Kaitlyn that I owe them for that visit to the neurologist or the epidemiologist, I can safely presume I didn’t do any lasting damage to the little guy. 

I succeeded! I went to a maternity ward, was supportive and pleasant, and held a baby without breaking it! I wasn’t able to see what a new mom looks like, but one battle at a time I suppose. For now, I’m going to relish in this success until the next opportunity for exposure therapy presents itself.