Attempts at Perfection & It’s Failures

“Have no fear of perfection – you will never achieve it.” – Salvador Dali

I can’t get my head around it.  Does anyone with diabetes who is motivated in their management think they can’t achieve perfection?  Yes I said CAN’T.

As a Person With Diabetes I think that not only can I achieve challenging feats beyond my day to day life, such as ascending the Peruvian Tundra to over 15,000 ft BUT I can also achieve perfection with my diabetes.

As a PWD I know that this mindset is superfluous.  BUT, I still want to pursue it, just in case I can achieve it.  You never know, right??  Isn’t that a great goal to set and pursue. Almost like a cure, really.

BUT….yes, I said BUT…I am reminded of how the attempts of trying to be all that to my endocrine system and diabetes management isn’t that simple. Even after coming into 40 years of living with diabetes and being a Mom of a PWD for 14 years.

I am reminded on our flight to Peru, no matter how hard I attempt to make my diabetes perfect, I cannot.

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Upon take off I am aware of the potential impact the air pressure can have on my insulin pump delivery.  The rule of thumb despite there is not total clinical evidence with regards to this is to disconnect on ascension and descending. Why?  The talk of the town is that upon take off the pressure can change the delivery of insulin to cause a low blood sugar. During the flight the pressure change can create air bubbles resulting in missed insulin after landing.

I have experienced this throughout the past 14 years of travel on an insulin pump but was not aware of the ‘talk’ that circulated about this until the past few years.

So, whether clinically relevant or not, I decide to take heed to try and avoid this.

We are prepared for take off at Pearson.  Status quo.  Prior to boarding I check my Continuous Glucose Sensor.  All is good in my diabetes world.

As the plane positions itself for take off on the runway I disconnect from my site with the intention of reconnecting within a few minutes after the rapid ascension is complete.

I am excited.  I am thinking about our trip, the flight which is 21 hours with stop overs.  In my mind I am running through what we packed versus the list I print and check off.  I am nervous.  I am landing in a city that has an elevation of over 8,000 feet.  I am worried after the stories I am told of elevation sickness.

The airline steward serves our snacks.  I give it to Steve.  Packed full of gluten. I don’t need a snack anyway.  I’m not hungry.  I look at some magazines.  I do a Word Search.

Several hours pass by.  I start to feel like the Sahara desert lives in my mouth. My stomach feels like a brick made a home in it.  My chest feels heavy.

I question these feelings.  Why?  It feels like I am high.  How come?  I don’t clue in to check my sugar though.  I attribute it to the elevation, the dry air, the excitement.

The steward comes around again.  Offers snacks.  I pass mine onto Steve’s again.  Maybe if I eat and drink a ton of water I’ll feel better.  I take one of my gluten free bars out of my bag.  I bolus, I eat. I feel like crap.

Is it the flight?  The cabin pressure?  I just can’t make sense of it.  Obviously my brain cells are not firing on all cylinders.  Doesn’t being on guard all the time with managing diabetes do that to a person?

Then…I get an itch at my site.  And so I scratch. It is so itchy I must lift my shirt enough to place my hand under so I can make skin to skin contact to find satisfaction. While scratching I realize my tubing at my site is flopping back and forth….I am NOT attached to my site.

I forgot to re-connect after take off.  That was 3 hours ago.

In my effort to achieve diabetes management perfection, I fail.

Now, forgiveness is mine. I am so insulin sensitive that I only end up with a BG of 11 mmol/L.  I check for ketones as well.  They measure at only 0.3.  So…I correct for the gluten free bar and basal rates missed as well as a small amount for the trace amount of ketones.  It takes several hours to come down and even though my sugar is only 11, I feel like I’m on the edge of DKA.  I  know what it’s like, I’ve been there.

We land in Peru and I am almost in target.

After that incident I make a promise with myself.  Disconnecting on a flight to achieve perfect blood sugars is not a goal I wish to achieve.  For what I wish to achieve I fail.  I avoid a potential low but instead end up high and feeling terrible.

What’s the lesser of two evils.  I can’t answer that but I will tell you I will no longer disconnect my site.

Where to Start…Our 12 Day Crazy Busy Trip to Peru…The Intro

I have heard this song “Home” by Edward Sharpe and the Magnetic Zeros off and on while listening to Songza.com for the past few years. Yes, the tune is catchy but the words hit the deepest chord within me.

What is Home?

The days my daughter Cayla and my son Kurtis were born I found my home. They were and still are the centre of my being and when they were little that was where I trusted I belonged. Where I felt beyond comfortable. I was in my realm. I always wanted to be a Mom. I knew I would protect them as best as I had in me to the death. They have been, still are and will always be a part of me and the core of my being.

Growing up my Mom was very fond of the story of Ruth and it seemed she quoted a verse in particular often and in a very fond way.  I didn’t understand the impact it would it have on my life until the past few years.  And so I also associate this Blog series on our trip to Pero to what Ruth says in Ruth 1:16.

Ruth 1:16 (ISV) | In Context | Whole Chapter

16 But Ruth answered, “Stop urging me to abandon you and to turn back from following you. Because wherever you go, I’ll go. Wherever you live, I’ll live. Your people will be my people, and your God, my God.

Besides my children I have never trusted anyone so much in my entire life as I have my husband Steve.  Even early on in our relationship with the decisions I made, I felt he always had my best interest at heart.  I trust he will love and accept me, diabetes and all. Never once has he ever had to say to me “Trust Me.”.  My gut just says I should. One should never have to say “Trust me.” to make one believe they should.   Actions speak louder than words.

In our conversations in the past many years, aside from our trips, Steve has been to 42 countries.  A majority of them have been for pleasure, as well, some for business and missions.

Of these countries he often speaks fondly of Peru.   He tells me it is the most beautiful place on the earth.  Then I must go there!!!

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We are aware of ‘rumours’ that Machu Picchu may not be open to the travels Steve experienced years before.

So, when do we go?

Well, life is funny like that.  In 2014 both of my children announce that one is moving to Edmonton, Alberta and one is moving to Wellington, New Zealand.  They won’t be home for Christmas.

For all the Mommies out there I can hear and feel your overwhelming voice of sadness and “that sucks”.  YEP!  It really sucks.

In early Summer I say to Steve that I can not see a Christmas tree standing tall, all lit up with the kids ornaments for the past 23 years hung in all its glory and no kids.  I threaten fetal position in front of the tree.

And so I ask.  Can I please go away with you to the most beautiful place on earth.  And it is written in stone, so to speak.  We commit ourselves to a trip to Peru to experience Machu Picchu on Christmas Day and Plaza Des Armas in Cusco on New Years Eve. One of the top 10 places for New Years in the world!

I am excited but as I research and speak more to those who have been I get nervous.

Despite my nervousness and apprehensions based on others fear mongering, Steve reassures me I can overcome anything that comes our way while we vacation in Peru. Just like Vietnam and Cambodia.

We are a spontaneous pair.  Our Vietnam/Cambodia trip begain with “hey do you want to go to Montreal for a long weekend?” and 3 days before taking flight instead of Montreal, we book a flight with no plans except a hotel ‘base camp’ for Vietnam and Cambodia…for the same price.

There wasn’t a glitch in that whole experience  (except running out of underwear in which I realize I barely fit into even a large size of women’s Cambodian underwear!)  I look back on that trip and it was worth every minute. So much so, we both want to go back.  Despite all the low blood sugars from the heat and humidity as well as losing my beloved Continuous Glucose sensor because it just couldn’t adhere to my skin. (I know how to make that baby stick now!!!)

Despite our challenges and crazy, spontaneous trip while in Vietnam and Cambodia, I experience great apprehensions with Peru.  The two potential issues I am most concerned about are elevation sickness and keeping safe from gluten and wheat so as to avoid a reaction, at worst a severe one.  The stomach upset is one thing.  The hives are another.

I am proactive with elevation sickness and speak with my family physician.  He advises I don’t need anything, I’ll be fine. He was just there and all was good.  He tells me I will be okay. This gives me reassurance.

I admit, on this trip I am not fully proactive in my celiac disease as I should be.  I am still in a learning curve.  This is my first trip as a person living with Celiac disease.  We assume given the Peruvians very large crops of corn and potatoes…there would be very little wheat.

Not so.  Stay tuned.

I’m OKAY!! Really!?

Wedding Cruise5With the exception of the time we dated in high school, my husband Steve is diagnosed with Type 1 spousal diabetes for just under four years.

It may seem silly but I assumed in all this time he knew diabetes like I did.  I can’t even tell you why I thought he would learn 39 years of living with Type 1 diabetes as I have experienced by observing signs, symptoms and random sharing of how I feel in certain situations.  He has never had formal education in the less than 4 years we have been together.

The moment I understood I need to share my life with diabetes more?

We arrived in Lima, Peru.

After settling on the last leg of our journey we decide to head out in search of a few markets and sites for some art pieces.

On the way back, my pump alarms that my sensor is telling me my blood sugars is 4 mmol/L.  My sugar is going down.  Stupidly, I have no sugar on me…Steve is so good he usually does have lifesavers in his pocket…but he has none.

I feel it is lower than 4 mmol/L.  But I am stubborn.  Steve asks if I want him to go into a store and get sugar.  I say it’s OK .

First, when my sugar trends towards low but I feel like I am not in danger, I don’t treat with rapid acting sugar, I set a temporary basal rate.  I think it’s a control thing.  I want to change the stupid system that really works…just to see if I can make it better.  I am so anti-sugar….I really want to take it…mental block.

So…I say to Steve, it’s okay, I’ll set a temp rate.

And we keep walking.

And several minutes later I become dull.  And quiet.  I lack my bubbly, sunshine Type A personality.

Steve knows but doesn’t know.  He hasn’t experienced such an extreme moment like this.

I personify strength.  Knowledge.  Power.  Ability.  I am never the victim.  He trusts that. Even thought his gut tells him different.

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So he trusts me and my choice.

Until I mumble I want ice cream.  And he asks further questions.  And I am indecisive and vague.

We end up in a grocery store a few blocks away from our hotel.  He asks me several times what I want to get….I don’t know.  In my mind I want to ask him to help me.  Save me from this terrible prison in my mind of wanting to be in control.  Not to ask for help.  I will take care of myself.  I won’t confess I have failed.  I won’t ask.  I refuse.  I won’t.  I have done this since I was a little girl.  My (mis)behaviour trumps my voice.

I am no good to anyone.  I know it.  I am too far gone to say that.

Steve finally suggests and I agree.

We pay out at the cash and I inhale.

Many minutes later Tracy returns.

Later that night we debrief.  He tells me…”I knew, but I didn’t because you know!”, but I did.  And I failed to tell him.  Thankfully he saw it today. Exactly what I just described.

He tells me “…from now when when you say “It’s okay, I’ll set a temporary basal rate.”  I am going to pop into a store and buy some candies.”

And he will tell me.  “You need this candies”.  And I now I will take them.  Regardless of how bad I want to be in control.  Because, we have this consensual contract.

It’s good to share my diabetes.  A liberation.  Enlightening.  It is a relief to give a very small piece of it to someone else.  Even though it is only a very small piece of what my mind thinks of 24-7-365, if feels good. Despite how much control I want.  And how hard it is to let go.

Travelling with My Pharmacy

DBB Huchay Cusco Blog

There will a few posts/Blogs about my travels to and within Peru.

BUT..

I feel this post in particular is a huge one and is pressing upon me to prioritize even though it’s not in order.

We spent Christmas Eve in Agues Calientes. We planned to climb Machu Picchu Christmas Day.

I became very ill with a very high fever and ultimately sinus congestion, sore throat, fatigue among other things.

I am proud of the way the situation turned out as I recovered very quickly compared to most times I experience this. My husband questioned if I should take part in the venture to Machu Picchu but I insisted despite feeling down and out I would not miss such an amazing opportunity. This is a chance in a lifetime!!! And so we did.

With that being said, after we returned to Cusco a few days later we made plans to take part in a two day trek up the Andes mountains, through the Peruvian Tundra. We would then be hosted by a family overnight before descending back down the next day to another town a few hours away from our starting point.

We reach an elevation of 15,100 feet. Understanding that breathing would be a challenge at the best of times, I am overly concerned that with my congestion and swollen throat it would present greater issues.

On our way to the drop off point 1 1/2 hours away by jeep, I ask our guide to stop at a pharmacy to buy cold medication to help keep the symptoms from being too overwhelming throughout the climb.

As I walk into the pharmacy I take note this is the very first lesson I learn.  Never assume I can go away for 2 weeks and be healthy the whole time. I usually pack cold medications, gravol etc for those ‘just in case’ moments.

This is the first time I didn’t take my personal pharmacy with me. Sigh.

Our guide Henry takes me into the pharmacy in Cusco. I tell Henry in English that I need an anti-histamine/anti-inflammatory. I expect something along the lines of Advil Sinus & Cold or Buckley’s.

After the Pharmacist asks Henry a few more questions in Spanish….”Is it altitude sickness?”…”No, I had a very high fever, sore throat and sinus congestion.”…He recommends a product.

I take a ticket to the cash booth/dispensary at the front of the store. She gives me the box of medication. I am so relieved I will have the meds to help with the congestion, I don’t consider that I didn’t tell the pharmacist I have T1 diabetes OR that I took time to read the ingredients.   At this point I don’t make the connection that Dexametasona (in English “Dexamethasone”) is a steroid!!! I mean, come on, I am a Nurse. I should know the 5 R’s!!

AND I can’t buy a steroid over the counter in Canada! For good reason!

I am told to take one pill now (it is 7:30am) and again at supper. I can take it twice a day for a few days.

Within an hour I can feel the relief. I am overjoyed….until…

Fast forward to that evening and into the overnight…AND the next day…my blood sugars begin to climb…and climb…and climb.

I take insulin corrections like drinking water with no change. Not even a flicker in my Continuous Glucose monitor display. My finger pokes confirm all is not right within my diabetes world.

I reflect back on when we arrived in Cusco. Within a day I was setting temporary basal rates on my insulin pump for low blood sugars and now??? I am insulin resistant in the Andes Mountains??

I play scenarios in my mind. Is it the altitude? Is it dehydration? Is it the anaerobic feedback from the intense activity which leads us to experiencing burning leg muscles, shortness of breathe so bad our lungs are burning?

When I work out at the gym and do intense heavy weights my sugars spike. When I do hill training when I run I get the same effect. Is this the same?

At this point I haven’t made the connection yet that the cold meds contain steroids.

I do think that in part, the intensity of the climb did cause an adrenalin surge that did cause my need for more insulin….pair it with an exogenous steroid in my cold meds and here is a recipe for blood sugar disaster.

My key take away?

Bring my own cold meds and pharmacy.

If ever in an emergency that I require medications while in another country, make sure to tell them I have diabetes.

If and when I decide to ascend to 15,100 feet (or higher), take note and act that if it feels anaerobic, increase my insulin rates to accommodate to it.

No doubt it is a tough balance to achieve but I wouldn’t want to throw my hands in the air and not keep playing the game. Next time I want to improve on this experience. I accept my sugars will never be perfect in these situations especially, but, I will do my best.DBB Dexalor

Gobbling It Up

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I was very guilty of this for many, many years.

Pursued & got the 6 figure job. I worked long, exhausting hours running an extremely successful career all while raising 2 amazing kids.

I thought my career & being the ‘perfect’ Mom would fill the void of what I was really looking for. I also thought building a dream home would make everything okay.

I knew why I did it, but couldn’t put it into words or stop the search. I didn’t stop ‘gobbling’ up until the past few years.

It took a lot of choice, non-choice & learning to accept all the ‘things’ I lost to put what mattered into perspective.

In the end finally finding a love that accepted me for who I was without having to prove myself ultimately stopped that seemingly endless search.

It’s an amazing release from something you are always looking for but can never find satisfaction.

Not that I don’t get sucked into it once in a while & have to step back & say to myself ‘whoa!!’…but I know beyond a shadow of doubt that I won’t ‘gobble up’ like I did. My search is over.

“We’ve got a sort of brainwashing going on in our country, Morrie sighed. Do you know how they brainwash people? They repeat something over and over. And that’s what we do in this country. Owning things is good. More money is good. More property is good. More commercialism is good. More is good. More is good. We repeat it–and have it repeated to us–over and over until nobody bothers to even think otherwise. The average person is so fogged up by all of this, he has no perspective on what’s really important anymore.

Wherever I went in my life, I met people wanting to gobble up something new. Gobble up a new car. Gobble up a new piece of property. Gobble up the latest toy. And then they wanted to tell you about it. ‘Guess what I got? Guess what I got?’

You know how I interpreted that? These were people so hungry for love that they were accepting substitutes. They were embracing material things and expecting a sort of hug back. But it never works. You can’t substitute material things for love or for gentleness or for tenderness or for a sense of comradeship.

Money is not a substitute for tenderness, and power is not a substitute for tenderness. I can tell you, as I’m sitting here dying, when you most need it, neither money nor power will give you the feeling you’re looking for, no matter how much of them you have.” ― Mitch Albom, Tuesdays with Morrie

How Green is the Grass?

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How Green is the Grass?

This pic is where the movie Laura Croft Tomb Raider was taped. We were there when we visited Ta Prohm at Ankor Wat in Cambodia. I’m a big Tomb Raider fan. it was pretty amazing to be where it was filmed. The tree you see in the pic was jaw dropping. It was also amazing to think that something with such grandiose roots, reaching for the sky could survive in such barren conditions. It seemed it was in a totally foreign environment in which it needed to survive, yet it thrived & boasted so with its huge roots.

Thinking about that tree I reflect back in time. I remember being a “Diabetes Consultant” i.e. a sales rep for Novo Nordisk Inc. I fought hard to get that position. I knew I was fortunate to be there. I also was confident I had the passion to move it forward & benefit others, namely Health Care Practitioners. My goal was to influence so they would improve the lives of those living with diabetes en masse. I wanted to change the world of diabetes. I had been on the other side working in I.C.U. & I wanted to stop the madness. I believed that the best way to make that impact was in this way. Because I believed so passionately & so deeply about ‘my’ cause I passionately believed Novo Nordisk’s products were the best out there. No other pharmaceutical company selling insulin, pen tips, insulin pens or Type 2 oral agents could have a product as good as the one I sold. Their pipeline & success was overwhelming. Based on my steadfast belief & guidance from those who taught me to sell, I learned to sell & I sold well.

Did I sell like a pharma rep? I have & will maintain I didn’t. I had a hard time asking for the business, closing the sale. Instead, I believed through building relationships, earning trust & education inadvertently I did sell. When I left the company I was vying for 1st place out of 65 reps in less than 5 years. When I began the territory I looked after was flat lined, when I left it was growing in double digits. I steadily climbed the ladder of sales success. My drive wasn’t because of the money or recognition. Why did I ‘want it all’? Because I wanted to tell others that I succeeded based on building trust, relationships AND most importantly educating my clients with passion because I believed. I believed in the best for people living with diabetes & I wasn’t afraid to say so. My clients reassured me voluntarily they heard me loud & clear & I lead them to believe. They wrote the products I sold because they trusted that I would provide for them what was needed to take care of their patients living with diabetes. I would give them the information they needed to help them empower their patients.

Little did I know I was establishing my diabetes roots & standing out in an environment that is tough to penetrate. I was often asked why I wasn’t a diabetes educator. I just couldn’t envision myself doing it. I liked the rush of sales & the impact I made. I loved the relationships I had. I could walk into clinics & see Docs that other reps couldn’t. I didn’t think there was anywhere else I could make such a huge impact.

After my tenure with Medtronic, I honestly didn’t know where I belonged & believed exiting the diabetes world may be best for me to take care of myself & my family. What I learned was, when the roots are deep, it’s really, really hard to transplant somewhere else.

Seven weeks today I have been a Diabetes Nurse Educator at the most amazing clinic for Type 1’s. I don’t know of any other like this. As I said, first, I didn’t think I’d ever be an ‘educator’, which now I see I always was. Secondly but most importantly & the reason for this Blog is the deep roots I have established with the relationships & trust I developed over the past 9 years. All of these things have brought me to where I needed to be. Many I work with were my pharma clients, now they are my colleagues.

The greatest thing I have learned in the last 7 weeks? For all the products; insulin, meters, insulin pens, pen tips & pumps….my passion for certain products has dissipated a lot. I have realized & I have preached it…each persons diabetes is unique. It is their own. The product needs to chosen for the lifestyle of the person living with diabetes…not the other way around. I sit at my desk listening to my patients & I ask…what tools & education can I share with you to empower you to live with your Diabetes Beyond Borders?

The roots just keep getting deeper.

How To Cross the Road

How To Cross the Road

In June 2012 we travelled to Vietnam and Cambodia.  It is considered a trip of a life time.

This picture is one of the streets of Ho Chi Minh City in Vietnam.  One of the first strategies we learned; how to cross the street without getting maimed or killed.  The bikes were a barrage with what seemed to be no break.  There were very few traffic lights.  The motorcyclists seem to be on a mission to travel from point A to point B.  Period.  It was quite a sight to see.  It was organized chaos.

It reminded me of a symphony.  The music was in front of them and they played at the right time with the right notes. We wish we could see the music so we could read and play it too.

The picture you see and the description above is how best to describe my mind.

I have a plan, similar to crossing the road in Ho Chi Minh City.  I need to get across.  The great part is, I can see the other side of the road.  The challenge is all of the opportunities and work that comes with meeting these goals is overwhelming me, like the constant barrage of motorcycles with what looks like no rules, traffic signs or signals.

Several challenges are new to me thus a few major learning curves.  I am in a different world with different rules.  Many opportunities have recently come to me which I have wanted for quite some time.  These opportunities are very promising, but, have changed the focus I thought was in place.  With that comes an abrupt change in how to complete the ‘BIG PLAN’.

I am aware of the multitudes of phrases and quotes that summarize how to eat an elephant, take baby steps and carpe diem.  Believe me, that is top of mind each day.

I make lists, I cross them off.  I thought crossing off the little stuff first, leaving the really big stuff last would be best.  I understand now this is not going to get me across the street.  It’s like taking a step on the road, seeing the bikes and stepping back on the sidewalk.

How did we cross the street in Ho Chi Minh City?  We looked for the biggest gap of motorcycles.  We held hands tight and began to cross.  We were concerned we would be hit.  We were surprised when we came in front of a bike that it would stop and let us cross.  We finally had the music.  We were learning how to be part of the symphony.

The Vietnamese motorcyclists chuckled at us.  I am certain I could hear them say in their chuckle…”Foreigners.”.  It was a huge sense of accomplishment to get to the other side.  And…we learned the motorcyclists had compassion and understanding of our goal.

It is time for my mind and actions to know and do the same.