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.

Being “Normal”

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What does every parent want when their child lives with Type 1 diabetes & it’s any special event whether it be Christmas, Hallowe’en, Birthday Parties or Easter? To portray it’s the one of the few times of their life they can enjoy what everyone else does. Well, sort of. But that’s the best we can offer, right? Do they remember or know any different? Kurtis never told me so. I don’t remember so.

From the ages of 8-11 I don’t remember what I did with Kurtis at Hallowe’en. That was the time when he took multiple daily injections. Life was a whirl wind. I worked shift work at the hospital. My whole life evolved around my children…I worked my job, my health, my diabetes…everything around the kids. I was a single parent a lot. I didn’t have a team mate I could pass the baton to & ask to take over. My focus consisted of; were the kids fed well, did they have lunches packed for school, were they doing well in school, were Kurtis’ blood sugars okay, what did I need to do make them ok, appointments for his diabetes, making sure Cayla didn’t feel like Kurtis was the centre of our family because of his diabetes, what did the kids have for homework, hockey, figure skating, testing Kurtis’ blood sugars day & night to keep him safe, setting my alarm to check him, arranging care for the kids for the few times I wasn’t there, making sure the people caring for him understood what to do with his diabetes…you get the whirl wind?

Do I remember what I did for Hallwe’en on injections? Vaguely. I know for a fact I would have kept his candy intake balanced so that his sugars weren’t crazy for days. I vaguely remember letting him pig out the night of after he returned from collecting his stash..to an extent. Then going forward matching meals with treats to keep it balanced.

Once Kurtis was on a pump, I was not so concerned. My mindset was eat it all sooner then later so that we have 1 week of craziness then 3-4 weeks of drawing it out & really messing things up. The bonus was he could put the carbs in his pump & burn it off with activity. I was lucky because Kurtis only liked certain candies. The rest he would never touch.

Christmas stockings & Easter hunts involved a lot of non-candy things from Wal-Mart & the dollar store. I kept it the same for both. The kids never said to me “where is my candy” or “why don’t get as much candy as the other kids”. I remember as a child living with Type 1 finding a brand new pair of running shoes (which I needed!) hidden for Easter! I was SO excited because they were the cool pair I wanted! You can’t substitute candy for something so wonderful as that!

Creativity & letting normalcy rule within the boundaries of keeping your child safe, is essential to an enjoyable, stress-free Hallowe’en.

Trick or Treat

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Trick or Treat

October 31st is a significant day for me. I have 3 major memories that I associate with this day.

1. Going out for Hallowe’en as a child living with Type 1 diabetes.

2. October 31, 2000 is the day I dipped my 7 year old son Kurtis’ urine to discover he had 4+ sugar and thankfully no ketones but knew he had developed Type 1 diabetes. I dipped his urine as he refused to let me test his sugar with a glucose meter. I had poked his fingers 2 years earlier and knew this day would come.

3. I became a parent of a child with Type 1 diabetes trying to figure out how to let him enjoy going out for Hallowe’en without allowing his blood sugars to go askew.

This Blog is 1 of 3 parts sharing my experiences with October 31st.

Part 1:

When I was a child there were no pumps, rapid acting insulin or carb counting. My Mom did not have the technology at her finger tips to count carbs, push a button &/or inject & eat the treats. For the first few years, my Mom & Dad would take me out for Hallowe’en. They would use the bag of treats for when I had low blood sugars. I don’t recall having them as a random treat.

I don’t recall how old I was but I was under 10 when there came a time my parents figured I would be old enough to keep the bag of Hallowe’en candy in my closet. They told me I could keep it in the closet in my bedroom on condition that I tell them when I felt “funny” so I could dip my urine…yes…dip my urine!! to test to see if I was negative (a possible low). Then I could ‘treat’ with my treats.

I recall trying to have self control but what child under 10 can keep a bag of candy in their closet & not eat it at will? I understand why my parents did what they did, they wanted to try and incorporate some normalcy for me. They felt by doing this it would help me feel included in choice.

What happened? Each day when everyone was busy I would sneak candy. How did I get caught? My Dad was an avid runner. He always chewed gum when he ran. One day he went to go out for a run and realized he was out of gum. He came to me and asked to take some gum from my Hallowe’en bag. I still remember the panic. I felt horrified. The bag was full of wrappers but nothing else.

Little did I know that my Mom had been perplexed for weeks wondering why my urine was dipping positive for high sugar. After trying to avoid my Dad from going into my closet to get my bag of stash that no longer existed I knew the jinx was up.

I stood there with a full body panic as Dad looked into my bag. Dad was pretty cool. I do believe in that moment in time he knew that him & Mom shouldn’t have allowed this to happen. It was explained to me the implications of what happened to my sugars as a result of my choices. Mom was relieved because now she knew why!! Two very important lessons I learned and interestingly will never forget.

What happened with subsequent Hallowe’ens? It was actually pretty cool! Mom, Dad & I with my little sister & brother would go through our stash as most do. When we did, Mom, Dad & I would negotiate the price of my stash. It was a game. With that money I was allowed to go shopping for my own treats. Off to the local convenience store I would with my $1-$2 and go buy whatever sugar free treats that were offered.

I don’t feel like I missed out. Not once.

Stay tuned for Part 2.

Change or Transition?

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Change or Transition?

The words spill across the physicians desk or the hospital bed “You have diabetes.” or harder yet “Your child has diabetes.” Your head spins trying to absorb what that means. Depending on what your knowledge or experiences are, thoughts, emotions and response after this moment can vary dramatically. What you do know is that from that moment on your life has changed forever. Forever. Changed. Where do you go from here?

At this point I challenge you to substitute the word change for transition. Change is defined as an act or process through which something becomes different. Yes, this is true when receiving the diagnosis of diabetes. Something has become different. Transition is defined as the process or a period of changing from one state or condition to another. Do you see the difference between change and transition?

The picture you see is of the Peterborough Liftlock. It was recently taken on a beautiful Fall day on one of our weekend walks. Wikipedia provides a great summary of the greatness of this world renown landmark.

“The Peterborough Lift Lock is a boat lift located on the Trent Canal in the city of Peterborough, Ontario, Canada, and is Lock 21 on the Trent-Severn Waterway.
The dual lifts are the highest hydraulic boat lifts in the world, with a lift of 19.8 m (65 ft). This was a considerable accomplishment at the time when conventional locks usually only had a 2 m (7 ft) rise. It is not the highest boat lift of any type in the world today: the lift at Strépy-Thieu in Belgium has a greater capacity (1,350 tonnes) and height difference (73.15 m)…Many local residents of Peterborough skate on the canal below the lift lock in the winter.
The Peterborough Lift Lock was designated a National Historic Site of Canada in 1979,[1][2] and was named an Historic Mechanical Engineering Landmark by the American Society of Mechanical Engineers in 1987.[3]”

Picture yourself sitting in a boat on the canal at the top of this lock. You will have to trust me at this point but the view from the top is amazing. Add the transition of colour on the leaves on the trees. It is breathtaking. I say the leaves are transitioning because we know that eventually those leaves will fall off and the tree will become bare. The tree is on a journey with an evolving objective. At this point it’s goal is to shed its existing facade so it can rest for the winter to produce buds and beautiful bright green leaves in the Spring.

Back to the locks…It is understood when you approach the lock that eventually you will transition to the water below and your journey will continue on. Whether you have a plan as to where you to go from that point can amplify the quality of the experience when you arrive at the bottom of the lock. Most would agree that a plan needs to be made in order for the next phase of the journey to be enjoyable and memorable. Without a plan to transition to the next location, all could be lost stressing out on what to do next rather then taking pleasure in the journey.

To be successful living with diabetes one must not be satisfied with just accepting change but beginning the transition to living a life in a different state. There are many steps to achieving this, a plan is essential. If these steps are taken and transition is accepted, not just the understanding and acceptance of change, you can live a full and productive life with diabetes. I encourage you to always plan and be secure in your journey knowing you are transitioning to the next destination in your life with diabetes.

Gaining Perspective

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Gaining Perspective

This is me at age 8. It was 3 years after being diagnosed with Type 1 diabetes. I am standing at the entrance of Camp Huronda, a summer camp sponsored by the Canadian Diabetes Association for Type 1 children & teens. It was the first time away from home longer than a day since I was diagnosed with diabetes & hospitalized for 10 days in 1975. I learned to inject myself with insulin within a few days of being at Camp Huronda. From that day forward I didn’t want anyone else injecting me. I liked that I could control how my injections felt & when the needle was going in.

Fast forward to 1987. At the age of 16, one morning my Mom finds me in bed, unresponsive, laying in my vomit. After calls to my Paediatrician & attempts to give me fast acting sugar with no success, my parents rush me to the hospital. The things I remember of that morning are Dad standing me in the snow in my bare feet to get me into the car as I refused to, seeing my church as they drove by it & watching my Mom cry at the foot of my bed in Emerg. A few days later as I lay in my hospital bed I noticed that the nurses caring for me didn’t know a lot about diabetes. I mentioned this to my Mom. To this day it seems almost unbelievable to think my Mom prophesied my future career without knowing how big of an impact I would make in the world of diabetes. When I told her my thoughts, she said to me, “You can change that. You can educate them so they know.” She encouraged me to go into Nursing.

If you go back to several of my Blogs you can read about the many experiences I have had living with diabetes & being a parent of a child, teen & now young adult living with diabetes.

Fast forward to 1999. After working in a Licensed Daycare as the School Nurse & caring for 2 children with Special Needs for 2 1/2 years, I decided to start a Home Daycare so I could be home with Cayla & Kurtis. Within 6 months I had a ‘full house’. It was a very busy time but I loved that I could be home for my children & create a home atmosphere for the little ones who couldn’t be home with their parents. Once Kurtis started Grade 1 I felt it was time to gain some hospital experience. While running the home daycare I completed my Critical Care Certificate. Working at the daycare & running the home daycare taught me so many things; time management, communication, creativity, nutrition, working with Special Needs, how to be calm when chaos is all around.

I still remember my first interview at the hospital. The 2 managers interviewing me mentioned I didn’t have any experience. I asked them how was I going to get experience if they didn’t hire me? I surprised myself that I asked them that question. I wasn’t one to challenge anybody. They were surprised too. That got me in.

After several years of working in several areas at the hospital & particularly the Intensive Care Unit, which I loved, I didn’t like the fact I was caring for people with complications, mostly from Type 2. There was one patient who died from complications of Type 1. It devastated me. She wasn’t much older then me. My colleagues would ask me certain questions about diabetes. I liked that. It didn’t take long for me to realize I was at the wrong end of the diving board. My time in ICU was invaluable. I learned time management, critical thinking, stamina, diplomacy, focus, patience, perseverance, when it was the right time to cry when I lost a patient & when I needed to hold back my tears,. I also learned that there are times that the truth needs to be told no matter how hard it is to hear. Working in ICU made it very challenging for me to keep my sugars in check. A critical situation would drive them sky high & a missed break could bring me low.

In 2002 I attended the JDRF Walk For the Cure. To this day, I don’t know what possessed me to do what I did. Kurtis & I used a Lifescan glucose testing meter. I heard there was a new one on the market & I wanted one for each of us. I walked over to the Lifescan booth & began talking to the rep. He gave me 2 new meters. After a few minutes of conversation, my mouth opened & without plan or thought I asked him if his company was hiring. Huh? What did I just do? It just so happened that he was being promoted & his position was opening. WHAT?!? Timing is everything they say. So it was with this as well. The interview process went smoothly, the offer was ready to be presented when an internal applicant surfaced. As with most companies, he was given the position. How did I feel? I was okay with it. I didn’t think it was the right time. The kids were still young & I had a great job-share position that was flexible with shift work. It worked for our family at the time. The Rep I met from Lifescan told me he would keep me connected & that he did. My foot was in a door I didn’t even know existed.

In 2004 I ended up with one of the best jobs I could ever imagine having. I became a Diabetes Consultant for Novo Nordisk. It was one of the hardest but most rewarding jobs. I learned Type 1 & Type 2 diabetes inside out & backwards. The company kept me current in Clinical Studies & relevant literature. What I liked most about it was meeting Family Physicians for the first time & them telling me they don’t ‘do insulin’. Several years later I had these same GP’s thanking me for teaching them & how much easier it was then they thought. Through out my years at Novo Nordisk my Mom’s words echoed in my mind several times. I educated Nurses, Dieticians, Doctors, Pharmacists and Nurse Practitioner’s. I did business on all levels of health care including hospital contracts & nursing homes. Working at Novo Nordisk helped me learn time management, business planning, triaging, focus, drive, passion, knowledge about every insulin available on the market, knowledge about every oral anti-hyperglycemic agent on the market, every insulin pen, syringe & pen tip available & it’s implications on therapy.

One of the most difficult decisions I ever made in my careers was leaving Novo Nordisk to work for Medtronic. It provided me an opportunity to expand my career, work experience and meet more Health Care Providers working in the field of diabetes. It was a short tenure as Medtronic decided to restructure the Corporation both in the U.S. & Canada. I was one of ~ 100 in Canada who lost their jobs as a result. Being a Territory Manager at Medtronic taught me many skills I needed to become better at or hadn’t experienced. It was a valuable experience despite the outcome. I learned about all of the insulin pumps provided by the medical device companies. I got to know Pumps & Continuous Glucose Monitoring really, really well. Little did I know how much of an advantage that would be. I worked within a team of 3 & communication was essential to follow up & close each sale. I learned how to work directly with the consumer & their needs. Though out the years I learned how to read body language & verbal tone very well. It took a long time but I learned to listen to my gut. For the most part it was right.

After I lost my job at Medtronic, I decided I wanted to leave the world of diabetes. I didn’t know where I wanted to be. I was certain I didn’t want to be an educator. I couldn’t see myself sitting at a desk staring at someones blood sugars, listening to their excuses. Why did I have this perception? I have thought about that a lot. How could I think like that given I live with diabetes? I think that in my mind a diabetes clinic consists of Type 1 & Type 2 together, intertwined…somehow connected but shouldn’t be. I didn’t want to educate like that. They are 2 different animals & so they should be treated as such. It wasn’t the patients fault I felt like that, it is how clinics are structured that frustrates me. So…I went out on my own as an educator & consultant through my company “Diabetes Beyond Borders” to change that. As a result Diabetes Beyond Borders has over 6,700 ‘likes’ on Facebook. I became a Certified Pump Trainer for Medtronic & Accu-Chek. I had a contract with a large on- line pharmacy in which I created marketing materials, provided education on insulin pump infusion sites & cartridges.

I have applied & been through several interviews for diabetes sales jobs. I would’ve taken them if they were offered but I just didn’t feel it anymore. What was I meant to do? Where was my passion?

A few months ago I was invited to a conference. It is called Type 1 Think Tank. It’s mandate is to more or less “think out side the box” to provide better care & outcomes for people living with Type 1 diabetes. I didn’t realize I was that important! I didn’t realize my experiences were so valued. At the conference I met a long time friend & colleague. She is the founder of the Charles H Best Diabetes Centre. I called on her clinic as a Diabetes Consultant & Territory Manager from 2004-2009. My son Kurtis went there briefly after his diagnosis in 2000 before a Paediatric clinic opened closer to home. The founder, Marlene, approached me and asked if I would be interested in a position as a Diabetes Nurse Educator. I never turn down opportunity but I was pensive given it was a 2 hour/day commute & I would be ‘stuck’ inside 4 walls 8 hours/day.

As soon as I sat down to the interview I understood why I had experienced so much throughout the years. This is exactly where I needed to be, where I want to be. I just didn’t know it. I have travelled down a road of learning & ultimately making an impact though all levels of diabetes. It was time to share those experiences with the people that really, really mattered. It was time to share my experiences with the children, teens, young adults, adults & their families living with Type 1 diabetes.

March Break Travel Tips & Tricks

For those anxiously awaiting for March break…are you travelling away from home? How do you plan for travelling with diabetes?

Since 50% of our family had Type 1 diabetes, back in the day when my kids had March break, to keep organized and sane I created a standard packing list which also included everything imaginable for diabetes supplies. If we were going away for 1 week, I would pack double the supplies.

I gave both of my kids their own packing list. Kurtis’ list also included the diabetes supplies he needed. I would encourage him to pack it himself. I reviewed the list with him to make sure it was all in his suitcase and carry on, if flying.

A few tips:

1. If on an insulin pump, call the company and ask for a back up pump about 2 weeks earlier (or find out from the company how much notice they need)

2. If on an insulin pump, bring enough insulin, syringes or pen and pen tips to sustain you or your child for the entire vacation IF by chance your pump malfunctions and you have to go back on multiple insulin injections.

3. Make sure all medication are in its original containers.

4. Have your family doctor or diabetes specialist write a letter stating you have diabetes and the specific list of supplies you will carry with you. (Kurtis & I have been pulled over by Customs. We have had to pull the list out and go through the bag taking inventory with list in hand.)

5. Wear Medical Identification such as a bracelet, necklace or tattoo.

6. Pack a water proof container where sugar tablets can be placed for any activity that they may come in contact with water.

7. If packing insulin, make sure to keep the insulin between 2-8C when in transit. It can be exposed to temperatures between 15-25C for up to 28 days. The best product to use for travel to keep insulin safe to use is a http://www.frioinsulincoolingcase.com

8. Buy Travel Medical Insurance

9. Pack a Glucagon kit.

10. NEVER leave your diabetes supplies on the beach. (I had a young client I sold an insulin pump to just before he and his family went on vacation. Carefully folding his pump in his towel on the beach, upon his return from playing in the water to hook back up he realized it was gone!)

11. Bring an empty water bottle if you use needles. You can place them in the water bottle and safely bring them home for appropriate disposal. Make sure to put the bottle with sharps in your check in not the carry on.

12. Make copies of travel documents, doctors letter, and contact information. Give it to one or more of your family members and/or friends if you lose any of this information.

If you would like an example template of the packing list I have used and still use, let me know, I will post it.

Travelling with Diabetes in Honduras

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Travelling with Diabetes in Honduras

My experiences this time around are not so much about travelling & diabetes but more so how a change of environment can open my eyes to what I didn’t realize at home given my daily schedule. Recently my time at home has been terribly busy. As a result based on my experience I’m going to share the sensitivity to changes can be more difficult to determine.

Based on previous travels I know that heat & travel affect my blood sugars, that is a known fact. I understand that I need to accommodate to this. One elimination of variability is that Honduras is only one hour time difference. That does not seem to be enough to affect my blood sugars. The heat is a definite contributor to a higher risk of having a number of low blood sugars. Adding activities such as swimming & kayaking frequent testing & temporary basal rates on my insulin pump are essential to hopefully avoid or at least minimize the number and severity of low sugars.

With that being said I had one late evening & night that the lights were on but nobody was home. Upon coming to my ‘senses’ I was perplexed. My activity level & the heat didn’t seem to be enough to affect my levels for so long & so severe. Still, I have not been as active in the past number of months as I used to be & decided it was attributed to increased activity. Based on that, I didn’t make changes, I determined I needed to be more aggressive in how I set my temporary basal rates.
The next night was just as bad. But, I clued in. I reviewed my basal rates on my insulin pump. I suddenly came to the realization that from 6pm to 12am I had increased my rates a few weeks before leaving. I did so due to the fact my sugars were running too high for my goals. I made the changes due to the fact I thought it was from hormones.

The other variable which was the ultimate eye opener….I was getting frustrated with my current infusion site (Sure-T stainless steel 6mm by Medtronic). As a result, I switched back to the infusion site I had used for 8 years, the Silhouette by Medtronic. It ‘felt’ better.

With the low blood sugars I experienced I realized that the Sure-T was driving my basal rates higher due to the fact it was not always a good ‘fit’. It ‘clicked’ when I saw that my basal rate from 6pm-12am was 0.6u/h. I have NEVER ran a basal rate that high! When I switched back to the Silhouette my insulin needs were not as high due to the effective infusion of insulin it provided. With that, I ran into very serious low blood sugars I have not experienced in quite a long time.
Once I adjusted my basal rates & did what I usually do when travelling, all was good!!
After 38 years, I’m still learning how to live with diabetes. Always learning to live Beyond the Borders. Sharing with you so you can live with Diabetes Beyond Borders too!!