International travel. I've only done it once before today. I'm writing while on a layover before my flight for my honeymoon. While I'm not sure what to expect, I wanted to write a little bit about what my preparation for flying with Type 1 Diabetes is like.
My first challenge was trying to figure out how many supplies to pack. I decided on a month's worth for our two week honeymoon to Europe. Now, for your pump supplies, CGM supplies, insulin, and million other various supplies needed for a month, it takes up a lot of space! So I did my best to pack it as neatly yet as compactly as possible in a small backpack that would fit in my carry-on bag.
My next challege was how to keep my insulin cool. I have a FRIO cooling gel case that I use for my insulin. I used it in The Mohave Desert on my Route 66 road trip with my hubby last summer, so I know it can "take the heat." Hopefully Europe's climate is similar to that of where we live in the US!
My third challenge today was conquering TSA. In our small, local airport, the personnel are typically very nice. I let them know about my diabetes supplies and took the small backpack out to be scanned separately from my carry-on bag. I also let them know about my insulin pump on my stomach, and went through the body scanner. (Side note: the body scanner doesn't use X-rays to scan, so my pump and sensor came out just fine!)
Well, I went through the scanner and my arm where my sensor was, my stomach where my pump was, my groin (say what?!), and my heavily-tattooed ankle lit up on the screen as being potentially dangerous. While the diabetes items weren't an issue, the groin pat down was a little awkward. The lady who performed it was very nice and I'm sure it's equally as awkward for her, so it wasn't too bad of an experience. I opted to stay in the open rather than going into a more private area for the screening so that my husband would still be present. And I passed the tests! I was able to get on the plane. No more security for us on these flights! Hooray!
I have been keeping a close eye on my CGM today, and have been extra sure to test my glucose levels. No lows or highs yet, so that's a plus! I hope this trend continues on the flight to Europe overnight.
I got some advice from my endocrinologist yesterday about traveling. She gave me a letter in case TSA gave me a hard time, but I didn't even need it. She also advised me to change my clock on my pump for local time, because my insulin needs are different during the night when I sleep than during the day when I'm active. The last piece of advice she gave me was to not worry about trying to know the exact total of carbohydrates for everything I eat, because portion sizes tend to be smaller there, we will be doing a lot more waking, and because the ingredients are fresher. She reminded me to consider dual and square wave boluses and to do temporary basal reductions for times we will be more active to prevent low blood sugars.
It will be quite the adventure! I'm very excited for our honeymoon, and I will be sure to update you on how it went when we return in a few weeks.
Until then, may God bless you (and your blood sugar levels!).
The Type 1 Divabetic
I know I can't be the only Type 1 Divabetic out there who seems to have a rougher time keeping their numbers in check around the holidays. This July 4, my husband and I will be traveling to 9 hours to visit his family for Independence Day weekend.
Not just the Fourth of July, but all holidays, tend to make my blood sugar levels wonky. It seems like it should be an easy fix, right? Just have whoever preps the food calculate the carbs...
Whether it's my mother, my mother-in-law, or my sister-in-law, or my grandmother, all of their cooking throws me off. Does my cooking throw me off? Of course not. I've been tracking what I eat for a long time for my husband and I, and he does the same thing when he does the cooking. We tend to know EXACTLY how many grams of carbohydrates are in our meals. I've even gotten really good at being just about spot on with "guesstimating" grams of carbohydrates at restaurants that don't have nutrition information available online or in-restaurant.
But when it comes to holiday food, I'm terrible. Just plain awful. It's not uncommon for me to run in the 300's while hubby and I are away visiting family. I think it's because it's never just a meal... it's the fact that food is constantly available. And yes, I know what some of you may be thinking: Can't you just not eat the snacks and stick with only eating foods you can do correct carbohydrate counts for? Well, if you know anything about me, it's that I'm a food junkie.
Yes, I'm overweight, but my husband and I are making better choices for our lifestyle and learning from our mistakes. However, that doesn't seem to help us when we visit family. Whether it's my mother's tacos and evening snack foods, my mother-in-law's anything (she's a real life Betty Crocker, I swear she can do it all and all really well!), my sister-in-law's appetizers or baking, or my grandmother's cookies, we can't seem to stop nibbling. Primarily because it's encouraged on both sides of the family to try at least a little of everything.
I think why I have a hard time with my blood sugars over holidays and family visits is because I can guesstimate carbohydrates but the larger portions make it so it takes my body longer to digest, meaning all the carbs don't hit me at once. If I could get the willpower to eat one meal and then wait a few hours before snacking, I'd probably have better control because I could test and correct 2-3 hours after the meal.
I just have a hard time with the willpower. Especially at my mother-in-law's house. My hubby is one of eight children and five of them are married, two have kids, so food and snacks are always out on the giant dining room table and the family always sits at the table to talk and catch up, as well as play games. It's not uncommon to grab a handful of whatever tasty treats my mother-in-law puts out and then half hour later try another snack on the table.
However, I am going to try my best this time when we go over there to visit this weekend to wait 2-3 hours between eating anything so I can test my blood sugar first and get more accurate readings, correcting if I have to. I really think that will be my best bet. There is no way this flavor-addict can resist all of the temptation, but I'm going to set that small goal and see what happens.
Do you have any tips or tricks for keeping your numbers in check while visiting family? I'd love to hear your suggestions.
May God help you keep your levels steady until my next post,
The Type 1 Divabetic
This is a photo of my husband and I at my sister-in-law's wedding over Memorial Day weekend. The small amount of available food and all of the dancing my husband and I did are what kept my levels perfect during the wedding for sure! I can't say the same thing about when we visited his mother's house the next day, though!
I'm back! I apologize greatly for a hiatus on my blog. I even started drafting this post in February and hadn't had time to finish it up. As I teach choir, I was all caught up in school-related events such as preparing my students for Solo & Ensemble, Choral Festival Clinic, the Spring Concert, and Graduation. I also teach kindergarten so I had a kindergarten concert to throw in the mix as well! Now that school is out, my classroom set of 24 guitars is restrung, and my classroom is all organized for cleaning over the break, I have time to rest up and focus on blogging again before I head out for our honeymoon--which I will blog about, giving my travel tips and maybe receiving some from my readers as well! But on to the sensors... The reason you are here, am I right?
I love my Medtronic Enlite Sensors. I truly do. However, all I hear from other people with Type 1 is that they hate the sensors. Why? They claim that they aren't accurate. I really don't have much for inaccuracy with the Enlites, and want to share with you my tips and tricks for getting good sensor readings.
Tip 1: Make sure you choose a good location for the sensor.
This may seem like a dumb tip, but I found that putting the sensor on my abdomen like Medtronic recommends personally doesn't work well for me in getting good readings. I don't know if it's because my clothing is tighter there, if I move around in that area a lot, maybe that I have scar tissue from pumping, or what, but my readings are hardly accurate and the sensors tend to fall off there. I tried putting the sensor on my leg and my love handles before trying it on my arm. The leg was painful for me and my love handles have some scarring from pumping so that didn't work out well for me. I tried putting it on the front of my upper arm, on my bicep area, about halfway between my shoulder and my elbow "crotch" (where your inner elbow is, but I've always called it the elbow crotch, LOL). In this area, it tends to nearly always stay on for the full six days (I use two pieces of the overtape when applying the sensor, and if it starts to come up around Day 4 or 5 I will use some Tegaderm to keep it from falling off) and has the most accuracy for me. It's going to take some experimenting to find a good location for you. I'm not a medical professional and I know if you tell Medtronic that it wasn't on your abdomen, you may not get a replacement sensor for any issues you may have because the FDA only approved the sensors for use on the abdomen. However, if you're having trouble keeping it on your abdomen or getting accurate results there, you might want to try moving it around a little.
Tip 2: Get someone to help you put your sensors on.
I know that not everyone has someone available to assist, or even willing to assist, in helping to put sensors on. Some people are squeamish, and others might be afraid to help you for fear of messing up. Other diabetics might live alone or not have close friends or family nearby. In this case, my tip here may not be for you. Before I met my husband, I had no one willing to help me out, but I also was much more independent then. But the first week I knew G, I had to change my sensor and infusion set for my pump. He watched me do the sensor and pump change, then asked if he could do anything to become more involved in my care. At first we were both nervous--he never did anything like it before, and I never had anyone help! But with time and practice, we've come to be a good team with getting my Enlites on just right. I insert it and he does all of the taping. And since I put them on my arm, it makes it so much simpler than doing everything with only one hand. If you're blessed to have someone able to help, ask them! It will make your life easier and you will inevitably grow closer to the person who helps you.
Tip 3: Calibrate when your blood glucose levels are stable.
We have perhaps all been informed that calibrating when you have double up or double down arrows isn't a good idea when it comes to calibrating. I don't even like to do it with single up or down arrows. The best times to calibrate are when you see on your sensor graph that the line is pretty steady. For me, this tends to be before lunch and before supper, as well as during the night. I sometimes experience dawn phenomenon so some mornings are good to calibrate and sometimes it isn't. I also don't like to calibrate if it's been less than two or three hours since I last took insulin. I've found that if a calibration is due but I'm not steady, it's better to wait to calibrate until they are stable than to calibrate anyway. However, if your levels are steady but the readings are incorrect (example: sensor says 247 but you test and are 185), I have found that it's okay to calibrate. Your graph may appear to suddenly shift the line at the next reading it takes but that is okay. For every bad calibration you have, it'll take your next four calibrations to cancel it out. I heard that juicy tidbit from the educator at my old clinic and I've found it to be pretty true. One bad calibration can ruin your whole day.
Tip 4: Don't calibrate if you're too high or too low.
Enlite sensors don't read below 40 and don't read above 400. However, calibrating near the extremes of this threshold can make for some inaccurate readings that I've found. I don't like to calibrate if my blood sugar is less than 80 or above 300. When I've calibrated below 80, my sensor tends to say I'm perpetually low and keep entering threshold suspend mode even if I'm back above 100. When I've calibrated above 300, it will keep alerting me that I'm high even if my blood glucose is back within normal range. It tends to be more accurate if you simply calibrate when your blood sugar levels are less extreme. Sometimes I'll correct for a high or low and calibrate later. This may mean that your sensor graph doesn't show a high or low as well, but you want the majority of your readings to be accurate rather than just accurate for just your high or your low.
Tip 5: Check your Cal Factor.
What is this? I was wanting to make sure I was doing everything correctly with my Enlites, so I did a Google search one day. I was already seeing great results with my readings but wanted to know if I could make sure I always had good calibrations. Your Cal Factor is what prevents those annoying "calibration error" messages. To see if you have a good number to calibrate with, after following all the above tips, divide your blood glucose reading by the ISIG number on the sensor info screen. Hit your ESC button a few times till you see the sensor information screen, not your sensor graph. It tells you the age of your sensor and when your next calibration is due--yes, that screen! A little farther down you'll see a number near the word ISIG. If the result of dividing your blood glucose reading by that number is between 3-8, you're in business, baby! I don't do this all of the time, but I try to do it for my first four calibrations with each sensor insertion and if I have a reading that is steady but off from what the sensor says. This is a most helpful tip in getting your sensor calibrated!
Tip 6: Use the same meter (or brand of meter) to calibrate.
I personally love the Contour Next Link I got with my pump. I have found that it seems to be very consistent in readings. I used to have a different meter before I got the Contour and would test from the same drop of blood twice in a row and would have a huge variance (sometimes 30 points higher or lower than the first reading!) in results. This isn't the case with the Contour for me. I did a test study for a meter company in return for some compensation, and even found that using their meter had different results than my Contour, so never used those readings for calibrating. If you use the same meter or brand of meter to calibrate, you'll have better results.
Tip 7: Be patient!
Medtronic Enlite sensors have what feels like a HUGE learning curve. Don't get discouraged! I know it is miserable to get alerts that you're high or low when you aren't, or for your sensor to read good levels when you are high or low. I know that sometimes getting the tape on too tight or two loose, or getting it wrinkled a little, can also be frustrating. Trying to find a good area to place the Enlites is tough too since it's all trial and error, and trying to learn how to tape it to that part of the body can also be tricky. Just be patient. Once you have it all figured out, it's very simple and you'll have much more accurate readings and less error messages than before. I'll leave you with a Bible verse I really like about patience. I hope you find it will give you some perspective when it comes to all of the hard work needed to learn just how to use your Enlites. May God bless you and keep you safe while you navigate the waters of sensor accuracy.
The end of something is better than its beginning. Patience is better than pride. (Ecclesiastes 7:8)
--The Type 1 Divabetic
My Enlite sensors were in many of my wedding photos this past December! Here in this photo of me (with my mom and granny!) you can see really well where I found the best sensor placement for me. You can also see the pockets near my hips that I had put into my dress. Each pocket had a small hole in the seam to feed my pump tubing through so I could easily access my pump throughout the big day. I totally recommend getting two pockets since in advance you won't know which side of your body your pump is attached to and you'll then be able to use the other pocket for lipstick, a handkerchief, and snacks for lows like I did. My pockets were so full but you can hardly even see that they are there! I had the same kind of pockets put in for a bridesmaid dress I wore over Memorial Day weekend, and the other 'maids were jealous they didn't think to get pockets!
Valentine's Day is a day filled with carbs and alcohol for a lot of people, whether they are single or (hopefully happily) taken. Herein lies the problem for people with Type 1 Diabetes! I haven't always had great Valentine's Days since I was diagnosed with Type 1 Diabetes at age 14. Most of the time, I was single or unhappily taken, and would eat copious amounts of carbs, throwing caution to the wind. When I hit age 21, alcohol got thrown into the mix. Sometimes, I would have what I call a "blood sugar hangover" for a few days after Valentine's Day.
It's still hard now that I'm a newlywed, as we tend to celebrate more than counting carbs. However, any person with T1D can celebrate (or mourn!) Valentine's Day safer than ever before. Here are my simple tips:
I know, I know, we all hate testing out blood sugar levels. However, testing before you eat or drink anything can help you get a good idea of just how much insulin to take for what you eat.
2. Count Carbs!
Sure, not everything we eat will have nutrition information readily available, but sometimes it's is right on the wrapper! At restaurants, you can ask for nutrition information. Many places that are national chains have the information that your server can get for you. For a homemade dinner, if you are cooking of course, keep notes of what goes into the entire meal so you can divide it into portions later. For something someone else prepares you, do your best to estimate.
3. Test Again!
About two or three hours after I eat a meal and dose my insulin, I check my blood sugar again to see if I have done a good job counting my carbs. It's also a good idea to check after drinking alcohol, too! This let's you see if you'll need corrective insulin or if you'll need some more candy! (Oh no, right?!)
If you have a Continuous Glucose Monitor, or CGM, having it calibrated as closely as you can BEFORE you go on your Valentine's Day binge will be a great asset. It'll show you trends for your numbers while you eat foods you normally don't eat.
5. Have a Buddy!
Sometimes we want to "celebrate" Valentine's Day alone, but having someone around to remind us to test or bolus can be helpful. Even if you ask a friend or relative to call and see how your sugars are doing that day can be helpful! Hopefully your date, should you have one, will be a perfect partner and help you out!
I hope everyone has a safe Valentine's Day this year. It may not be happy for everyone, but at least you can be healthier this year!
-The Type 1 Divabetic
This first blog post of mine won't sugar coat anything. (Pun intended.) I'm going to be the first one to admit that having type 1 diabetes is hard. Incredibly hard. There's so much that you have to deal with and it changes your life dramatically. I'm not saying that it's impossible to live with, but to live well with it... That's the challenge, isn't it?
First of all, you deal with the highs and lows of the disease. Yes, of course, you have low blood sugar, which at least makes my head feel like I'm getting a bit drunk, and you have high blood sugar, which makes me feel irritable and like I'm in a fog. Not to mention the long term and short term dangerous consequences associated with high and low blood sugar. But I'm talking other highs and lows.
There's the highs of having a good reading on my blood glucose meter. It also feels great when my CGM perfectly calibrated. I also feel excited when I estimate carbohydrate amounts correctly for a meal that I have no idea where to begin with carb counting. And my favorite... Sleeping all night without my CGM interrupting my sweet slumber that my blood sugar is high or low. There are more of course, but these are just a few of my favorites.
Then, there's the lows. I swear I have to pee all the time. The finger pricks are painful, and that happens around eight times per day. I have mood swings... Especially when hungry or if my blood sugar is high. Carb counting when cooking homemade recipes is tedious, and having only foods with nutrition information on them gets boring after a few days and isn't as healthy. Stress makes my blood sugars rise. Exercise can make them rise or fall. I hate when my insulin pump doesn't deliver insulin properly, and when my CGM is calibrated incorrectly or has errors that cause it to malfunction. I feel guilty when my blood sugars are bad during the night, which keeps both me and my husband awake when we both have to work the next day. Hormones and colds mess with the blood sugars too, and it's nearly impossible to regulate them during these times.
Don't get me started on all of the judgement of having diabetes. Somehow, nearly everyone thinks that we did something to cause this disease just like the people with type 2 have been painted by the media to have caused their diabetes. We haven't! We didn't ask for this. We have an autoimmune disease, where our bodies literally killed our pancreases. I know I hardly ate candy as a child, or soda for that matter. Yet, it seems that everyone out there thinks that my parents must have fed me sugar for every meal to cause this. The media has completely confused type 1 with being the same as type 2, and whenever I try to educate others on the differences when they say a poorly timed joke about diabetes, then I'm a bad person and should know that it's just all in fun. Oh, and the "cures." Okra. Cinnamon. Diet and exercise. It's all so frustrating--the judgement, the cruelty, the ignorance.
This disease is hard. I've prayed so hard that it will become easier. It hasn't become any easier, actually. A lot of days it feels harder. But I keep on going, and even more intently now that I am married to an amazing man who could never understand fully what I'm going through but tries his hardest. I want to be there for him, for us, for as long as I can. And I never want diabetes to stand in the way of anything we want to do. So far, we've drove all of Route 66 (more on that in another post!), had an amazing wedding day (another post as well!), and did just about whatever we have desired while doing our best to keep my diabetes in check.
Yes, type 1 diabetes is hard for everyone. Not even our doctors can understand what we face. To them, it should be easy to manage. We can do everything right and still have bad results--and that's so hard. I choose not to be a diabetic, but a divabetic. You can too. We may have type 1 diabetes, but it doesn't have us.
Until next time,
Type 1 Divabetic