Delicious Ambitions.

This adventure is uncharted territory for me:

Pinterest has given me an over-inflated sense of confidence in my yet-unchallenged gardening capabilities, and a trip to Lowe's has only further enabled me.

I know this patch of earth doesn't look like much of anything, but it took three hours and a partial sunburn and I'm kind of proud of how it's shaping up. It's my first vegetable garden and I'm hoping that digging up part of our yard isn't going to be all for naught. The tomato and bell pepper plants I started inside a few weeks ago will hopefully shape up into something we can eat later this year, along with a few other plants that people told me are "easy to grow". We'll obviously eat more vegetables if they're growing in our own backyard, yeah?

I spent some more time on it last night and I now have 3/4 of the garden area dug up and all of the stakes in place, which leaves a bit more grass to remove (this is why it's taking so long - I'm patching up bare spots in our yard with the sod, which I'm moving one tiny rectangle at a time because we don't own a wheelbarrow), some empty plastic bottles to bury (yay DIY/cheap-o drip irrigation system!) and some chicken wire to put up as fencing to hopefully keep dogs and rabbits at bay. All bets are off on squirrels though because I'm pretty sure that two feet of fencing isn't going to slow them down much; they'll just be like, "aww, that's cute of her" and go on to feast on my tomatoes.

And while I have my insulin-to-carb ratio pretty much figured out these days, my insulin-to-gardening ratio is something I'll need to learn. My Dexcom graph has been on a steady decline due to the added manual labor, so I'll look forward to an inverse relationship this summer between my insulin requirements and my (hopefully) gardening productivity.

"Good" Morning.

I wake up and am all, yeah! Let's start the day! Watch out world!

And then I look at my CGM graph.

::shakes fist at the heavens::

Twenty Eight.

It doesn't seem quite possible that it has been this long

Since my immune system and pancreas got it so wrong.

My beta cells keep dying so I wear this pump, you see

It looks so simple but isn't - the math is up to me.

Every day I count, I track, I dose, I worry, I guess

I wear the stuff; I eat the things; I try to do my best

But sometimes diabetes, it has its own agenda

Enigma wrapped inside a mystery, this contend(ah).

How do I bolus for stress? What's the ratio for grief?

The intangibles swarm invisible; flaunting their teeth.

Then again, when things go well and efforts don't seem fruitless

Pancreatic skills degrade; a diabetes hubris.

This means I must stay vigilant; my experience shows

"In range" is often just a rest stop between highs and lows.

This day won't look too flashy but here I'll commemorate

That today marks when my diabetes turns twenty-eight.

Spammy Spam Spam.

I have no idea how these people find me, but thanks for the LOL this morning, Internet.

The spam comments are showing up rapid-fire lately, but at least they're usually entertaining. (And if I start getting spam comments on this post about spam comments it will be way too meta and my blog will probably self-implode.)

Anatomy of a Dexcom Graph.

At first glance this graph looks... not fun, but something along the lines of "you were running high, did a correction bolus, and then you were low".

But looking at it another way, it's:

1. "Why is this high so sticky? I under-bolused for that sandwich at lunch because I could see I was dropping and knew I'd be home alone with my daughter for the next few hours, but apparently I overdid it. UGH. This feels so gross, and it's almost dinner time. Since all of those corrections over the past few hours didn't do much, I'm finding out what my pump would suggest for a correction bolus if I had no IOB and bolusing that amount."

2. "Yaaaaasss. Now stick the landing, you glucosey blood you."

3. "No no no noooooo [insert curse words here] do not want, stop it. Just level off! Stop dropping! You're good! Just stay right here!"

4. {inhales Peeps; notices legs are tingly/numb; delegates remainder of dinner assembly to husband; sits at dinner table waiting to regain self}

I find myself doing this thing where I underbolus for food or just run a little higher in general when I'm with my kid because I don't want to drop low while I'm the only one responsible for her, but I usually end up rage-bolusing my way out of it and end up low anyway, the very outcome I was trying to avoid in the first place.

Wow, so doge meme, how obsess, much annoy husband, very giggle!

Revisit: What We Aim For.

As I look back on how frustrating yesterday's #dayofdiabetes turned out (I spent the majority of it out of range), I'm reminded of why diabetes management is so frustrating in the first place. (Original post: 2011.)

* * * * *

Most people put their hard work into something with tangible results.

Chopping, dicing, mincing, stirring, baking, grilling, zesting... these things result (hopefully) in a satisfying meal.

We study hard and stay up late into the night and morning to cram for exams, so we can hold that hard-earned diploma in our hands.

We wake up early and throw ourselves into whatever it is we do as a vocation, and can find gratification in reputation, self worth, and means to earn a living.

We sweat and stretch and exert, so that our bodies stay healthy. So that we can win a medal. So that we can beat someone in a round of basketball.

We meticulously count calories and track exertion, so that we might lose (or gain) weight.

In all these things, there is a goal to reach. An achievement to celebrate. But when it comes to diabetes, the ideal end game of all our hard work is... nothing.

We work hard so that nothing happens. So that we keep our eyes, kidneys, feet, and everything else free from harm. We do all of this so that diabetes remains an invisible monster.

(What sort of motivating tool is that, anyway? Aiming for nothing? Nothing is a lousy reward.)

I think that's part of why living with diabetes can feel so burdensome at times - not only do we deal with the counting, the equations, the guessing, the emotions, the never-endingness of it all, but we do it all just to "keep up". Just to be "normal". We do it all so that nothing seems out of the ordinary.

We hope that all of that "something" we do leads to nothing.

The best possible result of our work is that you will never know there was any work to be done in the first place.

#DayofDiabetes.

If you're up for seeing what a real life day with diabetes is like (or, at least, what it looks like through tweets), there are several people using the hashtag #dayofdiabetes today to document every interaction with their devices, every medication decision, every pump or CGM alarm, every thought of "did I actually bolus for breakfast?".... you get the idea.

I'll be tweeting everything I do today that involves my #diabetes to give you a small glimpse of what it's like. #dayofdiabetes
— Kim / Diabetes (@txtngmypancreas) April 10, 2014

It's a small glimpse into what goes into managing diabetes every day, but it's a start. (The last time I did a #dayofdiabetes was while I was pregnant - it's a trip to look back at that day. I love being able to archive stuff like that. Yay internet! I'll be Storifying today's entries too, assuming I remember my Storify password...) UPDATE: Here's the link: https://storify.com/txtngmypancreas/dayofdiabetes-april-2014

Follow the fun on Twitter by watching the hashtag, and find the archived tweets later on on the Day of Diabetes Tumblr site.

The Answer.

All of a sudden, I couldn't focus my eyes on anything.

I knew my 8 month-old daughter had her eyes fixed on me; my peripheral vision worked enough for me to know that she was jubilantly swinging her legs back and forth in the seat of the grocery cart. I could tell that she was grinning and waiting for me to return her smile, as she often does. Instead I reached behind her to grab my purse.

My hand instinctively went first to my Dexcom receiver. I clicked the button to wake it up, and it told me I was at 113 mg/dL with a straight arrow, meaning that it thought my blood sugar was in range and steady. "I don't think that's right", I mumbled out loud - there's no other reason my vision would have suddenly changed. Reaching to the right-most interior pocket, I searched for that plastic tube's familiar shape; the one that holds my glucose tabs.

I picked it up and shook it. Empty.

"Ugh, are you seeeeeerious...", I muttered. I turned the cart around and headed for the checkout, still unable to really focus but knowing that all of the fast-acting sugar was up by the registers, so that's where we needed to go. Should I try to test?, I thought to myself. I decided against it for two reasons: I knew that trying to balance a testing kit on the handle of the grocery cart was a no-go because tiny hands would try to "help", and I also knew that it was safer to just treat the possible low blood sugar when in doubt, and test later to confirm. I caught Rabbit's gaze, smiling meekly at her. I would keep us safe. I would keep her safe. "We're okay", I said out loud in a sing-songy voice, mostly to her but also to try to convince myself because I wasn't so sure we were.

We got to the checkout and my eyes found the soda cooler. I don't want soda, part of my mind said. Don't they have juice? I don't see any. When I tried to look at the candy display to my right, it shifted and blurred. I could not come to a decision. Chocolate isn't a great low treatment because it doesn't work as quickly. Do they have Starbursts? Wait, that's not good either; lots of chewing. And on and on, until the rational part of my brain ducked its head in, cutting through the low-induced indecision for juuuuust a second to say, Literally ANY OF THESE THINGS can save your life right now, just pick one and eat it.

With Snickers bar in hand, I swiped my debit card. I didn't even know how much we had spent, but we had two bags of groceries suddenly ready to go in the main compartment of our cart. Maybe once I start walking, my eyes will be able to focus. (Sidenote: I have no idea why I thought this.)

I pushed the cart of precious cargo out to the parking lot, still not touching the Snickers. Too many things to juggle at once; I'll eat it once we get to the car. The sunlight hit our faces and the Rabbit squinted her eyes. "We're aaaaallmost there, punkin'." I felt the symptoms of the low finally kick in - I felt weak and helpless but determined that I would not pass out on the way to the car.

And I didn't - I even got the groceries into the trunk and my daughter into her carseat. (Not gracefully, but I did it.) Only as I finished inhaling the Snickers bar did I realize we'd bought bananas, so I ate one of those too. I turned up the radio (silent cars seem to upset the wee one) and we sat for a while in the parked car, my daughter batting at her toy monkey hanging from the carseat handle and me finally testing my blood sugar a few minutes later.

53 mg/dL.

That's the thing about living with diabetes - I'm fine, until I'm not. Once lucid again, I scolded myself for potentially putting us both in danger: Couldn't I have treated that low before we ever left the safety of the building, instead of confining myself to the car where no one might notice if I passed out? Shouldn't I have checked my glucose tab supply before we ever set foot in the store, knowing that grocery shopping makes me often run low? What if I did pass out? Would my daughter be okay? Would the paramedics find my medical ID bracelet; the one whose colorful beads make it look a lot like a normal, recreational one? Should I have said something to someone? Diabetes gives me so many reasons to question myself.


You can be as vigilant as possible, use the latest devices, dutifully take every medication on time, and eat all of the "right" things, and incidents like this can still happen. The answer to "Am I okay?" always has this asterisk on it, as the answer is never completely yes or no.

The knee-jerk response when I say that "I'm fine" belies the intricate nature of what's going on both in my body and in my mind, and I hate that sometimes I have to admit that the answer to the question "Are you okay?"  isn't so cut-and-dry:

Probably? I guess we'll know in a few minutes.

Diabetes Flop.

Some days I do my best with the life vests (diabetes devices) I have available to me, I leap into life and everything just works out.

Some days, I do my best with those life vests and leap into life and it's still not good enough.

Guess which day today is?

Occlusion alarms like whoa today.

The t:slim Air Bubble Dilemma.

Editor's note: as always, nothing on this site should be taken as medical advice. I am sharing some troubleshooting I've done with my insulin pump and if you'd like to recreate anything you see or learn in this post, please know that you are doing so at your own risk. If you're unsure, contact your insulin pump manufacturer to make sure you aren't going to void your insulin pump warranty with whatever you're wanting to try. I cannot be held liable if you accidentally turn your functioning medical device into a really expensive paperweight. 

I've been noticing a pretty consistent bummer of an issue lately when it comes to pumping with the t:slim:

My pump likes to err when it comes to air.

Little buggers!

It seems that air bubbles (which, according to Tandem's safety information, can compromise insulin delivery) like to gather in the connector area where the "pigtail" - at the end of the couple inches of tubing that comes directly out of the cartridge - and the luer lock of my tubing meet. I've also noticed a bunch of tiny air bubbles (a Tandem rep I spoke with referred to them as "champagne bubbles") that accompany the insulin I'm priming through the tubing with each new cartridge change.

Here's a better look at the "connector bubble" I'm talking about:

Yeeeeah, that can't be good.

I'm not alone, either: a Google search for "tslim air bubbles" pulled up around 7.6 million results, many of them discussions between patients and caregivers about what they've tried and how one might "beat" the air bubble quandary. (Some of the threads on TuDiabetes and within the Facebook t:slim group are notable.)

That Google search also led me to a YouTube video from a fellow pumper named Scott who has some fairly unique ideas on how one might combat air bubbles. I've tried a variation of his method a couple of times and while I'm still getting the hang of it, it does seem promising to me so far. Actually, it's kind of brilliant (and more work than it seems like you should have to do, but if it works...). Scott told me he's relatively new to pumping - he started using his first pump, the t:slim, last November after years of MDI - and applied some of the same principles he knew from multiple daily injections to his t:slim cartridge changes. He's also an engineer by trade, so yeah, that probably helps.

I'm going to reiterate that this video isn't medical advice and isn't the official way to fill a cartridge as recommended by Tandem Diabetes (but for what it's worth, everyone I've talked to at Tandem seems to be open to the possibilities of other ways of doing things, as long as they don't harm the pump). If you're going to try this, do so at your own risk. (And thank you again, Scott, for letting me share your video!)




I realize that having to bang the side of an insulin cartridge with a Swiss Army knife (is that what he uses?) isn't an ideal solution, but sometimes you have to improvise. (I actually use the old cartridge as my "hammer" of choice, but you do you.) The two key things here for me are the angle at which you're holding the cartridge when pulling the air bubbles out, and the whole in-out-in thing you're doing with the syringe.

At the same time that I started trying out some of these techniques, I also reached out to Tandem Diabetes (makers of the t:slim) to see what their take is. They said they're aware of the air bubble that tends to appear at the connector - the rep even commented that she sees them too, in her demo pump. We ran through all of the normal troubleshooting bullet points - is the insulin room temperature when you're filling with it, are you keeping the pump pigtail-side up when filling and priming, are you making sure there are no air bubbles in the filled syringe (for the record, I don't think I've ever been able to get every air bubble out of a filled syringe - it's just the nature of the beast - but I am usually able to flick the side of the upside-down syringe enough that they all collect towards the plunger, and I stop just short when filling the cartridge so that these bubbles stay in the syringe) are you making sure the luer lock is tightened all the way, etc.

One idea that a Tandem rep gave me and I've tried with success is: when priming the tubing, don't connect the tubing to the pigtail before the fill starts. The pump requires you to prime a minimum of 10 units each time, so what you can do is prime most of your air bubbles out before you attach the tubing. (The thinking here is that a 3 inch piece of tubing is a lot less space for air bubbles to escape through, than through 20 inches or more.) Once you've hit the 10u mark - or if you're feeling especially dexterous, you can just do this part once you see insulin at the top of the pigtail and all of the bubbles have escaped, and the pump is still priming - attach your tubing and continue to prime.

It seems like some combination of these processes might work best for me, and I plan to keep experimenting. If you're using a t:slim - what have you tried? Are you getting the same air bubbles I am, and if so, what are you doing to avoid them?

From Here.

Some days I need to remind myself
the ways in which framing impacts
my emotions
which impact
my behavior

That even when the glucose meter claims
three forty eight
it means that I know where I am, give or take
and that's more than I knew
just a few seconds ago

That forgetting to take my vitamins each night
for two weeks straight
also means that I had vitamins to take
that I could afford them
and tomorrow is another chance

That being angry or frustrated or envious
is okay
and maybe actually healthy
as long as I don't unpack and live there

That sometimes I should ask myself what
breathing feels like
not to answer it, but just to notice
because wherever I go from here
here is what I have
and so I will be thankful for it.