Thursday, May 24, 2018

What I Learned About Afrezza

At the end of April, I attended a meeting with Mannkind, the company who manufactures the inhaled insulin, Afrezza, with a small group of Diabetes Advocates and .Orgs at their HQ in Danbury, Connecticut. There we had the opportunity to meet with senior members of the company, including engineers and scientists and discuss Afrezza and Social Media.
I went in not knowing much about Afrezza, but was curious to learn all I could. 
I have friends (both on the pump and MDI,) who are fiercely loyal to Afrezza and I’d tried it once with positive results - more on that later. 
I went in with an open mind and hoping for another diabetes option for us.
Here’s what I found out. 
Afrezza is a crystallized, inhaled, powdered form of Regular insulin that works quickly via the lungs and the bloodstream and is used for mealtime dosing.

Afrezza works fast - as in wicked fast. As in it starts working in 3 to 7 minutes, reaches its peak in 30 minutes, and out of your system within 1 to 2 hours. 
Basically, the short time in the system helps to prevent low blood sugar hangovers - my words, not Afrezza’s. 

Other short acting insulins (Apidra Novolog, Humalog), take 20 plus minutes before they start to kick in.
WHY? Because being injected through skin has a slower turnaround time than inhaling.
Injectable insulins peak in 2 hours and exit the body somewhere between 4 and 7 hours.

As far as the Billing Code, Afrezza uses the same billing code as an insulin pump - so check your Durable Medical Equipment clauses in your insurance policy. 

FYI: Exercise activates Afrezza.

Clinical Trials
Clinical trials for Afrezza have shown no evidence of long term lung 
damage to patients. Our group was told that the reason why people have lung tests be
fore starting Afrezza is to rule out any unknown/underlying lung issues like COPD. 

Bitch Lows and preventing them 
Afrezza has been shown to reduce severe hypos by more than 30%. THAT"S BIG.
Dosing: Afrezza inhalable insulins are currently available in packs of 4, 8,12. 
Afrezza’s unit amounts differ from injectable insulin units -HealthCare Pro's help 
with the learning curve.
Friends who use Afrezza say it wasn’t difficult to get with the Afrezza program.
User Breakdown
Afrezza users are evenly divided into type1s - some of whom combine Afrezza with 
using their insulin pump. Using their pump for basal rates/correction boluses and 
dosing Afrezza for meals.  
The other 50% are type 2s.
Some users on both sides of the diabetes fence have experienced weight loss. 
Sidebar: There is currently no info re: LADA1.5 users at this time.

Is there a Patient Assistance Program? 
YEP. Go to Mannkind Cares Start Out Program and here's the link to the Patient Savings Card.

My Own Experience with Afrezza
My one experience with Afrezza was 3 years ago and it was a positive one. 
I was attending the Diabetes UnConference in Atlantic City and was out with some Diabetes Online Community friends who came to town early the night before the conference began. 
After copious amounts of Crab Nachos and bolusing multiple times - I could tell something was wrong. My numbers kept going up - even with an increased temporary basal rate of 40%. 
It turned out that my Medtronic infusion site had crapped out.
I had another infusion set with me, but low and behold that new site didn’t work either.

Yep, I was screwed. My blood sugar was well over 300 and I felt it.
I had two choices: Go back to the hotel a few miles down the boardwalk and change out my site, or take my friend M’s advice and try his 4 unit Afrezza and inhaler.  
I went with the Afrezza, inhaled, and 2.5 hours later (plus 1/4 of a turkey club,) my blood sugar was 167 - and I was happy.  

Closing Thoughts
I was impressed with what I learned about Afrezza, and while I don't want to give up my Omnipod, I would consider using Afrezza with my Omnipod therapy - and I'm going to discuss that with my Endo at my next appointment.
Also: Your diabetes is different from mine and collectively, people with diabetes need as many viable and beneficial diabetes options on the table as we can get!
Afrezza is an option. 

Disclosure – My expenses including travel, food, and lodging were covered by Mannkind,  and I was paid an honorarium - which I appreciated. 
With that being said, all thoughts are my own and I was not asked to write about Afrezza - but I did because I wanted to share what I learned with you - and now you know ~ 

Thursday, May 17, 2018

Diabetes: A Bitch Low Blood Sugar - And Waiting It Out At The Deli

I stood at the convince store/deli counter, clutching it with one hand and holding/downing a Nantucket Nectar Lemonade with the other. 
I'm sweaty and it feels like my whole body is shaking  — but I'm not sure.
I need to focus on drinking the lemonade and staying calm, so I do. 

The bitchlow had come out of nowhere  — and I was dropping fast. I’d been walking on the main street of my town when I broke out into a cold sweat — and right near the deli.
The register was on the other end of the circular counter and the woman behind the register watched me. 

I struggled to find my words and finally said: I’m sorry, but my blood sugar is low, I need to drink this now.
I was out of breath and as I spoke and my words didn’t tumble out of my mouth — my speech cadence was slower than normal and my mouth was numb. 
The woman walked over to where I was standing and said: It’s OK, I have diabetes, I know exactly how you feel. Sit at a table and pay me when you feel better — and let me know if you need food. 

And that’s what I did. 
I sat quietly at a table and watched the clock on the wall as the minutes ticked by. 
I finished three quarters of the bottle and waited until I felt stronger. 
I ran my hands through my hair out of habit and I felt the tears stinging my eyes.
I’ve noticed that when I get a bitch low that stops me in my tracks, I end up fighting back tears. 
My face is pale during the low, but as my blood sugar starts to come up, my eyes start to sting, and I can feel my checks turn red. 

I think part of my tears are due to the fact that I've  fought so hard to stay in control during the low, that an emotional wave of relief floods over me as things start slowly shifting back to normal and my eyes start to swell - and the other part is diabetes and my body's reaction.

And I hate this feeling. 

I hate feeling that if I don’t drink or eat I will crash to the ground. 
I hate that my words are halted and that I feel weak.
I hate that I am on the verge of tears. 
I hate feeling helpless, weak, scared, and determined all rolled into one.

I hate feeling alone. 

But for this particular blood sugar, I am incredibly grateful that I have a place to wait it out — and a person who watching from the sidelines. 

I glance at my medical ID bracelet and I feel myself calming down. 

I check my blood sugar at the twenty minute mark - I’m 83. 
Even thought the juice was over 60 grams of carbs, I decide to finish the bottle, wait another five minutes and then went up to pay the woman behind the register. 

She looked at me and said: Feel better, honey?? 
 I told her I did and thanked her for letting my pay after things settled down  and for “getting it.” 
She doesn’t want to take the money and I insist she does. 
I say goodbye, walked down the block to my car, get in and sit for a bit. 
Tears are streaming down my face at this point and I'm glad I'm wearing my prescription sunglasses. 

I’m home 10 minutes later and 50 minutes after that I check my blood sugar again. 
I am 116. And at that moment I am glad I drank that whole damn bottle.

And I breathe deep, walk to the bathroom and look in the mirror. 

I am a hot fucking mess - and not in the good way.

Mascara running down my eyes, tears stained cheeks, and I look a sad. 

I wash my face, and say THANK-YOU out loud. 
And I mean it. I am thankful that lows like that don’t happen very often, and I am thankful that I'm OK.
Then I smile at my reflection and forge ahead.... towards the couch. 
Dinner can wait, for now I'm going to chill. 

Monday, May 7, 2018

Spring Travel; Diabetes, High Ketones, Normal Blood Sugars, And The Stomach Bug From Hell

OK-first and foremost  — spring has finally sprung. YAY!

Secondly, sorry for the being MIA the last couple weeks. 

I came home from a work trip on the night of Tuesday, April 24th, with a 101.2 fever, Moderate to Large keynotes, and the stomach virus that has been the plague of spring 2018 for many — and it was horrible. 
It was the longest car ride home of my life and an hour after I walked in the door and 55 minutes I found out I did indeed have Moderate / Large ketones, (literally the color was somewhere between the two on the chart,) I Linda Blaired it, a'la "The Exorcist." 

I immediately felt slightly better and made a deal with myself. 
If my ketones went down to moderate in 80 minutes and I didn’t vomit again, 
I wouldn’t call 911. If either of those things happened, I would. 
I filled up my 24 once water bottle and immediately drank 1/2. 
15 minutes later I finished the other 1/2 and filled up the bottle again. 
I was scared but I was calm  — weirdly and mythodically so. 
I knew what goasl I needed to meet and had made peace with my plan B option. 
Yes, I was scared, but knowing that I had a plan helped me stay calm.

Luckily, 80 minutes later I checked my ketones and they were indeed  moderate, I didn’t vomit again and I downing drinking water. My blood sugars were normal with insulin on board. I drank a little juice and went to bed. 

I woke up in the middle of the night, checked my blood sugar and  keytones ( 109 bg and small to moderate Keytones on the color chart), downed 10 ounces of water and went back to sleep. 

I woke up Wednesday with small ketones, that quickly and thankfully moved Trace, and finally edged to Normal by Wednesday afternoon. My fever kept shrinking until it left me for good on Friday.

Which would be the exact day the whole, not being able to be too far away from the bathroom, thing kicked in with a vengeance. 

I continued surviving on Mixed Fruit flavored gatorade, saltines, and weak black tea because those were literally all I could stomach. 
After 5.5 days,I was finally was able to drink coffee (and leave my house,) Sunday, April 29th. 
The last day of April and the first day of May meant working on deadlines and I flew to Boston on May 2nd. 

Dealing with all of the above reminded me of some important things that I'm going to share with you. 
  1. We ALWAYS need to bring Keytone Strips/Keytone Meter and thermometer when we  travel — and even if we're only going away overnight 
  2. Why? because you can have normal-ish blood sugars and still have nasty keytones — even if you drink lots of water. And if those sneaky keytones get the upper hand, no good will come of it.
3. You can feel “off,” but because diabetes can be a tricky bitch, your blood sugars might not reflect that. I felt tired and in need of a nap early Monday afternoon - but my blood sugars were stellar and I wrote it off as  travel day fatigue. 
But it was an easy travel day by car. Looking back, feeling that tired was a sign of things to come.
Also: You can feel hot and blame the traveling and hotel air conditioning, but it might actually be a fever. I was walking around with a fever that alternated to the chills for a good part of Tuesday - and I blamed the forced air heating and air conditioning system. 
Here are my stats from Tuesday, April 24th. 
For the most part, everything looked "OK," numbers wise. 

Insulin total breakdown for 24 hours on 4/24 
Bolus history 4/25

4/24 bg from early in the morning.
Elevated morning bgs thanks to a low bg
in the middle of the night. 
4. ALWAYS make sure that you not only have regular ginger-ale in your pantry, but 3 or 4 bottles of your favorite flavored Gatorade and saltines, because if you end up with the stomach virus from hell, regular Gatorade is your best friend. It helps keep your hydration levels and electrolytes where they need to be, gives you drinkable carbs, and is the only thing (besides maybe a few saltines), that won’t add to the destruction of your gastrointestinal system.

5. Also, stomach viruses can be f^cking tricky, not to mention confusing. 
I had damn near normal blood sugars ( Bgs were constantly running on the low side of normal), for 5 days — it was like I was like my pancreas was messing with my head and I was this close to thinking that I was making insulin. But I was still “real people sick," and barely eating anything. 

6. Sleep is your friend and hydrate like your life depends on it — because it does.

7. Stomach viruses NEVER come at the right time and playing catch up is not easy — but you do it because you must. 

I’ve had trips scheduled the last two weeks and I travel again on Thursday. 

Sharing all of the above because it’s diabetes and life related and I think we need to be reminded that everything can look good on the surface, but there can be a literal shit storm (sorry I couldn't resist,) brewing - So check your blood sugars and your keytones!   

New blog posts re: what I learned on my travels soon!

***FTR, when I was down for the count being real people sick, I made sure to let a couple close friends and family know what was going. I live by myself and like to think I can handle it all - but when I'm under the weather, I let a few of my "go-to," friends know.... just in case I need help. It makes me feel better - and it makes them feel better. 

Friday, April 13, 2018

Kindness Counts

Not a diabetes post, but from the heart. 
Wait, I take that back. Kindness counts in life and life with diabetes - so while this post isn't about diabetes - kindness matters when it comes to life.... and life with diabetes

I was on my way to get my stitches out at UrgentCare the other night. 
Traffic was bordering on crappy, I was getting hungry (and bordering on hungry,) so I decided to stop at the Starbucks looming in the distance, grab an early dinner and “wait out,” the traffic.
With knapsack on my back and Starbucks coffee card in hand, I grabbed a table, took off my coat and plopped my knapsack down on the two-top, then went to place my order. 
I’d noticed when I walked in that many of the small tables had been pushed together and the single occupants of said tables had spread out their stuff and made their own office cubicle - and just because they could. 
And that really bugged me. Why take up two tables and 3 to 4 chairs for one person - especially when seating was scarce. 
But I didn't say anything because sometimes I’ve been accused of making a  mountain out of molehill — and I was bordering on hangry - things could get ugly quick. 
So I said nothing - and I didn’t feel good about it.
 Nope, I just stood in line and ordered my egg white, spinach and feta wrap with extra sriratcha. 

Cut to 25 minutes later: My delicious wrap devoured, computer set up, and yours truly typing away on a WORD file at my tiny table. 
The front door opened and 3 elderly women walked in, one of whom was struggling to use her  walker. 
The ladies stopped in their tracks - midway between the counter and seating, when they realized their wasn’t a seat to be had. 
I know I wasn’t the only who watched them struggle to find a place to sit - but nobody offered to give up their extra table or seat. Nobody did anything.

So I did. 

I stood up, looked around and assessed the situation. I asked the girl sitting behind me if she was using her extra table - she was - her boyfriend was in the bathroom and  her mom were in line grabbing coffee. 
I asked if I could use her extra seat, (there were 4 chairs,) and she gave it to me willingly. 
Another woman at a table near the wall offered her extra table (which I didn’t even realize she had,) and I asked a man sitting in primo spot near the outlet if I could have his extra chair - and he said, “SURE.” 
Everyone was nice…. except the teenage girl’s mother who had just come back from getting her coffee. She gave me a dirty look and told me I’d taken her seat. 
I didn’t have time to make a federal case and I didn't take it personally.
I apologized, put the chair back, grabbed my extra seat and set up the table next to mine. 

Then I motioned for 3 women to come on over. 
It took less than 2 minutes from start to finish and the 3 ladies were shocked and grateful. 
Head Lady In Charge: I was watching what you were doing, but I didn’t know you were doing it for us - THANK YOU.
ME: No worries, there’s room enough for everyone!

The teen's mom tapped me on the shoulder and apologized - and told me quietly that she didn’t realize what I was doing. 
 I could tell she felt bad. It was a misunderstanding and I told her just that.
 And I meant every word.

Between you and me, when I saw those three women, images of of my own beautiful mom popped into my head. And I thought of my friend Mark who would take my sister Debbie to the mall - wheel chair and all, when I’d lost patience with her
I also thought of my friend Cathy, who drove her 93 pound dog Misty to the Rehab Center 
35 minutes from where we lived, to visit my Uncle B (who loved dogs,) in the rehab center after his health had taken a turn for the worse and 4 weeks before he died. 

And in my head I thought: KINDNESS COUNTS


And Kindness matters. 

15 minutes later, a Starbucks employee walked up to me on the sly, bent down and whispered in my ear so that the 3 ladies couldn't hear: “what you did was so awesome, THANK-YOU,” and dropped a $10 Starbucks Gift card on my keyboard. 

And then it was my turn to be shocked and appreciative of her kind gesture. 

It doesn’t take much to look up from our screens and do the right thing. 
It doesn’t cost any money to be nice and engage with others - we all need to do that more often. 

We all need to look up from our screens more than we do, look around and consider others, not just ourselves. We need make sure everyone has a seat at the table of life. 

Kindness not only counts, kindness matters and a little kindness goes a hell of a long way in a world that needs more kindness and compassion

Kindness makes us feel good and gives us perspective on the world around us and the people in it. 

And kindness comes back to you -  which is also very cool. 

Tuesday, April 10, 2018

My GTMH Bag... That Goes Inside My Big Bag

We all have our own diabetes idiosyncrasies - I certainly have mine! 
They make us feel safe, keep us organized - even if they can occasionally annoy the crap out of us!
I was leaving a meeting the other night — walking down the darkened hallway, the last out the door — besides the organizer and a couple of stragglers. 
I reached inside my work bag to make sure that I had my Omnipod PDM before walking out the door and to my car. 
I’d tossed my PDM (in its funky Owl PDM case),in my work bag after checking my blood sugar during the meeting, but hadn’t placed in the zippered “Go-To /Must Have,” bag 
( and which shall be referred to as my GTMH Bag for the rest of this post), I keep in my work bag. 

My GTMH Bag contains my phone, wallet, pod ppm/test-strips case, an extra tube of glucose tabs, and lipsticks in various shades because I'm all about options.

Yes, bags/cases, inside bags. Say what you want, but that medium size, cheapo, zippered bag keeps all my important must-haves in one spot and prevents them from spilling all over the inside my jam-packed big-ass bag. And that works for me. 
Also: D-Bags are important!
Also: HA-HA  

Earlier, I'd checked my blood sugar during the meeting and on the sly and hadn't put it back in the GTMH Bag 
I felt around my work bag and knowing it wasn’t in the GTMH Bag. 
I couldn’t find it. And I started to get a little nervous, but I played it cool. 
“Wait one-second and sorry guys, let me just make sure I have my insulin pod’s PDM,” I said all nonchalant and while my heart was beating a million miles per minute  
I knelt down, slightly embarrassed and full on determined to be quick about it. 
I stuck my hand in my bag and felt around, finally finding my pod case next to my notebook and a KIND bar — safe and sound and exactly where I’d put it. 

Me: FOUND IT and sorry for the hold up, guys.
Sally: That’s OK - it took 10 seconds! It must be hard always having to carry stuff around.
Me: Nahhh, not hard. Well OK, sometimes it is. 
But it's a luxury and a necessity that I’m grateful to have - even if it comes with some crap annoying moments. We all have stuff to deal with— mine happens to involves extra electronicals, food, and other D stuff. 

And then we said our goodnights, walked to our perspective cars and  people started driving off.  
Right after I locked my doors and put the key in the ignition, but before I put my car in DRIVE and headed home, I took a beat.
Then turned on the overhead light and made sure that all my important items were in the my GTMH Bag.
Phone, wallet, extra roll of glucose tabs and lipstick case — all exactly where they should be.
Then I grabbed my pod PDM/test-strips case, tucked it in my GTMH bag, zipped it up tight, and placed it back in my work bag.

All was right in my world and I was good to go~

Tuesday, April 3, 2018

Mondays Man....Amirite? Also: Sometimes We Do Stupid Sh*t.

Hey guys - HAPPY APRIL and HAPPY….. spring?

The first day of spring brought snow and followed by a short week and holiday weekend.  
Easter/Passover weekend kicked off Friday night and well into the early hours of Saturday morning -with several bad sites, resulting in multiple omnipod site changes - including one a few minutes before 5 a.m.
Can somebody please invent a Dead Spot Detector, STAT!!! 
Saturday required copious amounts of caffeine, completing deadline that I had planned to start at 9 a.m. on the dot, but didn't start until closer to noon. But I did it!
And finally, trying on and ordering much needed new prescription RX sunglasses at a great price — and to match my new prescription specs - also purchased at a great price.
More on a good deal re: fancy and much needed new RX eye wear once I see (also, see what I did there,) if my second pair works out.  

 Easter Sunday was peaceful and involved a 3 mile beach hike on the one seasonably/warm day in forever, lots of sea glass and Easter chocolate. Yep, it was a good day. 

Then Monday came along. Mondays, man…. amirite? 
Yesterday was most certainly a Monday - and involved me receiving ten stitches on the top of my foot. 
Sometimes, we do stupid shit. 
Like, breaking a glass on Saturday - and even though you swept and vacuumed, DO NOT walk around barefoot — and if you wear glasses because you're blind as a bat - WEAR THEM.  

And if you spill tortilla chips on the floor; then think you stepped on one of the chips as you grab the dust pan to clean up, then wipe said “chip” from the bottom of your right foot to the top of your other foot, (and think for one split second , look how dexterous my toes are,) and before you bend over start sweeping up - MAKE SURE IT’S A DAMN TORTILLA CHIP - and not a freaking shard of glass. 
Also, even if you clean the big ass cut on the top of your foot with cold water and antibacterial everything — do not wipe it down with alcohol IV Prep pads — because the sticky stuff will get all over and make your cut look weird, and you will start to freak — until you remember that’s there’s sticky stuff on the IV Prep Pad. 
Then you have to clean it all over again, apply pressure, and keep your balance/embrace your inner contortionist while doing all of the above. 
Also, your heart will beat super fast as all of this is happening and you might feel a little nausea when you see all the blood.
ALSO: When in doubt, get checked out. 
I went to UrgentCare because I wanted to make sure the big old cut on top of my foot was clean and bacteria free - you could have knocked me over with a feather when they told me it required stitches - 10 of them. 
That would be when I freaked a bit - OK, a lot a bit. 
Because quite frankly, I’d remained weirdly calm from the time I cut myself; cleaned myself up, drove to UrgentCare, and right up until the moment they told me I needed stitches. 
Living with type 1 for as long as I have and knowing about what can happen when it comes to our feet and or any part of our bodies when it comes to wounds and all the many  “what-ifs,” , I couldn't hold back anymore. 

Yep, the waterworks started. 

The Positive: I texted friends to mentally calm myself - like if I was going to bleed out, 
(YES, I can get a lttledramatical,) at least a few friends would know what was going on
My friends are indeed good and they eased my mind.
The nurses were kind, and the Doctor on call administering the stitches was an extremely talented (and very sweet,) retired cardiac surgeon  - so you know my scar is going to look fierce! 

My blood sugars behaved quite nicely and I appreciated that. 

Rest, Ice, and elevation for the first few days - and walking around in sneakers - the left one knotted on the side, not laced on top, all week.

It looks like stepping up my spring cardio will be postponed until I get my stitches out next Tuesday. Speaking of steps… as in walking, National Walk to Work Day is on April 6th — which is more like "National Walk at Work," week for most. Either or - read my article about it, HERE

Today was better than yesterday, tomorrow will be better than today, and I am a lucky duck, indeed~