Revisiting my new year’s resolution

I’m using the bonus hour that I acquired this morning when a low blood sugar woke me up to write this post. Last night I couldn’t fall asleep. I was pleased that my blood sugar was in the 80’s, having come up from a slight post-dinner low and stabilized at this most ‘normal’ of levels, but I had the nagging feeling that it wouldn’t last through the night.

See here is my big blood sugar-sleep dilemma: earlier in the week I’d had a bedtime snack close to bed and woken up with high blood sugar the next day. I was frustrated by this, but I had slept wonderfully. I find that the snack helps me fall asleep, but presents the challenge of usually requiring a little bit of insulin. Just the right amount though – too much and I’ll wake up low in the middle of the night (which is kind of dangerous you know), too little and I’ll wake up parched and drowsy the next morning (high bg).

So last night, I managed to avoid the bedtime snack. I’d brought up my low with a little bit of fruit right after dinner and then coasted. But being so close to 80 mg/dl made it hard to fall asleep and then I dropped over night.

Instead of sleeping this morning I’m doing research. I want to experiment with some of the food recommendations made by Adam Brown in this month’s issue of Diatribe. I think if I can find more foods that fill me up at dinner time without spiking my blood sugar, I’ll have less of a desire to snack later on.

There is always something great in Diatribe! I am amazed at how much I enjoy it and find useful diabetes wisdom every time I drop in. Check out the links above to see for yourself.

Finally, just in case you aren’t already in awe of sleep, I’ll leave you with this Radiolab podcast about its powers.

Wild Adventures with Diabetes

Today diabetes took me on a walk. I’ve been a little resentful of diabetes lately. Sometimes it feels like my blood sugar controls every move I make. It decides what I will eat, if I’ll give myself a shot and how much insulin I will take, if I’ll exercise and for how long and how hard, and sometimes even how I feel about myself.

The last few weeks have been so busy and I’m longing for a little break, just a weekend away from everything, blood sugar included. But you know what, there really is no taking a vacation from diabetes. Checking my blood sugar less and loosening some restrictions in my diet might mean that diabetes takes up less of my time for a day or two, but pretty soon, not feeling as good as I could if I was sticking tighter to my ideal range doesn’t feel very luxurious at all.

So today, around 3 pm, when I was supposed to be working on my manuscript and doing other computer-based tasks, I checked my blood sugar and it was 180 mg/dl. I don’t like sitting when my blood sugar is over 150 – it agitates me to know that I could go on a walk or run to bring it down. It also agitates me when I think about how often blood sugar interrupts my plans. I’ve gotten better at choosing my plans over my perfect blood sugar in the past few years, but it’s a Sunday, and despite my agitation, I decided to let diabetes take the reins.

Immediately, driving off into the countryside around Chapel Hill, I was glad that I did. The sun was bright on budding green fields edged by thick stands of trees waving in the breeze. The trail I found was soft, dirt and gravel, easy on the feet. A muddy Piedmont creek ran alongside it. Towering strong-armed beech trees lined the path. And just when I was almost back to my car, I look up ahead on the trail and saw…

photo 1.JPG
My poor photography skills do not do her justice. Also, I was not going to get any closer.

a six foot long Black snake. I was mesmerized. My mind left diabetes and everything else behind, and as she slithered away I felt some real freedom from all of it for the first time in awhile.

 

Applying for Marketplace Health Insurance

Last Saturday I graduated with my Master’s of Public Health! I’m so excited for everything that’s ahead of me, except losing health insurance coverage on May 31st.

A friend and I who help each other get through life’s hurdles, sat down to apply for marketplace coverage together. She just turned 26 and has had to go off of her parents’ health insurance. As for me, my coverage as a student research assistant only extends to the end of May. Because having health insurance is vital for all people, but especially those living with diabetes, I wanted to share my experience with the process.

Website screening tool: First I went to www.healthcare.gov and clicked the big green button that says “SEE IF I CAN ENROLL.”

Turns out after entering all of my info that losing coverage was a ‘qualifying event,’ so I was eligible.

Creating an account: At some point I had to create an account – which I did. The security questions for this process were really funny to me – I would suggest writing your answers down somewhere because they weren’t the easiest to come up with.

What if I don’t know?!?: The hardest part of using the screening tool and applying was estimating my income. I’m at a point where my income is in flux – my hours at work and the way I get paid are changing. I’m also hoping to find full-time employment soon and know that if I do, my annual income will be different than what I’m able to estimate now. Dealing with that uncertainty is hard, but in keeping with all recent blog posts, it’s just a part of life. In this context, the instructions make it clear that it’s important to update your account frequently if your income changes. There is also flexibility with how much of the premium tax credits you can use if you qualify, which can help those whose income might change.

Premium tax credits: Based on my current income, I qualified for a substantial premium tax credit which I could apply towards my premium when selecting a plan. I didn’t realize this before beginning the process, but you don’t have to use your whole tax credit each month, rather you can choose to use only part of it and have the rest applied as a credit at the end of the year when you file taxes. On the flip side, if you use it all and then your income goes up, you may have to pay back in some of it on your taxes. It wasn’t super easy to decide how to use this information, so I just elected to use enough of my credit to make my premium manageable each month.

Selecting a plan: This step involved a lot of reading and deliberating. The website helps to point you in the right direction by allowing you to enter your preferred doctors and prescriptions to see if they are covered under various plans, along with the level of health care you plan to use. For us people with diabetes, that’s a really hard one to estimate. Additionally, I was frustrated that no matter how I wrote ‘test strips’ or with what brand name I used, I could not get the system to register them under preferred prescriptions. Hopefully others will have better luck with this. Ultimately I chose a plan banking on at least one type of test strip being affordable. I’ll report back on my experience with this once coverage starts.

More documents: It seems like there are always more documents. I have to prove that my health insurance coverage is ending, so I have to send in a document/letter to this effect by the end of the month. Oh and I have to pay for the first month, which I can’t fault them for. What I did like about the process is that you could begin the application and revisit it and then select a plan and confirm enrollment before having to send in the supplementary documents or payment. This way, I was able to move forward and secure coverage that will begin June 1st, even while gathering my other resources.

Overall experience: Applying for marketplace health insurance coverage is not easy per se, but it is doable. My personal suggestion (based on my typical approach to things) is to get the process started, create an account, do the eligibility screening, and then know that you can find the information you need and log back in once you have it to complete things. If your situation is not very clear cut, I think it’d be really helpful to have a navigator (i.e. real person) to help you through the process. At our school there is an insurance office above our student health clinic and I’m assuming this is the case at many universities. During open enrollment, volunteer navigators are available to walk you through the process, and although I don’t know if that is true at all times of the year, I suspect real-person assistance is available and would be helpful. If you have experiences with this, please leave a comment with your thoughts!

How to beat the springtime blues

Springtime blues? “What’s that about?” you ask. After about four years of consistently feeling miserable for about a week every April, I think I’ve finally realized that for me, something about springtime wreaks havoc on my diabetes management.

I find myself suddenly feeling sluggish, cloudy and hungry.

My blood sugar levels go up and stay up, like they’re stuck on a higher plateau.

Insulin just doesn’t bring me down like it typically does and because I’m running higher, my appetite increases and I just want to eat…carbs.

And then all of a sudden the insulin will bring me down like a ton of bricks and I’ll be arrested by an intense low blood sugar.

So…I have some hypotheses. It does make sense to me that the same inflammatory response caused by seasonal allergies would not be so great for T1 diabetes, which by its nature is an inflammation of the immune response. My friends with T1D have turned me on to some research to suggest that springtime is a hard season for many people with various autoimmune conditions.

Spring is also a time of new beginnings, change, waking up from winter and everything suddenly gets so busy. In this space of having so much to do and so little time to do it (and feeling like my head is full of pollen), my typically stress and diabetes management technique of daily concerted exercise hasn’t been as attainable. So I’m here to share – with no guilt – that this week I got a massage.

This was actually my second of two 30 minute massages with Monique Kennedy, who I recommend highly if you’re in the triangle area. Check out her practice: Exhale Massage Therapy – where you can book directly online.

And the name really says it all – exhaling (a topic I’m excited to write more about soon) and its partner inhaling are so hard to prioritize and yet so very beneficial. Since the massage and the reminder to breathe deeply, to prioritize resting and recharging, my blood sugars have been just a little bit more ‘normal.’

I’d love to hear other people’s experiences with autoimmune conditions and spring time and about massage as part of a healthy life!

Choices

On my first day of grad school, my pod alarmed in the middle of an orientation session and I had to rush home, still unsure if the bus I’d chosen was the right one to get me to my apartment. On the way, my iPhone 4 and I struggled with the spotty internet to email my advisor and let her know I wouldn’t be able to meet her – technical difficulties. That’s not really what I told her of course. I explained it all – because you can’t just explain a little bit of diabetes once you get going. It’s hard to just say “My blood sugar was low” or “My insulin pump malfunctioned.” I always feel like I sort of have to justify that statement with, “Oh and I have Type 1 diabetes. And I’m ok – I’ve just got to handle this.” The good-hearted people of the world want to know that you’re ok, which is touching. It can be really hard to give people who want to help and be there for you some reliable protocol to follow, because so much of diabetes is adapting to the moment. So much of it is being in-tune with your own body and responding in what might seem, to an outside audience, like a contradictory way from how you responded before. Sometimes I eat cake, sometimes I don’t. That doesn’t mean that in one situation I’m thinking about diabetes and in the other I’m not. It’s always there, presenting choices or at least weighing in on them.

This post is meandering because my thoughts are meandering right now. If there could be a central theme here, it’s choices and how they fit into our otherwise unpredictable lives. Diabetes reminds me that I make many choices in the day, from how I treat my body to how I communicate my identity, positionality and needs to others. It also reminds me that no matter how fixated we become on one choice or path or reality, our pod could always alarm right in the middle of it and we’d have to respond. This is another diabetes metaphor, but please don’t let that prohibit you from translating it to your own life if you are a person without diabetes (or not, maybe you don’t like metaphors). I’m just grappling with this – the contradiction between writing and reading our lives, both of which (I’m gently arguing), are quite necessary.

Yes, there are ants in my car

Yes there are ants in my car,

because I left a half-eaten honey packet open in the cup holder.

It’s 26 grams of carbs, but I only needed 13 ~ apparently.

And those things are expensive.

No food waste!

The last time I drank a juice box was yesterday.

Safety first means never leaving home without fruit snacks in my pocket

and my monogrammed silver bracelet.

One time on a first (and last) date

I tried to jump a curb on my bike

Which was also a first and last experience

and I didn’t make it over the curb – but I did make it

over the handle bars – and knocked my pod loose.

Which is a weird thing to explain – and an unlikely sounding excuse.

Sometimes I alarm.

Sometimes happiness is an 87 –

Sometimes it’s a fresh supply of test strips.

A hundred small reminders in the day,

that I have to remember not to forget.

Of course if I’m being truly honest,

it’s not so clear what came first…

the diabetes or the ants.

Find your break

This past weekend I went on a run with a friend. I resort to running when I’ve crammed my life so full that I feel it’s necessary to expedite working out. My usual preference is for walking, which I’ve just returned home from.

Here are some of the things I saw on my walk:

  • White and pink Dogwood blossoms. Dogwood trees have a distinct smell – sweet and earthy.
  • A black and white cat tiptoeing through an overgrown corridor of leggy flowering grasses.
  • A mockingbird trilling from a tree limb.
  • Tightly packed azalea flowers flocking front porches.

This walk and yesterday’s yoga class were inspired by suggestions from two people whose wisdom I value. They suggested that in order to get everything I needed to done, I take a break. Different times call for different sorts of breaks, and lately I’ve needed a computer break. Like my friend, I’ve been losing productivity as one assignment blurs into the next. I’ve been losing sleep too and waking up with high or low blood sugars. These past couple days, stepping away and doing something slowly has made space for me to breathe – which, one could argue, is just another way to practice public health.