Storytime.

Yesterday I had to go to Urgent Care. I’m pretty sure you all heard my groans from wherever you are. I’ve had a tension headache that has been pestering me for about a week, but yesterday it got painful enough that I was getting physically ill and I had a few other strange symptoms.

So I checked in and waited the standard 3 hours that most people wait in Las Vegas. When I finally saw a doctor, he looked in my ears, asked me a couple questions that he didn’t allow me to answer without being cut off. I was annoyed, but he made a good argument for me to rule out meningitis – meaning I needed to be transferred to an emergency room.

I texted my mom saying a spinal tap felt like overkill. As moms do, she said to listen to him. I obliged. I love my mom and totally trust her judgment. Additionally, she gets zero blame for what ended up happening.

About a half hour after they said they were calling an ambulance to transport me, the nurse comes in with a cup for a urine sample. That was not discussed (as you’d expect it to be in an urgent care setting), so I asked her what it was for. She said she didn’t know and to follow her. I asked her to get the doctor again because the sample wasn’t discussed. If it was for blood sugar I was going to decline – there’s no need to waste money on something I can provide that’s at a 5 minute delay (via CGM) compared to a 2-4 hour delay for the urine strip.

The doctor comes in and asks what the problem is. I asked what the urine sample was for and he said, “To rule out diabetes.” My jaw dropped as I asked, “To rule out diabetes?” And he said, “Yes, we need to make sure you don’t have diabetes.” At this point in time I saw red, called him a f****** moron, told him to read my chart, and I walked out of the clinic past the ambulance that was there to pick me up.

“Yes, we need to make sure you don’t have diabetes.”

– Negligent MD at the urgent care

Urgent and emergent care should NOT be sub-par, uninformed care.

I drove myself to a different location of the same urgent care company. In tears, I asked to be seen. They asked if I had just been seen at the other location and I answered yes and said I wanted to see a different provider because the doctor at the other property did not listen to me.

They got me into a room within about an hour. Before I saw a doctor, the medical director came in and told me I was supposed to go to the emergency department, not urgent care. I explained the situation. She said she would rather not start a new appointment – I told her I was there for a new appointment and would like to be approached as a new patient. I told her that as long as the provider will hear me, read my chart, and give me a fair assessment, I want to be seen there. She made a couple disapproving grunts and left the room. I think maybe they wanted to go home, the clinic had closed at this point.

Anyway, the doctor came in. She did a physical, including a neurological assessment, and agreed with me that I definitely have a tension headache. She added that I’ve also got symptoms of an upper respiratory infection. She gave me a Toradol injection and muscle relaxers to relieve the headache, as well as instructions for resolving the sinus infection without antibiotics (which is standard for someone like me who is allergic to a class of antibiotics). When I asked, she quietly agreed that the spinal tap felt like overkill, but that she always hesitates to challenge the findings of another doctor.

Photo by CJ Murray, Filter by WordPress.

My takeaways from this experience are many that I have had before. Firstly, when my doctor didn’t listen to my answers to his questions, I should have spoken up. If I had told him this when I first felt shushed, I could have asked more questions to prevent all of the miscommunication. Second, I need to trust my intuition. My intuition was telling me that a spinal tap was not necessary, and the second doctor confirmed that for me. I should have asked to have my appointment transferred to another location for a second opinion instead of storming out. Third, refraining from calling my doctor a f****** moron probably would have gotten me more respect when asking for an appointment at the other location. I’m lucky the staff was as kind as they were – legally, they could have refused me service and told me to go to Emergency.

Hindsight is 20/20, or maybe 20/25 in this case. We all continue to learn from things that have happened in our lives, and this one will be a recurring event in my memory.

Do you have a medical horror story you want to share? Tell me about it in the comments, on twitter, or at sonjac@nevada.unr.edu. Everyone deserves comprehensive healthcare – let’s hold our providers accountable.

More on Diabetes Stigma

There has not been a ton of research regarding how diabetes stigma affects healthcare outcomes. One of the most notable articles was published in The Patient – Patient-Centered Outcomes Research in 2013. Social Stigma in Diabetes was written by Schabert, Browne, Mosley, and Speight as a call to action for more research on the topic1. They provide a framework for addressing diabetes stigma as of 2013, most of which is still relevant today.

Schabert et al. 2013

As I mentioned in Barriers to Care: Stigma yesterday, Australia is handling diabetes stigma quite well. Notably, Australia is where 3 of the 4 authors of this piece are based. It’s no coincidence.

Looking at the diagram above, I think it would be a good idea for the United States to begin its stopping stigma at the source: healthcare providers. It is important to understand that healthcare providers begin their journey in medical school with the mission of helping people live. While that is great, the approach they are often given seems to be to employ scare tactics as a way to motivate people to take better care of themselves. As we know, scare tactics don’t work. In fact, they are counterproductive. I am not implying that every medical school teaches that way, but it’s obvious that many of the seasoned professionals, especially primary care providers, were taught to use this approach.

Since the United States does not currently have a national healthcare program, it is difficult to address suggestions on a national level without the help of a national organization like the American Diabetes Association and its Standards of Care. Standards of Care 2021 address the facilitation of behavior change and well being2. An excerpt from the recommendations section of the article:

“…in response to the growing literature that associates potentially judgmental words with increased feelings of shame and guilt, providers are encouraged to consider the impact that language has on building therapeutic relationships and to choose positive, strength-based words and phrases that put people first.”

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes—2021

Encouraging providers to use better language is great, but this ADA guidance provides no resource regarding how to change language that has been used for decades by many of our diabetes providers.

So, what can we do as people living with the consequences of diabetes stigma?

Correct your provider. If your healthcare provider is using language that bothers you, tell them it bothers you. “I understand this is the language you are used to, but it bothers me. Could you please try referring to [diabetes topic] this way instead?” You may get an understanding response. You may not. This simple interaction could be a good indicator of whether this is the best provider for you – part of a doctor’s responsibility is to hear you and help you meet your needs. Neglecting your anxieties is not helping you meet your medical needs.

Correct the public. Whether it’s your Aunt Sally telling you horror stories about her friend who passed away after having complications, people telling you their MLM product will cure your diabetes, or a friend who is concerned about what you are consuming, share the truth with them. Is there an article in the paper or a magazine that is off-track? Send in a letter to the editor. I completely understand that it is exhausting. If exhaustion is a factor, it’s okay to triage those misconceptions and address the ones that are easiest for you.

Educate someone who facilitates your health insurance. I was able to speak with the Director of Health Outcomes in the company I work for, that provides access to my health insurance (I pay a hefty premium – I want them to hear me). I was having trouble getting treatments approved because of the “cookie cutter” approach they take to diabetes. I explained how this is not conducive to productive healthcare outcomes because people with diabetes are all biologically different and require different treatments to produce similar outcomes. She understood, and was able to get me everything I asked for (except for blood ketone strips, which is just a frivolous denial on their part – blood ketone meters can help prevent hospitalization costs for them since they provide a more timely indicator3).

Seek therapy. Cognitive behavioral therapy and dialectical behavioral therapy have been paramount in improving my patience with healthcare providers. There are many types of therapy, and many different kinds of therapy licensure. Look into it. See if there is a capable diabetes mental health provider near you on the ADA website.

Seek Peer Support. Can’t afford therapy? Start a conversation in the DOC on any platform (literally any platform – Facebook, TikTok, Twitter, Insta – we are EVERYWHERE). People are always willing and able to listen. It’s not the same as professional, licensed therapy, but sometimes peer support just has to do.

Please remember, it is not your responsibility to correct anyone. This is simply a plea to reduce perpetuation of diabetes stigma, feelings of shame, and enabling the use of fear tactics. Stigma can end, but it won’t end unless we address it.

Do you agree with my take? Disagree? Have different ideas? Or have initiated your own approach to stigma? Please share your feelings and ideas in the comments, on Twitter, or at sonjac@nevada.unr.edu. I want to know more about you and how you interpret and adjust to stigma. We are in this together!

Sources:

  1. Schabert, J., Browne, J.L., Mosely, K. et al. Social Stigma in Diabetes. Patient 6, 1–10 (2013). https://doi.org/10.1007/s40271-012-0001-0
  2. https://care.diabetesjournals.org/content/44/Supplement_1/S53
  3. https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/monitoring-diabetes/checking-for-ketones/

Barriers To Care: Stigma

Image from: https://www.mhpcolorado.org/fighting-the-mental-health-stigma/

Diabetes stigma is real. People who do not have diabetes may not understand that it is commonly stigmatized, but people with diabetes are reminded of it every time we hear a diabetes joke about your chocolate cake, losing limbs, or being asked, “Should you be eating that?”

Spoiler: Yes. The answer is always, “Yes I should be eating this, and I may have more when I’m done with this,” (tone/ sarcasm). Fortunately, not everyone is as snarky as I can be when it comes to diabetes stigma.

While my attempt at humor helps me in coping with stigma, it doesn’t help to change anything. In fact, it’s counterproductive. In order to change the stigma surrounding diabetes, we have to be willing to take people seriously and educate them when they perpetuate stigma.

So what is the best way to accomplish a change in or elimination of stigma?

Education!

Diabetes Australia is way ahead of the game when it comes to ending diabetes stigma as a barrier to care. When I started this blog, I was blessed by the DOC presence of Renza via her blog Diabetogenic. Renza works with Diabetes Australia and has been actively involved with the Heads Up on Diabetes campaign.

Link: https://youtu.be/K-YCS-ZZsBE

This week, I attended a digital conference held by DiaTribe called d21 Lightning Talks: Stigma and the Stories We Tell. According to the website for the event, the idea for the talks stemmed from a TED talk by Chimamanda Ngozi Adichie called The Danger of a Single Story. It’s about 20 minutes, and I highly recommend it.

“The single story creates stereotypes. And the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story.”

-Chimamanda Ngozi Adichie

Source: https://youtu.be/D9Ihs241zeg

The only way perceptions will change is if we are willing to tell our transparent stories, correct misconceptions, and educate about the reality of living with diabetes.

How do you deal with diabetes stigma? Let me know in the comments, on Twitter, or email me at sonjac@nevada.unr.edu.

  1. Schabert, J., Browne, J.L., Mosely, K. et al. Social Stigma in Diabetes. Patient 6, 1–10 (2013). https://doi.org/10.1007/s40271-012-0001-0

Barriers to Care: Myself

As much as I don’t want to admit it, often times I am the biggest barrier to my health outcomes. I would like to point out that I am going to address this topic as my own personal struggle in an attempt to avoid the possibility of victim blame or ability shame. There is nothing fair about living in today’s world with any kind of chronic illness, and the blame we place on ourselves regarding our health outcomes can be debilitating.

Research has found that approximately 55% of women with diabetes experience anxiety vs 33% of men1. I am in this 55%. When I have to go to a new doctor, I will sit and fixate on excuses I can make for my personal accountability prior to meeting the doctor – I don’t even give them a chance to prove me wrong, I simply assume they will blame me. This is not healthy and keeps me from receiving the care I deserve.

Following the establishment of care with my first adult endocrinologist, I undeniably turned into my worst self. The defensive person I became couldn’t have possibly been open enough to hear the opinion of a medical professional that hadn’t lived my experience. As a result, I ended up with the eating disorder I wrote about last month. Instead of learning to cope with my emotions, I took control in a way I felt I could.

One of the most important changes in me taking responsibility for my care came in the form of a job that, frankly, sucked. By taking on the role of servant leader, I opened up my eyes to what I had the power to change by serving the people who were working for me. This personal development made it so I was able to connect those principles to my personal experiences in healthcare.

Source: https://greencastleconsulting.com/greencastle-behavior-embody-servant-leadership/

Looking at these principles, I wondered if there was a way for doctors to change their approach to in order to better serve their patients. After careful consideration, I realized that there was nothing I could do to make medical professionals change their methods of care. Instead, it was time for me to take these principles and apply them to myself and how I can help my own diabetes care.

  1. Doing whatever it takes to help people win: In this case, I am people. The win would be meeting my personal healthcare outcomes (which for me is simply a set time in range and standard deviation). I have control over the actions I take, even if I am not perfect.
  2. Set the example: Making myself successful in meeting my health outcome goals is difficult since diabetes is 24/7/365. Keeping in contact with my friends with diabetes helps me stay on top of my own health, especially because they understand the everyday struggle.
  3. Motivate others through thoughtful approach: One of the bad habits I have to address is my anxiety and making excuses. It is not possible to have a thoughtful approach to my own diabetes if I am not honest with what has happened as a result of my personal actions. I have become unapologetically honest with my healthcare providers – and as a result I have been kicked out of a couple practices. BUT this approach has helped me find the care providers I am comfortable being vulnerable with.
  4. Value and try to understand others: Even when I do not agree with the opinion of a healthcare provider, I will listen to them and try to make sense of their thought process. This goes for other PWD and their approach to creating their own goals.

As a result of addressing these principles, I am able to:

  1. Gain commitment through consensus rather than compliance: I hate the real C word. Compliance (*shudders*) is a trigger word for many people with chronic illness (shameless plug: look for next week’s Barriers to Care for more information about language and stigma in diabetes). Being honest with care providers and expecting a respectful and professional response from them should be achievable. Find the care team that will hear you and help you make accommodations in your life so that diabetes fits in, rather than changing everything in your life for diabetes.
  2. Engage with principles: For example, ask questions in terms of goals: “I would like to be able to (insert goal here). How can we make that happen?” The image above says without emotions, but that’s just not realistic. It’s perfectly normal to have emotions – it is up to us to be honest about those emotions and how they affect diabetes. “I do not feel great about (insert occurrence here). It makes me feel bad. What can I do to change this outcome in the future so that I am able to feel better about it?”
  3. Realize that your success comes from the success of others: This is a bit of a stretch, but it’s true. Finding a healthcare provider who will assist you in accommodating diabetes into your life is imperative for taking an active role in your personal health outcomes.

As strange as the comparison may seem, this is what has worked for me. Am I perfect? Absolutely NOT. I am far from it. I will always have setbacks, just like anybody else with chronic illness, but making this connection was imperative for me to create and achieve my personal goals.

Have you had a diabetes epiphany you’d be comfortable with sharing? Tell me all about it in the comments, on Twitter, or at sonjac@nevada.unr.edu. This week, I encourage you to take an honest look at yourself and how you interact with your healthcare team. Is this relationship working? Are you looking for excuses? Do you have outlined goals you can use to question and motivate your care team? We got this, Fam!

Sources:

1. Penckofer, S., Ferrans, C. E., Velsor-Friedrich, B., & Savoy, S. (2007). The Psychological Impact of Living With Diabetes Women’s Day-to-Day Experiences. The Diabetes Educator, 33(4), 680–690. https://doi.org/10.1177/0145721707304079

Endnote: Phoebe drug this tub toys to the “doggie couch” in the living room on her own. She knew what she needed to do in order to achieve her goal of relaxing with an array of easily accessible toys!

Spotlight on PWD: Shane Bowers Photography

Shane Bowers is a photographer from Southern California who has been living with Type 1 Diabetes since 1995. I met him while we were teen campers in 2006 at Bearskin Meadow Camp (hosted by Diabetes Youth Families). We were able to reconnect in 2018 during an adult retreat held at Bearskin. Shane is an incredibly talented photographer with a focus on nature.

Here are excerpts from our conversation:

Sonja: Why do you love photography and how does it help you be the person you want to be?

Shane: I love to go out in nature and escape from the city lights. I love to reconnect with the quietness of nature and being captivated by the beauty. I love to capture that beauty for others to see but not just that, for others to go out and experience [the beauty of nature] for themselves. Nature reminds me to take time for [the important] things in my life, to breathe and to see how the living things in nature can still thrive in extreme conditions.

Sonja: What kind of photography do you consider to be your specialty?

Shane: I specialize in landscape and astrophotography, but I have done weddings, graduations, and other situational photo shoots.

Sonja: How do you deal with having diabetes during photoshoots? Or is it a non issue?

Shane: Diabetes is always a factor in everything I do, especially when I go backpacking or on camping trips for my photos. Carrying all my camera gear and extra food for when I go low is heavy. My last trip my camera and backpack probably weighed 30 pounds together.

Sonja: And finally, are you available for hire? And are your prints available for purchase?

Shane: I’m available for hire. I’m very flexible with price and schedule. And all my prints are for sale: you can view them on Instagram. Direct Message me on Instagram for pricing or inquiries.

This photo was taken in Ventura, California at the pier. When I come to the beach to take pier photos, everyone tends to take pictures the same way. I had the idea to capture the waves crashing against the pier as if it was snowing. So I call this one, “Snowing in Ventura”. Often times we miss the beauty around us we see everyday, but if we change our perspective just a bit, we can see a whole new view we’ve been missing. 
– Shane Bowers

Photography is a career for Shane – he turned his teenage hobby into a way to live the life he wants to live while being the person he wants to be. He attended California State University, Channel Islands, and has a degree in Photography and Graphic Design. Shane has been working professionally in photography for 6 years.

Where we met, at diabetes camp near Kings Canyon National Park 💙

I hope my conversation with Shane will inspire you to be the person you want to be while living a life you want to be living. Please follow Shane on Instagram and remember to show support to our fellow PWD.

Do you know someone who would make a great Spotlight on PWD feature? Please share with them. Feel free to reach out to me or let them know to DM me.

I’ll be posting again tomorrow – anything in particular you want to read about? Let me know in the comments, on Twitter, or sonjac@nevada.unr.edu.

Silver Linings – An Updated List

Two weeks ago, I wrote a blog titled Use What Mother Nature Gave You. In summary, I recommend using the little perks that are provided to us as a result of living with diabetes. Click the link to see how I get testing accommodations, free National Park access, and make sure I have active Intermittent FMLA available at work.

This post is focused toward people in the United States – I honestly have no idea what kind of silver linings might be available in other countries. If you live in another country, tell me about some of the benefits in the comments! I’d love to learn more about international perks to having diabetes. I have a pretty large audience – and WordPress lets me know all the different countries. It has been so fun following you on Twitter, Facebook, and in the comments section!

After seeing a post in one of the diabetes groups about TSA tips, I knew I needed to continue to update these silver linings. Here are a few more suggestions from folks in the group, as well as a bit of additional research I’ve done to make sure everything is accurate.

  • TSA allows a medical bag to be packed containing “otherwise prohibited” items. Use the link provided to navigate what might be allowed in addition to your regular luggage. People have reported being able to bring juice boxes in this medical bag, which can save money and hassle if that’s your preferred low treatment. It appears that many people have a travel letter from their doctor, but some don’t.
  • Some people mentioned that saying you have diabetes supplies in your bag when going through “event checkpoints” saves more hassle than it causes. The speculation was that it is safer for security not to go into your purse/pack if you have diabetes supplies inside. Makes sense to me, but certainly not a guarantee of being hassle-free.
  • At Six Flags (unsure which one or if this is a universal policy), you can go to the ADA desk at the entrance of the park. They will issue you a group fast pass so you aren’t standing outside in the heat for long periods of time. Some people say that Disney will still honor this policy – but I have heard conflicting information. Cedar Point was also mentioned. And Silver Dollar City in Branson.
  • If you fly Southwest, you can get a medical pre-board to sit with your travel companion in case of a medical emergency.

Now that I’m at the end of this piece, I realize this will be an ongoing feature in my blog. So, keep an eye out for Silver Linings again in the near future!

Please share with me what your perks have been! I want to hear from you. Leave me a comment, an email (sonjac@nevada.unr.edu), a Tweet, or a Facebook comment! I love reading what everyone else’s experiences are.

We’re a family, whether we like it or not. Let’s make the best of it.

Next week, I’ll be showcasing photography by fellow T1D Shane Bowers. Check out his Instagram and Wix before next week’s post! If you make art of any kind, please share with me! I love promoting other PWD and their passions.

Some days are better than others.

Today isn’t the best diabetes day.

For those of you who do not read loop: glucose of 364 mg/dL, 5.24 units of active insulin, 56 units of insulin delivered on the day, as of 3pm. I’m writing this at 19:45 and I’m exhausted. As you know, failed pump sites (or not receiving insulin) make for such a long, miserable day.

Disclaimer: This is my personal experience. This is not a guide of how you should deal with a similar situation. I am not a medical professional and this is not medical advice.

Since there is no fix-a-flat can of magic for this kind of predicament, we do what we can do make sure we are taking care of ourselves.

My blood sugar was fine when I got home from work at 6am. I ate a meal, and went to sleep. When I woke up, I noticed my Dexcom had been alarming high glucose for hours (side note, I have NEVER woken up to Dexcom alarms).

Here are the steps I took when I woke up:

  1. Checked my blood sugar on a glucometer. I don’t even usually carry one anymore since I have the Dexcom, but It’s still here and I still use it to back up strange readings. After confirming the HIGH reading from Dex was the same as my meter, I checked Ketones.
  2. I have a blood ketone meter – they are going to be far more accurate than urine strips, which can be up to 4 hours delayed with their readings. And thanks to the keto diet, they are super cheap to purchase online. I honestly grab those supplies on Ebay because my insurance company refuses to cover them. Anyway, blood Ketones read 1.8 mmol/L. That’s high enough that I could have made a trip to the ER for fluids, but I also have other options based on a plan my doctor and I came up with.
  3. After confirming the sad status of my body, I replaced my Pod. I filled it with insulin and put it in a different area than it had been before. The site of the old Pod is most certainly infected. I put some bacitracin on it and I’ll check it again tomorrow.
  4. INSULIN! I took more insulin. Based on my personal insulin needs, I had about 10 units of correction (1:50 insulin sensitivity factor correcting down to 100 mg/d). Additionally, I ate a 15g carb snack and took insulin for that as well. When ketones are involved, it’s better for me to have a little more insulin on board and babysit the Dexcom.
  5. Next, I downed about 40oz of electrolytes in an hour. I found powder sticks of electrolytes at Costco. They taste awful, but holy crap do they work! I just water them down a bit more than advised – for taste.
  6. Finally, I went back to bed. My body was MAD! So I turned on Game Show Network, snuggled my doggies, and set an alarm so I would remember to check my blood sugar every hour.

I woke up at 7pm at 75 mg/dL and dropping. Had a small spoonful of icing, and now getting ready for work. No, I don’t feel great. Yes, I could use my Intermittent FMLA. But I’m feeling far better and honestly want to go to work. It’s nice having people around, and I’m lucky enough that my supervisor is T1D and totally gets it. If I start to feel bad again, I’ll go home without it becoming an issue.

How do you deal with bad blood sugar days? Have you set up a plan of action with your doctor? Tell me about it in the comments, on twitter, or email me at sonjac@nevada.unr.edu.

Hurley, the helpful Rhodesian Boxer.

And We’re Back to the Heavy

When I saw this tweet, I knew exactly what I wanted to write about today.

Posted with permission from @lolmyheadhurt

Diabetes is emotional. It’s not the needles, counting carbs, and eating apples all day. It’s fighting your insurance company to cover the treatment that works right for you. Diabetes is sitting in the pharmacy crying because someone messed up your insulin prescription but you need it TODAY. It’s convincing new doctors that you know what you’re doing, even with their ego in the way.

It’s no wonder people with diabetes are 20% more likely to receive a diagnosis of anxiety1. So, for the next few weeks, I plan on addressing a common source of anxiety for people with diabetes. This week, I’ll start with the one I hate talking about.

One of my very specific anxiety struggles is with doctors. I don’t like most of the doctors I have met in a clinical setting, but I’m not sure it’s entirely their fault. Most of this dislike stems from the insurance and corporate healthcare requirements for quick patient turnover. I am the patient who wants to know that you hear me and my concerns, and I want direct answers to my specific questions.

When a doctor is given a 15-20 minute window to see a patient, they typically come in later than anticipated and leave earlier than anticipated because this short timeframe is supposed to include time for clinical notes. As a result, instead of getting direct answers to my question, I would get, “What is your chief complaint. We only have time for one thing.” It wasn’t often worded that way, but the message was clear: I don’t have time for you to make more than one inquiry.

People with diabetes will always have more than one inquiry. It’s just a consequence of chronic illness. Another consequence of chronic illness is a lack of available time and money to get appointments, screenings, and (sometimes) the patience to deal with it.

As a reader, I want you to keep in mind that these things may not be an issue for you. If that is the case, great! I’m jealous, to be honest. But that tweet at the top of the page is real for so many of us.

Like the majority of hyperactive people, I tend to psych myself out (in a bad way) prior to going to the doctor. One of the things I have worked on in therapy is distracting myself from the things that are out of my control. One practice that works for me is to keep my favorite color at the front of my mind.

If I see anything that is yellow while I’m obsessing about something, I take a deep breath, shut my eyes, and imagine something I love. This typically ends up being dogs, or something else cute and sweet. But my body still shows a response to this stress in my blood sugar.

Do you have any coping skills to get you through appointments? Get over stress? Redirect your mind? Is this a non-issue for you? Let me know in the comments, on Twitter, or at sonjac@nevada.unr.edu.

Hope you had a great holiday, and that everyone you know still has the same number of fingers as they did yesterday 🙂

  1. https://www.psychiatrictimes.com/view/treating-patients-comorbid-anxiety-and-diabetes-mellitus

Pretty Sure the Heat Hates Me

Every time I spend more than 20 minutes in the heat my blood sugar skyrockets. This is a terrible predicament to be in because I live in Las Vegas, and I love going to baseball. I went to a Las Vegas Aviators game tonight. I would put money on it that anyone with diabetes can tell what time the game started and when I got back into the air conditioning.

My actual interstitial glucose readings for July 1, 2021 14:00 to present – no range shown because high is set at 110 and low is also set at 110. Loop works better for me this way.

I’ve spoken to multiple care teams about this. When I was in Central California for college, they simply said to stay inside if it was over 90º. Living in North Dakota, I was more worried about my pump tubing accidentally freezing! In Kansas City, they recommended I keep my pump in a cooling pack. Where I grew up near Eureka, CA, this was not a problem: highest average high is 63º, lowest average low is 41º.

I have only been in Las Vegas for 5 years, but this is a trend that happens for me every year during June, July, and August.

I’m currently using Omnipod Eros, Dexcom G6, OrangeLink, and my iPhone 11. All of these devices can overheat. The insulin inside the Pod can overheat. Your body can overheat. Any of these factors can be bad news when it comes to staying out of the hospital, so let’s brainstorm ideas for keeping our devices safe, our insulin safe, and our bodies safe.

  • Drink a bunch of water. I don’t mean one bottle of water every hour, I mean 32oz of water every hour. Dehydration is a killer, and not just for people with diabetes. In fact, when in the heat and dehydrated, people with diabetes are more likely to have increased blood sugar and slip into heat exhaustion. To make matters worse, we know the faucet that poses as a bladder when our blood sugar is high. It simply exacerbates the problem.
  • On the other hand, high temperatures can make some people’s blood sugar drop. If you don’t have a CGM with active alerts, checking your blood glucose every 30-60 minutes can help catch lows early, or find highs to detect dehydration while it’s still manageable.
  • Keep insulin at home. I know some people (formerly, me included) have a habit of keeping insulin vials in their purse, or pens in their pockets. If you can manage to leave it at home, do it.
  • If you can’t leave insulin at home, check out cooling pouches. I recommend checking Etsy for “reusable insulated sandwich bags”, second hand stores, or hitting the back-to-school section after school starts. I got one of these at a closeout retailer (Home Goods, maybe?). The other I found in a thrift store – I use 4 frozen Otter Pops to keep the inside cool (TSA has never taken them from me, either!). There are also Frio brand bags that you wet to keep the items inside at or below room temperature. AND THEY WORK! I used to have one, this was just a cheaper way to replace it after one of my dogs made it a chew toy.

  • Cooling Towels are a great way to keep yourself cool. They have become more affordable in the past 5ish years – I have even seen them at dollar stores! I tend to hold the cool towel to areas like wrists, neck, chest, and lower back.
  • A personal fan. I’ve even seen them made as necklaces, on hooks, and as cell phone accessories. I feel like it’s a no brainer where it’s humid.
  • Prep for a day by drinking extra water or electrolyte drinks. Be cognizant of the amount of sugar in electrolyte drinks, although some come in “zero” now. I am not the T1 who will bolus for soda (because I can’t stand sugared soda), but I know many people do and I do not blame you! Just make sure you keep on top of it so you don’t accidentally make yourself high the day before, increasing your risk of heat exhaustion.
  • Make your own shade. I have season tickets to the Las Vegas Aviators. I work overnights, so I only really use them one or two days a week. I know that on Sundays (day games), my seats are in direct sunlight. I sell them instead of going. And if I wanted to go, I would take advantage of the few air conditioned areas in the ballpark for an inning or two. I have also brought an umbrella to use as a sun shade, just be careful not to burn yourself on the parts!
  • As for my devices, I keep them in my purse, and I keep my purse out of direct sunlight. They seem to do fine unless they are in direct sun for more than 5-10 minutes.

What do you do to stay cool? How do you keep your devices cool? Do you take insulin with you in the heat? I want to hear your stories! Let me know in the comments, or check me out on Twitter https://twitter.com/SonjaT1D. And as always, feel free to reach out to me at sonjac@nevada.unr.edu.

Stay safe and have a good weekend! Please be kind with your use of fireworks. I know my dogs are already pretty upset, and those with past trauma may have a hard time as well.

Benjie says to please be kind with your use of fireworks!