Diabetes Art Day 2012...

Portion

Control

'You are special'... Not Really.

To see this year's other entries to Diabetes Art Day for 2012 click here.

This is important: Professor Jean Claude Mbanya, president of the IDF speaks about diabetes around the globe

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July 27th, 1921 insulin was discovered by Banting & Best and their dog friends. I think about them sometimes. Sometimes I wonder what I would said if I got to somehow skip back in time a bit and have a chat with them. I know when they realized that what they had and what it meant for people with diabetes, the group decided to sell the patent for $1. This allowed the drug speedier production. I wonder, considering this good will, what they would think of some of the situations described by Professor Mbanya, president of the International Diabetes Federation, where parents are faced with the grim reality that treating their one child with diabetes could mean devastating hardship or even death for the rest of the family? I would surely feel embarassed to tell them that at this point in time there are still people who die from diabetes, because they simply don't have access to the insulin they need. 

Back-up Packrat

I've developed this odd quirk whereby I have back-ups of EVERYTHING: back-up shampoo, back-up conditioner, back-up toothpaste, back-up granola bars, back-up laundry detergent, back-up coats, back-up bags, back-up etc... And I get REALLY anxious if I don't have my back-ups.

It finally dawned on me it stems from a bonafide anxiety around always requiring: back-up food, back-up glucose tabs, back-up insulin, back-up infusion sites, back-up cartridges, back-up needles, back-up medical things etc...

The bad news is I got a lot of clutter. The good news is I'm ready for the zombie apocalypse.

Curiously, most of these symptoms are similar
to those of a low blood glucose... though with respect
to the last point: I'm not so picky about what I
eat when low.

MacGyver Moment: Knit Pump Case

So, my Mum got in a bit of an accident last weekend (she is okay, but a bit banged up and stressed) and I wasn't able to finish all the posts for Diabetes Blog Week. My post for Sunday was for Karen, who started and organizes Diabetes Blog Week. Something I realized about Karen while reading her posts this time around is that she also knits! So, in the spirit of Karen's awesomeness I have amalgamated the interests of both her blogs with a knitted pump cases! 

There are two cases I have made. Both are supposed to be worn around the side of a bra...

Fig. 1: Where you can wear it
(though, really, wear it anywhere you like)

The first is a little more simple...

Simple Knit Pump Case

Yarn: Bernat Satin [100% Acrylic; 100g; 149 m/163 yrds] (I used the colour Buff, but there are a lot of colours to choose from- beige and earth tones to bright and colourful)

Needles: 5mm/US8

Button: 15mm button

Gauge: 18 sts/24 rows = 4X4 inches using size US8 needles

Directions:

Body section:

Cast on 16 stiches.

1st row: knit all stitches.

2nd row: purl all stitches.

Repeat these two rows until the piece measures 6.5 inches and ending on a purl row.

Begin to decrease for the strap:

Row 1: K1, SSK, knit to last three stitches, K2tog, K1

Row 2: Purl all stitches.

Row 3: Knit all stitches.

Repeat these three rows until 5 stitches remain.

Continue in stockinette stitch until the strap measures 6 inches (from the first decrease round.)

K2, YO twice, K2together, knit to end.

Next row, P3, drop the next sticth (one of the YO), P2.

Continue in stockinette for another 1 inch and bind off all stitches.

Finishing:

With the wrong side (purl) facing you fold the body section up 3.25 inches. Join seams on either side to create a pocket.

Weave in all ends.

Sew a 15mm button on in the middle of the upper front of the pocket (opposite side of the strap.)

Fig. 2: Really off-scale schemata...
be thankful I don't give instructions for bridges.

In the Round Knit Pump Case

Yarn: Sirdar Snuggly Baby Bamboo [80% Bamboo sourced viscose, 20% Wool; 50g; 95 m/104 yrds] (I used the colour Nestle, which apparently has been discontinued)

Needles: 4 double pointed size 4mm/US6

Button: 15mm button

Gauge: 22 sts/28 rows = 4X4 inches using size US6 needles

Directions:

Body section:

Cast on 30 stitches, distribute evenly among three needles and join for knitting in the round.

1st round: Place marker to mark beginning of round. K all stitches.

Continue knitting each round until the piece measures 3 inches.

Next round K2tog, K13, SSK, K to end of round.

Next round K all stitches.

Next round K2tog, K11, SSK, K to end of round.

Next round K all stitches.

Next round K2tog, K10, SSK, K to end of round.

Next round K all stitches.

Next round K2tog, K8, SSK, K to end of round.

Rearrange stiches onto two needles, so that there are twelve on one needle and twelve on the other.

Bind off in kitchener stitch. 

Strap:

From the original marker placed to mark the beginning of the work, pick-up and knit 15 stitches.

1st row: K2, P until last two stitches, K2

2nd row:  K2, SSK, K until last four stitches, K2tog, K2 (13 stitches left)

3rd row: K2, P until last two stitches, K2

4th row: K2, SSK, K until last four stitches, K2tog, K2 (11 stitches left)

5th row: K2, P until last two stitches, K2

6th row:  K2, SSK, K until last four stitches, K2tog, K2 (9 stitches left)

7th row: K2, P until last two stitches, K2

8th row:  K2, SSK, K until last four stitches, K2tog, K2 (7 stitches left)

9th row: K2, P until last two stitches, K2

10th row: K all stitches

Making sure to end on an odd row, repeat last two rows until strap measures 6 inches (or desired length) from the pick-up stitches.

Next row: K3, YO twice, K2together, knit to end.

Next row: K2, P, drop the next sticth (one of the YO), P to last 2 stitches, K2.

Next row: K all stitches.

Next row: K2, P to last two stitches, K2.

Repeat last two rows for one more inch.

Bind off all stitches.

Weave in ends and sew on 15mm button on middle of front.

Some notes about the patterns: 

• I have an Animas 2020 pump and, so, all the measurements were derived from this pumps dimensions... but I the material ends up having a fair amount of give and I think the measurements would work well enough for the Metronic pumps as well...
• It may seem weird to have a smaller strap, but it makes it easier to take the pump out of the case without having to undo the button...
• I did this last pattern I did from memory. If any of the decreases are off, please let me know...
• I don't mind (if it ends up working well and you end up liking the pattern) people sharing the pattern, but please give credit and link back here. (Thanks <3)

Letter Writing Day

Today's topic for Diabetes Blog Week is Letter Writing Day:

You can write a letter to diabetes if you’d like, but we can also take it one step further.  How about writing a letter to a fictional (or not so fictional) endocrinologist telling the doctor what you love (or not) about them.  How about a letter to a pretend (or again, not so pretend) meter or pump company telling them of the device of your dreams?  Maybe you’d like to write a letter to your child with diabetes.  Or a letter from your adult self to the d-child you were.  Whomever you choose as a recipient, today is the day to tell them what you are feeling.

Dear 15-year-old Self,

If this time-machine thing works out as planned, it's January of 1994 and you're sitting in the car on the way to the hospital. Yes, you have diabetes. No, no matter how much you bargain with the ether, it isn't going to go away. You are about to enter a medical system that does not do well with informing young people of what is going on. So, let me give you the heads up on some of the things that are going to happen over the next eight days:

1. When your parents bring you toileteries from home MAKE SURE THEY BRING YOU SOME DECENT/NORMAL SMELLING SOAP. The Bacto-Stat soap they give you to use in the hospital smells like disease. So discomforting.
2. They are going to TAKE YOUR BLOOD EVERY FOUR HOURS, EVEN IN THE MIDDLE OF THE NIGHT. It will freak you right out the first night, because nobody told you it was coming. 
3. They are going to WAKE YOU UP AT 6 AM THE FIRST DAY YOU ARE THERE. Since you are still practically in a coma you will do something (that maybe only you ever find) incredibly funny. Enjoy it. 
4. That first morning they wake you up at 6 am THEY WILL BRING AN ENTIRE NURSING CLASS TO OBSERVE YOU. No one will ask if it's okay. They will just barge right in like it is their right to do so. If you don't want them there, tell them to leave... but not until after you do the incredibly funny thing.
5. There will be a nurse that comes in to your room. She will not even greet you. Whatever you do, DO NOT LET THIS NURSE GRAB YOUR ARM! She will take something called a Heparin Lock (or Hep-Lock). It will look like a long large gauge needle and she will just shove it in your arm. They will tell you it is so they can take blood from this IV instead of always taking it from your arm, where it will hurt and bruise. BEWARE: This is a lie! There will be only one nurse with the Heparin and she will generally not be available. Then, they will just take the blood from your arm anyways!!! So, for the love of God, I repeat: DO NOT LET THIS NURSE GRAM YOUR ARM.

In general, diabetes will be a lonely disease for a very long time. People will help out (and that will be awesome), but no matter how many are in the waiting room you still have to learn to go into those doctor encounters alone. Growing up people will feel badly for you, they may call you 'brave' or 'courageous'... even though you don't feel sad for yourself, nor brave about any of it. Don't let people treat you like your porcelain or fragile (I know that you won't!) Don't strive to be normal-- it's a bullshit social construct. Do visit the Banting House in London, ON sooner; it will give you a greater appreciation for wonderful it is that you get to finish high school, go to university (ugh, THREE degress... I know), make great friends and love a lot. Most of all feel proud of yourself, because you will handle a complex chronic illness (in combination with the lot of crappy life circumstances you already know about) with grace and determination... and that's all anybody can ask.

Sincerely and with love,

Your 33-year-old self.

Diabetes Art Day

For more information on Diabetes Art Day, please see Lee Ann's blog post here: http://www.thebuttercompartment.com/?p=5441

Show-and-tell...

I have rectified the aforementioned problem by introducing my pump to the entire office at this morning's all-staff meeting. I just said that I know people have had questions and, so, rather than repeat myself to each concern (which was getting quite stressful) I thought it best to just present it to the group.

I introduced several issues I knew to be of concern: I went through how the pump works, the various types of diabetes, the misconception that people have, like: somehow people with diabetes cause their own illness and that treatment starts with diet, then if it's really bad you go on needles and then if it's really really bad you end up on a pump. I relayed that the truth is there are various regimes for various types of diabetes and that everyone is different. I told them that I do not manage by diet, but rather I have an insulin to carb ration that tells me for every gram of carbohydrate I eat I know I take X amount of insulin to keep my blood sugar under control. I said that managing this way meant I could eat whatever I wanted, included candy and treats.

Finally, I told people I realized that their concerns come from a good place and I wasn't blaming people, because I realize there is a big public information gap regarding diabetes. I finished by letting people know it was okay to ask questions if they wanted...

I'm pretty sure, though, that I covered most of what people were curious about or had misunderstood, but we will see...

Dream a little dream- Life after a cure... Diabetes Blog Week- Day 7 (Ha! I did it!)

Lightyears ago, when I was working in a little used bookstore on Queen Street, my boss told me this story about his brother... He said that his brother had a form of epilepsy. I don't remember the name of it exactly, but he had frequent and severe seizures. He was on a fair amount of medication to curb them, but at some point brain surgery became an option. So, he went through with the surgery and the doctors were fairly certain they'd removed the part of the brain that was responsible for the seizures. He was so terrified of them returning though, he refused to stop taking the medication they'd first prescribed him.

I tell you this, because it was one of the first things that came to my mind when I read this final topic for the Diabetes Blog Week was this story. And, honestly, if suddenly the perpetual five-year-plan until the cure for diabetes was up and sitting there was a cure... I think I'd still be testing my blood sugars for a good long while after: Every time I got thirsty. Every time I felt tired. Every time I got shaky. And, yeah, it would probably subside a bit over time, but I'd always wonder if and when it were coming back.

Another story that came to mind: when I started using an insulin pump it totally a positive change for me... physically. For the first time that I can remember I wasn't tired all the time. I think I mentioned somewhere here before, but when I told one of the nurses/diabetes educators helping make the transition to the pump she told me that this was fairly common. Apparently long acting insulins are pretty hard on your body. NPH, the crap stuff that I was on for a large part of my MDI routine, is notoriously nasty... which why it is affectionately referred to as "Not Particularly Helpful" amongst some medical professionals. That plus the fact that I spent years with impossible to avert daily lows, some of which were so low I felt like they were digging my grave for me, I got kind of pissed off that it took sooooo long for me get on the pump.

Actually, I don't even think I realized until I just wrote those words, that a lot of my anger when I got my pump was probably related to me being resentful for all those years of crappy insulins (remember the infernal Regular and Lente???) and multiple daily injections. I know it works great for a lot of people. But, really, that stuff was my own private hell, which is something I couln't realize until a better way of being came along... kind of what I think the shift from insulin pump to cure would be like...

Finally, my very first knee-jerk reaction when I read the topic for today's post: I've met so many awesome people because of my diabetes, I have to admit that I had a moment of sadness thinking that our relationship might go away without the common link of illness. Which I know isn't true- I think the relationship would just change. We might not have the same day to day struggles with the "D-beast", but I think we'd always have the lingering link of being ex-D-beast peoples. At least, I hope we would all stay in touch. I would miss you guys if you all went away. I guess the second thing I realize as I write this- my online D-friends aren't just diabetes support; sometimes you guys are life support. Which is great, so I wouldn't want that side-effect to be cured along with the broken pancreas.

Anyway, I don't mean to end the week on a bummer note. Nor do I don't mean to suggest that I wouldn't jump at a cure in a nano-second or that I wouldn't be happy (extremely happy!) or grateful. I think, though, that having recently just made the shift from needles to insulin pump, the reality of good things sometimes being a mixed bag is still very much a reality for me. And, maybe like most things in life, it's just complicated.

Here, though, I'll end with some happier thoughts:
- Having said all that, I'd totally test the limits of my new found food freedom by a one-time gorge on deep-fried ice cream. I don't know why, but I really get a hankering for that stuff every now and then... and cherries. I really like cherries... and pie. Cherry pie, of course. Stawberry-rhubarb too. Pie is one of the worst things to carb count.
- I think I'd also keep my pump by my pillow as a nightlight, 'cause I've gotten kind of attached to the little guy. I might even wear it around in public occassionally and tell everyone it's my new super gigantic pager...
- And my last, somewhat perverse thought? I'd tell everyone my diabetes was coming back in five years... just so that if it really were creeping back, it would take it's dear sweet time about it.

Diabetes Snapshots... Diabetes Blog Week- Day6... almost there!

This is Pump-kin...

And this is my relationship to Pump-kin in pictures...

For better or for worse, we are attached at the arm.

The Diabetes Triangle

Yesterday was crap. It was aweful. Some people have problems with highs, I have problems with lows. Bad lows. I hadn't had any really horrible ones since starting the pump over a year ago... and then yesterday happened. It's not so much that I went really low as the fact that I was riding the edge of a low for hours, seemingly regardless of what I ate or altered. And that, to me, is worse than a full-out low, because in those numbers between I get really, really disgustingly nauseous.

I don't know exactly how it happened, but I have a theory: the diabetes triangle.

As you can see from the scientifically calculated diagram below the triangle involves three points (weightloss, overcalculated bolus, recent illness requiring basal adjustments) that combine into the perfect storm. While in this tempestuous state all traditional monitoring and diabetes navigation apparatus breakdown and you must survive based on instinct.

Said instinct usually involves gross amounts of food, coupled with temporary basal reductions. Generally, when emerging from the triangle monitoring systems and sensibility return to previously working states... usually reading high, though yesterday I somehow made it out with the relatively normal 10.0 mmol/L.

After this fiasco, today I was reminded of the horrible lows of the olden days of Lente and Regular insulin... Unfortunately, that also provoked the 'terrified to eat because I'll have to bolus' feelings of said yesteryears.

Snowageddo... Oh, wait...

There is no snow here this season. Just cold- so I only have Coldageddon advice: keep your pump tucked inside your jacket so it can be nice and warm... (at least if it's Animas.) Mine decides to lose its prime when going from the cold outside to the warm inside. Apparently it is a common enough problem that customer support knows about it... The obvious annoyance is that if you don't realize it's lost its prime then you don't get insulin and your blood sugars have a field day. Yes: field. day. I've started the practice of checking my pump when I get in from the outdoors, just in case. I love my pump/kin, but it's one annoyance I could do without.

If you do live with snow, you should read about Diabetesaliciousness experiences of this year's Snowmageddon.

Meeting in absentia...

I have really wanted to write this and not at the same time. It's not that I don't want it said, but more that I am not sure I have the exact words… I kind of think that there exists something in-between spaces. Like, when you enter an old house and touch a window frame: how many people before you stood and made contact with that point before you? It's like past, present and future all come together in that space. It exists, but doesn't. It's just kind of in-between. History? Memory? Connection, maybe? I don't really know that you can confine it to a word… or perhaps it is a different word for different people in different points of time.

People generally associate the discovery of insulin with the city of Toronto, but no event exists in isolation and there is a backstory to this story. Prior to moving to Toronto to begin his research into diabetes, Frederick Banting lived for a short while in the city of London, Ontario. After kind of a miserable start in private practice Banting also began to teach medicine at the University of Western Ontario. He had no relation to diabetes, but one day a colleague asked him to fill in and give a lecture regarding the pancreas. One evening he lay in bed reading material to prepare for the talk. At 2 am he woke up and wrote down an idea that came to him regarding a possible treatment for diabetes… and that is how his trek to Toronto and the eventual discovery of insulin treatment began. The house where this small moment took place still exist in London. It is now a museum. Most of the house covers various aspects of the site's history, but the bedroom where Banting dreamt his original hypothesis has been preserved.

I visited the space with a friend on Wednesday. As we entered the bedroom the curator told us of the various other visitors to the room. There are, essentially, three groups of people that come to the museum:

(1) the average cultural tourist, with no ties to the issue
(2) researchers:

• The rational bunch generally decried any sense of mysticism about the room. But eventually there came a point where they would lean on the bed to comment on the wall paper or some other detail of the room. "It's not the mattress," the curator would mention "it's the bed frame that's original" and invariably the researcher(s) would inch back to grasp the bed frame.
  
• Of course, there are exceptions to every rule: one gentleman from South America who had been doing diabetes research for over twenty years would was positively giddy as he sat on the bed. He managed to convince the curator that if he was just allowed to have a quick nap in the bed perhaps it would provide the inspiration he needed to cure the condition. The curator noted that if that was all that he needed to come up with a cure, he would sure oblige- and, so, he dimmed the lights and let the researcher have a quick rest in the room.

(3) People who have a direct association with diabetes:

• A family with a 9-year-old girl who had been diagnosed with diabetes some five years earlier. Though the rest of the family entered to bedroom, she would not enter the room. She merely stood by the door, never crossing the threshold.
• A woman whose father had been among the first to receive treatment in Europe; this allowed her to be born 15 years later.
• A young mother whose baby had been recently diagnosed with diabetes. She came into the room, sat on the bed and began sobbing. The curator let her be, but after ten minutes, he could still hear her crying from down the hall. He grabbed a box of Kleenex from his office and went to the room. When he entered and offered a tissue the mother stood up and stopped crying. "No. I don't need that. I will not cry anymore now. I know that my child will be okay." At which, the curator took the Kleenex for himself as he started sobbing.

To the side of the bedroom sat a small shelf with a short write-up and dozens of written cue-cards. Apparently, when the museum opened there were cards placed so that people could leave suggestions and comments regarding the exhibits. Rather, people began to leave notes to Frederick Banting. So, the museum decided instead to leave the cue-cards out for people to inscribe a public message to the late doctor. There were several different languages present. A lot of them looked like children's writing. Most of them were simply put: "Dear Dr. Banting, Thank you."

I sat on the bed. I held onto the railing and in that moment I felt like I was holding the hand of every other person that had entered and held onto that space... including the person that came up with the idea for the research that would eventually save my life just over 70 years later. I can't describe what that felt like and I rather suspect that every person that has sat in that same spot has experienced a different connection to that space. I can tell you this though: when I left that site I no longer hated my body and its misfunction. I will never again feel angry for the regimen that follows being diabetic. Somehow, at that moment I made peace with my body and its broken pancreas, because what I realized in being momentarily transported back to a time when there was no treatment for diabetes is that it was once a inescapable death sentence: that disgusting lethargy and thirst that I felt prior to being diagnosed and medicated is generally how people stayed until they eventually died of a slow starvation over six months to a year tops.

January 16th, 1994 is when I was diagnosed and when that anniversary surfaces next Saturday I won't think of it as 16 years with diabetes, but 16 years of life I wouldn't have had if it weren't for insulin... And for that my note read: "Dear Dr. Banting: Have had diabetes for 15 years; thank you for saving my life."