Friday, April 28, 2006

Money & Diabetes

Wanted to clarify my last posting in response to a reader comment:
"Worries: Arguing with Jack about money & diabetes"

I didn't mean to say money and diabetes in connection to each other. As we all know, health is priceless. It would be ridiculous & cold-hearted of me to resent the money we spend on testing strips and infusion sets (although I do resent the fact that our insurance does not cover either).

I don't argue with him about how he manages his diabetes, because I think he does a damn good job at that. I do argue with him about how he manages his life (e.g. driving, looking after the kids) and that he could take into greater consideration the fact that he has diabetes. What he can do to best mitigate the dangers of hypoglycemias.

And I argue with him about how much money he spends on non-essentials when we only have one salary coming in, living in one of the most expensive areas in the country. Yep, I'm the saver and he's the spender. Why not enjoy life now, because you could be gone tomorrow? he says. True, except that you may live to be 100 and not have enough to live on. And so it goes...

A lot of patient literature refers to those who live with a PWD as "loved ones". It's funny (or not) but sometimes I don't feel like a "loved one" at all. In the heat of those moments and dark of the night, I'm not feelin' much love for Jack. Momentary lapses born out of frustration and fatigue, I suppose. And then I feel guilty because he's the one with diabetes; I have the easy part.

Friday, April 21, 2006

My Life as a Dog

Random notes from 1-4am last night

- Got up every 1/2 hour to calm 3-year old K, who's sick & coughing.
- Got up once to nurse baby, her dark liquid eyes blinking at me.
- Woke Jack up to suggest that he check his BG (which he did (43), drank some juice, came back to bed without any fuss - woohoo!).
- Stayed awake listening to them breathe and snore.
- Had Billy Bragg's "Blake's Jerusalem" run through my head over and over
- Had "The Magic Schoolbus" theme run through my head over and over
- Thought about some movies:
* Really Disliked: "Breaking the Waves"
* Liked: "Spring, Summer, Fall, Winter...and Spring", "Night on Earth", "Curse of the Were-Rabbit", "My Life as a Dog"

"My Life as a Dog"

Thought it was time to take a step back after many months of rage and sadness and self-pity, and think about the dog. In the film, the young boy tries to take the positive view of his tragic-pocked life: it could always be worst. Like the dog which was sent up in the experimental rocket ship.

As much as I complain, my life is sooo not tragic or miserable. We go swimming at a local pool every now and then. About 6 months ago, I noticed another family: father, mother, twin babies. The father sat in a wheelchair calmly watching over one twin seated in a stroller; he had obvious limited physical mobility. The mother was always energetically playing in the pool with the other baby. The next week, she would have the other twin in the water with her, smiling and laughing. Well surely their family logistics is three times as difficult as mine!

- Jack's diabetes, future complications, financial strain of paraphernalia.
- Jack being unemployed for almost 2 years, desperately wanting a job.
- Assorted worries about the kids, present and future.
- Possibility of being layed-off from the struggling ill-managed Corporation, and losing insurance coverage.
- Arguing with Jack about money & diabetes.

Good things:
- Jack is a great husband and tries-hard-father.
- Jack loving bonding with the baby because he's at home taking care of her.
- Everyone in my family is healthy.
- My boss is great.
- K is 95% potty trained!
- Crunchy crusty bread smeared with a thick layer of Plugra butter (best butter on this side of the Atlantic).
- Getting a surprise, sizable refund from the IRS for 2004, yesterday (how weird is that?!).

Regrettable things
- Our idiotic foreign policies.
- My gas-guzzling v6 midlife/mommyhood-crisis car.
- My father never knowing sweet baby.

To CGM or Not To CGM (cont.)

We continued our conversation about the continuous Glucose Monitors last evening. Jack was still hesitant, and I prodded him about other causes for his reluctance. He admitted that he didn't want another thing stuck into him in addition to his pump. He's had good success with the pump, except for the infusion sets. Sometimes they work, sometimes not. It is a pain, when his BG is very high, to guess whether it's really his BG, or whether it's simply because the infusion set's bad and he's not getting any insulin.
Although, he did recognize that getting a CGM will decrease the need for finger-sticking (which he does ~15 times/day). Anyways, I suggested he read blogs of folks who are already on the CGM's. He said he would (without much enthusiasm). To be continued...

I would like to acknowledge Amy's blog, DiabetesMine
a great source of the latest diabetes technology & advances, as well as an insightful commentary on living with diabetes. I've pulled many of my D references from her site. Thanks Amy!

Wednesday, April 19, 2006

To CGM or Not To CGM

Continuous Glucose Monitoring (CGM) Gadgets

It's hard to believe that just over a month ago, I was despaired at ever having peace of mind when Jack's alone with the kids. And now, I feel as if I've hit the jackpot (not quite gold, but at least silver).

Just over this short period of time, not one, but two CGM gadgets have received FDA approval. After comparing available options, it's clear they each have their benefits and shortcomings. But I'm excited about Dexcom. These are the characteristics that I care about*:
- The FreestyleNavigator seems to have the most potential, but it's still awaiting FDA approval after three years. Listen to the informative presentation from the 2004 Diabetes Symposium.
- The MiniMed Paradigm REAL-Time System is a step closer to the artificial pancreas, but come on folks, it costs $1000 plus $35 (or $40?) per 3-day sensor.
- The Dexcom transmitter has the smallest footprint, and at $500, a lot more affordable. The 3-day sensors each cost $35, but rumors say it's possible to wear them up to 7 days (Abbott is currently seeking FDA approval for the longer use). Matt Vogel's blog about using it

Jack's (Mental) Challenges

Anyway, I've been subtly making all of this information available to Jack, trying not to cram it down his throat. His reaction? (1) He doesn't see the benefit of getting glucose readings every 10 minutes instead of every 2-3 hours. (2) The gadgets are too expensive.

Well, I think, I'm quite sure I didn't marry a stupid man. Someone actually awarded him a PhD once, and he sounds reasonably intelligent in normal conversations. Although, my boss has a theory that PhD's are so focused on the esoteric that the logic of pedestrian life passes them by. Hmmm. Anyway, my crack rebuttals go like this:
(1) It'll be easier to catch highs and lows before they happen.
(2) CGM will help to keep his BG within normal range. Yes, his HB1Ac is always around 5.3, but that only measures his average BG, not how widely they diverge from the norm.
(3) He's ok spending thousands (and I mean thousands, although I steadfastly refuse to know exactly how many thousands) of dollars on two speakers for his beloved/treasured/idolized stereo system, but he complains that a few hundred bucks is too much for the improvement of his health? Hah! Got you there!

More discussions after I get home tonight. We'll see how that goes...

* I guess I should do the disclaimer blah blah: I'm not compensated in any way by Dexcom, nor am I making any recommendations for treatment or gadgets!

Friday, April 07, 2006

An Amazing Night & My Children's Diet

An Amazing Night

Hurray, last night was amazing. No, no, not in that way (though, don't I wish...).

Baby wakes up for her 2am feeding, and then I stay up reading because I can't go back to sleep. I'm already feeling miffed at this particular parenting book (more on that in another blog!), so my annoyance radar is a bit sensitive. I feel Jack's foot jerk - once, twice. I reach over to check, but he's cool. Is it a hypo or just an exciting dream?? I wait 5 more minutes, and there's the unmistakable foot jerk again. Oh s_, I think and shake him: "Jack, are you low?" A rhetorical question if there ever was one - he has no idea anyway.

Amazing happening #1: He wakes up right away: "I don't know, but I can go check if you want." His kneejerk reaction has always been: "I don't think so!" and then turn around to go right back to sleep.

Amazing happening #2: Last night, he immediately gets up, goes to the kitchen to check, I hear the clinking of a glass, fridge opening. He comes back to bed. He's quiet and lucid and calm. Turns out he was 41, but you'd never have known it. Strange - sometimes he's 39 and completely out of his mind. Then he's 41 and completely rational. So last night was amazing. If only all hypos could resolve like that!

On my children's chances of becoming diabetic

"If the father has it, the risk is about 1 in 10 (10 percent) that his child will develop type 1 diabetes." So my children have 10 times the risk of developing diabetes than the general American population.*

It's clear that genetics predisposes people, but only that and interaction with environmental factors actually causes diabetes. There has been a lot of speculation the last few years on those environmental factors. Some of those factors I can only ignore because they're out of my hands: body trauma, viral infections. Others I incessantly worry about because I do have control over them. This is the stupid part, though. There are no conclusive studies that prove that any one of these is a culprit: length the child is breastfed, time of introduction of soy and cow proteins, hydrolized vs. non-hydrolized infant formula, volume of cow milk injested in toddlerhood. Even the highly-respected Joslin Diabetes Center counsels parents: "To be prudent, mothers of infants at high risk of developing diabetes may want to breastfeed as long as possible and rely on cow's milk only in moderation after the baby is weaned."* Oh, and beware of folks who advocate against children drinking milk at all (I'm convinced they're not so much concerned about the kids' health as much as wanting to push a vegetarian agenda).

The best literature review I've found on this subject concludes: "The question whether milk is involved in the pathogenesis of type 1 diabetes still needs further clarification."**

Jeesh - What's a mother to do in face of such contradictory advice and findings??

Well, this mother drove herself a bit nuts with the first baby: paranoia about not letting anything but breastmilk pass his lips until he was 6 months. Goat milk until he was almost 3, questioning whether she's increasing his risk every time she fills up his bottle with cow milk now. Questioning whether the yoghurt she fed him at 9months will trigger it.

She hasn't learnt and is driving herself a bit crazier with baby #2: Fed her 4oz of soy-base formula at 4 months, and is now questioning whether that'll trigger it (thought at the time that soy had no risks). Is horrified that she fed her beef at 7 months (didn't think that beef contained cow proteins???!!!). Wondering whether she should feed her yoghurt?? It's so healthy & tasty & full of calcium! Should she be denied on inconclusive studies?

Well that's the crux, I suppose. None of these studies has proven anything - as we know, biology and the study of human biology is particularly fickle. If I were to believe and rely on the scientific method, I wouldn't be worried about feeding my children whatever. However, my nagging paranoia (oh, faithful companion) warns me to be cautious. What if one of those hypotheses turn out to be true? I could not forgive myself if either my children were to develop diabetes.

On the other hand (you see, so internally conflicted!), I wouldn't blame any other parent for their child's diabetes. Blame is simply not warranted where there is no intention to cause harm...just as I could never blame my husband if either my children were to develop diabetes.

So I just continue to worry about my children's diet. Not quite convinced that it has any impact, but not quite convinced that it doesn't either.

*Joslin Diabetes Center
**Milk and Diabetes (J├╝rgen Schrezenmeir, PhD and Alexandra Jagla, PhD - 2000)