#t1dm

[disability-shout-outs]

Shout out to folks with Diabetes Mellitus Type 1!

[gifsfromthecrows]

fun mast cell fact: I just rejected a dental implant 👍 they did an X-ray and the dentist was like ?? there's a dark line all the way around the implant ?? and she took it out -- I went to see her in the first place bc it was wiggly and a little painful -- and she said I had formed a layer of fibrous tissue between it and the bone. she was showing her assistant like look look check this out gjfbfjdj anyway she also said the only other guy this happened with was diabetic too (I am too) so just. wacky immune system stuff for the win

[faofinn]

No. 7 THE WAY YOU SHAKE AND SHIVER

@whumptober

@whumptober-archive

Shaking Hands | Seizures | Silent Panic Attack

The last thing Harrison expected to see wasn’t Taidgh seizing on the floor, but it was close. 

Tai wasn’t meant to have seizures, this wasn’t meant to happen. Using his phone to call an ambulance, he swiped Tai’s against his arm. 

1.2. Fuck. 

That explained that. He grabbed the emergency kit from the coffee table, trying to protect Tai as he did so. 

“Ambulance, is the patient breathing?”

“Not properly.”

“Is the patient conscious?”

“No. he’s a diabetic, he’s having a seizure from a hypo. His BM is 1.2 and going down, about to give his glucagon.”

“Alright, I’m arranging some help for you now, stay on the line for me and-”

Harrison zoned out slightly, occasionally humming a response. It was a struggle to hold his arm still, but he managed, apologising as he did so. He moved to Tai’s head, stroking his cheek as he waited for it to work. They’d never been this bad before, never been this low. His phone always lagged behind, too, so quickly checked manually. It was worse than he’d expected at 0.7, the lowest reading they’d had and the lowest Harrison had seen, even at work. 

“C’mon Tai, sort yourself out, pull this back, yeah?”

The shot seemed to finally be working, Tai’s seizure slowing and then stopping. Harrison rolled him more onto his side, trying to clear his airway now that he could. A quick swipe told him it was starting to raise, which was more than he’d expected. The ambulance was taking forever, they always felt like an eternity when you needed help. He kept murmuring to Tai, trying to reassure what little he was aware of.  

There was a knock on the door, and finally a shout. "Ambulance!"

"In here!" Harrison called back. "Just come through."

"Hi, can you tell us what's going on?"

"Uh, yeah. This is Tai, he's type one, normally well controlled. He was last seen half an hour ago, I came back fifteen minutes ago and he was seizing on the floor as you see him. His blood sugar was alarming on his phone, so he's obviously had a hypo - it was 1.2 when I swiped it. Gave the glucagon as I called you guys, and then checked manually too, it was 0.7."

"Sorry, zero seven?"

"Yeah." He let out a quiet laugh. "Zero. I've never seen it that low. Stopped seizing after the glucagon, about three minutes after? He's just starting to come round a bit. When he's been really low, he can get a bit aggressive, but he's just scared and confused."

They nodded. “Alright. I’m sure he’ll be more settled with you here, so you stick with him. You know him best.”

“He doesn’t mean it, he always feels shit for it when he comes round.” Harrsion kept talking, running his fingers through Tai’s hair. 

“Which is fair enough, really.”

“What’s his sugars at now?”

“1.3 now.” They said, after a quick moment to check.

“Oh, it’s coming up then.”

“It’s still not where I’d like it.”

“No, course not.” Harrison shook his head. “Least he’s easy enough to stick.”

“One of the better cannulas I’ve had today.”

“He’s got good veins.”

“Got one good thing going for him, then.” They joked, trying to put him at ease. “You work at George’s don’t you?”

“Yeah, was meant to be my day off, believe it or not.”

“Always the way.”

Taidgh gave a groan, uncoordinatedly trying to pull away from the hand holding his.

“Hey, Tai. You’re alright, just an idiot, eh?”

The paramedic smiled to themselves. “Alright, well done. It’s Tai, is it?”

Tai rolled onto his back, blinking at the paramedic. He had no clue what was happening, or who was talking to him, but he’d heard his name.

“Welcome back to the land of the living.” They said gently. 

Tai grunted, deciding to roll back onto his side, and trying to fall back asleep. He pulled his arm over his head, trying to hide himself from the light.

“Careful, Tai. You’re gonna pull your cannula.”

“Here, let’s have this arm.” The paramedic said gently. “Let me look after this, yeah?”

Harrison moved quicker than Tai did, gripping his arm to stop him swinging. “Gentle, Tai, they’re trying to help.”

“I’m sorry, Tai. I know it’s not nice.”

"How much of that glucose has he had?" Harrison twisted to look. "He's going to have to go in, right?"

“I’m afraid so. He’s responded really well to it, but given the seizure and how low he is, I’d like him to go in and get looked at properly.”

"Yeah, I thought so." He hummed, stroking Tai’s forehead. "He'll not be happy with that, bless him."

“Hopefully it won’t be for too long.”

"You're gonna be better off trying to move him sooner than later." He said, then looked up guiltily. "I'm not trying to tell you how to do your job, not at all, I've just had to do this a few times with him. He's got less chance of refusing treatment if he's strapped in the ambulance."

They smiled. “You’re not telling us how to do our jobs. You’ve got the experience with him, he’s your partner. I’d much rather do it the easy way - he’s a big guy and I’d rather not get punched today, this is my first shift of four and it’s going to suck working the rest with a black eye.”

Harrison managed a laugh. "He's got one heck of a right hook."

“I’d rather not find out for myself, if it’s all the same to you. And I doubt he wants to hurt me either.”

"He's soft as shite really."

Tai gave a snore in response, grumbling sleepily to himself as he tried, and failed, to get comfortable. Harrison smiled sadly, hating hope small and vulnerable Tai looked. The other paramedic had disappeared off to grab the trolley, leaving the other to redo Tai's obs.

"Oh, that's better. 2.1." The paramedic hummed. "Definitely responding to the glucose there. We'll give him the last 100 there, and get him off to hospital. Hopefully he'll be more with it in a little while."

When the other paramedic returned with their trolley, they were quick to get Tai up and onto it before he fought them too much. It was nicer for everyone if they did it that way. Soon enough, he was in the ambulance, and they were able to get going. 

Just as Harrison had said, Tai started to become more aware in the ambulance, his grumbles growing more coherent. 

"'ars?"

Harrison smiled, squeezing his hand. "Hey, love. You're alright."

"'urts."

"You had a bad hypo."

Tai hummed. That sort of explained that, but he had to admit he didn't really care.

“We’re going to get you looked at and feeling better.” The paramedic reassured. 

"'m better."

“Not quite better enough.”

"He's pretty sure he is." Harrison laughed.

"I am." Tai agreed, rubbing his face with his free arm. "My tongue hurts."

“Yeah, it will, you had a bit of a seizure.”

"That's Finn."

Harrison laughed again. “Not today.”

"Are you sure?"

“As sure as I can ever be.”

"Was I low?"

“Really low.”

"How low?"

Harrison didn’t want to scare him. “Uh, very low.”

"You're lying to me."

“I wish I was.”

"You won't tell me how low."

“At one point it was 0.7.” He admitted.

"Oh." That was low. His face screwed up as tears started to fall, and he pulled his hand from Harrison's to rub them away.

That was why Harrison hadn’t wanted to tell him. “It’s okay, it’s coming back up now.” He said gently, brushing his tears away.

"I feel rubbish. I didn't mean to."

“I know.”

"I tried."

“It’s not your fault, it happens. We’re looking after you.”

"I'm sorry."

“You don’t need to be sorry.”

[teachingrounds]

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Beyond Type 1 is the largest diabetes org online, funding advocacy, education and cure research. Find industry news, inspirational stories and practical help. Join the 1M+ strong community and discover what it means to #LiveBeyond a diabetes diagnosis.

All this week on Teaching Rounds, we're going to share patient perspectives and online resources for people living with Type 1 Diabetes Mellitus, starting with  Beyond Type 1!

[echsellentlizard]

Diabetes for Beginners (Type 1)

At a bare minimum, check your blood sugar before each meal and before bed. Sometimes you might be afraid to look because you feel like you’re a failure if you’ve let yourself go too high, but that’s just not how it works. Blood sugar is controlled by many factors and you only have control over a few, so don’t beat yourself up for not being able to calculate the perfect insulin dose. The best thing you can do is check often and make lots of smaller course corrections—it’s always easier to catch and fix a 250 than a 450!

People who aren’t diabetic and haven’t experienced real hypoglycemia will tell you to follow the 15-15 rule, and will be perplexed that you lack the “willpower” to adhere to that. The 15-15 rule is good, but when I have a blood sugar of 50, there is no force on earth that can keep me from eating everything in sight. What I do about that is to try to make sure that I have hypoglycemia munchie snacks on hand. These will be relatively low-carb items that are time-consuming to eat. Salad greens and peanuts with shells work best for me.

Drink water. Small amounts throughout the day are ideal for staying hydrated.

Exercise can make you hypoglycemic but it can also help keep your glucose levels more stable over time. I don’t like to exercise. I have a step counter and I only average 5k steps a day. Don’t feel like you need to do spin class or whatever, just find out how active you normally are, and try to kick it up slightly. Also do some stretching on a daily basis, even if it’s just toe touches, because it’s very dangerous for a diabetic to lose mobility.

Don’t exercise for at least an hour or so after a meal. Your body puts digestion and carb absorption on pause when you exercise, but the insulin you dosed is still working in your system. You will go hypoglycemic. If possible, exercise before meals instead.

Nasal sprays for allergies (Flonase) can be sprayed on your skin before inserting a CGM or infusion set, and helps with reactions you might have to the adhesives. Use them after cleaning the skin.

Don’t put open vials or pens of insulin back in the fridge. It doesn’t extend the shelf life; it actually can shorten it, because insulin is a hormone and isn’t stable when subjected to temperature fluctuations.

Don’t mess with weird cheap over-the-counter Walmart insulin unless you have absolutely no choice. That stuff is obsolete for a reason.

[redtailhawk19]

Diabetes rant

Been awhile since I posted but I'm just really sick of having to pay x amount to live. I need to vent or the urge to off myself will win and i'm not going to let the assholes win. So ignore if you want I just want to vent. My bg is five hundred currently so yeah. I'm just kinda pissed.

Diabetics in America, type 1 and type 2 have to make do by buying insulin from other companies, paying out of pocket prices that can range from 200 to 1500 for a month supply. Relying on Diabetic Facebook support groups where other Diabetics donate extra supplies, copay cards that only work half the time, and fiancal assistance programs that you only qualify if you're in the lowest possible income bracket. This is the fault of Pharmacy benefit managers, insurance companies, the top three pharmaceutical companies, Eli Lily, sanofi and novonordisk that own the patents. Then all three blame each other for the high price, blame the pbms and insurance companies who into blame each other as well. Fun fact Eli Lily came out with a generic insulin. Insulin lispro it's basically humalog. Not that they have been advertising it, the bastards. I've been told at my pharmacy an out of pocket price of humalog is $546 for a month's supply of vials, what's is insulin lispro's out of pocket price for a month's supply? $180 per vial. Had anyone had any luck finding out what it cost the companies to make their analog insulin? I've been looking for that data for 8 years still haven't come across a legitimate source. I heard once from a novonordisk drug rep that Eli Lily makes one vat of insulin for $50 dollars. Lol representative was trying to make the other company look bad but they all do it. So you have insurances that pick which insulins get to be on their formulary. BCBS for example favors humalog. So good luck unless you're allergic to humalog they will deny any prior authorization for another fast acting. My BCBS ins doesn't care that fiasp and novolog work better for me. Now I'm using humalog u 200 which is working for now thank God. Let's now get started on Continuous Glucose monitors, dexcom g6, freestyle libre and guardian sensors.

Having a CGM literally saved my life, I have a 'good insurance plan' I have an 800 dollar deducible, 5000 out of pocket. Met my 800. Dollar ded at the first of the year. Wanna know how? I had to drop $1000 to pay for a 3 month supply of dexcom g6. So I met my deductible so now everything is great? Wrong! I still have to pay %20 coins. So if I want 3 month supply I have to pay $367 dollars of my portion. I don't know about most people but I find it difficult to come up with that sort of lump sum of cash. It's September and I'm only 2000 in on my 5000 out of pocket. Why because I don't go to the doctor unless I have no other choice. I have enough trouble just paying for my diabetic supplies let alone the copays, and remaining balance left over at the end of doc visits. Only doc I see regularly is my Endo. Then BCBS had the gall to keep making me use dme (durable medical equipment) companies that charge a hell of a lot more than pharmacy benefits do. Supposedly bcbs is going to let commerical insurance patients use pharmacy benefits in October so if you have BCBS and use a dexcom CGM have your doc or Endo send prescription to community Walgreens who also has a $120 coupon.

Freestyle libre is at least trying to do something, funnily enough because they market their CGM as a meter and for type two diabetes. Out of pocket price is 75 using e vouch for a month supply, sensors last 14 days, 1 hour warm up time, no alarms but they are working on it. You can use a smart phone and save some money by not getting a reader. Guardian don't know much about but I tried one and sensor died on day one. If the senors work then it does have some advantages. transmitter lasts a year and is rechargable, and you can restart sensor fairly easily.

Pumps Omni pod, tandem and Medtronic.

Gotta Omni pod hands down even though I got a tandem tslim x2 pump. Omni pod is tubeless, Omni pod pods can be potentially pharmacy benefits. So go omnipod also because you can hack the classic pump with the open aes algorithm and get a artifical pancreas because #we aren't waiting. FDA approval takes forever!

Good news on dexcom front, G7 supposedly will come out in end of 2020. It will last fifteen days, 1 hour wait time and transmitter is inside senors so you throw whole unit away. Why is it going to be less expensive? They want to market it towards type 2s.

Did you know you can restart dexcom g6 transmitters and senors. Well you can check out YouTube for fellow Diabetics' instructions. It will save you money and stick it to the assholes trying to monetize diabetes.

It sickens me that Sir Fredrick Banting and his cohorts sold the patent for insulin for a dollar each, total sale being $4 dollars to Ontario college. They sold it so it would be affordable and accessible for everyone.

Back in 1942 Eli Lily and two other companies got in trouble for price fixing insulin. What's the difference between then and now? The government actually did its job and stepped into to stop them.

Everyone who price gouges insulin and Cgms and pumps should be ashamed.

I'm sick of being taken advantage of for an autoimmune disease I don't have a choice in. I'm pissed. I want justice.

I want a healthcare system that won't bankrupt me. I want a system that actually focuses on preventive care and not being for profit. Fun fact our healthcare has not always been for profit. You can thank president Nixon for that.

"Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be."

Also fun fact that is when the big top three insulin producers starting raising the prices of insulin and they haven't stopped since.

So the solution to fix our healthcare system is pretty damned simple. Go back to having it be non for profit.

[er-bsn-rn]

FED. UP.

[mdrambles]

Diabetes Camp: Day 3

Today started with a jump in the lake at 7AM--it was chilly outside, but the water was still warm from the hot day yesterday. This is called the “Polar Dip” at camp, and for each person that jumps in the lake on behalf of a particular cabin, the cabin gets points; the med staff are worth 10 points each. Yesterday, one of the preteen male-identifying cabins asked me if I’d jump in for them, and I was kind of flattered but also a little apprehensive...

Turns out the apprehension was an accurate gut feeling, because even though the actual dunk in the water wasn’t so bad, it was WAY warmer in the water than out!

So the actual “polar” part of the Polar Dip was the very quick walk back to my cabin for a warm shower while dripping wet!

We finally wrangled control over my uncooperative camper’s sugars--all it took was replacing a broken (read: cracked and completely non-functioning) insulin pump and FINALLY coaxing the kiddo into changing his pump site. It was quite the negotiation, considering he’s a 7-year-old.

Last night, there was also a medical staff collaboration I walked in on in preparation for the Camp Show taking place two days from now. I joined in on re-purposing “A Whole New World” for the campers--looking forward to the show!

I also find it interesting to note that a bunch of campers have called me “nurse Sabrina”, since all of our med staff except one of the staff physicians is female-presenting, and I am pretty obviously working with the MD staff. I also noticed that my name tag and my female co-resident’s name tag both bear our first names only, whereas my male colleague who was on service at camp last week had a name tag saying “Dr. [firstname]”. Such are the subtle (or not-so-subtle) gender gaps in medicine and healthcare... the main times it actually becomes an issue is when campers ask for help with tasks that are in the nurses’ scope of practice, since I am very useless in these situations!

While on call for the day, I have become much more acquainted with some of the other non-diabetes complaints that come through at camp. (The extra exposure to peds emerg came in VERY handy for the general wound care, MSK injuries, and head injuries...) I also hung around with the nurses and witnessed a really powerful conversation between some of the teenaged campers that had to sit under nursing supervision for a bit because of low sugars requiring treatment and rechecks.

One of the male-identifying adolescent campers spontaneously started sharing the story of his “diaversary”--his diagnosis of diabetes. It was very cool to see the teens share their experiences in response, and how they bonded immediately on this common ground. This was particularly powerful since there aren’t many other environments likely to foster this sort of situation, and I felt really privileged to bear witness to it. It was also saddening to hear each of the kids describe their diagnosis of diabetes “ruining” something--for one girl, presenting in DKA “ruined” her parents’ anniversary. For another, her initial presentation was also in DKA at her father’s birthday party on father’s day. It was hard to hear the kids talk about their experiences as a burden on their families, since it was completely out of their control...

On a somewhat more harrowing note, tonight’s an overnight trip for our youngest male-identifying cabin. I have never felt so terrified by so many different things in my life. My supervisor and I walked over to the overnight campsite with the “trip” nurse who would stay onsite with the kids, and the kids were ALL OVER THE PLACE, chasing each other around the open fire with broken sticks and just generally a clown fiesta.

They are pretty high-energy and rambunctious on a regular day (and one of them is my particularly difficult camper-patient) with somewhat tricky-to-control glucose levels... mix in this open flame, sharp pointy sticks, and lots of shouting (and s’mores)... total pandemonium. I felt my blood pressure rising just trying to calculate carb counts!

Hence, insulin rounds were certainly very eventful. We ran into some further communication issues with their counselors (HOW MANY CARBS ARE IN A S’MORE?!), but fortunately everything was sorted out. Lesson learned: it’s generally better to under-bolus than over-bolus insulin since you can always give more but can never actually take back insulin you’ve already given... Whew.

(Still caught a photo of the sunset, somehow!)

For the night on call, spent some time hanging out with the nurses for “night rounds”--all the bedtime sugar checks! The nursing and dietetics team at camp here are so great--they’re tons of fun, have lots to teach me, and they are so kind! (Also they are super hilarious.) Couldn’t ask for a better med team! <3

One of the nurses even told me that I’d be really fun to work with in general, which is always very high praise. Many of these nurses don’t regularly work in peds, so they have even more experiences to share from their regular jobs. I really hope the kiddos are treating their nurses and dietitians well--they’re the best!

Our med team lead also bought me some ice cream from this artisan creamery, which I got to enjoy on call. So nice of her! Also--NOM.