Sunday, May 20, 2018

Sleep: A Fickle Friend

My relationship with sleep has always been odd. I love sleep. But when I was a child, I had night terrors. I always needed a night light, and I still can't sleep in total darkness. I'm also a violent sleeper. My friends who've shared rooms with me say I run in my sleep, kick in my sleep, throw things in my sleep...

I wake up and the room is a mess. My stuffed animals are everywhere. My blankets are askew. Bottom line is, my sleep has never been particularly restful.

As I adjust to adulting and having a full-time job, one of the things I've prioritized is trying to get as restful a night's sleep as possible. But the more time I spend trying to get a good night's sleep, the more I am reminded of an unpleasant truth: type 1 is not at all conducive to rest. And I am not alone in this. Other T1D's feel the same, as do their family members I'm sure. How does any parent of a T1D child get a full night's rest? My mom still doesn't sleep, and I'm 26 (sorry mom).

There's many parts of diabetes that interfere with sleep. To start, the equipment. Anyone with a pump knows what it's like to wake at 3am entangled in tubing (Podders excluded). There are times when I drift seamlessly between sleep and wake, just long enough to grab my pump, roll to the side, and place it so it's not wrapped around my waist. This may not be a lot of time awake, but it adds up.

Then there's the tech. CGMs can simultaneously help and interfere with sleep, depending on the person. On the one hand, the CGM is a great tool for waking those who don't feel their lows or highs. This is essential for getting a good night's sleep - because who can rest when they're worried about dropping low and not feeling it? Those who don't feel their lows and parents of young children can more than likely rest easily knowing their CGM is there for them. On the other hand, some CGMs are less accurate than others. False alarms ringing out in the night are incredibly frustrating. There's also the risk of over-checking and over-treating - seeing a downward/upward arrow when you roll over and glimpse at your graph, and giving an unneeded correction or laying awake with worry. Much like having a cell phone in the bed, the CGM is stimulation. It is a double-edged sword.

What else?
High BG - up all night to pee.
Low BG - up all night to eat. Followed by a rebound and a wave of nausea.
Bum pump site - have you ever had to change your site in the twilight hours while still half-asleep? Not fun.

Along with all of this comes the general anxiety of just being diabetic - and trying to sleep. Whether it's worrying about lows or highs, worrying about whether a correction will work and how you'll be when you wake up, or trying to remember if you've re-stocked your bedroom juice, diabetes is not a disease that plays nice with restful sleep. Because of this, I try to get into my bed early enough that I have more than enough time to get in eight hours - since I know 100% of the time in bed will likely not be spent sleeping.

Sunday, February 18, 2018

Running While Diabetic

I've always loved to run. When I was a little girl, I was quick. Like, faster-than-the-boys quick. As I got older I lost my speed. I dabbled in sprints freshman and sophomore year during track, but it didn't stick. As the years passed I struggled to find a niche in exercise, something that I really loved and could bring myself to do on a regular basis. I was surprised to find myself back to my roots - in running.

When I was a teenager I never thought I could run distance. I didn't feel I had the energy or the stamina. But as I went through college and got more familiar with the treadmill and the track, something shifted. I found I could run small distances if I paced myself. I loved the feeling of settling into just the right pace, where I could breathe somewhat normally and didn't feel like I was going to have a heart attack. It gave me a great feeling of satisfaction afterwards.

Lately I've gotten back into running. My brother and I ran a couple of 5k's, and I found myself falling back in love with the feeling of accomplishment and exhaustion a good run gave. Planned 5k's and runs in particular are exciting for me. When I have that concrete goal ahead of me, I find it easier to get myself motivated.

My main challenge with running is, of course, keeping my blood sugar stable. It's an extra level of sorcery to master in addition to the complexity of just having diabetes. I experience drops during my runs, after my runs, in the middle of the night of my runs, you name it. Then there are the spikes. The adrenaline a good run gives works as a double-edged sword, and can lead to BG spikes during or after runs. I am still in the process of finding a routine that works for me. Typically I take my pump off during the run itself. Gatorade is usually helpful when it's thrown in the mix, whether I drink it during or before or after, or all three.

Lately I've been following along with Type One Run's "Couch to 5k" program on Facebook. Although I've done 5k's before, I wanted to get back in running shape after my last one in November and get going towards preparing for my goal this year - a 10k. The program has step-by-step instructions for every day and can be done without a gym membership, which I love. What I love most, though, is the sense of community and the abundance of resources the group brings. Having a group of type ones easily accessible means being able to ask for advice and share your own helpful tips. So even though I haven't found my perfect routine for a stable BG (and let's be real - probably never will), I have a pool of tips and tricks I can dip into until I find what works best.

Sunday, February 11, 2018

Don't Ruin Your Daycation

Overnight Stays & Daycations with T1D

If you've traveled with type 1 before, you know how much pack and prep is involved. Extra supplies, more extra supplies, keeping your medical supplies in your carry-on, and the works. But things are easy to overlook when you're just going for a quick overnight getaway, or taking a daycation to a local spot. Because you're going so close, it can be easy to under-pack and forget the essentials.

This past week I took the train into NYC where I stayed overnight at my brother & sister-in-laws'. While it's relatively close (about an hour by train), I would find myself in a real pickle if my tubing got caught in a subway turnstile and ripped my site out. Getting back home via NJ Transit without planning ahead is a real hassle, and it would cut my trip short, which would bum everyone out. To try to avoid this, whenever I go to places that aren't easy to get home from, I make sure to pack extra everything - even if it's a short trip.

Of course, this means bigger baggage. But this is a necessary evil that I've found to always be a part of the type 1 lifestyle. This week, I stuffed my new canvas tote to the top and tried to keep it safely tucked under my arm during my trek. Something I find helpful is stuffing everything important towards the bottom of the bag, or wrapping them in clothes so they're less likely to fall out. Of course, I keep my meter and some juice easily accessible in my purse. Top priorities are:

Batteries. I always forget about batteries, until I've got 30 minutes left in my pump and have to scramble around wherever I'm at, thieving from remote controls.
Test strips. Sneaky in every way. You watch them accumulate, used, on the floor of  your purse, but then are shocked to find the tube empty.
Chargers. Not just for your phone. If you've got a Contour meter like me, or a T-slim pump, pack that charger. There's outlets everywhere these days.
Extra pump site. I keep these everywhere. One in my car, one in my overnight bag waiting and ready to go, one in my office. You never know when you'll need one.
Extra low supplies. Swedish Fish and Skittles are particularly non-bulky and pack a lot of punch in one bag. I am always learning about new on-the-go low treatments from fellow T1s, so if you've got other ones, please share in the comments!

So whether it's the great unknown or just a city brunch, make sure you're fully packed and prepped for anything!  Don't let T1 spoil your daycation if you can help it.

Tuesday, January 30, 2018

SOS!! Prescription Assistance Resources

Prescription medications. They play a huge role in the life of those with type 1. And they go beyond just medications - they include glucometers, test strips, lancets, pen caps, syringes, and so on. Many people with type 1 also live with autoimmune comorbidities, such as hyper/hypothyroidism or lupus, which means - you guessed it - more prescriptions. What many people don't realize is how costly these medically necessary medications and medical equipment can be, even after insurance coverage. For example, even with insurance coverage my co-payment for my insulin was roughly $230 for a 3-month supply. I am lucky. There are many people do not have insurance to soften the blow.

When you have type 1, getting your medical supplies can feel like a beast that you are expected to conquer all on your own, with no guidance. This may be why so many people fall between the cracks and struggle to care for their diabetes. Between living as a type 1 for almost 25 years and working in the field of medical social work, I have been privileged to glean handy information and resources that can help tackle this monster. Here is the quick and dirty handbook.

Terms to Know

Copayment. What you have to pay for your medication. 
Once your insurance pays their share (say, 80% of the cost of the medication), you are responsible for the balance (20%). Each insurance company is different in terms of how much they pay. Typically, insurance companies offer the most coverage for the cheapest medication, or the generic. As an example, your insurance may cover 80% of the cost of a generic (or formulary) medication, but 70% for a name brand (or non-formulary).
Formulary. The type of medication your insurance will provide the most coverage for. 
On the flip side, they will cover less (and you will pay more) for non-formulary or name brand. Then there are excluded medications/medical supplies - medications that your insurance company will not cover at all. However, if your medication is on the exclusion list, you may still be able to get coverage. 
Example: The insulin I use is on my insurance plan's exclusion list - meaning they do not cover it at all and I would be responsible to pay the entire price out of pocket. However, my insurance (and many others) allows my doctor to submit an appeal or letter of medical necessity for said medication. Once approved, the company agrees to cover the insulin as a non-formulary.
Get in touch with your insurance and ask what department can assist with this. It will likely be the prior authorization department.  If your doctor's letter/appeal is approved, your insurance may agree to cover this excluded medication to some extent- they won't cover as much as they would for a generic, but  they won't cover nothing.
Co-pay cards: Prescription assistance for commercial insurance - not for those who are on Medicare/Medicaid or uninsured. Co-pay cards can typically either be downloaded from the manufacturer website or given to you by your provider.
Prescription Assistance Programs: Programs that provide financial assistance/reimbursement for your out of pocket medication expenses. Typically those with Medicare or those who are uninsured are eligible. Applications can be made by mail or online, depending on the program.

Resources to Have

NeedyMeds. Probably my favorite resource when it comes to prescription assistance, NeedyMeds is a one-stop shop for assistance programs, downloadable coupons, and co-pay cards. Simply type in your prescription (you may need to know the generic name), and it will prompt you to choose co-pay card programs, assistance programs, or coupons, as they are available for that prescription. Link below:

Good RX. Another useful tool, Good RX provides a price comparison between your local pharmacies and downloadable coupons for your scripts. They have an app, or it can be used from your phone's browser or email. If you're old school, you can simply download the coupons and print them to take to the pharmacy. Link below:

Whether you are uninsured, under-insured, or insured by a crappy plan, there are resources out there that can likely help. I encourage everyone to try out these resources. No one should have to pay exorbitant amounts of money to stay alive. Your doctor may be aware of other programs as well, so don't be afraid to ask them. You will likely need their help or their signature for some of the assistance applications. And this doesn't just go for type 1 - this goes for any and all prescriptions for any and all medical conditions.

Note: This post was written based on my experience, and is in no way an attempt at a thorough explanation of the ins and outs of insurance coverage. Each plan is different, and each person will have different experiences. Feel free to comment with different experiences or questions below.

Friday, January 26, 2018

It's Not You, It's My Insurance

Breaking up with your doctor

Is there anything more uncomfortable than a breakup? Especially one where there’s no bad blood (yet)? Perhaps not. Recently I had a change in insurance coverage. My new policy allows for lower copays and prescription discounts with a hospital group endocrinologist. Naturally, I jumped at this – I have only been seeing my adult endo for a couple of years, and while she is very kind and helpful, the pros outweighed the cons in regards to switching – especially cost wise.

As exciting as this switch is – as fellow T1Ds, you know how big a deal any decrease in out-of-pocket expense is – it has caused me a significant amount of worry. What an icky feeling, having to tell my doctor I am switching. I weighed the options on the drive to the office. What exactly would I say? Who would I tell first – the office staff, or the MD? Will they be offended? Will they fax my chart, or will I have to sign a whole heap of paperwork to release the records? As I sat with this discomfort, I felt an eerie sense of déjà vu. Thankfully, my APN and MD were incredibly gracious and understanding. I left the office with a bittersweet feeling. Reflecting on my visit, I felt familiarity wash over me – like I had just broken up with my endo.

So what to do if you’re in this jam?

Make your decision before you enter the office. Switching doctors is a big decision for someone with type 1. Typically the recommendation is to see your endocrinologist every 3 months. This is way more often than your annual PCP visit. If you’re super comfortable with your endo and are feeling secure financially, it may be worth the extra out of pocket to stay.
Stick to your decision. Once you make your decision, stick with it. Don’t waffle in the office. Professionally, the staff should understand that this is your decision even if they are sad to see you go. It’s okay to express these feelings on both ends, as long as no one gets carried away. Be kind, but firm. If you need a scapegoat, tell them you simply can’t afford to continue there. Blame your insurance. No one likes insurance anyway, doctors included.
Have your records faxed. Not all offices will do this, and some require a signed release of information. Be prepared to ask about it while you’re there, and have the fax number of your new doc handy. If they can’t fax it, they should be able to give you a hard copy to take with you to your new significant other.

Relationships – doctor relationships, romantic relationships, friendships – can be hard. Endings are usually inevitable. When it comes down to it, you gotta do you. As the wise men once sang, “every new beginning comes from some other beginning’s end.”

Tuesday, October 31, 2017

5 Ways to Self-Care at Work

1. Plant.

Stuck under the buzz of fluorescent lights for 8 hours a day? Fear not. Having greenery around your office/cubicle is a nice way to counter being stuck inside. Try something low-maintenance (think succulents, cacti) especially if you're not a plant expert. They thrive with minimum water and light - even indoor light. As time goes by and with a little research, you'll get more familiar with how to care for your plants. I keep a little spray bottle tucked away in my drawer, and give them a quick spritz each day in the office, focusing on the soil. For flowers, I snip the stems and switch out the vase water. Interacting with a living thing at work that can't argue with you is a nice distraction to have. Try starting or ending the work day by tending to your plant friends - this way you have a consistent, pleasant start and/or end to your day.

2. Go outside.

Or look outside. Whatever you can manage, even if it's walking outside from one building to another instead of taking the indoor route. It's easy to get sucked into the flow at work and completely forget what time/day/year it is - especially if you work in a windowless environment. The benefits fresh air and natural light have on your body are numerous.

3. Take your whole lunch break.

If you're a fast eater like me, that half hour lunch break has a tendency of turning into a 15 minute lunch break. But this is your time. Take it! If you finish eating before break ends, stay put. Whether you're in the break room, your car, your office, or the coffee shop, don't return to work until that allotted break time is up. Fill up that time with anything you want - deep breathing, dawdling on your phone, catching up with a friend - anything that helps you recharge before returning to the madness.

4. Single-task.

Multi-tasking is great when you're in a pinch, but a key part of mindfulness and stress reduction is focusing on what you're doing right this minute. Stay in the now. The more tasks you try to do at once, the less space your brain has to devote to doing each task effectively.

5. Leave on time.

When did leaving on time start being viewed as leaving early? It's hard to say, but the pressure to stay late even if you arrived on time has definitely become more prominent in the workforce. Clocking out at 5:30 on the dot is now a task that's often met with thinly veiled shade. While being dedicated and staying late occasionally to finish an important job is admirable, it's important to weigh when it's necessary to stay late, and when it's not.

Remember - even if you love your job, work is a part of your life - not the whole thing!

Thursday, March 17, 2016

What is Diabetes, Really?

Diabetes is...

An out of place juicebox on the corner of the yoga mat
disrupting the zen.
A parent's cold sweat in the middle of the night
when the phone rings.
Fingers absently tracing over tubing
checking for kinks.
And finger tips, callusing over - while inflamed tissue grows
on the belly.
Bruising and leaving purple polka dots.
It's an intrusion - 
on sleep;
on the mind;
on the body.
It's sagging eyelids and a churning tummy
forced awake in the middle of the night.
A ravenous hunger and, an hour later,
a deep-seated nausea.
A constant tug of war between
peace of mind -
and staying alive.
It is a victory cry - at the end of a hike, a recital, a first sleepover, a first date.
The hurdle that makes the crossing of the finish line
It is the longest significant other ever to be entangled with.
It is mine.