Making Endo Visits Suck Less

It's no secret that we all dread going to the endo. No matter how much we like our docs, there always seems to be a level of anxiety that accompanies us to the office. If nothing else, this visit is a strong reminder of the chronic illness that we are living with and managing every day. After more than 20 years of doctor visits and a handful of different endocrinologists, I've learned some ways to make these trips suck a little less.

Treat. Yo. Self.

This idea was actually inspired by my older brother. Like most normal humans, once a year he goes for blood work. He's not the most comfortable with docs and needles, so after his appointment he stops for a Snickers bar. After hearing my mom talking about this I thought, why don't I get in on that?

It doesn't have to be candy (unless you're low). It can be something a little more betes-friendly, and it doesn't have to only be before/after your endo appointment. When I go into the pharmacy to pick up my medications, I look for a little something for myself. Whether it's a mini-cactus for my office, a Justin's PB cup, or a new face mask; it makes the trip a little happier. 

After my endo appointment I'll do a little something more - stop at Starbucks or Playa Bowls, or I'll book a facial for the same day. It can be something small (or big!), but you get the general idea - do something pleasant for you.

Write out your questions.

If you're like me, you have a lot of thoughts that gather in the couple months between appointments. It's easy to let these float around in your head and then have your mind go totally blank once your butt hits the exam table. This can lead to feeling flustered and defeated after the appointment. Something I've started doing is writing down my thoughts and questions as they come, and bringing the list with me when I go to the doctor. That way, when my doc asks how things are going I actually have something productive to work on.

Stand your ground.

It's essential as a type 1 to have an endo who is willing to work with you. Someone who is on your team, not trying to act as your boss. If you have ideas - taking a pump vacation, switching insulin, trying a sensor - speak up! This is your time to advocate for yourself. Your doc may not be on board right away, but they should listen to your input and hear what you have to say. After all, you are the one living with this disease 24/7.

Bottom Line.

Medical management can be boring, at best. But mixing in little joys and treats when we can acts to improve our outlook and quality of life.

Trust & Type 1

Trust is essential in any relationship. It allows us to feel safe. It gives us permission not to worry; not to have doubt. When we have trust, we can rely on our significant other. As someone with type 1, I rely heavily on my medical supplies. But what supplies earn that trust? And how long does it take to earn it?

The glucometer.

This is the OG diabetes tech. It's what I've been using since infancy. When I was a baby, my parents used to prick my toes to test me (I was diagnosed at 13 months old). Because of this, my glucometer often feels like my lifeline. It's been there literally my entire life, giving me the data I need to treat myself. Granted, there are days that my numbers are so wacky that I stare at my meter in frustration and wonder, are you lying to me?

The meter has evolved over the years - becoming slimmer, quicker, and requiring less blood from my callused fingers. But the idea is still essentially the same. Prick the finger, get the number, react accordingly. I would say that I rely heavily on my glucometer - because I trust it.

The pump.

Coming along in my grade school years, the pump took some time to earn my trust. When it first came out, I remember writing in my diary in wonderment, marveling at the fact that I didn't have to use MDI (multiple daily injections) anymore. I remember putting my "very last syringe" in my memory box the night before my pump training. It was a huge deal for me.

Maybe because of this, I was crushed when I had a rough go of it the first time around. I struggled with highs; had one particularly traumatizing, painful, kinked catheter; and site changes for some reason terrified me. I eventually went off the pump for a year or two until my parents & I felt I was ready to try it again. I've remained a pumper since then.

But still, there are days where I feel that doubt niggling at the back of my mind. What if my pump malfunctions? What if I can't get my insulin? What if I get too much? Can I really trust this device functioning as my pancreas? Clearly, this doubt isn't significant enough to cause me to switch back to MDI, but still, it is there.

The CGM.

Thus far in my diabetic life I've had two CGM experiences - Medtronic Enlite and Freestyle Libre, the system that I currently use. I was weary of this tech at the beginning, and was adamant that I didn't want something else attached to me. I was also a high schooler, and annoyingly stubborn. As I got older, I began to grow curious. But alas, it wasn't meant to be - my insurance did not think that this (statistically proven life-improving) technology was "medically necessary." So, I went without until I enrolled in my own insurance this year.

If you follow me on Instagram or read my blog, you know that I'm in love with my little Libre. But it's a new love. It's still deepening. The trust still needs to grow. I get asked all the time, "So you don't have to prick your finger anymore?" And I wince, because I know I really don't have to as often as I do. But kicking an almost-26-year habit is hard.

To be fair to myself, there are discrepancies between the readings, and for the Libre it is recommended to check via finger stick before making treatment decisions. Still, there is room for improvement on my end. I feel the doubt trying to drown me, telling me "just make sure" or "just prick your finger, it's no big deal." I am hoping that with time, I'll develop a functional doubt:trust ratio.

Bottom line.

As human beings, we're comfortable with what we know. We are, in fact, creatures of habit. It's been my experience that people who were diagnosed at a younger age, or many years ago, are more familiar with the older tech and are more weary of relying so heavily on the new stuff. But those diagnosed during this stage of the game, where CGMs are the norm, feel much more comfortable trusting in their gadgets. A big part of this is about feeling safe. I feel safest testing my sugar the old-fashioned way, because it's what I knew for so long. 

My hope is that with time and practice, my trust will continue to deepen. My other hope is for you to know that if this is something you struggle with as well - you're not alone!

Planes, Trains & Snow Delays - Costa Rica 2018

Pura Vida.

"Pure life." It's the phrase of Costa Rica, where I spent the last 6 days. I can say with certainty that the country measures up to this saying. It was beautiful: lush with wildlife, green forest, and full of amazing views and experiences. Every day, especially those where we ventured outside the resort, felt full of life.

Me and my best friend, who I've known since babyhood, traveled together and this is the farthest south we've gone so far. The flight from Newark was about 5 hours. We stayed in the northwestern part of the county, in the province of Guanacaste. This was my first trip with my Omnipod as well. Overall, my diabetes wasn't troublesome during vacation.

What I packed.

To say I over-pack for vacation is an understatement. But hey, better safe than sorry, right? For this trip I knew I would have to change my pod twice, so I packed six pods - four more than needed, just in case any didn't work or fell off in the jungle. I packed extra batteries for my PDM. An extra pump - my old Medtronic - with two infusion sets and reservoirs to go with it if needed. A full vial of insulin, an extra glucometer, charger for my glucometer, some extra lancets, and two full bottles of test strips. Oh, and low supplies.

For my lows I packed a big baggie of gels, and two juices. I've learned recently that you can bring your juice through TSA at the airport in your carry-on. If you inform them why you're carrying it, they will swab it and let you bring it through. We didn't check any baggage, so this was super-helpful. I also have a small army of pills I take daily, so I filled up my 7-day pill case and packed all the bottles as well - that way I can show what the pills are and that they are prescribed to me, if needed. 

Lately I've been using Vial Safe to keep my insulin safe during travel. I kept my PDM, libre, and glucometer with a gel in my Clark double zip bag from Myabetic. This was my go-to bag for vacation - brought it to the beach, carried it in my backpack at the airport, and used it as a little clutch at night. I also brought the new Jay sling bag from Myabetic which I found VERY helpful during our excursions. It fit lots of stuff and is more sporty and water-resistant than the other bags, which was good because it poured during our rainforest walk. When we went zip-lining, I was able to clip it around my waist like a fanny pack. All of my extra supplies go into my zippy "All My Diabetes Shit" bag by Casualty Girl.

Keeping the shoogs in check.

Something I've learned about myself is that I run high on vacation. Whether it's the adrenaline, the high fat food my body isn't used to, the drinking, or a combo of the three, I'm not sure. What I did this time is created a "Travel" basal program with doses .2 units higher than my regular basal. It worked well with a little tinkering. After dinner I still would need a jacked up temp basal for a couple of hours. It's amazing how sensitive our bodies are to change. At home I really don't drink with dinner and we eat very healthy. Even having 1-2 drinks on vacation and eating food that was richer but that I didn't necessarily think was "high fat," my sugars would skyrocket without that extra basal.

Something else I strongly recommend is water. It's so important to stay hydrated when you're laying out in the sun, especially if you're drinking. I grabbed a water with every drink I had, and every hour or so out by the pool even if I wasn't drinking. It just makes my body feel better. 

Excursions.

As lovely as it is to lay by the water, have some cocktails and just do nothing, mixing in excursions is a must for me on vacation. I love to see the country I'm in, learn about its history and its people, and experience everything I can in the time I have.

Our first trip was to Diamante Eco Park, which has an animal sanctuary and an aerial zip-lining course. We got to see monkeys, jaguars, sloths, and toucans! I never realized how beautiful toucans are and now have developed just a tiny obsession with them.

After the animal sanctuary it was off to zip-lining over the mountains. I've zip-lined before, but this was something else. The second zip was Superman style - face first. It was high over the ocean, and we could see our resort in its entirety from above. Definitely not for the faint of heart, but an amazing experience for those who love these kinda things.

Our second trip was much longer. We took a bus to Lake Arenal, which was about a 3 hour ride. However, we had a great tour guide who taught us all about the history of the country and showed us all the sights. We had lunch in a local town where I met a little cat and fed her some of my tilapia. After lunch, we took a boat across the lake and had an amazing view of the volcano. Afterwards we stopped at another eco-park and took a walking tour through the rainforest, followed by some time at a hot springs lodge, then wrapped up the day with dinner at a beautiful hotel up in the mountains over the lake. There are tons of eco-hotels in the mountains near Lake Arenal that I would love to stay at one day. The views are amazing and you really are  surrounded by the beauty of the country.

Airport Shenanigans.

I'm a fairly light packer, so I try not to check baggage unless absolutely necessary. For this trip, I brought a mini-suitcase as a carry-on, and a big backpack for a personal item. Some airlines also allow you to carry a medical bag at no additional charge - make sure you look into this! It can be super helpful, especially if you have to check some bags.

Coming home to New Jersey, we were expecting some snow. Some snow. We were not at all expecting the hot mess that was to come.

In retrospect, we should have had some sense of foreboding when the hotel phone rang at 2:40 AM. Our shuttle ride was scheduled for 3:20 AM, but there must have been a miscommunication - the driver arrived at 2:30. We scrambled our things together and hustled down to the lobby, still half-asleep.

Things went relatively smoothly after that until we got to Houston. We had a layover there, and once we landed and had lunch we saw that our flight was pushed back an hour. Okay, not so bad. However, just as we were about to get on the plane, we were stopped. There wasn't anymore room for carry-ons. We would have to check a bag. Quickly, I crammed all my medical stuff into my backpack and forked over my little suitcase. We boarded, got comfy and waited.

And waited.

And...got delayed another hour.

Once we finally took off, everyone's nerves were a little frayed. This didn't improve when, two hours into the flight, the pilot made an announcement that Newark was totally iced out. We would be landing in Cleveland and waiting the storm out. It turned out that we would have to wait until the next morning to fly back home.

Small calamities like this are why it's so important to be over-prepared medication-wise. Also, to have everything essential on your person. We had no access to our checked bags overnight. I may not have had a toothbrush, but at least I had my insulin.

After an airport dinner with our fellow stranded souls, we made our way to a hotel airport, punch-drunk from exhaustion and missing our pets. At the end of the day though, we were happy to be safe and sound from the ravages of the storm.

Bottom Line.

Bottom line from this trip: Be prepared. Over-pack. Visit Costa Rica if you love the outdoors and love outdoor activities. And again: Over. Pack.