Candid Diabetes

The Bad Kind

Sometimes my life is a lot like my purse. I am constantly trying to fit my little black glucometer case in between my wallet, cell phone and all of the other assorted paraphernalia that roams around with me. It's a tight squeeze, and every once in a while I am forced to do the flip-and-shake to downsize my load - now, if only I could do that with my life...

There's work. I'm beyond crazy busy, doing three completely different jobs and often working past my nine-hour days. Honestly, I thought I was stressed at my old job...little did I know. Fortunately, my diligent work is actually paying off with the new job - I've already gotten a substantial raise (6%!!!) and I feel as though I'm finally being rewarded for my intelligence, multi-tasking abilities and hard work. Come the beginning of February, I'm moving to a different position so hopefully some of the stress will be alleviated and I can really dig into what I love.

The beginning of 2008 rang in with me becoming a student again. Work has paid for me to take a part-time Financial Accounting course with a University that offers online studying. I have to tell you, these online courses are astonishing. I never imagined that you could work towards a professional title by learning on a website (exams are on-site at the University, of course)! If I ever wish to, work will pay for me to take all of the mandatory courses required to become a Certified General Accountant. And I can do it all from the comfort of my own home! Though I am enjoying being a student again (believe me, if I could have afforded it, I would have become a professional student lol), it feels as though I'm leaving my dreams of becoming a CDE (Certified Diabetes Educator) behind. I almost feel like I failed myself a little bit - and maybe I did. Instead of taking the Nursing course that I did, I should've just gone for my Bachelors of Science in Nursing, become an RN, and worked my way towards the CDE designation that I always wanted. I should've just taken a big bite instead of deciding to get a taste for things. Hindsight, gotta love it, eh? I know that I can always go back to that dream and make it a reality, but a part of me really thinks that my wants have changed. Working in Geriatrics and Long Term Care was a big factor in that - not only did I really not enjoy the politics, but it was emotionally exhausting. I ended up getting out of the healthcare field entirely and falling by chance into Accounting, which I have (and for those who know me well, they know that this is a shocker) realized that I enjoy. A Lot. So maybe this is the thing for me, or maybe someday I'll decide that Healthcare is where I'm meant to be. Who knows...

I used to have a life. I used to have hobbies (no knitting anymore, at least for a while - the only hobby I can justify giving up lol). Now I hardly have time to even write this entry here, which is why I am frantically typing at twenty minutes to six (!!) on a Saturday morning. But, in spite of all that, 2008 is definitely going to be an interesting year!

The most exciting thing that is going on in Tiffanyland right now is that, in June, my younger sister and I are taking a five day vacation to Florida. I have not been on an actual, leaving home and traveling to a different country holiday since I was a teenager. Yes, it's a little pathetic, I know. Right now I am terrified that something is going to happen that will prevent me from going. I am going to be submitting my paperwork for a passport this week (have to get that photo done...and can I just say, this whole mandatory passport to get into the States really irks me!) and we've already discussed the things we want to do/see. Disneyworld, the Kennedy Space Centre and maybe even a little swim with dolphins (I have wanted to swim with dolphins ever since I was 10 years old!). And, while we're there, I'm going to be meeting, in real life, one of my favourite people from Insulin Pump Forums!!! (I never like to name names without prior permission, so we'll leave this as a mystery guest lol) I cannot even begin to convey with words how excited I am about the whole thing. My younger sister and I are actually going to spend five days together (and yes, I imagine we'll want to kill each other in that sisterly-love way), which is a very special thing, given that our dislike of each other has been a constant for the past ten years or so. Somehow, over the past year, we've actually grown closer again, this girl and I who used to spend all day together when we were kids. I'm not given to mush or public emotional-vomiting, but this really means something. 

Of course, not everything that's stuffed into my life is great. My older sister is getting married again (that's good for her, really) and decided that she needs her father there (who happens to also be the man who was also my father, but who is now just a stranger to me, as I have not spoken to nor seen him in ten years. If you've read my [very] previous blog entries, you'll know why). A few months ago, she had a huge fight with my mother, younger sister and I about this (I spoke calmly as she yelled some awful, never-to-be-repeated things in my ear via the telephone). I know there are people who are bigger than me, who would be able to stand in a room with the man who made the first 14 years of their life all fire and brimstone...I cannot. Not even for her. Which she knew, given the fact that I had told her, point blank, prior to her even becoming engaged. My feelings on this aren't going to be vomited here, because frankly it's an open wound right now and I don't feel like getting all mushy and public about it. She and I didn't talk for almost four months, until she called me on Christmas Eve and apologized. Now, when we chat, the wedding is not discussed. I've drawn my line and I'm not budging. If that makes me the bitch, so be it.

And the big bad in my life right now comes with a heap-load of shame. In fact, I am even having a hard time typing it out for all the world to see. Because you are the world that doesn't see me. In the real world, I have, since quitting my old job and leaving so many people that I loved so much and a happiness that I just can't seem to find again (man this is hard, just say it already Tiffany!) gained an immense, unhealthy amount of weight. I've paused, stopped typing, started typing, deleted it, paused again...I am seriously, grossly ashamed. My clothes hardly fit me anymore, I can barely stand to look at myself in the mirror. Somehow, over the past several months I've become an emotional eater. Stressed out? Eat some chips. Bored? Have a big heaping bowl of frozen yogurt. Why be active when you can sit on the couch and read a book after work? (oh god, my poor dog) Don't get me wrong, I've gained weight before. A few years ago I got pretty fluffy - which I ended up losing - but nothing like this. Nor am I a waif, I'm a curvy girl, hips and breasts. But seriously, I used to have a waist! I am a very small person, short with really tiny bones (I'm 5'2" on a tall day, my feet are a size 5, and I can shop in kids shoes and clothing...well at least I used to be able to) and my fighting weight is about 110. Now I am way, way beyond that. It's like I woke up one day (I swear to God, it was last week!) and overnight I had become a short, female Sumo wrestler. To me, this is such an awful thing that I'm having to restrain myself from deleting this whole paragraph. No, I am not vain, nor am I shallow (though I have a host of other faults, like this new rotundness). I am the picture of unfit and unhealthy. And I'm so incredibly mortified that I actually did this to myself. Hello...Diabetic!! Not to mention the severe history of heart disease on the paternal side of my family. This means I am supposed to be perfect, failure is not an option! So I ask myself, why am I publicly spewing this for all the world to see? Well, it's for me, really. I feel like somehow I managed to deny to myself that my eating habits had become unhealthy, and that I wasn't being a big, fat couch potato. So here I am, forcing myself to face something I hadn't even realized I'd neglected, writing it in stone. No more ignoring it. This will serve as a harsh reminder. I put myself back on a Diabetic diet this past Monday and I'm picking up the Pilates again and walking every day again. Fortunately, I can lose weight just as easily as I can gain it so I don't have to fight my body, just my new bad habits (which, as I'm sure we all know, are much harder to lose). I will lose all of this weight that I've gained, and one day soon I'll read this paragraph and laugh in victory.

And if this entry wasn't already long enough, here's an update from the D-side:

2008 will also bring me up to two years with the Paradigm RT Continuous Glucose Monitor. It's really quite neat to think that, over a year and a half ago, I was the only RT CGMS blogger and now we have scads and scads of people online who are wearing the system (or a different CGMS), and loving it. I think that really goes to show the potential of this technology. Though I'm not going to expound on my further experiences right now, I will say that I still love it. It's still accurate, even with sensors that expired in August of 2007.

On a lighter note, a funny thing happened at work the other day. I have a pumping buddy who works with me (a first for me, I've met other D's IRL but never worked with another Type 1) and we have what my coworkers like to call Diabetes Meetings. My buddy was having some BG problems that I was helping him with at my desk, and a client overheard us talking about it and asked my buddy if he was a Diabetic. Buddy says yes, we both are, and client says "My wife is a Diabetic too". So I asked him what kind:

"She has The Bad Kind," and believe me, it was said exactly as I've written it.

I laughed. Not just a little chuckle, but a big hoot. I actually repeated what he said while I laughed.

"The *AHAHA* bad *AHAHA* kind *AHAHA*! What kind *AHAHAHA snort* is that?"

I shocked him, it was written all over his face. I may have even insulted him, but geez, this guy is the Husband of a Diabetic and he knows the Types of Diabetes as being either Bad or Not Bad??? Sadly, this is not the first time I've heard a variation of this, and I don't even doubt that you've likely heard the same.

"She's on insulin," he says to me, in an almost-whisper, as though that state of affairs was a dirty secret that shouldn't be aired in public. I proceeded to question him, doing my best to educate him at least a little bit on his wife's disease, though I doubt he really heard a word I said.

I hope, though, that the next time he's talking to someone about his wife's disease, he'll be able to tell them that she's a Type 2.

And that, insulin or not, Diabetes is so much bigger than The Bad Kind.

DOC Webring Update

Well, it was a tough decision, and hard to do after all of the work I had put into it. The end result is, I think, for the best.

The Diabetes OC WebRing has been closed.

Unfortunately, I didn't receive any inquiries for assuming management of the Ring - but this let me know that closing it was the right thing to do. I'd been questioning the need for it and whether or not it was actually being utilized, and I think that in the end it won't be missed much.

To those of you who did use the webring navigation bar to visit the blogs of the Diabetes OC: I apologize.

If you have a Ring navigation bar on your blog, please remove it as soon as possible (so that people don't try to use it and get frustrated when it doesn't work). I did not send out individual emails to each member of the ring because, frankly, I have hardly the time to post this announcement. I hope that this post, and the one on the DOC WebRing website, will suffice.

I would appreciate some help from the DiabetesOC in this regard - if you have the time and inclination, please post a quick note on your blog to let your readers know that the Webring has been closed, and that navigation bars need to be removed. I'd be very grateful!

Goodbye, DOC WebRing. I'm sure you'll excuse me for the little sigh of relief that just slipped out...

The DOC Webring

I'm in the midst of making a very hard decision right now. Due to extreme time constraints, I am forced to consider removing a little bit of online work from my shoulders. I have the Forums to run, this blog (which, though I rarely post, doesn't require my active participation) and the DOC Webring to maintain...not to mention the full time job I have, the three dogs in my house, my various hobbies and social life, and College, which starts January 1st of 2007. Hard though it is to admit, I just can't keep up with it all.

Unfortunately, in the midst of all this, the DOC Webring has suffered, Big Time. Because it requires time that I just don't have. So, I'm forced to clean house. I love running the Forum and would not even consider giving it up. And of all my responsibilities, the DOC Webring would have the least impact if it was closed.

But, before I do that, I wanted to see if anyone has any interest in taking it over. I think the Webring, if given the proper time and duty, would still be a very helpful tool for traversing the blogs of the OC. But, from a management perspective, it can be a lot of work. And, frankly, I'm questioning the need for and use of it, and have been for some time. We have Allison's website (excuse me for the lack of linkage, it's 5:40 in the AM [!!] and I just don't have the energy!) and also the handy headlines available from Diabetes Daily - and based on the numbers, the DOC Webring isn't maintaining the traffic that it should. I'm sure that's in part my lack of management, as well as the difficulty that people have installing the html code for the navigation bar.

All of this has me wondering: Do we want a webring for the DOC?
And is there anyone interested in taking it over?

I'd much rather transfer the webring to another pair of capable hands then have to shut it down completely. If anyone is interested, please send me an email. The webring is run through a ringserver host, and is free, so there's no monetary commitment. If necessary, I'd be willing to leave the current Ring homepage up and active for as long as this blog exists. All emails would have to be transferred (obviously) to the new owner, and a new email account would have to be set up. HTML coding is a requirement of managing this webring, so experience is definitely a bonus, since the navigation bar is made strictly of code (short and sweet) and many members require assistance installing the code on their blogs.

If you think you'd like to manage the webring, please email me and I'll be glad to answer any questions and discuss it.

I won't be making any final decisions for the next two weeks, which will hopefully be enough time to get feedback either way.

Sorry, guys.

CGMS Billing Codes Announced!

I feel quite fortunate to live in Canada, where private health insurance for CGMS supplies seems to be much easier to obtain (though not necessarily a given - smaller plans often won't cover CGMS or supplies). We've had quite a bit of discussion on the Insulin Pump Forums about how difficult it is for people in the States - the often lengthy, drawn-out appeal process and the sheer frustration of being told 'No' again and again.

So I was very excited when I received an email, just today, from Shannon von Felden of the JDRF (Manager, New Technology Access/Government Relations). In this email, Shannon advised me that the Centers for Medicare and Medicaid Services (CMS) have announced that billing codes will be available on January 1, 2008 for continuous monitoring technology, an endeavor that was strongly advocated by the JDRF. 

Is this good news? Well, though it sounds like great news to me, I will gladly admit that my ignorance of US health insurance practices leaves me wondering. What is this going to mean for you? Is the process of obtaining insurance coverage for the transmitter and sensors of the CGMS going to become easier for those of you in the States?

I hope so....

While I wait for someone to give me the down-low, here are the proposed billing codes that, upon the new year, will hopefully make the process of becoming a CGMS'er (or obtaining a CGMS for your child or just cutting cost of the expensive sensors) a whole lot easier:

Sensor CMS Billing Code: A9276
Transmitter CMS Billing Code: A9277
Receiver CMS Billing Code: A9278

To read the announcement on JDRF's website yourself, have a look at the JDRF Artificial Pancreas Project. Then share the news and the link with everyone you know!

Thanks to Shannon von Felden for taking the time to share this great news with me!
 

Sharing the Burden: A Caring Friend

One of the hidden treasures that lives on this blog, and that continues to generate emotional - and often heartwrenching - discussion is a story that began with Linda almost two years ago. This amazingly candid and beautifully real description of loving a Type 1 Diabetic has, in turn, brought others who've shared their equally heartfelt stories and offered cherished advice.

And, in some cases, Linda's story opened up similar tales from caring people who, like so many of us, feel so inept in the face of this disease. I, who have read these stories silently and cherished the bravery from the chair I sit in now, found a new offering this past Halloween that touched me deep down where it hurts. This latest story resonates enough with my own past experiences that I've actually broken my blogging silence to re-post it here, front and center, offering it to you in hopes that you can give this commenter something that I am unable to give. She calls herself a concerned friend, a name that speaks for itself. The rest, I ask that you read in hopes that you can give her some advice, or even just some comfort.

I had to comment and ask for advice because I was, up until recently, dating a Type 1 (he has been type 1 for 17 years). I am still pretty heartbroking but more importantly I am scared for his life. Here is the background: I sell insulin to Physicians for a pharmaceutical company so I am pretty educated about the disease and the complications that may occur later in life if the Type 1 does not control his/her diabetes. When I found out that this guy I just started dating (third date he told me) was type 1, I was shocked and slightly scared. I couldn't believe I wasn't aware of it and that he hid it so well from me. Of course, as soon as he told me he was a diabetic i drilled him with questions. I asked him if he was in control and what his A1c was? What drugs he was on, who his doctor was, etc etc. Basically I drilled him with questions because I wanted to know everything about him, his diabetes and if there was a future with us what would it look like. Did he take care of himself. Was he healthy. I guess that all sounds pretty intense for a third date but it seemed to be pretty acceptable at the time. Anyway, I continued to date him because I believed he was taking care of himself. We definitely started to fall in love. There was a few things I questioned but he was so secretive or sensitive about talking about his diabetes that I tried not to bring it up to much. Basically I didn't want to be a nag. Anyway long story short he ended up in the hospital and I found out he was not taking care of himself (a1c was 8.7, blood sugars are never checked, made up sliding scale, not taking insulin correctly, etc). I also know (and am probably the only one in his life that knows) that he has ED issues already(he is only 27 years old). I think it is safe to say he is in denial because he never checks his BS, always has excuses for the ed and for not checking his sugars, excuses for why he is on sliding scale rather than carb countin, why he will only take R insulin, Why he won't go on a pump, etc? So after about a week from when he was released from the hospital for DKA, I wrote him a letter and begged him to start taking care of himself or else I couldn't be with him. I wouldn't stand by and watch him hurt himself. That I know too much about the disease and I didn't want to be someone's nurse for the rest of our lives. I just asked him to start taking better care of himself. HIs response: He basically told me to F-off. However, one week prior to all of this drama he told me he loved me and wanted to get married and have kids, etc, etc. SO even more drama insued after our break up, and we are no longer speaking. Unfortunately he is so much less responsible than I ever thought because as I mentioned before other things ocurred, much more drama that he did not take responsibility for. So I don't want to confront him. I really don't want to ever speak to him again but I am concerned for his life. I don't believe anyone (friends or parents) realize how poorly he takes care of himself, hohow much denial he realyl has, and what complications he is already dealing with. SO my question is: do I just allow this person to continue down this road, do I try to anonymously speak to his friends or parents, or do I just leave it alone? No one in his life really talks about his diabetes openly with him and it seems as though none of his friend really understand the disease. His mother is pretty knowledgeable about the disease and she knows what he should be doing but he doesn't live under her roof. She assumed he had been taking care of himself appropriately since he left home 9 years ago. But, when we were in the hospital she told me that she wasn't sure any more what he has been doing. And she admitted that he always has excuses for his diabetes care. But again no one is doing anything about getting him back to reality. So my question is do I walk away and never look back or is there something I can do without having to go to him?

~ A concerned friend

For my part, I understand. Because, you see, I was once there. I cared about another Diabetic who failed to care about himself. Like you, A concerned friend, I walked away holding close to my chest a concern for his health that never disappears; unlike you I had immersed myself in the care of my friends' disease, almost making it my own, failing to understand what you knew going in. And that, in the end, was the cause of our parting. I lost my best friend, and I am so very, very sorry that you lost the man you'd loved.

Though I have no advice, a lifetime of living with this disease and knowing - and caring for - others has shown me that Diabetes is insidious. The sheer pressure of living 24/7 with every aspect of this disease can undermine confidence to the point of avoidance. All I can say is that you can't force another person to care about themselves, and that I think that, in your situation, you did the right thing.

Thank you from this Type 1 Diabetic for being a concerned friend, and for sharing your story with us.  You have, inadvertently, reminded me why this blog continues to exist.

CGMS Update (And, when clever titles and well-thought out posts desert me)

I'm still here. (I actually almost cheesed out and wrote "I'm still standing" glarrrrg - suffer in misery with me if that song is stuck in your head now)

Blogging, for the most part, has run it's course and peaked in Tiffanyland (did you know that there are such things as Tiffanyisms? Yes indeedy...And that the term 'double-double' is in the Canadian Oxford Dictionary?! Credits to the TV screen at the Tim Horton's drive-through this morning for that little nugget!) I, grand disdainer of groupy-stuff (Tiffanyism), actually prefer the community of an online support group to blogging. Except when  something gut-busting funny grabs my attention or I am the recipient of strange events that only happen to me. Erm, so yeah, I'll still be popping around occasionally unless the world tilts off of it's axis and I slide into oblivion.

But since that hasn't happened yet, today's popping is focused on the thing that I don't talk about enough (here): the Paradigm Real Time System. Yes, I am still wearing my CGMS. Big-smile-time: my transmitter (the Gen 1 version, not the fancy new MiniLink that isn't available in Canada yet thank you very much this sucks) is still running. Heh, you may be sitting over there thinking to yourself 'so the frick what?' My aging little/big Gen 1 transmitter is almost a year old. And I use it every day, and have only taken a day off of it here and there for the past 10 and a half months, and it's not dead yet. Really, who cares now right, since the new MiniLink is available (but not in Canada yet - bastards)...honestly I know that this is only a big deal to me. But people, I got a Low Transmitter alarm like TWO MONTHS ago!!! And it's still ticking!! 1 - 2 - 3 - YAY!! So for anyone who might have the old transmitter without hopes of getting the MiniLink anytime soon (and can I just tell you, the MiniLink is seriously small, several members over at Insulin Pump Forums have it and have posted pictures which bring tears of envy to my eyes) this one's for you, low transmitter battery and all.

But, like I said, the MiniLink is a nice dream for us Canadians (I can't tell you how much that ticks me off). Though I haven't seen it myself, I do know that it's small. And rechargeable. And it doesn't require those big ugly transmitter adhesive pads. It's still waterproof and still uses the same sensors as my Gen 1 transmitter, which is a bonus. And rechargeable. Wooftey.

Me and my old transmitter will continue to plug on (baha) until the little sucker dies at which point I'll likely trade it in for a new Gen 1 transmitter (thanks to some deal of Medtronic's where you buy a box of sensors and get a new transmitter free -- I have six boxes of sensors in my fridge. Yes, six. They owe me, seriously). But my stubborn side really wants to see my transmitter die, and I want it to last another two months. Then I win. In Tiffanyland.

But jeez, I have strayed from the whole point of this blog post. I was originally going to talk all about the RT after 10 and a half months of use, but honestly I don't know where to start here. What else can I add to what I've spoken about in the past?

• It's accurate
• I love it, for so many, many reasons
• The sensors can be worn for more than three days. The pump will say "Sensor End" and all you have to do is go into the sensor menu and choose "Sensor Start" to reboot it. Don't disconnect. Do this every three days, and voila suddenly your three day sensor is actually a two-week thing. And bonus, there is no two hour initialization time. If I restart the sensor within minutes of the sensor end alarm I get a calibration request right away and we are live. If I wait longer to restart it only takes about 15 minutes to initialize. I should note, though, that my friends on the forums have experienced a strange occurrence with the sensor re-starts (strangely, I've never had this happen); on the 7th or 8th day, the pump will lose the sensor signal and no amount of trying will boot it back up. So, what they do is disconnect the transmitter from the sensor and then reconnect it (don't take the old sensor out) and then tell the pump that you have a new sensor. Disconnecting seems to reboot the system, so you will have a two-hour wait period but hey, it's better than inserting another sensor! One person on the forums (Drea) reported wearing a sensor for 25 days! I haven't gone that long yet...
• Exercise without having to worry about lows? Check. Sleeping without having to worry about anything? Check. Actually getting the flu and not having to worry about lows and highs and anything else?! Ye-ah check baby!!

And if the proof is really in the pudding (though god only knows how pudding can be proof - of what, I ask??) then here are the results:

March something-or-other-can'tremembertheexactdatetoolazytocheck Lab Results VS Paradigm RT Estimates:

A1c Lab Results - 5.9%
Estimated A1c based on Solutions software of downloaded RT CGMS readings - 6.0%

Need I say more?

A Little More Moo

Anorexic models beware.
Introducing Princess Pumpernickel of the great estate of bread-n-butter!

(Her stage name, consequently, is derived from occasional head-shake-inspiring performances; namely [pun intended!] the teeth-gritting border-collie-gymnastic-contortions that somehow result in an empty bread bag on the living room floor and a half-licked pound of butter laying on its' side by the dog bowl. Apparently Border Collies are magicians as well as agility artists)

The Hypoglycemic Imagination

The snow was deep and the air was crisp with a March chill, but I felt none of that. I was taking the new ATV out for a ride; it was blue and shiny with big nubby tires that sent this country girl's heart a-thumping. I zoomed past pine trees with an ecstatically free dog racing at my side, shifted into a lower gear when the snow hit up to my calves, woman against the elements, thrilled with adrenaline. Though I could've gone for hours, I turned the handlebars over to my mom and stood on an icy dirt road, waiting for my turn to come around again.

A few minutes later she parked, dismounted and started to walk toward me. My arms flew up in a quick wave as, behind her, the running quad began to drive away without her.

"MOM!" I yelled, "CATCH IT!" And I ran, and ran, and ran and watched as my shiny new toy drove off into the great white unknown as though possessed by some crazy cartoon episode. My hands started to shake and my legs got that buttery feeling, as though they were stiff strands of spaghetti cooking in boiling water.

BEEP Beep beep! from my pump stopped me in my Sorel-clad boots. A thought flitted through my head, too quick to catch and easily ignored as I unhooked the box from beneath my down-filled parka and looked at the screen. A quick press of the ESC button and 3.2 mmol came up backlit by green, compliments of the transmitter currently seated in my thigh. One little arrow pointing down next to that number told me that it was time for some glucose tablets.

I don't remember pulling them out of a pocket or even chewing until the powdery substance melted away in my mouth. I do remember the taste, that grape flavour that doesn't really taste like grapes and sometimes makes me nauseous. But I was running again; I'd spotted blue through the trees and I was off to rope me a live quad!

WEEEEOOOOOOO-WEEEEEEOOOOO-WEEEEEEEEEEOOOOOOOO-WEEEEEEEEOOOOOOO!

My Sorel's stopped pumping again, I cleared the message on the screen of the pump to stop the shrill noise of the siren and this time I glared at the offending interrupter on my hip when it showed a rapidly declining BG level. Couldn't it see that I was busy here??? Who's stupid idea had it been to get this annoying CGMS anyway?! No sooner had I thought this than the siren started up again, blaring away to its content, and this time impervious to my attempts to turn it off.

It just wouldn't stop!

And that thought squeezed it's way into the crevices of my brain, this time deep enough to make me pause.

I said it aloud to myself. "This isn't right" My brain, slow as it was from lack of energy, ran sluggishly back over previous events, my will the only thing keeping it from flitting off into rambles. Snow - not cold. Shaky and foggy after eating glucose tablets (I ate them, right? I'm not imagining that grape-y taste?). ATV driving all by itself, no thumb on the throttle.

Wait. A. Second.

I don't own a quad. Quads don't drive themselves. How come it's not cold out here??? Why are my hands still shaking like a johnsing alcoholic? AND WHY WON'T THIS STUPID SIREN STOP BLARING IN MY EAR?????

A light bulb actually went on over my head. Seriously, I looked up at it before saying to myself, "OK Tiffany, it's time to wake up." (It was actually pretty cool to see a light bulb above my own head - even if it did look like a cartoon bulb, drawn light-lines and all) And with a snap of my fingers, I jerked into the body that lay in my bed, eyes open. Reaching with one hand for the pump that continued to whine it's discontent with my ignorance, while the other delved into the drawer of the table beside me, shaking as it searched desperately for a tube of grape glucose tablets. So tired; my eyes wanted to close, to just surrender, to ignore the anxiety, the shakiness and the weakness and just slide back into sleep and dream of riding a non-existent quad. But, as we always do, I forced myself to ignore, instead, the will of my body and choke down a half-dozen glucose tablets. So that I would wake again from another dream without the frantic need for sugar and the panicked loss of control.

And even though I'll never know for sure if the taste of grape in my mouth was real as I stood in that field of snow, or if it was just the product of my imagination reacting automatically to a situation that is as normal as breathing.

But I do know that I always wake up. Whether it's because of my own awareness or the little oval transmitter stuck to my thigh - or a combination of the two - I will always wake up.

Emergency Broadcast!! (Or, Justifiable Murder)

Those of you who know me well will also understand why I can take these few minutes to log into Typepad when I have no time for blogging.

It's all about Hockey.

I have, for my entire life, been a dyed-in-the-wool, rabid-eyed Edmonton Oilers fan. I'm a screaming, ranting, raving, loyal until death fan who curses them when they're down (a trait of all true Oilers fans) and sing loudly our pride in both our hockey and our city. Hell, I played street hockey when I was a kid, skated regularly on local ponds and rinks. I rush home at night for Hockey Night in Canada and I've been watching the Oilers religiously since the glory days of Wayne Gretzky and Mark Messier.

I've never liked Craig McTavish and have often had heated discussions with fellow Oilers fans; the whole management team needs some revamping. We all agree. No more now than ever.

Time for some bad (really bad) news. If you haven't heard yet, which tells me only that you don't like Hockey and probably have no interest in this post anyway (you suck, seriously).......Ryan Smyth, #94, the heart and soul of our Edmonton Oilers and the most beloved player since Mark Messier, has been traded. The world is tilting off of it's axis, I feel it. Yes, you heard me right. Ryan Smyth was traded this afternoon. To the Islanders.

But wait, it gets worse.

We got two prospects (who's names don't even deserve mention here, yet - they have some big shoes to fill and a lot of proving to do to this fan) and a 2007 first-draft pick. Now, if you don't understand the terminology, this means that, when the head honcho's of the Oilers organization traded a veteran star forward who averaged a point per game for our floundering team.......we got second-rate newbies. Well done, Mr. Lowe.

Yes, Ryan Smyth was asking for too much money compared to our other top players. I, who would've loved to see Smytty as a lifer, will admit that. But seriously, we traded our team ICON for more prospects???

And there is a certain irony in the fact that jersey #11 will be retired tonight, after this controversial, and frankly idiotic, trade. We retire Mark Messier to the vaulted ceilings of Rexall Place on the same day Ryan Smyth is traded.....do I smell a distraction here? Do I need to spell out the irony of these events?

As my buddy at work said:

"That's OK. I have a Flames Jersey."

Shove it, Mr. Lowe and crew.

When I Grow Up...

7 weeks old and 5 lbs...hard to believe it's been almost 2 years since I brought that rollie-pollie little Border Collie home...

Even as a puppy, it was extremely difficult to find Miz Mollie sleeping. I have one photo of her zonked out at 6 weeks old, head on my leg. It's been framed and bronzed and will not be shared here to prevent stalkers, blackmail and possible kidnapping attempts. And Franz is on call for backup.

At 10 weeks old, her Border Collie characteristics were already showing. If you look really closely, you can almost see the wings and halo. A future agility star, perhaps?

Or the resident little devil?

Curse those puppy stubs!! Even though she can now jump over the back of the couch, and is no longer smaller than her cousin Gizmo (the Chihuahua on the couch) she still loves 'dogging' around with her two best buddies.

At four months, her ears were coming up and she was actually outgrowing Gizmo. She slept on my pillow at night, and I came to learn that even puppies are fascinated by infusion set tubing.

And then she became obsessed with water. And what's better than water right in the house, all year long? Shower, anyone?

There were those Kodak moments when my Kodak (errr disposable camera) was woefully absent. Like the time I was running a bath, the bathroom door wide open. Wile E. Coyote decided she wanted to have a little jaunt in the tub...without realizing that the tub was already half full.

And then there were those indescribably frightful moments when she showed me how very conscious I have to be of her nature; she is uber-Border Collie. I can never forget this fact.

Just yesterday, I could pick her up and tuck her in the crook of my arm. But suddenly she was bigger than Lady, her Border Collie housemate.

And the cute, cuddly little puppy that inspired so many "oohs" and "ahhhhhs" started transforming and losing her puppy face.

She grew into the big ears; everything that was long about her suddenly looked right. Her long legs, her long neck, her long nose. Instead of being just cute and cuddly and having such a charismatic puppy attitude, Miz Mollie grew up overnight into a dog of substance. She is more precious to me now, having come into a little bit of her maturity, then she was as a cute-looking puppy. My constant companion, who is eager and willing to do anything for me. 

Though she'll be two in April she remains, in spirit, as goofy and playful as she was when her face and form matched her inner youth. She makes everyone around her laugh at her antics, and I love her for every head-shaking thing that she does.

 

This summer, when all the snow has melted and the weather has warmed, Mollie and I may just be taking a trip out to meet some sheep. An encounter with a flock of ducks has shown (to what may be my inexperienced eyes) a strong herding instinct. And when chasing her walking buddy (a Golden Retriever who, unfortunately, moved to the city) she sweeps wide and cuts off her path, looking so much like trial dogs. I have no idea where to start, but being the consummate Diabetic that I am, I'll find out. (and, as always, I would be grateful for any advice or suggestions!)

To companionship and unconditional love.

8 Month Remarks on the TGMS & All Sorts of Navigators

February 2, 2007 will mark 8 months since I first began using the Paradigm RT system. I know that I've been woefully absent from this blog lately, and that I haven't talked about Minimed's TGMS as much as I've wanted to or maybe should have. I started as one of the first bloggers to wear the Paradigm RT system (and have been using it longer than most) but I've been joined since by my TGMS peers, freeing me up to spend all of my time on the Insulin Pump Forums. And though I am starting to question my future desire to blog, I do feel compelled at this moment to provide you (whomever remains and reads this blog to my most gratuitous delight) with an update.

Besides my rep/trainer at Medtronic of Canada, I have not yet met or spoken to anyone who has been using the Paradigm Real Time insulin pump/TGMS combo for longer than I. Which is a little bit of a PITA, because sometimes it sucks being the first person to do something. I don't know when my 8 month old transmitter is expected to die, I don't even know what it will do when it gives up the ghost. And there's nobody to ask besides my rep, whom I don't communicate with that often because lately she tends to give me the Wrong Answers.  Oh, I know that there are a few people up here in Canada who've been using the system for a good 6 months longer than I have...but I can't seem to connect with these people. I have ended up being my own guinea pig. Squeeeeeeeak.

And as that annoying little furry rodent, I have received email after email asking questions about the Paradigm RT or telling me about how you want one, and you're so glad that I've written candidly about my experiences (I say that apologetically because I've been lacking in the writing area, obviously). So, I've made a list of common questions about Minimed's pump/TGMS combo here, answered solely by the voice of my own experiences over the past 8 months, and supplemented by the helpful posts of members on Insulin Pump Forums. Yes, some of these will be repeats, some you might have already heard. But I hope that it helps to answer or clarify any questions you may have. And, as always, don't be shy about emailing me; I am quite happy to answer!

Without further ado, Candid Diabetes presents:

The Paradigm REAL Time FAQ

Q: Can the sensors only be worn for 3 days (72 hrs)?

A: No way. The longest sensor that I've worn was 12 days; there is a member on the forums who wore a sensor for 19 days!! WOW! I might have to try and beat that now...the trick is that, when the sensor ends, you just tell the pump you want to start a new one. Voila, it believes you and off you go. And an added bonus: when you simply restart the system, it only takes a few minutes to initialize. Most of the time, my pump prompts me for a calibration within 5 minutes of my restart, and the transmitter is up and running again. Some of the people on the forums have noticed that their pump loses the transmitter on about day 7 or 8 (I have never personally had this happen) at which point they remove the tape from the sensor, unclip the connection between the current sensor and the transmitter, and then reclip it and retape. They tell the pump that a new sensor has been inserted and, in most cases, the pump grabs the RF transmission again and it's good for another three days (or longer). When you unclip the sensor from the transmitter, it requires the 2 hour initialization time.

Q: Where can you wear the sensor/transmitter?

A: The sensor can be inserted pretty much anywhere you'd put an infusion set, it's all about personal preference. I've had sensors in my arms, hips, upper abdomen, lower abdomen, my thighs and the sides of my stomach. Thighs and arms are my favourites. For me, there is no difference in accuracy based on the insertion area.

Q: Can you use the sensor if the insertion site bleeds?

A: Yes, definitely. I've had sites bleed upon insertion, at which point I use a tissue and put pressure directly over the entrance, stopping the bleeding. I've had sites bleed periodically throughout their life. It doesn't seem to affect the accuracy of the system, it just looks nasty. And there are ways to avoid bleeding; personally, I change the insertion angle either shallower or deeper depending on the area, and then I leave the introducer needle in for a few minutes after insertion. This has fixed my bleeding problems. A member on the forums puts ice on the site prior to insertion, and I believe that this has helped her.

Q: Is it hard to insert the sensor?

A: Sometimes. For example, my abdomen, which has seen it's fair share of injections over the past 16 years, has tougher skin than anywhere else on my body. Also, the introducer needle for the sensor looks like half of a hollowed out needle, and the sensor is tucked in the hollow area, so it takes more effort from the inserter to push it in. For myself, I find that placing my fingers on either side of the Sen-Serter 'feet' and holding my skin taught helps to eliminate a partial insertion.

Q: If the sensor doesn't go in all the way, do you have to remove it and put a new one in?

A: No. If the sensor isn't in all the way, removing the Sen-Serter (the device that automatically inserts the sensor) and pushing the needle in the rest of the way manually works fine. This can be tough though, and it's important to ensure that the needle is in all the way in order to use the sensor correctly. Pulling the skin taught while you manually push the needle in has always worked great for me, and I've never had to remove a set that didn't insert.

Q: Do you find that the transmitter is large and bulky to wear?

A: I've talked about the size of the transmitter (the gray oval piece that transmits sensor signals to the pump) many times here on Candid Diabetes. My answer, as always, is yes. It's big. It can be bulky, depending on where I've inserted it and what I'm wearing. Do I care? NO. I mean, really, so I'm part cyborg now and sometimes the thing is obviously visible under my clothing. BFD!! Do I think that you should care about the size? NO WAY. All the time I hear from people who say that they are waiting for a smaller transmitter, and I understand, but I can't help shaking my head. Yeah, a smaller system will be nice but the benefits are much bigger than the physical aspect. In comparison to how much the TGMS has helped me, the size is completely irrelevant. Would you buy a smaller car just because it's small, when a larger car is available that is safer and has more features?

Q: How many times do I have to do manual BG tests when I'm using the Paradigm RT system?

A: First of all, I don't believe that any current technologies are reliable replacements for manual glucose testing. As a pumper, you should be testing your BG levels no less than 4 times a day; whether you calibrate that many times is up to you.

Q: Is the transmitter/sensor waterproof?

A: The transmitter is completely waterproof and can be worn while showering, bathing and swimming. In the summer, I swam for hours during the day with my transmitter on and working. Obviously, you can't go deep sea diving with the system attached, and hot tubs are out of the question. But as long as the sensor is well taped, particularly the connecting area of the transmitter and sensor where water should never enter, you can bathe and swim at your leisure. So don't believe anyone online who tells you that it needs to be removed if you make a trip to swim at your local pool. Just be aware of the depth restriction and never let water into the connection.

Q: What does a "Weak Sensor" error mean?

A: The pump will alarm a "Weak Sensor" error when the signal from the transmitter is either not strong enough, or blocked. Moving the pump closer to the transmitter generally corrects this error. The transmitter is still sending data to the pump while the error is being displayed, and upon full reconnection, these values will be displayed. On the forums, we've also noted that a persistent "Weak Sensor" error can indicate that a sensor needs to be replaced.

Q: What is a "Lost Sensor"? Why do 'lost sensor' errors occur?

A: Lost sensors occur when the pump is no longer receiving a signal from the transmitter. This can be the result of having something dense between the two objects, like having the transmitter on your stomach at night while you sleep, and the pump behind your back. RF just can't make it through tissues and bones. "Lost Sensor" errors occur after a series of weak sensor errors that are not corrected. Also see question 1.

Q: How accurate is the Paradigm RT system?

A: You've heard me say it before. Mine is right on the money 90% of the time. Now, that's not saying that all of them are; I've heard from many people both on the forums and outside that they have had instances when accuracy is all wacked out. Can I explain why mine is accurate and others have issues? Not really. I only know that correcting my own errors also corrected a lot of problems in the beginning, and I try to always tell people that they should first scrutinize their own techniques before they even consider blaming the technology.

Q: What is your favourite part of wearing the Paradigm TGMS?

A: Definitely freedom. Freedom from fear of going hypo while I sleep at night, freedom from testing more than 12 times a day every day, freedom from the insiduous highs and lows of sick days, the freedom of being able to go for a run with my dog and actually knowing ahead of time what my BG level is going to do (love those trend arrows)...so many things that would take hours to detail here. I can now anticipate and prevent high's and lows rather than chasing around behind them after the fact. It is awesome, fantastic, every great adjective in existence couldn't begin to describe how much the TGMS has changed my life for the better. Has given me an almost non-Diabetic life...

The TGMS battery in my little gray oval is still going strong after almost 8 months, obliterating those preconceptions that we had about having to replace the unit every six. I don't know how long it will last. All I know is that I've used mine almost continuously since I got it (with only a day off here and there per month) and the battery status still says "Good". Yes, I've heard from others who've had to have their transmitters replaced because they just weren't working properly (in some instances this was the result of erroneous training of Minimed Help Line Staff), and if you want a broad spectrum of experiences than you should visit the Paradigm RT section of the Insulin Pump Forums. All I can tell you is what I know, what I've told you just now and in the past. My experiences have been heavy on the good side, and I'll gladly shell out another $600 when my little transmitter dies, if necessary.

Oh, and for those of you who are avidly waiting for the Freestyle Navigator CGMS, have a look at this:

Diabetes Self-Care

It's a blog from a lady named Wendy who is on a trial for the Navigator! Lot's of pictures and she explains things quite well.

But honestly, I know that I might be the exception but my RT seems to work just as well in terms of accuracy! And with the RT I can fool the pump into thinking that I've put in a new sensor, thus saving major money (though yes, I do have 100% coverage on insurance but still...) and mine's hooked up to a pump. Yeah the Navigator sounds great but it honestly doesn't sound any better than what I've got! Then again, I've never worn the Navigator so I can't realistically compare the two.

When it comes down to apples and oranges, though, I think I'll stick with my Paradigm RT. And hopefully soon I'll be wearing a smaller, all in one and still waterproof sensor/transmitter combo (slated for 2007).....

An Unintentional Bond in a New Year

I rang in the New Years up north with a dog on my lap.

The Aurora Borealis was dancing across the dark sky, undulating in patterns of green and pink and silvery-white. I could almost taste their current, like live tingles, on my tongue. The temperature  was mild and didn't threaten frostbite. My curly hair had been straightened by the expert (AKA my sister) and I was ready to mix, mingle and drink my way into 2007.

When we arrived I was greeted on the driveway by a big, brindle Boxer. You may have noticed that I am an animal enthusiast, with a special place in my heart for dogs. This boy was beautiful; an obvious purebred with fantastic muscle tone and markings, and a friendly personality. Naturally assuming that he was owned by the host and hostess, I gave him a big hug in the darkness of the unlit driveway and spent a few minutes cooing over his handsomeness before I joined the party. I left him outside, intending to tell his owners that he was running loose and would benefit from the warmth of the indoors.

But I forgot. Until an hour into the festivities, when I stepped outside to escape the smoke and found him standing there, shivering.

Anyone who knows boxers knows that not only are they short-haired, they also cannot regulate their body temperatures very well. This means that they are not suited for very harsh weathers - whether it's cold or hot - without particular care being taken to ensure that they are not exposed to extremes. The night felt cool but tolerable to me in my ski-jacket, but for my bare friend it was akin to -30 C. I crouched down to his level and placed my warm arms around him, snuggling his shaking body into my chest and bracketing him with my knees. He leaned his full 80 or so pounds onto me, as though I were a furnace that he wished he could curl up inside. My eyes made quick inventory of his form in the bare light situated on the garage; his nose was surrounded by pink skin, and on closer inspection his back feet were bleeding between his toes and under his nailbeds. He had frostbite.

I hastily picked him up in my arms. God, he was heavy. Though I'm used to carrying his equal in weight, his bulk was cumbersome on my petite form. But I had to get him inside. The party was in the garage, where a pool table, food and music (and of course, drinks) had been set up. I toted him over the threshold and set him down, immediately heading for a cup of water. While my back was turned, he was shooed out by the owner of the house, who explained to me when I turned back that this was not their dog but that he'd been hanging around all night.

My head was fuzzy and I, who am normally a go-getter, am often turned silly by alcohol. My aggressive nature is diminished when I drink, leaving only my humourous, fun-loving side behind. In a sober moment, I'd have explained politely that this animal was in dire need of shelter, and demanded that he be allowed inside while the local authorities were contacted. Instead, I shook my fuzzy head and started out after my new friend, all the while thinking vaguely that there are some people I just don't get.

Luckily, my (sober) sister saw me leave and stepped out after me, her eyebrows lowered as she asked me what was up. As I removed my jacket and placed it around the dog, I explained his situation to her and asked her if we could stick him in the truck and take him home.

"Wait," she said, "I'll be right back."

So, once again holding him in my arms, this time wrapped in the precious body heat from my jacket, I watched as she walked quickly away, her fingers already busy on the dial-pad of her cell phone.

"It's OK," I whispered softly in his freezing ear, patting the square head tucked into the crook of my shoulder, "I gotcha." And there we waited for brief moments until my sister returned, calling out for me to bring him into the garage, her ear pressed to the phone in her hand. She had called the SPCA and had talked to her friend, our hostess, who had agreed to give the dog entry to the garage.

Once there a blanket came out of nowhere and was spread on the ground at my feet. I laid my not-so-little friend on the covering and bundled him up with the loose fabric, where he instantly lowered his head and started snoring. I woke him up to give him a small drink of water and a piece of sausage, and he sat like a king on his throne as people came to pet him, check him over, and remark on his general good looks. He stayed with me all night, pulling himself up to walk at my hip when I left my chair, even spending a good portion of time with his bulk snuggled on my lap enfolded in the blanket, legs overflowing, looking at me with his big, sad eyes.

And at midnight I did not kiss the guy in the green sweater; instead I kissed the nose of the gentle soul on my lap, who stole a little piece of my heart, and I cuddled him close to my warmth.

Of course, being New Year's Eve, the message that my sister left on the SPCA Emergency line was not answered. Though she was willing to allow me to bring him home and let him sleep in their warm garage, her boyfriend, D, inserted a very valid point: as a heavy duty mechanic, their garage contained chemicals of a dangerous variety and it just wouldn't be safe to leave the dog in there. And, with my dog having made the trip with me, we already had three dogs in the house, two of whom were males. Male + male generally = territorial disputes. Oh, and the Boxer wasn't fixed. Yikes.

But I'd made a friend that night in the wife of one of D's coworkers, and she was willing to take the dog into her home until the owner was contacted. And if the owner was determined unfit (seriously, this dog had easily been loose for 48 hours, and though I know that Boxers are high-risk for running away, anyone who owns a Boxer should just know better) or couldn't be found, she would find him a good home. Her parents would take him, she assured me, and they'd bred Boxers when she was younger. And yet it was so difficult for my arms to relinquish their hold, hard for my heart to believe it when my head said that he couldn't come home with me. Especially when he looked back at me, his eyes asking tentatively why I wasn't coming, staying on me until the door closed behind him.

Do I get attached too easily? Yes, in a way. I've always fallen in love with the special animals who fall in love with me in return. I can pick up a million cats or dogs at the local animal shelter, but only one will truly speak to my heart. This big boy not only spoke, he yelled. And I let him go because I had no choice. I had a five hour drive home the next morning; I couldn't have rightly just walked away with someone else's animal.

I never got her number, though I gave her mine and asked her to contact me no matter what. I'm still waiting, though soon I will start making my own inquiries. If he needs a home, I want to provide it.

And so I will simply wait...

Happy 2007 everyone!

Stress & The BS

You know that frantic, panicky feeling you get deep inside of your stomach, as though you just swallowed a cup full of worms without chewing?

For the past two weeks, my stomach has been filled with big old garden earthworms that are down there doing the macarena. And you know what, guys? Boogey-ing earthworms are not good for blood sugar levels.

Stress. Loads and loads of stress have taken residence on my shoulders. Which, in the scheme of life, is just cake. Stress happens all the time, and usually I cope with it well enough to have people remark on how calm I am under fire.

For the past week, though, my blood sugar levels have been up. I can often use my BG levels as a gauge for my own physical and mental well being; sickness, like the flu, will cause a persistent, sudden increase in BG levels. Temp basals won't touch 'em. Corrections are only a temporary solution. Extreme stress will cause those same elevated levels. My body maintains itself in the 8.0   mmol range during these times, which, for a Hyperphobic who usually sees numbers between 4.0 - 5.8 mmol, is a big red flashing sign of something being wrong. (Which is kind of nice; I can tell when I'm getting over the flu [or a cold, or whatever] when my BG's suddenly bottom out.) 

The big, flashing red sign is pretty busy right now. There's the regular Christmas craziness thing (am I the only one who doesn't have the tree up yet??) which inevitably leads to overspending and coming up broke for the month of January. Cake. Not even something that would normally lead to those nasty 8.0 mmol readings on my CGMS.

These frustrating numbers are the result of my job.

We've been purchased by one of the largest companies in the industry. And nobody knows if the accounting department will have jobs a month from now. OK, so I'm expendable. For the average person this would suck, but it wouldn't suck as badly as it does for us Diabetics. Especially us pumping/CGMS-ing Diabetics. Health benefits are as important as our insulin. Yeah, I've been here before and I almost went over that edge of having to give up the pump temporarily. But I don't want to do it again. I've got the best of the best, and I like it. I deserve it. We all deserve it.

The new company has rolled out their health benefits plan to us and I'm checking into the coverage. So far I've learned that Rx meds are covered at 80% direct, compared to the 100% direct that I currently receive. The Benefits Administrator has told me that Diabetic supplies, including pump supplies, are covered at 100% reimbursable. OK, that's awesome. I have asked him to investigate the possibility of having my pharmacy collect the reimbursable monies so that I don't have to spend that money at all. So, cake.

But the sensors, when brought up, caused his eyes to glaze over in confusion (or else it was that whole I'mpretendingtolistenbutreallyI'mthinkingaboutworldpoverty thing). And he had no answer for me when I asked him if the new program would cover the cost of a new pump (yep, current one covers 100% cost of a new pump every four years).

And to top it all off, my workload - in which I already do the combined duties of four people - has increased. My salary hasn't, and it won't. I am working hours later each night and still it's just too much.

Did I forget to mention, my washing machine broke down? Not only am I a possibly unemployed future MDI'er...but I smell.

I've been trying to look at this as a good thing, but my glass is neither full nor empty right now. It just needs washing.

Visit The Bathroom Before Reading This Post

I cannot stop laughing. And I am talking loud, full-bodied throwyourheadbackandholler laughs.

Head over to Scott's house and read this post. Have a good laugh, and then mosey on into the comments section and read through it. I made a remark to Bernard asking him to put the meter under Georgie's hat, which prompted some creative thinking and Bernard threw up this one*:

The G-Force meter, maybe?

*Bernard/Scott/George: I totally had to scam this and get it up so everyone could see LOL! If any of you want me to remove it, say the word and I'll ignore you**.

**Heh just kidding.

*snort, chuckle, laugh*

To Just Listen

There is no way to tell someone that they have taken their life and straddled it, thin as paper, on the sharp edge of a razor blade.

I once tried to be doctor, nurse and friend to another Type 1 Diabetic. My personality persisted, his A1c went down by almost a full percentage...then a 0.2% rise brought his nature to the fore-front, that character that defeated any effort before he ever began. And I finally faced the reality that no matter who or what I am, I just can't do it for someone else.

I can't make them want to do it for themselves.

She drinks too much, too often. Alcohol, in my family, is the enemy. My father is an abusive alcoholic, my grandmother is an alcoholic. It worries me to say that word in conjunction with her name; the child who sang to The Little Mermaid with me, too young to live in the bottom of a bottle.

Of course, with the alcohol comes the morning after, waking up beside someone unfamiliar. We all make mistakes, we all make mistakes at least once. But she has done this numerous times, she has gone to the hospital the next morning, mascara smudged beneath her eyes, to beg the morning after pill. Terrifying does not describe it. 

And if that isn't enough, there's a weight problem. A very large weight problem. And what comes with obesity, guys? Let's see, well there's heart problems. Oh, and Type 2 Diabetes. Huh, imagine that.

You've heard the commercials; the difficulty is not in getting help for the problems, it's getting the loved one to realize that they have a problem. But it's as though they live in a bubble, a cocoon where nothing they do actually registers with their own conscience. Or maybe they lack a conscience, maybe they don't have that internal switch that instinctively clicks when we realize we've screwed up. That feeling that tells us not to do that ever again. I don't know. All I know is that we're all we've got left, just the four of us girls. My mother, who has cried on my shoulder out of sheer terror, the two sisters I've grown up with, and myself. A unit, small and shaky.

Oh, as a third generation child of alcohol, I know about the family effects. But we don't try to control her drinking, we don't try to insulate her from the effects of her drinking, we don't enable her. She is an adult who has made choices for herself...but then I remember the first time. She was 13 or so, at the town fair, slurring and stumbling as we caught sight of her. A child who was chubby from day 1, who seems to need dependency. Food, alcohol, sex.

She won't go to counselling. She diets, and inevitably returns to all of her old habits. Her friends provide her moral ground and are in no way admirable. Yet all of this fails to describe who she truly is. She is beautiful, with her dark hair and her cheekbones. A fantastic soccer player, but a girl who is so incredibly lazy. She has a wonderful sense of humor and all the selfishness of a teenager, but has a flair for style. She is smart and bold, but hasn't yet stepped into her own womanhood, even at 22. She is my sister, the girl who called me nee-nee with childish glee.

And I don't know what to do. We don't know what to do.

Our words haven't been enough, our actions haven't been enough. Is there anything we can say, anything we can do? Will I turn around, ten years from now, and know in my heart that I didn't do enough?

Because I can't do it for her.