Wednesday, November 23, 2011


not a misspelling
pumpkins are certainly ubiquitous these days, but that is not what i was referring to. as you all know, i work in pediatric endocrinology. this means i spent a lot of time taking care of kids with diabetes.

in a nutshell, diabetes is a pain-in-the-ass disease. yes, it's wonderful that there are ways to manage the disease [the discovery of insulin turned 90 this year!], but all of them require a significant investment of time and energy, and another thing to always worry about -- not exactly fun for an already busy 15 year old, or mother of a toddler.

we see our type 1 patients approximately every 4 months in clinic -- which is fun as a physician, because you get to know these kids well. each visit begins with a finger prick to check the hemoglobin A1c -- a measure of what average glucose levels have been over the past 3 months. it's like the diabetes report card, and it's a lot of pressure! keeping the A1c in the goal range is NOT an easy feat, and it can lead to a lot of power struggles/stress within families.

we often spend time during the visits trying to troubleshoot and coach the patients [or parents, depending on age] about how to make things better. but even without the experience of having diabetes, i can appreciate that many of the things we suggest ["keep carbs consistent!" "always bolus BEFORE you eat!" "NEVER miss an insulin bolus!" etc etc] are easy to SAY . . . but not in the least easy to DO.

and that's why i think it's awesome that i am currently wearing an insulin pump.

don't worry -- it's only saline in there!!

some reps from one of the pump companies provided loaners to all of the endocrine fellows [i'm the sole pediatric representative!]. yesterday afternoon, i got to experience what it feels like to have the little catheter inserted into my skin [we chose an area as far from the baby as possible :) ] and to have something attached to me all the time. so far? borderline annoying. it isn't painful [although i can 'feel' the insulin going in for boluses!], but it's hard to hide under clothes, since it's the size of a pager with tubing attached.

to make the experience more real, we were also given glucose monitors and instructed to basically use the pump as a patient with diabetes would. this means that i have a basal rate [low level of saline] going at all times, and that i have to give myself extra insulin [bolus] every time i eat anything with a significant number of carbohydrates.

this means checking sugars [again, not really painful but another extra thing to do!]

pre-breakfast. i'll spare you the action shot of the finger-prick!

[i am sure my blood sugars are higher now than usual -- pregnancy is a naturally insulin-resistant state due to a number of hormonal changes. hence the need for routine screening for gestational diabetes! i guess this will be a little preview for me.]

then, you have to estimate the number of carbohydrates in the meal you're about to eat. my standard breakfast had 56 grams -- woah! then, you enter that number along with your blood sugar, and the pump calculates how much insulin is needed.

you then press a button and it goes in.

again, nothing about the process is terribly tricky, but it is time-consuming and i can already see how patients are tempted to just skip it all sometimes, especially if they'd have to leave the room in order to not have to do it in front of friends. and i realize this is 50 times easier for me than it is for someone with diabetes -- i don't have to recheck sugars if they get out of control during the day, because they won't! and there's no need for me to worry that the catheter could kink during the night, causing me to be super-sick by morning [there are alarms for these things, but they aren't always fail-proof -- we get a fair amount of PICU admissions just due to pump failure].

but i've had this on for less than a day [we're supposed to wear it for 3!] and i already feel like i get it a little more. which is better than nothing! wonder what my glucose will be after pumpkin pie . . .



workout: 3.1 mi, 10:05/mi average.

chicken caesar for some reason, caesar salad has been one of my favorite foods during pregnancy. i decided to make the cooking light version this week.

the verdict? ehh, okay. but it was missing something -- probably the creaminess that makes it unsuitable for cooking light in the first place! i didn't calculate carbs last night for the pump [figured i'd start today] but they probably would have been pretty low.

spanish: check . . . i think. i almost can't remember?!

reading: NO again!! in my defense, i am participating in a prenatal/children's health study and i had a post-work visit that ended up taking almost 2 hours.