What! No Insulin In The Pharmacy Of The Largest Store In The World!

As some of you know, I have type 1 diabetes, an organ specific autoimmune disease, not to be confused with the more common type 2. 

People with type 1 must inject insulin in order to survive. I get mine via an insulin pump. 

I've now had this illness for about 33 years and not once during all those years have I thought that I may die from lack of insulin. 

I have excellent health insurance, not all diabetics are as fortunate as I am. 

Then this happened:

On or about the 6th of December, I submitted my insulin refill request to Walmart Pharmacy, a division of the largest store in the world. 

Some time went by, I never received a text that my order was filled, so I called them. 

The person who answered told me they were out of insulin. His tone of voice was nonchalant, as if this was no big deal. He didn't know when their order would arrive. 

Fortunately, I don't wait until the last minute to reorder, so I have a vial and some leftovers in a few other vials. 

But what about people who can't afford this way too expensive medicine? (Fortunately, Lilly who produces the insulin I use will again reduce the price in January 2022.) 

Unfortunately, some people need large amouts of insulin every day to just survive, for them, it can get hideously expensive.

You know I'm old now, somewhat wise, so few things make me angry these days. 

But the cost of insulin does. It's one of those things that just infuriates me.  

Yes, I know there's been talk in congress, but that's it, just talk. I don't have much hope things will change.

What about those people who wait until the last minute to reorder? Because they don't have the money. I'm sure for now, they will find insulin somewhere, but still.

I called back today, December 15, to find out when I could expect to get mine.

The guy said they expect a delivery on the 19th, which is this Sunday. 

Exactly two weeks after I ordered it.

That is, if it does show up on that date.

I can't help but wonder if this may be a sign of things to come.

Much has been written lately about supplyline problems. When I read it, I thought mostly about delays in Christmas presents, no new cars to buy, and so on. 

Insulin and other life-saving medications were just not on my mind. 

It seems inconceivable that a real danger to people's lives could be caused by these supply issues. 

Not right now, but eventually.

Not somewhere else.

But here.

Type 1 Diabetes ~ New Technology And Me

Bound to be some problems, right? And I set myself up, for sure.

I've had Type 1 diabetes since I was 49 years old, so over 30 years now. Most commonly ocurring in children and young adults, it can happen later in life as well. 

The first 10 years were very difficult. But still, I was grateful it happened later in life, so I could have all those fun adventures I had when I was young.

Since I got my first pump more than 20 years ago, everything has been much easier. I'm usually able to manage my diabetes  well.  My A1c is always under 7 (in case you've heard that TV commercial -- 7 is the cut off point for reasonably good control).

Some days are easy, everything works, my sugars don't rise too high, emotions are under control (yes, they make you sicker too), and no tempting/but bad food has landed in my system. 

Other days are sheer hell, but I won't dwell on those. They come and they go and life goes on.

However, while I'm so very grateful to have been fully vaccinated for covid-19 with the Moderna vaccine, I've had problems managing my diabetes since I received my second dose. 

Since I got my first pump over 20 years ago, this has never happened. 

I've talked to my diabetes team, but will not have the complete discussion with them until the beginning of April. I must have a blood test before then and also upload my pump data to their office. 

I know I will get some good advice and make changes toghether with them to my insulin pump programmig. 

I also got a new insulin pump recently. I set it up myself, no problems. I verified it with Kathy, who is part of my team, and also a friend by now. 

But Kathy and I forgot to go over the meter. The thing that I use to check my sugars. It's supposed to transfer the data, the result of the each blood sugar test, to the insulin pump. My previous ones did this also and I don't recall any issues with setting them up. 

This one had 21 steps to follow, most of them logical, but confusing at the same time. Makes no sense I know, it may have something to do with my advanced age and lousy blood sugar control (the higher the sugars, the thicker the brain fog).

Funny thing was, I thought I had messed everything up, tears of frustration were gathering in my eyes as I entered a strip in the meter, pricked my finger and added my blood. 

I was so sure it wouldn't work. But then I looked, and, as Errol would have said, "there it is!" and there it was. In both places, both the meter and the pump. 

I had done everything correctly. 

So there it is, and the lesson(s): 

No point in getting frustrated, particularly not before you know that you messed up. 

Things may not be as hard as you think they are. 

Or you may be smarter than you think. 

And save those tears until you really need them. 

I'm sure you, my friends,  can come up with some more.

New Insulin Pump And Other Diabetes Supplies Require My Full Attention

 

So I will take a break for about a week. 

I've had a pump since 2000 and I never had any problems with setting up a new one as they didn't change all that much in the five-year periods that would pass before I got a new pump.

This one is completely different. I'm having problems with the setup, such as moving from one place in the menu to another higher up or lower down. Logically, it seems one would press the up or down arrows, but no such luck. So I'm getting nowhere with it.  

I've looked at the training video that came with this pump, but it focused on the important changes, not my more minor issues.  A youtube video didn't help either. 

I will call my friend Kathy, who works at Medtronics, the company that makes the insulin pump, and find out if she will train me. 

I met Kathy at my doctor's office years ago. Five years ago, she came over to train me on the pump I have now. Afterwards, we drove around the back roads of the canyon and bonded over some fun adventures we had with people on horseback protecting their land, signs threatening to shoot trespassers, and a phone call to someone we suspected of infidelity. Kathy had lived in the canyon and knew these people. 

We had so much fun, bonding over childish stuff. It's funny how grownups can easily become friends when we return to our giggly childish roots. But Kathy is also a highly qualified professional, with lot of valuable knowledge to share. So I'm blessed to know her.

All this to say I need to take the week off. 

Which, of course, is exactly why I need to take this week off. I just can't quit once I begin to type away...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

And those beautiful photos you have commented on lately were taken by Errol with my little Sony point-and-shoot camera. I loved that camera. Sadly, I broke it when I fell with it while the lens was extended. 

And Errol, who made a living as a general contractor and builder, was also an artist with a wonderful eye for composition and design. 

Thus the combination of the little Sony camera, the wintry scenery, and Errol's talents get the credit for those recent pictures and my current header photo.

See you next week. Stay well and have a great week. 

Note

I finally found the training manual I needed. I've been working with it for a while this morning and things are beginning to make sense. And it says in there that I will also be trained by a person. Inputting the wrong data in an insulin pump could have dire consequences after all.

Backyard Photos And An Update

I haven't felt well for a while and not inspired to take photos or post something here. Part of my feeling unwell may have had to do with a reaction to yet another medicine to lower my LDL cholesterol. My LDL is just fine, as is my HDL and all the rest. It's only because I have diabetes that the doctors insist I take something. They want the LDL to be half of what is OK for a healthy person. I looked it up online and the consensus among doctors is that all people with diabetes should be on a statin drug. That's how huge the risk of heart disease and strokes are among our population. 

Since I can't take statins, Medicare approved something called Repatha. One day, a commercial for Repatha came on my TV. My ears perked up when they began to talk about the side effects. They were exactly the way I felt. Plus, they said this drug may raise your blood sugar. So now I think maybe that's why I suffered with high sugars for a couple of months. A very scary situation for me, since I have always been able to control them. So I stopped taking this drug and will discuss with my diabetes team when I see them next week.

Other than that, I have a bit of a hard time breathing, so I will make an appointment with my pulmonary doctor. I haven't seen him for a long time and I haven't taken any medicine and felt fine until now. 

I went outside and took some pictures the other day. After all the rain and snow, the land is getting green. This makes it look a lot better, but since my tractor guy has retired and left the canyon, I worry about fire abatement when the weeds get going later in the spring. My neighbor, Joyce, tells me we will figure it out, and to not worry. She's so calm about everything and is becoming such a good friend. We also need to fix our road, which is washed out in several spots. Hopefully, there will be wildflowers though, to make up for my worries. 

The dogs are fine. Samson is now running around loose outside and is so happy. I feel bad I didn't dare to do this earlier. He comes when called, smiling his happy Samoyed smile (a few treats in my pocket helps). 

This is an old picture of him and my favorite. He was young here, this summer he will be ten. And Faith will be five next month. 

This & That From The Canyon & Diabetes Support Group Meeting Notes

On Thursday, I went to the diabetes support group meeting to listen to a visiting podiatrist who talked about how to take care of our diabetic feet. He began by going over all the various foot problems that can develop in all of us, but are particularly difficult to deal with in people with diabetes. He also gave us some advice on how to best take care of our feet.

But the thing was, this doc wanted to scare us  straight! He said as much, then he followed through. First he provided some gruesome statistics: Every 6 seconds, someone gets a foot amputated somewhere in the world,  and diabetes is usually the culprit.  Plus this: There are two kinds of gangrene, wet and dry. Dry gangrene is not considered an emergency because the affected body part, say a toe, will eventually just break off! It’s the wet kind that will rush you in for emergency surgery. 

 The first bee I ever managed to capture with my point and shoot camera. I am happy!

But it didn’t end there, he proceeded to show us photos of every kind of diseased foot you could possibly imagine. There was a parade of fungi, corns, callouses, hammer toes, bunions, and gangrene. There was a diabetic foot that had stepped on a nail and it’s person had no knowledge of this, but walked around with the nail in his foot, only to be discovered by this doctor in a routine foot exam. There was a poor foot, whose person had walked barefoot to his mailbox, in the Tucson, Arizona summer, no less. I imagine on very  hot asphalt or concrete. That poor foot was severely burned. Neither of these two guys felt a thing due to diabetic nerve and other damage to their feet. 

I can still feel my feet so I don't pay too much attention to them. I never walk barefoot and I never wear open toed shoes or sandals. I fear injuring my feet too much. After this, I believe I will pay a bit more attention. The best advice he gave was for us to check our feet every day, use a mirror if you can't see your feet properly. If you have diabetes, you must see your doctor for any little thing that happens to your feet. Just to be safe. 

I was worried, but I was able to sleep without nightmare images of these terrible feet showing up in my dreams. For that I'm grateful!

A canyon update: First, the weather -- it's around 42 - 46F when I wake up at five a.m., so it's pleasant for a few hours. Just right for walking the dogs and working outside. But when the afternoon comes around, it gets hot again. I heard it may change by next week. I hope so. 

As you can see, the gray rabbit brush is in full bloom. Native Americans in this area made tea from the rabbit brush and used it for medicinal purposes. While pretty for a few weeks each fall, it's a fast spreading weed. Being busy with other things, we have let it get out of hand. Basically, you need some heavy machinery to remove the bushes, which we don't have right now. What we do have though is me! See below. 

Our other predominant plant here in the canyon, the juniper tree is bearing fruit. The juniper tree is a tree that looks like a bush and it has berries that are not berries at all, but cones, like tiny pine cones, covered in blue skin. Go figure! Coyotes and other wild animals will come and feast on these cones after they fall to the ground. Bears like them too and we once had a bear strip a juniper of a lot of branches, eat the berries, and throw the stripped branches under the tree. 

I have always wanted a field of my own and now I have this one, the near field in the picture. It's fenced, but not used for anything except for me to walk through, look at, or sit in. The rabbit brush has now spread into my field and I don't like it. So I have a new morning chore: Cutting back the rabbit brush. Too bad I'm doing it while it's flowering, thus spreading the seeds, but it can't be helped. They have to go. So far, I've cut back about 10 bushes and at last count I have another 13 to go in the field. It's slow going, these guys are big. They are sort of dried out at the bottom and break off easily, which is great.

I can only do about one bush a morning. Then I sit back, rest, and enjoy the soft desert wind as it wraps itself around me. I watch the marvelous little birds that have been around all summer long. Huge flocks of them fly up from the field to perch on the wires, then one of two drop off, and soon they all fly down into the field again, twittering all along. Peace comes over me. How could it not? 

Yesterday, as I opened the front door, I saw a huge plane flying over the canyon, very slowly and making a droning noise. At first I became concerned, what was it? Was it in trouble? Then I remembered the Endeavor, but I didn't know it was coming. They actually did a fly-over here, over our canyon! Then the plane turned, flew over Tehachapi, and on out over the San Joaquin valley to Sacramento and San Francisco before turning back to Los Angeles, where it will have a permanent home at the Science Center. It was wonderful that I just happened to see it and I'm still excited about it.

Have a great day everyone.

Diabetes Support Group and Turkey Vultures (Missed Them Again)

Yesterday, I woke up to a foggy morning and rushed out to wash the Jeep. It was too dirty to take to town, but it's such a tiny little car so it was a fast and easy job. Then I took off to town to attend the Diabetes Support Group meeting. When I came home, my husband asked if I had seen the hundreds of turkey vultures on the hillside by the road. No, I had not. Darned, I am so in love with these birds, but I didn't notice them at all. He said there were about 200 of them. The sky was black as they flew over our house and settled on the hill behind us. I imagine they decided to spend the night in the canyon before moving on to points south.

At the meeting, the subject was: Food, Fat, and Feeling Full.  Eve, the diabetes nurse educator who runs the group, does it on a volunteer basis, and she is wonderful. Love her and I have also made some, if not friends, but good acquaintances there. And you always learn something.

In this meeting I learned how genetics and hormones influence the way we eat:

• Obesity has doubled in adults and tripled in youth since 1980.
• Your mother's genes determines whether you will have a weight problem or not. This was news to me.
• Appetite is the desire to eat. Hunger is needing to eat.

Eve's handout listed many other things; these were interesting:

• Leptin is a hormone that is released by fat cells. It modulates food intake and energy expenditure. It also regulates bone mass. And - it makes us feel full.
• Ghrelin is a hormone in the stomach that makes us feel hungry. It also increases digestive system movement, lowers blood pressure, and lower insulin secretion. Ghrelin is stimulated by the sight and smell of food and goes to the brain to give the hunger message.
• Researchers are looking for ghrelin blockers and leptin sensitizers.
• There are also hormones in the small intestine that make us feel full and tell the brain to put calories in storage. 
• Fewer dopamine receptors in the brain can lead to carbohydrate addiction because the brain isn't getting the message that the body is satisfied. Exercise will help with this problem. 

We talked about a lot of other food related issues, but I found  genes and hormones the most interesting and new to me. A very good meeting, as always.

I will end by saying that the obesity problem in children and young adults scares me. Type 2 diabetes has increased in tandem with the increase in obesity in young people. Diabetes is a horrible disease and the earlier you get it, the worse your prospects for a healthy, happy, and long life will be. 


Finally, while my husband wondered in awe how hundreds of turkey vultures can fly and soar together without colliding, I wondered what they eat as they migrate. 

Diabetes Meeting Inspires Me To Do Yard Work

On Thursday, I went to the diabetes support group meeting in town. This time, Eve, our diabetes educator, covered the American Association of Diabetes Educators 2010 Convention.

For those of you new to my blog, I've had type 1 diabetes since I was 49 years old. It's more common that children and young adults get it, but adult onset happens. Only about 10% of all people with diabetes have type 1. Most people have type 2.

We talked about heart disease, one of the many complications of diabetes. Whether we have diabetes or not, I think we all know what we need to eat and how much to help prevent heart disease. So I will only mention these two recommendations: Meditation (prayers count) for five minutes twice daily and exercise for 150 minutes per week.

Eve also reported on recommendations that the Cleveland Clinic made to their employees. These included meditation, dietary changes, and exercise, starting with 100 minutes of movement a day that should include 30 minutes of walking. And then build up from there.

Since I just hate the word exercise, I really liked the word MOVEMENT. It has such a nice ring to it. I know I have been unwell and spent far too much time sitting right here, at the computer, writing, blogging, reading blogs and so on. So movement interested me and this morning I decided to keep track of how much I move right now. Of course that made me move MORE, but that's a good thing.

In future Diabetes Support Group meetings we will cover:

Eating Healthy on a Budget
Merits of the Mediterranean Diet
Let's get Physical

I'm looking forward to all of those.

Of all the products that were displayed at the convention, the coolest one, as far as I'm concerned, was an insulin syringe with a retracting needle. Since it's illegal to dump sharps as regular trash, this would make life easier for people who use syringes. They will no longer have to worry about disposing of their needles safely and lawfully in special containers at special sites and so on.

The weirdest (to me) was something called OraMoist – A New Approach to Dry Mouth, Now Available at Walgreen's! So a moisturizer for the inside of your mouth. Hopefully, we will all continue to drink water and remember that thirst and a dry mouth are warning signs of high blood sugars. I guess, to be fair, there may be some who suffer from chronic dry mouth that would be helped by this product.

This morning, I felt motivated to move, so this is what happened:

Starting at 7:15 a.m., I walked Angel to the mailbox to put a letter in for the mail carrier to pick up. We ran into our neighbor on the road and chatted for a few minutes while being eyed suspiciously by his steer. Total time back and forth: 20 minutes.

Back home I cleaned the dog enclosure, did three minutes on the exercise bike, and then decided to rake some of the grass cuttings that were left after Rachael and I mowed the grass/weeds earlier in the summer. Using my bad arm, I figured it would be a good way to help strengthen it.

Yes, I know: This is the smallest stack of hay you ever saw! But I did it using both arms. It will be slow going until I get stronger.

Another thing that has been getting on my nerves outside: All the branches sprouting at the bottom of this tree.

So I went to the shed and got the proper tool, whatever they are called escapes me right now. And started cutting….

Oh boy, using that tool really, really hurt, but I got the thicker branches cut. And no pain, no gain, so I figure I can count that as part of my shoulder exercises for today. Tomorrow, I'll get the rest with a regular pair of scissors. So that was my morning and my score:

Movement: 105 minutes, of which 15 was walking, and 3 were on the exercise bike. So I guess I can sit here for the rest of the day, reading blogs (just kidding)!


I hope you all have a great day!

An Excellent Blog Adventure from Africa, Physical Therapy, and Drivin' Down the Mountain with Spuds

I've been following two great blogs from Africa for some time now:

In her blog, Food, Fun & Farm Life in East Africa  Lynda blogs about her life on a very large farm in Tanzania. She's a mom, a great cook with recipes to share, and a wonderful writer with stories of interesting adventures and her no less interesting daily life. Mount Kilimanjaro is not far from where she lives and the scenery is beautiful. You'll meet the people of Tanzania, you may see some African wildlife, and of course there are cats and dogs on the farm.

Talk about wildlife! I also follow One Stoned Crow a blog from Namibia. For a heart-pounding blog adventure, check out this post for August 12, 2010, about several Elephant encounters these guys had in the Etosha National Park. There are some unbelievable pictures they took from inside their car while being charged by different Elephants, not once, but several times. There's also a lovely photo of an Elephant mother getting her baby out of the water. I'm capitalizing Elephant here, because they are so BIG and these guys are in a Corolla, for heaven's sake, that may or may not start up in time for them to make their escape.

Lynda recommended this blog a while back and I've been following it ever since. It's great fun to read in general, but this particular post will make your heart beat faster – I guarantee it:

You can also find both blogs in my sidebar.

Next an update on my not so adventuresome life:

Wednesday, I went to physical therapy and worked hard. There were several old folks like me with shoulder problems, all of them further along in their therapy and they seemed to be taking it all in stride, painful as the therapy is. So we were all moaning and groaning, but keeping up with our assigned tasks. I got a print-out of my homework that will make it easier for me to remember what to do. Then I had lunch with Suki's mom, which was lovely. And I could put the fork in my left hand and reach my mouth for the first time since May, so therapy is making a difference. (That's of course the way we eat in Sweden, knife in right hand, fork in left, and old habits die hard.)

Yesterday, I drove to Bakersfield to see my endocrinologist about my diabetes. Bakersfield is located in the San Joaquin Valley, the breadbasket of America. We are at 4,000 feet so it's a pretty steep drive down the mountain to the valley. The highway is the thoroughfare for an enormous number of trucks per day, thousands and thousands. I'm not sure how many right now, but as you drive, you do have BIG company.

I stopped on the way there and took a couple of pictures.

I find this desolate landscape fascinating.

It's about 50 miles from my house to Bakersfield and I drove it more or less with one arm/hand. My blood pressure, that is always good, was 150/73. The doctor said from stress. He also thought I babbled too much and had his nurse come in to check my blood sugars, but they were fine. I think I was just nervous about all that driving and very tired too and a bit worried about making it up that mountain and home again. My doctor changed one value on my pump and gave me a prescription for something, other than a statin, to lower my LDL. It's only 89, but they want it under 70 because of my diabetes. This would help to prevent heart attacks and strokes, which people with diabetes are at a much greater risk for than the general population. Yuck, I hate to take medicines and the statin was horrible!! But I guess I'll try this new one, it might work after all.

Going back up the mountain, you have to stay in the fast lane, because trucks with heavy loads move so slowly you risk running into them from behind if you're not careful.

Spuds kept me company in the car.

I got Spuds at Newark airport the last time I went to Sweden. I spotted Spuds in an airport store and had to have him. So I bought him and he was the best companion on my flights. He keeps me calm. I've kept him close by since my accident and I can hold him when my hand hurts in the night. He is a little beanie dog, easy to squeeze, and it helps the pain. So, since I was a bit nervous yesterday, I decided to take him along. I hope he had a good trip.

Diabetes Support Group Meeting

The other evening, the UPS truck came slipping and sliding up our muddy road and delivered this: My three-month insulin pump supplies.

Which reminded me that I had forgotten to tell you about the latest diabetes support group meeting where Eve, our Diabetes Educator, shared some info from the Diabetes Technology meeting of 2009. Usually thousands of people from all over the world attend. This year only 600 did  - I guess the economy is hitting everyone.

Some Points of Interest

For those with Type 1 (that's what I have) they are working on:
-Oral-lyn, an insulin that's sprayed into the cheek.
-Nasulin, yeah, you guessed it, sprayed into the nose.
-Inhaled insulin – the industry has had problems with this, but is still working on it.
-IN-105, an oral insulin in development. It would be in tablet form.

As far as the artificial pancreas goes, they are still working on math formulas, using computer simulation. This whole issue of an artificial pancreas is so enormously complicated. Which makes you realize how complex, wondrous, and perfectly designed a fully functioning human body is.

Information for people at risk for Type 2 diabetes:
-They are working on a drug called Oxima that will be used with metformin (don't know what that is) and diet for prevention of Type 2 diabetes for those with metabolic syndrome (weight carried around the waist, high BP, insulin resistance, and so on).
-There is also a new test called Pre-DX to see who's at highest risk of developing Type 2. It measures a hormone, C - reactive protein, and insulin.
Also in development: Better needles, better insulin, and better insulin pumps among some other very technical, medical, stuff that I won't go into here.

Are you hanging in there: While I know this is interesting to some, I worry it may be boring to others. But diabetes is an epidemic of scary proportions and since I'm so fortunate to go to this great and informative group meeting every month, I feel I must share what I learn.

But let's take a break and a look at a pretty little cup from England. The plates in the background and the cream pitcher belonged to my grandmother.

OK, break is over!

Eve went over eight weight loss drugs that are in the works at various labs. Since it will take a long time (see below) before they become available, I will not go over them here.

Then she went on to provide some interesting data about clinical trials and the cost of developing new drugs:
-In 1975 it cost $138 million to develop a drug. Now it costs $1.9 billion. Only 31 new drugs were approved in 2008. It takes 10 - 15 years to develop a new drug and only 2 in 10 drugs return the cost to develop them.
-An interesting fact I didn't know: Few other countries spend money on research and development of new drugs.

Finally, I'm sure you all will be glad to hear that they are working on an anti-aging drug called Progensa.

After all this medical stuff, let me leave you with a sunset in winter. Or maybe a sunrise, looks like that could be it. There are almost NO clouds here in the summer, but in the winter they are magnificient.

Diabetes Support Group Meeting

Fly Away: Travel Tips for People with Diabetes

We all received this Christmas gift from Eve, our Diabetes Educator, friend and all around wonderful woman.

With the holidays approaching, Eve brought some handouts with travel tips and since yesterday's group was small and informal, those who had traveled recently shared their experiences with the group. And we all shared both fun and scary travel stories.

The last time I went to Sweden was in 2005 and I had no problems at all, flying Continental all the way, with a change of planes in Newark.

Some people in the group had only good things to report, but others had some tales to tell of the lack of awareness of diabetic needs from both airline and security staff. One woman even had the water in her water bottle checked to make sure it was indeed water. Others had not been allowed to bring juice onboard, for example.

Some Helpful Tips:

• Get written prescriptions for all medications and supplies.
• Take twice as much medicine as you think you'll need.
• Bring all medicines in their orginial prescription bottles. One woman had all her pills confiscated because she brought them in one of those pill boxes that you use to sort your pills by day.
• Wear a Medic Alert tag or some other form of I.D. A lot of information about Medic Alert was shared because of this tip. Several people in the meeting had never heard of this great service that provides your most important medical information to first responders in case of an emergency.
• Bring food for one day in your carry-on bag. (Some attendees said you are not allowed to bring food on airplanes any longer. I don't know how that works, so check with your airline ahead of time.)
• Drink lots of water while in flight. (Hopefully, you will be allowed to bring water onboard or they will have water on the plane.)
• Depending on where you are going, don't forget extra batteries for your glucose testing meter and insulin pump, if you use one.

Insulin and Travel:

• Insulin pump users take intermediate and regular insulin plus syringes in case of pump breakdown. I would add this: Find out how to convert to intermediate insulin from your doctor. I have had to this and it isn't all that easy. Somewhere I have a note with a formula worked out in case of pump failure.  
• While insulin should be kept in the refridgerator, you can keep it at room temperature for one month. I always keep a bottle in my glucose meter bag and it works great for me. I just have to remember to keep it out of the sun. Insulin should not be left in temperatures above 86 degrees Fahrenheit.
• Some prefilled pens and Humulin insulin cartridges have different storage needs, so check with your doctor or pharmacist before traveling. Some of these can only be stored for seven days after puncture. And you must keep them in an insulated carrier.
• If taking insulin in flight, less air needs to be injected into the bottle.

When traveling across time zones, keep this in mind:

• Traveling East will shorten your day and decrease insulin needs. Some people decrease their insulin dose by 20% on the day they travel East.
• Traveling West will lenghten your day and increase overall insulin needs.

Since I got my insulin pump, I traveled to Sweden twice and had no problems because of the continuous background, or basal, insulin delivery that is, for me, the best feature of the pump. I imagine it would be much more difficult without a pump.

Then it said in the handout: Most important rule is to avoid Hypoglycemia.

To this I would like to add: If you use insulin, bring plenty of Glucose tablets, particularly if you travel abroad. I know many people don't like them and there are other sweets, but who knows what may be available in a foreign country. If your blood sugars crash, glucose tablets will raise your sugars fast and they don't melt in the heat like chocolates and some candies do.

Finally, I noticed something in the handout that I didn't know: Medicare does not cover treatment outside of the US.

Oh well, there is always something new to learn.

The quotes were from handouts from the Lifeskills Teaching Guide, 1998 Diabetes Education Society, Inc.

Diabetes Support Group Meeting

Fish Market, Old Town, Stockholm, Sweden - 2005

What Makes Us Eat?

This was the topic of yesterday's diabetes support group meeting. The answer may be that some people eat too much because it is addictive and the food industry is aware of this and plays into it big time.

This is a quote from the hand-out we received: 'Opioids are chemicals produced in the brain that have rewarding effects similar to morphine and heroin. Stimulating the opioid circuitry drives us to eat.'

We went over how all this works: From when we first put food in our mouths to how the sensory experience of taste travels through the midbrain reaching regions where the sensory signals of food are integrated. These signals are ultimately relayed to the nucleus accombens, an area of the brain that is the center of reward.

I won't cover all of it, but here are some points I found interesting:

• The size of this pleasure center in the nucleus accumbens is the head of a pin.
• When animals were given opioid antagonists, they ate less.
• Dopamine drives desire and impels us toward food.
• A cue triggers a dopamine-fueled urge--dopamine leads us to food--eating food leads to opioid release--production of both dopamine and opioids stimulate further eating.
• Hyper-palatable foods, like those with sugars, fat, and salt continually stimulate the dopamine response. The brain continues to want the food that excites it, no matter how much of it you eat.

I found all this interesting, but I couldn't relate to it because I just can't eat that much. I love good food, don't get me wrong, but I seem to have some built-in portion controls in my brain. Eve said I may have a surplus of dopamine and don't need a lot of food to stimulate the response. That sounded fascinating to me and I would like to find out more. Of course, it could be in my gene pool too. Or, I could simply be blessed, as one of the participants in the group said. Amen to that, I say.

Then we moved on to the food industry. I find the damage they do to all of us who have to eat deplorable.

Quoting again: 'Modern food processing techniques allow us to eat faster by eliminating the need to chew so much. Refined food melts in the mouth, so calories eaten go in much faster.'

On this, a woman in the group told us that she had broken two front teeth in an accident and this took a long time to heal. Because of her pain, she had to chew very slowly and carefully on the sides of her mouth. The result: She lost 15 lbs in a relatively short period of time, without even trying.

We also found out that the food industry is looking increasingly to chemical flavoring to drive up consumer desire.

Then we discussed how to beat overeating, how to deal with urges, and food rehab. I don't have room for all the suggestions here and I think everyone who is working on their overeating problems know them pretty well. If I had to, I think I would focus on these solutions:

• Limit exposure:  Don't dwell on the menu with the pretty pictures. Don't buy calorie rich food, and so on.
• Remember the stakes:  Our health is very important.
• Exercise:  Exercise generates the same kind of chemical rewards in the brain that food does.
• For food rehab:  I would eat food that satisfies: Lean protein, whole grains, beans, fruits and non-starchy vegetables. Well, I would probably eat some starchy ones too. And some chocolates for rewards.

To conclude, I just had to stick in some pictures of this very healthy bread.

In the old days in Sweden, they baked this bread and hung it on poles below the farm house ceiling, hence the hole in the middle. This is the prototype for the Wasa Rye Crisps and all the other crisp breads we eat today.

This is how it looks packaged. This bread has few calories and contains little more than rye flour and water. And it tastes absolutely wonderful. It is one kind of bread the Swedes of old found satisfying -- dopamine or not -- and I'm sure they still do over there.

Yesterday's meeting was primarily geared to people with Type 2 diabetes and weight issues, but I enjoyed is because, as always, I learned something new. And I enjoy breaking away from my hermit ways and do a bit of socializing every now and then.

I remain in awe of Eve and the fact that, thanks to her, our small town has something this informative and helpful to offer its citizens with diabetes.

Thank you Eve.

Diabetes and Me

I woke up this morning feeling fine, but then I checked my blood glucose and the result was 278! Normal fasting bg should be around 80. Once I saw the result, I didn't feel so well any more. But I got up, fixed breakfast, let the insulin pump figure out the correct amount of insulin, based on the carbs I planned to eat and a correction for the high sugars. It was around five in the morning and still dark outside. Daylight brought a wonderful surprise....fog!

I went outside and took a picture of the first tree to lose its leaves this fall.

Since it was so lovely outside, I decided to forget about not feeling well and take my dogs for their walks.

I love the fall color of this plant.

As we walked back home, I couldn't ignore the fact that I felt really bad and when I reached the house, I checked my sugars. Now, less than two hours later, they were 72! What a drop! I felt nauseous and decided this may not be the morning to go to town as planned. Just stay home and rest for a while. But first I had to eat something. One of the lesser joys of having diabetes: You must sometimes eat when that's the last thing in the world you want to do. But I did and then I made a cup of chamomile tea to help me calm down and stop feeling frustrated about not being able to move on with my day.

Here is a rabbitbrush we saw on our walk.

Then I came in here and opened the computer. And got a message that told me there was something seriously wrong. Then Windows gave me a Corrupted Error Report. Not a very good morning so far. But I'm mushing on and the computer is so far cooperating.

By now I think it may be time for me to post my diabetes list. I follow a diabetes blog by a young woman named Kerri who has a good sense of humor and is a cat lover. She also has Type 1. Kerri recently listed 30 things about her diabetes and her feelings about it. She encouraged her followers to do the same.

I did my own list, but never posted it. While Kerri has a diabetes blog and many interested followers, I don't. But this morning, I changed my mind and will post my list here, actually my two lists.

Some Benefits of Diabetes

1. I stopped smoking 16 years ago.
2. My diet has greatly improved and so has my general health.
3. I walk and/or hike with my dogs almost every day. I doubt I would push myself as hard to exercise if I didn't have diabetes.
4. I'm no longer a hypochondriac. I used to worry about every little ache and pain, cancer, this and that. Diabetes keeps me so busy I have no time to worry about any other illnesses that my be lurking out there.
5. I like my doctors and my support group meetings. Technological advances interest me. I don't mind most of the little day-to-day things, like checking my sugars and counting carbs, involved in managing this illness.

Having My Say

1. What I don't like about diabetes:  Type 1 diabetes is relentless and does not give you a break. Not ever. You can never let up your vigilance and being spontaneous is practically impossible.
2. What I wish people would understand:  Type 1 diabetes is very different from Type 2. When people talk about diabetes, they usually refer to Type 2. That's what about 90% of diabetics have, so it's understandable, but it is not what I have.
3. What's weird:  As your sugars get more normal, there is always the risk of them going too low. Passing out from low blood sugars could have dire consequences, especially for someone who lives alone.
4. What I'm afraid of:  Having low blood sugars in the night, while alone.
5. Something else I don't like about diabetes:  Low blood sugars are an invisible and dangerous consequence of this illness. So are high blood sugars. While all that goes on inside of you, there you are, looking just fine. So normal expectations are being placed on you. While you can't be normal just then.
6. What bothers me:  When well-meaning people tell me that I won't get complications because I take such good care of myself. This seems to imply that those who get complications or die from this illness didn't take care of themselves. I really want people to know that only in recent years, thanks to better tools and better insulin, has it become easier to gain control. But it is still difficult. And the internal, invisible, damage is cumulative.
7. What diabetes has taught me:  I can make it through the night.
8. What is most difficult:  To not take my low blood sugar drama/trauma out on my dogs or my husband.
9. What else have I learned:  I can't expect anyone to understand what this is like. 
10. What I can't live without:  My glucose meter and test strips.
11. What I would do if I didn't have diabetes for one day:  Walk barefoot in dewy green grass (if I could find some).

If you made it through all the way to here, thank you so much for listening. I feel better now and may just go on that trip to town.

Our field. I love having a field of my very own. A city girl's dream, I guess.