Today is May 4th.
And it's Star Wars Day, because as the saying goes, "May the Fourth Be with You."
Yes, I am a Star Wars nerd. Not as hardcore nerdy as some out there, but definitely enough to appreciate this playful spin on 05/04.
In fact, a recent visit to my endocrinologist brought Star Wars to mind as it became clear that my doctor wasn't pleased with my diabetes slacking of late; I ruminated on how unfortunately, the "Diabetes Force" has certainly not been with me these days.
We're both smart and honest enough with each other to agree that most of my D-challenges are of my own making, in that I am not a disciplined diabetic and tend to slack more than I should. This has always been my story. You might even say that the Power of the Dark Side has always tempted me and often triumphed. Kinda like Darth Vader, one might point out...
Stormtrooping Diabetes, Sort Of
Yep, I'm still disconnected from my insulin pump. Two years later. It's safely resting in my firesafe, collecting dust.
For a refresher: it was May 2016 when I said "Goodbye, Medtronic," as a result of beung unhappy with the company's poor choice to enter an access-limiting deal with United Healthcare to make it the exclusive preferred brand of pump covered.
At that time, I switched to insulin pens and inhaled insulin Afrezza. Both have worked very well for me, and I've grown to very much like not being hooked up to a pump all the time. It's also quite a bit less expensive since I don't have to worry about purchasing infusion sets and reservoir supplies. Yes, I'm actually saving hundreds of dollars per year (also in part because of my wife's great prescription benefits with low co-pays on insulin and most medications that I take).
All of this has convinced me that instead of a temporary "pump hiatus," I'm on this path of Multiple Daily Dosing for the long haul. Until such a time when a truly automated close loop device that I can trust is available, one that works with my trusted Dexcom CGM and does better than what's currently out there.
Of course, since I have that pesky knack for slacking and not doing what I'm supposed to in regard to diabetes management, I've noticed that in the past year my motivation has been gradually moving toward the point of burnout. I go between mobile apps and handwriting logs, to mix it up and keep my attention, but even that has been getting spotty.
I've taken a few CGM vacations and have seen a consistent rise in my BG patterns, especially in the evening hours when I often snack and don't adequately count my carbs and dose insulin for what I'm eating.
With all of that, my A1C is quite a bit higher than where we like it to be. This has all impacted my behavioral health and that's something we have noticed, too.
Which leads me back to the point, that the D-Force hasn't exactly been with me lately. And that I've been feeling more like a Darth Vader then a Jedi Master.
True Confessions of a Darth Vader
OK, fine. Admittedly I've been acting like Vader who embraced temptation and lost himself to the Dark Side... it seems, I've been wearing a mask myself in terms of diabetes.
When I'm writing about diabetes here at the 'Mine, I can essentially put on a facade of being all professional about this illness, without delving into my real-life D-care. I'm just focusing on the story at hand. Even when I reference my own D-experience in some posts, it doesn't necessarily translate into any action in my personal life.
In essence, I'm wearing a costume. That's also a fascinating train of thought, given the new Star Wars Costumes Exhibition touring the country and coming to my local Detroit Institute of Art. One of the exhibit organizers says: "The type of clothing you wear sort of reflects the way you act, if you’re a good person or a bad person, your cultural background, what environment you come from." We bought tickets and plan to check it out, but that all brought on some deep thought... Hell in a sense, I realize I've been talking about diabetes almost as if I were in a costume -- filtered, not reflecting the actual way I am living my life with diabetes.
A costume... kinda like Vader. (((sigh)))
BTW, did you know that the actual voice of Darth Vader -- legendary actor James Earl Jones -- lives with type 2 diabetes himself? I had the privilege of chatting with him by phone a couple years ago, after he announced his T2D publicly and began a marketing campaign for one of the big diabetes Pharma companies. He was diagnosed in the 1990s in his early 60s, but didn't share that with the public until two decades later once he reached his mid-80s.
Why not before, I asked him?
"Time," James Earl Jones told me, in a commanding voice that evoked images of Vader on the other end of the phone. "I’ve been working steadily for 60 or 70 years now and haven’t had time to commit myself to talking more about it publicly. But suddenly I’ve had more time to do it and this (talking about diabetes) is something I really wanted to do."
He also shared that his family and friends have been the most important source of support and motivation for doing what he needs to.
"The community is so strong and it is a family experience," he said. "I realized when I was diagnosed with diabetes, my whole family became diabetics. Not that they suffer the same things that I do, but they understand and we have to work as a family in living with diabetes. They became my support group, as well as my doctors."
That particular quote stood out to me, and relates to where I am right now in dealing with this "Dark Side" of my own diabetes negligence.
Being One with the Force
And now, coming full circle: I've been working hard over the past month to get back on track, trying to turn that Vader voice inside to a more positive "You Can Do This" message.
One of things I most appreciate about my current endo -- and fortunately, many doctors I've had experience seeing over the course of my 34 years with T1D -- is that he listens to me. He doesn't just offer unsolicited advice, but rather asks me at every appointment: "What one thing can I help you with today?" I really like that.
As I examine what Jedi Mind Tricks (so to speak) I might employ to awaken my own inner D-Force, I realize it comes down to a handful of key points in my diabetes routine:
Equipment Choices: In the past, when I have taken pump vacations for a short period of time to mix things up in my D-management, a time has always come when the insulin pens or syringes weren't doing the trick for me anymore and I felt the need to go back to pumping. Not the case this time. I have no interest in being connected to a pump again for the foreseeable future, at least not without any fully closed loop capability connected to it. I'm also not interested in putting the energy into a Do-It-Yourself closed loop system. So my Afrezza inhaled insulin along with Tresiba, and Novolog pens will remain my insulin delivery methods of choice. I do use Nightscout and xDrip mobile apps and data-sharing software to help me monitor trends.
Carb Wars: Too often, I just don't accurately dose insulin for what I am eating and drinking. It's a matter of discipline, especially in the post-dinner hours when I am relaxing and less inclined to be thinking about my diabetes. I need to do better here, and I must constantly remind myself how important this is overall. I'm thinking what might help is a tutorial or two on How to Develop Jedi-Like Concentration.
Basal Skills: As I've shared before, Tresiba is my basal insulin of choice. I've been on that for almost two years now, and I really like how it has a longer active time than any of its competitors. In particular, I like that I don't have to split the dose in half as has been necessary at times with Lantus and Levemir. The labeling says dose within 42 hours, but over time I have found it works best if taken within 32 hours. It's also important that it takes 3-4 days to actually build up in your system to be effective. I tend to miss doses and sometimes haven't tracked the times of my doses, so I have been working to diligently log using the mySugr mobile app when I'm dosing Tresiba.
Dental Woes: On top of all this, I have been procrastinating for more than a year on needed dental surgery. I had some teeth extracted, but delayed getting the implants done. This has all led to less-than-ideal dental health, which is a big deal because dental care and diabetes are so intertwined. Yep, we're more prone to gum disease and overall worse teeth. My BGs have been a bit wonky thanks to these prolonged issues in my mouth. In early April, I finally pulled the trigger on getting the implants and another needed tooth extraction, and now I am hoping this helps alleviate some of my glucose variability.
The Pudding Effect: Just a note that after my dental surgery, I spent a couple weeks eating mostly soft foods -- pudding, yogurt, eggs, applesauce and the like. A bonus is that my CGM graph was outstanding due to the lower carb counts! And the pain meds and antibiotics didn't mess with my CGM results all too much, I noticed.
Maybe just by writing all this down, I'm helping to awaken my D-Force for positive change. As I sit here gazing at the mini Yoda figure dangling from my key-ring, I can't help but recall the iconic phrase the Jedi Master passed along to Luke Skywalker:
"Do, or do not. There is no 'try.'"
Totally, Dude. I am now doing, not just trying, in resisting the Dark Side.