I Survived CVS and All I Got Was This Box of Needles

This week I find myself increasingly in wonder over the fact that with all of this stress my blood sugar levels have managed to not fly through the roof. This post is designed to be a well-needed breather from amidst the depths of my hectic last week in Florida.

My pre-moving to-do list is about 5 pages long and about every bit as complicated as it sounds. Truck maintenance, ordering party supplies for work, completing my college shopping list, errands up the yin-yang...

Seriously, when I first got on Summer Break I thought it was about the greatest thing ever to be able to spend the whole day to myself just running around, doing errands instead of doing tests and essays for school. I thought exactly that: "Wow, this is great! No school, no essays, no nothing. It's so nice to just be able to spend a day with myself, running around. OMG I'm a graduate. Life can't get much better than this. I wish that I could do this more often."
Let me just take this paragraph to say that I no longer feel this way and that if I have to spend another day of doing errands that I will most likely take a nosedive off of the closest multistory building I can find, since Florida couldn't be bothered to have some actual mountains.

On top of that, I've come to the marvelous conclusion that when people actually manage to get things done on time, it makes things run oh-so much more smoothly. Conversely, when people do not get things done on time, it  makes things get very messed up and needlessly SEVERAL TIMES MORE COMPLICATED.

Proven:
Last week I went into CVS to get my prescription from my Endo filled. 200 test strips, 100 needles, a package of Ketostix, 100 lancets, 2 Lantus Insulin pens, and 2 Novolog Pens. Simple enough, right? Wrong. Turns out the people at my CVS are "special people".

Enter Lacy into CVS: "Hi, I've never done this before. I'm dropping off a prescription."
Lady glances at me. Smiles harmlessly, giving no indication of the nightmare soon to follow. "Your name?"
I figured I'd spell it out to make it easy, even though my name is not a difficult name to spell.
"L-A-C-Y-B-A-L-L."
Confused look from Pharmacist woman.
"Ball is part of your first name? What's your last?"
Hmm. Lacyball. Nope. Not really feeling it.
I shake my head.
"No, Ball is my last name. Lacy is my first."
"Ok. And your insurance?"
"I don't have insurance. Do you take Medicaid?"
"Of course. Is it an HMO or just straight Medicaid?"
"Just straight Medicaid. Here's the card. Do you know what the Co-Pay is?"
"Umm... I don't know. When do you want to pick this prescription up?" She asks, handing me back my card.
I shrug. CVS is 5 minutes down the street. "That depends. When can I pick this prescription up?"
"Is 2 p.m. ok? I'll call you."
"Sure." I said. I didn't realize it was so fast, and I felt rather pleased. Was it really this easy?"

No. I should have taken a hint when I never received a phone call.

"They won't call you," Mom says. "Just go in and pick it up."
So the next day I head into CVS to pick up my prescription.
"Here's everything, but we're waiting on a confirmation for the Novolog and the Ketostix are on hold."
Okay, no problem. Lovely.
"Thanks," I say. "The Co-Pay is what?" "There is no Co-Pay," The pharmacist says. I felt guilty, letting taxpayers foot the bill for my pricey medications. But I knew I'd contribute to society and not always be a worthless College Student. Someday. So I am pleasantly surprised as I leave CVS.

The next day I go in to check and see if I can get my Novolog. It is, after all, Insulin, and thus essential to life.
The pharmacist greets me. "Hi, are you picking up a prescription?"
"Hopefully. I came in Yesterday. Well, and the day before. Is the Novolog in?"
The pharmacist checks. "Nooo... still in hold."
"Err, okay. So what do I do to get it off hold?"
"Umm, I don't know. We're just waiting for the Doctor to approve it with Medicaid."
"Do you know how long that will take?"
The pharmacist shrugs. "I'm not sure, m'am."

This scenario continues all throughout the week. And all throughout this week. Now I have been to CVS so many times that the pharmacists all greet and address me by name. They ask me when I am going to start working there. I blush as I tell them, "I've been in here so much, you probably think I'm a Druggie!"

But even though I deserve a gold star for perfect attendance, still no luck with the Novolog. I went back to the Endo for my appointment yesterday and we figured out, apparently my HMO (once approved) will cover Novolog, but straight Medicaid won't cover it. It covers Humalog, which is basically the same insulin, just a different brand. Tomato, Tomoto. My Endo comes back into the Doctor's room with a bag full of samples for me to tide me over. I felt like a little kid at Christmas. My mom thinks it's weird that I get excited about new Diabetes supplies, but the other Diabetic Doctor Ladies at the office swear they get the same way. Then she switched my prescription to Humalog pens, and gave me another prescription for 300 pen needles, since, using about 4-5 a day, I go through 100 fast. My new nifty Humalog pen actually looks like a nice, really fancy and expensive pen (accurate enough, seeing as insulin does cost a not-so-small fortune), and it takes refillable pen cartridges instead of being disposable.

So I take my new prescription back to CVS, blushing a little again that I am back for the eleventy-first time this week. The pharmacist reassures me that my prescription will be ready in one hour, and naively I believe that my insulin problem is solved. They also just then take the time to tell me that Medicaid doesn't cover my Novolog. As much as I am flattered that they clearly preferred my company instead, Y'think they could have told me that sooner, before I became BFF's with all the pharmacists?
Time passes. The problem is not solved. An hour later I get a call that CVS needs a prior-authorization for the pen needles because I can only get 100 a month, apparently (hardly enough), and that the Humalog has to be ordered and won't be in until tomorrow. So today I come in, expecting my prescription, and run into yet another problem. Prior-authorization has not been done yet, so no pen needles, and apparently, according to the pharmacist, "Humalog doesn't make penfills anymore. They only have the vials. But that's not a problem because you use the pump, right?" I glance it her. Politely I say (because I've really grown quite fond of this particular pharmacist lady, and I feel we have now worked our way up to casual conversations) "No, I do not use the pump. I have to shoot myself up over 5 times a day. Syringes are very inconvenient. Now I don't think that Humalog discontinued the pen... my Endo just gave me one with several refills yesterday." We both lean over the counter to chat. "Anyways, I think they just discontinued it," The Pharmacist Lady says. "But I'll call the Doctor and then call you back." I look at her speculatively. "I promise," she says, as if reading my mind.

Well, after 5 calls from CVS (some one minute apart), and several calls from my Endo, the prognosis is this: The people at this CVS are special people, The Endo argued that Humalog did not discontinue the pen and refused to believe CVS, CVS argued that Humalog did discontinue the pen and refused to believe the Endo, Humalog did not discontinue the pen prescribed to me, the Humalog Rep had to call up CVS to tell them this, the prior-authorization form did finally go through and is awaiting Tallahassee approval and, well, I'm not quite sure if I'm getting my insulin sometime soon or not. Most likely not before I go to Georgia, so luckily I have enough samples to last me. Seeing as once I get to Georgia I'll have a whole new batch of worries to bother about when I have to apply for Georgia Medicaid, find a new Endo, and transfer all of my prescriptions to a pharmacy there...

And all of this trouble over a bunch of needles!

So that has been my past few days/two weeks at a glance. Stay tuned for more drama, excitement, and insulin as I prepare to bid "Adieu" to Florida and maintain my sanity until then.

Mad Scientist

When I first got Diabetes, I was like, "Ugh, screw it. I'm going to eat just like everyone else. Sure, smaller portions and less carbs, but no WAY am I going on some low-carb diet. That would be like letting Diabetes win. Right?"

Funny now, I'm actually leaning towards a low-carb diet, though.
I played mad scientist by doing my own little at-home experiment this past week, to see if a low-carb diet really would improve my Blood Sugars and Diabetes management. I'll admit, I was a bit of a skeptic at first; but my results actually left me quite shocked.

I tried eating low carb for a week and honestly, I have to admit it: I experienced undeniably better Blood Glucose control when eating low-carb, versus eating carbs and using basal-bolus treatment. Basal Bolus treatment, for my readers who may not know, is basically a method of administering insulin: it gives a lot more freedom because, as opposed to eating more or less the same number of carbs at every meal and giving insulin based on your blood sugar level at the time, on Basal Bolus treatment you calculate the number of carbs in your meal and then determine how much insulin to give based on an insulin-to-carb ratio. For example, for every 20 carbs I eat I give myself 1 unit of insulin. If my taco from Taco Bell contains 40 carbs, I would give myself 2 units of insulin. For every 100 points over my Blood Sugar range of 80-130, I would give myself an extra unit of insulin in addition to the insulin I'm giving to cover the carbs. So if my blood sugar was 254 before eating a taco with 40 carbs in it, I would give myself 3 units of insulin. This is the "Bolus" in Basal-Bolus therapy. The "Basal" is the once-daily, Long-Acting Lantus administered each day. You won't always be able to give exact units in Basal Bolus therapy, but by rounding it gets the job done. I'd usually plug this in to an actual math problem to calculate the exact number of insulin units to give, but basically how I've described it is the overall gist of it. Albeit, I am new to basal bolus treatment, and imperfect at it. I imagine I will get better in time. Until then, though, I need to stop eating cereal ... because Special K may be healthier than some cereals, but that doesn't mean that "a little extra" isn't going to make my Blood Sugars whacked when I mindlessly shovel them into my mouth and don't bolus for them. No more guesstimating, Lacy. Get with the program!

I ate a lot of salad, eggs and chicken during my low-carb week. And I took the experiment a step further with a Diabetic no-no: I did not give myself insulin for them when I ate them. My endo freaked out when I told her that - "No, you probably shouldn't do that... you should eat carbs with your meals, too," She told me. So I'm on the blacklist for not following Doctors orders. And I felt kind of bad. And quite honestly, I didn't think it would work, either. But the evidence was soon right in front of me. Even though I took no insulin to cover the low-carb meal, it hardly raised my blood sugar at all. And how could I just deny the fact that eating low-carb really did work will for me, all while cutting down on the amount of shots I had to give myself each day? Instead of giving myself 4 shots, or 5, during that week I usually only took 1 shot - my Lantus, the long-acting insulin that I always have to take that keeps my blood sugars under control for 24 hours. Sure, I still had to test my blood sugars, but that was the closest to a needle-free day that I could get, and I liked it.

It wasn't just being able to cut down on needles, though. I noticed during the week that by taking less insulin and eating low carb meals, that my blood sugars remained much more stable. I experienced little if any bouncing up-and-down of blood sugars: no 200's one hour, then 45's the next. No more terrifying nighttime lows. I didn't even get any if at all lows, because I didn't accidentally bolus with too much insulin and too little carbs. For the most part, I stayed very stable within the 70-120 Blood Sugar range that entire week. My sensitivity to Lantus also seemed to improve as well.

In the end, I felt very encouraged and hopeful after experimenting with a low carb diet. I would have thought that I would miss eating a lot of carbs, but honestly, I didn't. Instead, I've learned to value my carbs more than I had before - such as, why would I want to eat only 1/2 a cup of pasta when I could have salmon and vegetables, or a big bowl of delicious salad? Or, low carb diet aside, why waste my carbs on carb-laden drinks or hamburger buns when I could have - and much better appreciate - a slice of cake instead? Or ice cream?

It feels nice to eat healthy, and nice to take care of my body. Diabetes treatment can be tough as it is an everyday challenge where you never know what to expect, but if there's anything I've learned, it's that every little thing helps. Walks in the park, a salad and vegetables instead of potatoes and rice... each day I'm learning something new.

In conclusion, would I follow a low-carb diet all the time? Well... no, not all the time. There are so many delicious foods, some with carbs, and some without, and I want to be able to appreciate and try them all. But is a low-carb diet something I would be willing to try more of in the future? Definitely!

In the meantime, I am excited to get all of the new recipes I can get my hands on. I may not necessarily be eating healthy by choice all of the time, but that doesn't mean that I can't still enjoy my food.


Playing Mad-Scientist for fun? Maybe I will make a good Biology major, after all!

To Pump, Or Not to Pump?

Browsing through my list of D-Blogs for the week I stumbled upon a guest post on sixuntilme.com that adressed the subject of, "Why MDI's?" It inspired me to write my own post as to why I use MDI's.

Even since my own diagnosis with Type 1 Diabetes, little over two months ago, it sometimes feels as if I am in the minority when it comes to giving myself multiple daily injections. Nearly every time I mention or hear about Diabetes, or contact other Type 1 Diabetics, I hear about the insulin pump. I have never met another Diabetic who gives themselves multiple daily injections - (though of course, this doesn't say much, seeing as I know very few Diabetics). Everyone seems to laud the merits of the insulin pump as if it is the greatest thing since sliced bread. (Note: that last passage isn't meant to offend insulin pump users in any way: using a pump is a decision I respect and support.)

When I first got Diagnosed, my nurses told me, "If you get the hang of doing your injections and managing your Diabetes right, soon we can get you an insulin pump!" My first night in the ER my nurse told me, "I'm a Type 1, too. I've had my insulin pump for two years. I love it." She made it sound wonderful, like this magic machine that completely managed Diabetes for you. Of course, I soon discovered the truth - insulin pumping was just an alternate treatment for Diabetes and, basically, just a needle stuck to your side with tape over it. Not to mention the infusion sets look scary as hell to put in you. But I wanted the insulin pump then. The way I figured it, I was 17 years old, and I could handle an insulin pump no problem. I hoped to manage my Diabetes as well as possible so I could "be good and get my pump." After all, why on Earth would I want to face the downsides of MDI's? 5+ shots a day, constant finger pricking, carrying my supplies everywhere? But the more I read on the pump, the more I started to question my wish to rush into getting a pump. I consulted other Diabetics, read up on the pump, did my research, tried to envision what life would be like with a machine attached to me 24/7. And one day while I was driving with my mom I said, "Mom, I don't think I want an insulin pump."

I'm on Medicaid currently, though only because of my age and my mother's income: my coverage will only last a few years before I can no longer remain on it. If I wanted to get on the pump, time is of the essence, because once I get off Medicaid there is no way I'd be able to afford the pump until I'm out of college and working, with health insurance. But it's been a few months, and I still believe my decision to not go with the pump is the right one... right now, for me.

So many people give merit to the insulin pump, and yet I feel that the benefits of choosing MDI's often go understated. This simple yet overlooked way of treatment manages to balance freedom and good sugar control at the same time, at least for me. I like the freedom that MDI's give me. I give myself my Lantus at around 9pm each day. That keeps my blood sugars managed for 24 hours as long as I give myself Novolog before meals. In an insulin pump, only short-acting insulin is used in bursts throughout the day, so it is essential to keep the pump on in order to manage blood sugar levels. With MDI's, I can give myself Lantus, bring my Novolog pen and go on my way. I can wear sundresses without having to worry about where to stick my pump. I don't feel like a living robot with machines attached to and beeping all around me. I can jump in a swimming pool without a second thought. My cat will not attempt to play with any tubing attached to me. No little kids will ask me when I am working, "what is that thing attached to you?"

Sure, MDI's have their downsides. I have to carry my insulin supplies with me where I go. I have to give myself many shots every single day. I have to stick my finger multiple times a day. It can be sometimes rather time-consuming and annoying to have to take multiple breaks out of your day to do these things. Giving an injection is not always as convenient as perhaps pressing a button on a machine would be, especially when out to dinner. Sometimes it can be annoying to have to try and search for a place to give myself an injection when in public (lifting up one's skirt in a restaurant is oft frowned upon.)

But MDI's have their upsides, too. Sure, my control could always be better. But honestly, who's couldn't? If you're Diabetic, you're not a pancreas. You're not perfect. You can't always have good blood sugar control, and sometimes, you will slip up. However, that is not to say that you can't do an adequate job with whichever method you choose. I've only had Diabetes for a few months and my blood sugar levels have stabilized quite well. It can be tough, frustrating work, but I almost always manage to keep them in range. Occasionally I will slip up by learning that some foods affect my blood sugar worse than others (example, white rice makes my blood glucose go crazy, pancakes always leave me a little on the spiky side, but milkshakes and pizza do hardly anything at all). And at parties I still need to work on not grazing at the chip bowl. But I feel that MDI's are what work for me. With MDI's I truly believe that I am capable of giving myself just as good of care as I would receive from a pump, as it is a method that still requires me to be very on top of my Diabetes.

Would I ever consider the pump? Yes, I would. But I want to wait. I want to see what better options of treatment for Diabetics they come up with in the future. Maybe someday they actually will come up with a full-blown "smart pump"; in which case, sign me up. But for now, I feel that the pump is an unnecessary reminder to me of my disease, which does not have enough benefits to justify my wearing it. And old-fashioned as MDI's might seem, I am perfectly content with my insulin pen needles in hand and machine-less body; because, that freedom is just one more thing that Diabetes has not taken from me.


* Note - in this post I've attached many websites in links for any readers interested in learning more about Diabetes and Diabetes treatment. Please feel free to utilize these resources!

"She Took the Loaded Questions Out of Her Head..."

Alright... I've been seriously slacking on Blogging lately. I promise I'll pick it back up once things get settled down - moving is just a short week and a half away, and there's so much to do.

This past week has been one of the best I've ever had!

Once I survived the initial grueling Graduation Practice, things took off smoothly from there.
Rainy Wednesday I cleaned for the party and went over to Smith Prep (my old school) to help paint the walls. It was fun to get messy and share some conversations with both new and old friends. I experienced a minor lapse in judgement when I forgot to pack a snack in case of any mid-afternoon hypos, and ended up having to sit down whilst in the middle of painting with a shiny BG of 61 staring out of the glucometer screen at me. A little frantic that it was going to drop lower and I'd have no way of driving myself home, I was happy to discover that there were boxes of pizza in the adjacent room, and all was well from there. (Lesson learned: I will not forget to bring my snacks ever ever again.) My grandmother came that evening with a suitcase full of dresses to pass down to me - and I went to bed early to be up for graduation in the morning.

I woke up at 5:30am to get showered and prettied up for graduation, wearing an all-white dress to go under my all-white graduation gown. I was elated as I checked to make sure I had the graduation tickets, glucometer, insulin, and graduation cap. On the way we stopped by Starbucks. I was proud of myself - I resisted from getting any carb-laden frappuchinos and settled for a passion fruit iced tea instead. The lady at the register told me "Congratulations" and, with a smile, gave me my tea for free! Several other people in the store smiled and told me congratulations, and I was so excited as I walked out of the store, carefully sipping my drink so as to spill none on my clean gown.

We arrived at the UCF arena and I rushed to the gymnasium where my "class" was lined up on the bleachers, in order, to wait for commencement. I was glad I hadn't brought my cell phone as the teachers had taken to patting students down in order to make sure they had no electronics on them. I wrestled my tiny self through the crowd to the front of the line in order to grab my name card and found my correct seat, then kicked off my shoes and sat down to wait. The teachers all laughed at my bare feet. I had a fun time talking with the other nervous, excited Seniors around me as we spent 1.5 hours trying to occupy ourselves until we could finally march on stage. "Do you think it's too late to apply for Bright Futures? I think the deadline is today..." the guy next to me asked. "Ohmygoodness! I'm so excited!" The girl beside me gushed. Finally, after and eternally long wait, we lined up. Hearts fluttering, we walked through the  back halls of the arena until we finally came to the entrance into the arena. We walked out onto the bright floor, cameras flashing and parents cheering. I was all smiles. It suddenly dawned on me that, although the graduation practices had been long, seemingly pointless and boring as all get out, ultimately, I was glad to have made the choice to go through with it. It was all worth it in the end when, heart beating fast, butterflies in my stomach, I heard my name called: "Lacy Elizabeth Ball, Summa Cum Laude", and walked across the stage to receive my diploma. That moment was one of the proudest moments in my life. After 13 years of hard work, I had finally reached the finish line, and the reward was wonderful indeed.

Friday was the day of my party. Thursday I had worked hard after graduation to make sure everything was ready - that way I didn't have to stress. I had made cookies, sugar-free cake, went shopping for food with my mother and grandmother, and set up the tents, tables, and moonwalk in the backyard. The house was cleaned  and all ready for visitors. The party was fantastic. I got to see friends from as far back as Kindergarten and all of my high school friends. We played Loaded Questions and talked and jousted and ate good food. Memorable Quote from the party: "She took the loaded questions out of her head!" We even got to witness Mr. Phillips, our old teacher, battle Blake to a jousting match. It was terrifying and exhilarating :)

Saturday I went to Rock Springs with my two friends, Emma and Erica. The water was so cold and the initial shock of jumping in made you question whether or not the swim was worth it, but 5 minutes in the water and it was so hot outside that it soon began to feel like bath water. And it was so beautiful! I always love taking a trip to Rock Springs. It's right down the street from me, so I wonder why I never go more. 

That evening I went out to eat with my brother, sister-in-law, and Dad. Sunday we went out to breakfast at Mimi's and did a little more college shopping at Bed Bath and Beyond. I can't believe I'm moving in a week and a half! It was, all in all, a wonderful weekend, and I'll remember it for the rest of my life.

Oh... and my blood sugars behaved wonderfully all weekend. :)