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Posts from the ‘Blood Sugars’ Category

104 mg/dL.

Am I the only one who stops when this number pops up on a glucose meter and thinks, “Damn.  That could be on the meter advertisement box.  I’ve got this.”

Meter box advertisement #latergram

A photo posted by Kerri Sparling (@sixuntilme) on

(Ignore the fact that I will surely be low, or high, or somewhere not exactly 104 mg/dL in a matter of hours.  But in that moment, I’ve got this.  Actually, since writing my post the other day, I’ve been actively working to spend more time in range and I’m seeing better results.  Averages are tipping back into my favor, and I’m reminded once again how much of diabetes is a total crap shoot and how much is something I can change … and how much those ratios of crap:change fluctuate.)

That Escalated Quickly.

After downloading and uploading and reloading all my device data to Diasend, I’ve seen the Big Picture, and it kind of blows.

For a good, long clip, things have been completely fine.  In range most of the time, not too many gross lows, and highs were classified as an extended 180 mg/dL, with symptoms to boot.  Well done!  Diabetes on point!  Celebrate by shoveling snow!

But a hiccup here and there have given way to a slippery slope of fuckery.  My two week average a month ago was fine.  My two week average yesterday was gross and not at all where I want it (and know I can have it).

I’m glad I’ve looked at my data, because I’m not sure I would have noticed just how dodgy things had become.  (And a quiet but still curmudgeonish thank you to the need for a flurry of paperwork in order to get my new insulin pump through insurance approval, forcing me to provide blood sugar logs and other data points in order to convince my insurance company that yes, I do have type 1 diabetes.)

I didn’t realize how much higher my two week average had become until I looked at it and recognized the need for change.  Two weeks for me makes a big difference, because it’s in that time frame where I make crappy tendencies into crappy habits.  Ignoring high alarms is okay for a day, but not for a week.  Forgetting to pre-bolus can roll by a few times but more than that equals out to crummy postprandials.  Carby food choices that are lackadaisically carb-counted brings on the blood sugar roller coaster.

Eff that noise.

Time to deescalate this.  Quickly.  Before it becomes as piled on as the three foot mound of snow on the back deck.

Animas Vibe: A Few Weeks Later.

Again, disclosure:  I work with Animas and have a sponsorship contract.  Here are more details on my disclosures. And this is the Mr. Plow theme song.  Mr. Plow would be great, about now, since the snow keeps dumping down outside.

It’s been several weeks since I’ve switched to the Animas Vibe insulin pump (with integrated CGM technology – doesn’t that sound like a rehearsed phrase?  How about “insulin thing with CGM thing built in and have you seen my coffee, pleaseandthankyou.”), and I thought I’d take a crack at some second impressions, since the first impressions were only compiled after a few days.

Talking ‘Bout CGM:  I am still into the concept and application of having one device that does the work of two.  While the Vibe still requires that I wear an insulin pump infusion set and a CGM sensor as two separate insertions, it removes the need for an external CGM receiver.  I wrote about this last time, but to reiterate:  I am okay with not using the separate receiver.  I’ve traveled a lot in the last few weeks and the first few trips, I brought along my CGM receiver so I could plug it into the SHARE port.

For the record, I still haven’t upgraded to the 505 software.  Judge all you want.  :)   Which may explain my identical CGM graphs.  (And, also for the record, I’m really, really excited to see the new Dexcom receiver.  That may change how I feel about clouding, as it would be much simpler.)

But then Chris and I came to realize that we aren’t good at this whole “data sharing” thing.  As much as it sounds like a good plan in theory, we aren’t good at the application of it.  I think this becomes a patient-specific preference sort of thing, and for this PWD, I’m not a data-sharer.  But as I mentioned with that previous dead horse that I keep flogging, I like options.  Love them, actually.  And anything that gives data options – LIFE options – to people touched by diabetes, I am all for it.

(That sentence was a grammatical nightmare.  Ignore the sloppy parts and move on, yes?)

DiasendYesterday, for the first time in a long time, I downloaded (uploaded? loaded.) my data to Diasend.

The data collection portion is cumbersome.  I hate dongles and charging cords and all the extra beeps and wires required to make sense of diabetes data.  (Which is why I’m such a fan of the Verio Sync idea, which uses bluetooth technology to automagically suck the results off my meter and spit them into my iPhone, but there are issues with that system, too, because it’s only iOS compatible.  Pluses in one way, minuses in another.  But see aforementioned “I love options” sentiment, because it still applies.)  But I did download my pump data, which also downloaded my CGM data.  And, because I was feeling ambitious, I uploaded my glucose meter, too.

So this was my first time looking at Diasend with information about my insulin doses, glucose meter results, and CGM results on the same screen.  (No, I am not sharing my results.  My numbers have been absolute shit lately and I’m not going to pepper my blog with confirmation that I have diabetes.  I’ll let the c-peptide test that’s required by my insurance in order to cover my insulin pump serve as that confirmation.  Yes, that’s a thing.  Yes, more on that later.)

Diasend is good for granular information, but the information on the “compilation” tab was ace for me.  Seeing my blood sugar averages based on time of day was powerful.  (I have midnight to 11 am nailed and awesome.  Everything not in that time frame needs a solid snuggle these days.)   As a Mac user who hasn’t explored the new Dexcom/Mac Portrait (I’m woefully behind on everything that doesn’t involve Birdy these days), seeing my Dexcom data on my laptop is amazing.  I’ll be exploring Portrait in the next few days but in the meantime, I’m happy that information can be siphoned over to Diasend.  And it puts the constant flow of data into digestible context.

Pump Stuff.  Since I was a Ping user before, using the Vibe feels familiar and easy.  I’m still glad this sucker is waterproof and the button clicking process is familiar to me.  All of that feels the same.  One thing I have noticed is that the more my CGM needs attention, the faster the battery in my pump needs replacing.  This is annoying, but makes sense despite the annoyance.  For the first time ever, I’ve invested in lithium batteries for my pump and it seems to hold much better than the alkaline ones I have been using for the last … forever.  But overall, the pump feels familiar and comfortable, and since I hate change, that familiarity is a plus for me.

Alarms, for whatever reason, remain easier to hear and feel when they are coming from the pump.  This was a huge concern of mine because I thought the pump alarms would be muffled by clothes and bedding, making them hard to catch.  But I actually respond to low and high alarms more readily on the Vibe.  I am not sure why.  Maybe because it’s attached to my hip and I feel the vibration?

What remains to be seen is how the changing state of Dexcom progress will affect my feelings about this pump.  Right now, it’s the only one integrated with the CGM I already use, so that’s a huge plus.  But I am concerned about the fact that the software in the Vibe is already behind on the current Dexcom system.  I know the FDA process creates hurdles that are hard to clear, but since the Vibe has already cleared the Big One, can I expect that updates and upgrades will come fast and furious?  As a PWD using the Animas product, I hope this is the case.

And lastly, I’m hoping to have this pump covered by my insurance company.  I’m still trying to get a c-peptide test done (travel, snow, and issues with fasting) to fulfill the requirements issued by Blue Cross Blue Shield, so that journey remains ongoing.

Thankfully, I’m still pretty effing sure I have diabetes.   So yay?  Yay.

Twitter Rant.

The lows that have been creeping in lately need to stop.  They are inconvenient at best, completely debilitating at their worst and the in-between is a muddled mess of glucose tab dust and frustration.  Yesterday I had a diabetes technology fail coupled with a highly symptomatic hypoglycemic event that occurred simultaneously with a phone call to the Joslin Clinic … which sent me over to Twitter with an agenda of rage.

First, it was my Dexcom receiver that went berserk on me, telling me on both my Animas Vibe and my G4 receiver that my blood sugar was 202 mg/dL with double arrows down but after my feet weren’t responding to the “MOVE!” commands from my brain, I grabbed my meter to double-check. And saw a blood sugar of 43 mg/dL.

I immediately went for the glucose tabs and housed several of them. The low symptoms were intense – confusion, anger, tears, and a hand too shaky to hold the jar of tabs properly, so I held it with two hands, like those stock photos of baby panda bears drinking from a baby bottle.

Then the phone rang, and I answered it because: 1. When I’m low, I make bad decisions, and 2. It was the Joslin Clinic calling and I always answer their calls because Joslin.

Yes, my insurance company is requiring a c-peptide test to confirm my type 1 diabetes status in order to cover my new insurance pump.

The irony was not lost on me.

I felt like a crumb for ranting but sometimes I’m a crumb.

And then the anger/adrenaline surge subsided and I was in that “weak with post-hypo panic, stupid body, knew I’d be fine in a few minutes but what the fuck” sort of fallout.

Eventually, as it always does, my blood sugar came back up and my brain tuned back into things happening on the planet. My CGM/Vibe/meter were back in alignment, showing me in the 80′s and holding steady.

But I’m still waiting for Joslin to call me back. You know, to confirm the type 1 diabetes I’ve had for 28 years.

Missing Meter.

The initial search through my bag was kind of nonchalant.  “Where is my meter bag?”  Bright pink with a smiling bear on one side, it’s a hard bag to misplace, even in the seemingly unending abyss of my purse.

But the flurry of leaving the house that morning to catch an early flight left me mentally snowed-in.  I brought it with me, right?  I know I checked my blood sugar that morning, and I had a clear memory (didn’t I?) of pricking my finger on the plane after we had reached cruising altitude, so where the hell was my glucose meter?  I had it just a few hours ago?

“Where is my glucose meter?”

The search went from casual to frantic in a matter of minutes, when I realized that my meter bag was nowhere to be found.  Not in my suitcase, not in my book bag, not in the rental car.  No memory of where the hell it could be, and all the moments I’ve ever checked my blood sugar on a plane were melting together.  Did that happen today, or had I been working off info from my CGM graph all day long?

Just as Chris and I confirmed that my meter was, indeed, MIA, my Dexcom sensor alarm went off, warning me that my sensor was going to die in two hours.  And the “low battery” alarm went off a few minutes later on my pump, reminding me that it needed a new battery.

“Everything is breaking and I’m an idiot.  I’ve never, ever left my glucose meter behind before.  Ever!  On so many of my trips, I’ve packed an extra meter, but even on the trips where I didn’t, I still didn’t lose my meter!  I’ve never lost my glucose meter before, in like three decades with diabetes.”  I was rambling, but frustrated.  The device I needed most to properly dose the drug I needed most?  Missing.  Data crucial to my safe survival?  Inaccessible without purchasing a backup system.

(And, as luck would have it, I had just refilled my meter bag with a brand new bottle of 50 test strips and a fresh AA battery for my pump.  Reminded me of the time I replaced my car’s exhaust system, filed the tank up with gas, and then proceeded to total the car.)

Thankfully, finding a pharmacy that sold the brand of glucose meter I had strips at home for was easy enough.  (I didn’t want to have to replace the meter, again, when I got home.)  And thankfully, we have the means to purchase a meter and a bottle of test strips without insurance coverage.  But holy shit, I was shocked to see the sticker price for a bottle of 25 test strips.

“Forty five dollars?  For 25 test strips?  That’s bananas!”  I said the pharmacist.  “How do people afford these things without insurance coverage?”

She shrugged.  “They don’t.  They buy the CVS brand and the strips that go with that one.  Most people don’t pay for the top tier strips out of pocket.”

“But the accuracy is …”

“It’s what it is,” she said.  She finished ringing up the meter and strips (and AA batteries for the pump), bringing my grand total up over $100.  For a meter, 25 test strips, and batteries.

“This is the price for maintenance,” I said to Chris.  “For the stuff that keeps me healthy.  I can’t imagine what the cost would be to do more than “maintain.’”

After reuniting with a glucose meter, our trip continued on without issue.  But throughout the rest of the week, I thought about having access, and having the financial means to replace things I accidentally lose, and being grateful.  I thought about the Spare a Rose campaign and how far $5 goes.

This holiday season, I’m more grateful than ever for more things than I realized.

(And when we came home on Friday evening and I went into the bathroom, I saw my glucose meter sitting on the bathroom counter, halfway hidden underneath a hand towel.  Never again!)

 

Hypo Management.

“Ninety-five percent of the time, I’m fine.  The lows are ones I can treat myself, even if the number is really low.  Usually my symptoms are shakiness or like this brain fog.  When the lows are really gross, I usually cry at random.  Or I throw things.  No real in between.  But the majority of the time, I can take care of things myself, and then it’s over.  Like nothing happened.”

I tried to explain this to a friend who was asking when it’s necessary to intervene during a low blood sugar, but explaining the slide from “fine” to “holy effing low blood sugar” sounds confusing when I say it out loud.

That’s the weirdest part, for me, that whole panic-then-peace part of severe hypoglycemic events.  My lows have historically come crashing in at a breakneck speed, which is part of why using a CGM has been a pivotal change for me.  Getting a head’s up on when a low is happening, or being able to treat it even before it becomes a problem, has helped me feel safer in the face of hypo unawareness (a lack of low blood sugar symptoms) and fast-dropping numbers.

My endo suggested that I raise my low alarm on my Dexcom from 65 mg/dL to 80 mg/dL in efforts to catch lows earlier, and in the last month or so, I’ve had far fewer chaotic hypos.  Instead, I’m grabbing the lows before they even become low, snagging a 70 while it slides versus waking up in the trenches of a 40.


Low alarm at 80 has been the best suggestion in a long time. #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Small little tweaks here and there make differences I couldn’t have imagined. … that, and I’m burning through my supply of glucose tabs with a little less vigor.

 

Tootsie Roll of Doom.

Low blood sugars can sound like stories told ’round the campfire, with great embellishments and drama as to who can tolerate the lowest number without tipping over.

“Low?  I wasn’t just low.  I was so low that my eyes were swimming away from my face and my meter said 52 mg/dL but I still got my own juice.”

“52?  I was 41 mg/dL without any symptoms at all and then my hands fell off so I ate them.”

“Pfffft.  I was 30 mg/dL and eating popcorn and I was coherent enough to eat individual kernels of popped corn until 100 hours passed and I had steadily climbed back up to 115 mg/dL without a rebound high.”

Impressive.

Most of the time, my lows are symptom free and I can function properly.  I feel lucky that, in the last 28 years, there have been more functional hypoglycemic episodes than ones requiring assistance.  I’m glad I can treat my own lows.

But sometimes numbers hit differently.  A blood sugar around 65 mg/dL usually feels a tiny bit off, but nothing too jarring.  No shaky hands, clumsy tongue, loss of peripheral vision stuff going on, mostly just a Dexcom alarm going off, forcing me to take a closer look at my graph and thinking, “Huh.  Time for a snack.”  (This lack of hypo symptoms is what prompted me to look into a continuous glucose monitor in the first place.)

At other times, the 65 mg/dL comes in like a freight train, barreling towards me with symptoms hitting full force, which happened yesterday while I was brushing my teeth.  A waves of confusion washed over me and put a twitch in my hands, making my desired grip onto the bathroom counter hard to come by.  My tongue went numb and I forced myself to spit the toothpaste into the sink, knowing the next mission was more challenging: get downstairs and eat something fast.

The first thing I saw was a giant Tootsie Roll in Birdzone’s Halloween bucket.  (Flashbacks to being a kid growing up with diabetes, where the Halloween bucket was always saved as a “for low blood sugars!” salve but instead was something I dipped into without admitting it, until there were only Almond Joys left.)  Normally, Tootsie Rolls are a candy that repulses me enough to steer me clear, the low symptoms were intensifying and my knees felt wobbly, so I unwrapped the candy and shoved it into my mouth.  And then I learned of a new hypoglycemia symptom that was in play this round:  a confused jaw.

Chewing on that Tootsie Roll candy was a disaster.  It was slightly cold, making it tough to work through regardless, but the massive chewy scope of the thing was too much.  In the fog of a low, I clamped down on the stupid thing and felt a familiar popping sensation.  The Tootsie Roll was working to raise my blood sugar, but in the interim, it had pulled off one of the frigging composites from my tooth.

Once the low had subsided, I called the dentist to fess up and make a fix-it appointment.

“What happened?  Did you bite into an apple or something?” asked the receptionist.

“No, it was actually a Tootsie Roll but …”

“Oh, Halloween candy.  Yeah, we get a lot of calls this time of year for stuff like this.”

And in my head, I was all, “Wait, no it was a low blood sugar and it was THIS BIG and I finally had symptoms – they were rotten – in the 60′s which is why I went for the Halloween candy …”

… but instead, I was all, “Yep.  Tootsie Roll of doom.”

 

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